Symptoms Of Congestive Heart Failure Research Articles

Adjuvant Paclitaxel and Trastuzumab for Node-Negative, HER2-Positive Breast Cancer

BackgroundNo single standard treatment exists for patients with small, node-negative, human epidermal growth factor receptor type 2 (HER2)–positive breast cancers, because most of these patients have been ineligible for the pivotal trials of adjuvant trastuzumab.MethodsWe performed an uncontrolled, single-group, multicenter, investigator-initiated study of adjuvant paclitaxel and trastuzumab in 406 patients with tumors measuring up to 3 cm in greatest dimension. Patients received weekly treatment with paclitaxel and trastuzumab for 12 weeks, followed by 9 months of trastuzumab monotherapy. The primary end point was survival free from invasive disease.ResultsThe median follow-up period was 4.0 years. The 3-year rate of survival free from invasive disease was 98.7% (95% confidence interval [CI], 97.6 to 99.8). Among the 12 relapses seen, 2 were due to distant metastatic breast cancer. Excluding contralateral HER2-negative breast cancers and nonbreast cancers, 7 disease-specific events were noted. A total of 13 patients (3.2%; 95% CI, 1.7 to 5.4) reported at least one episode of grade 3 neuropathy, and 2 had symptomatic congestive heart failure (0.5%; 95% CI, 0.1 to 1.8), both of whom had normalization of the left ventricular ejection fraction after discontinuation of trastuzumab. A total of 13 patients had significant asymptomatic declines in ejection fraction (3.2%; 95% CI, 1.7 to 5.4), as defined by the study, but 11 of these patients were able to resume trastuzumab therapy after a brief interruption.ConclusionsAmong women with predominantly stage I HER2-positive breast cancer, treatment with adjuvant paclitaxel plus trastuzumab was associated with a risk of early recurrence of about 2%; 6% of patients withdrew from the study because of protocol-specified adverse events. (Funded by Genentech; ClinicalTrials.gov number, NCT00542451.)

A Joint Model for a Longitudinal Pulse Rate and Respiratory Rate of Congestive Heart Failure Patients: at Ayder Referral Hospital of Mekelle University, Tigray, Ethiopia

Pulse rate(PR) and respiratory rates(RR) are main symptoms of congestive heart failure(CHF) and the abnormal PR and RR are broad indicators of major physiological instabilities. The lower PR and RR are associated with a strong and healthier heart. CHF is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. The main objective of this study is, to investigate the joint evolution of PR and RR of CHF patients and identify the potential risk factors affecting the two end points. The latest data from Sep.2012 up to Aug.2013 have been taken from medical charts of 264 adult CHF patients to model separate and joint linear mixed effect for PR and RR. The baseline mean and standard deviation of PR and RR are 126.11 and 18.98 and 31.64 and 10.99 respectively. The association of the evolution for PR and RR was estimated to be (ρ=0.7054) which is statistically significant with 95% CI of (0.642, 0.769). PR and RR showed a decreasing pattern over time in both joint and separate models. Furthermore, a positive and significant association was observed between the two end points and all covariates except LVEF and time. Finally, to identify associated effect fitting joint model for paired endpoints is recommended.

Left atrial thrombi which occlude the pulmonary vein in a patient with mitral mechanical prothesis valve: The role of Computed Tomography(CT) in imaging

A 70-year-old female patient was admitted to our emergency department with symptoms of congestive heart failure (dyspnea, bilateral leg edema, tachypnea, palpitations,etc.). Her history showed that she had been operated on for rheumatic mitral valve disease, and had a 10year history of mechanical mitral valve replacement with a bileaflet prosthesis (St.Jude, No:27). Cardiovascular examination showed mildly muffled mitral mechanical valve sounds. Electrocardiography (ECG) revealed atrial fibrillation with a heart rate of 110 beats per minute. On lung auscultation, there were bilateral basal rales. Examination of other systems yielded normal findings. Laboratory findings were within normal range and her international normalized ratio was 2,6 adequate in therapeutic interval. After hospitalisation, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) showed moderately increased mitral mechanical valve gradients (a peak at 26 mmHg and a mean at 8 mmHg), a normal mitral valve area of about 2.8 cm2, non-restricted leaflet mobility, mild paravalvular leakage, and also dense spontaneous echocardiographic contrast in the left atrium and the left atrial appendage. The patient had a normal range ejection fraction of about 55%. TEE revealed an annular non-obstructive thrombus on the atrial side of the mitral mechanical valve, and two other thrombi. One of these was separate on the posterior atrial wall and measured 2.3 cm x 1.7 cm, the other was layered on the remaining anterior atrial wall and occluded the left upper pulmonary vein opening (Figure A-C). After heart rate control with intravenous administration of metoprolol, an ECG-gated 64 slice contrast enhanced computerized tomography (CT) was performed to evaluate the coronary artery, mitral mechanical valve and the left atrium, and this depicted the masses, suggestive of thrombus, involving the left atrium and occluding the left upper pulmonary vein connection to the heart (Figure D). There were no significant stenoses in the coronary arteries, and severe lung edema with remarkable deposition of transudates on the fissures and alveoli. Peripheral embolisation is the most common manifestation of left atrial thrombi. Obstruction due to left atrial thrombi is a rare event and when present is usually due to the obstruction of pulmonary veins, and is usually detected by TEE. In our case, CT helped to determine the extent of the thrombus in the left atrium and its relation with the other cardiac structures (valves, etc.). 317

Postoperative usage of tolvaptan in a patient with aortic valve stenosis complicated by Child-Pugh classification B liver cirrhosis and hepatic edema.

We report the case of an 80-year-old woman with postoperative congestive heart failure (CHF) complicated by Child-Pugh classification B liver cirrhosis and hepatic edema successfully treated with tolvaptan. The patient suffered from liver cirrhosis and underwent partial hepatectomy for a hepatocellular carcinoma diagnosed together with a severe aortic valve stenosis. Aortic valve replacement was performed under cardiopulmonary bypass. The postoperative course was uneventful until CHF and hepatic edema symptoms appeared on postoperative day (POD) 2. The symptoms were treated with intravenous human atrial natriuretic peptide and oral diuretics. As the condition showed no improvement, oral tolvaptan was administered on POD 11 and thereafter, which markedly improved the symptoms. This is apparently the first report describing the effectiveness of tolvaptan for the postoperative management of fluid balance in a patient with cardiac and liver dysfunction.

Excluding infection through procalcitonin testing improves outcomes of congestive heart failure patients presenting with acute respiratory symptoms: Results from the randomized ProHOSP trial

Background/objectivesWe sought to determine whether exclusion of infection and antibiotic stewardship with the infection biomarker procalcitonin improves outcomes in congestive heart failure (CHF) patients presenting to emergency departments with respiratory symptoms and suspicion of respiratory infection. MethodsWe performed a secondary analysis of patients with a past medical history of CHF formerly included in a Swiss multicenter randomized-controlled trial. The trial compared antibiotic stewardship according to a procalcitonin algorithm or state-of-the-art guidelines (controls). The primary endpoint was a 30-day adverse outcome (death, intensive care unit admission); the secondary endpoints included a 30-day antibiotic exposure. ResultsIn the 110/233 analyzed patients (47.2%) with low initial procalcitonin (<0.25μg/L), suggesting the absence of systemic bacterial infection, those randomized to procalcitonin guidance (n=50) had a significantly lower adverse outcome rate compared to controls (n=60): 4% vs. 20% (absolute difference −16.0%, 95% confidence interval (CI) −28.4% to −3.6%, P=0.01), and significantly reduced antibiotic exposure [days] (mean 3.7±4.0 vs. 6.5±4.4, difference −2.8 [95% CI, −4.4 to −1.2], P<0.01). When initial procalcitonin was ≥0.25μg/L, procalcitonin-guided patients had significantly reduced antibiotic exposure due to early stop of therapy without any difference in adverse outcomes (25.8% vs. 24.6%, difference [95% CI] 1.2% [−14.5% to 16.9%, P=0.88]). ConclusionsCHF patients presenting to the emergency department with respiratory symptoms and suspicion for respiratory infection had decreased antibiotic exposure and improved outcomes when procalcitonin measurement was used to exclude bacterial infection and guide antibiotic treatment. These data provide further evidence for the potential harmful effects of antibiotic / fluid treatment when used instead of diuretics and heart failure medication in clinically symptomatic CHF patients without underlying infection.

Hybrid treatment of aortic and mitral paravalvular leaks: A novel approach

Paravalvular leak (PVL) is a well-recognized complication of prosthetic valve replacement. Peri-prosthetic regurgitation is clinically significant in 1–5% of patients with PVL causing symptoms of congestive heart failure and/or hemolysis. Traditionally, cardiac reoperation and surgical re-replacement of the valve has been the treatment of choice. Reoperations carry higher risks than primary operations and tissue fragility may make successful prosthetic valve re-replacement difficult. Percutaneous closure of PVL is a newer and less invasive technique, gaining popularity especially in high-risk surgical patients. However, the long-term efficacy is unknown, and the technique is limited by the size of the PVL. In the case of multiple PVLs in high-risk patients, another viable alternative is to employ a hybrid strategy. This combination of surgical and percutaneous approaches has not been reported previously. Our report describes the use of a hybrid strategy in the management of multiple PVLs in a high-risk patient. This synergy relies on the Heart Team concept, and may result in improved outcomes with PVLs in high-risk or non-surgical candidates.

P208 A pilot study of low-dose capecitabine plus trastuzumab as first-line treatment for patients older than 75 years with HER2-positive advanced gastric cancer

Background Elderly patients often present with concomitant co-morbidities and age-associated physiologic problems, such as impaired organ function and functional changes that make the selection of optimal treatment difficult. We report the treatment outcome in 13 elderly patients with HER2-positive advanced gastric cancer who were given low-dose capecitabine plus trastuzumab. Methods Patients older than 75 years with gastric cancer were eligible for inclusion if their tumours showed overexpression of HER2 protein by immunohistochemistry (IHC 3+), or gene amplification by FISH and IHC 2+. Capecitabine 1000 mg/m 2 was given orally twice a day for 14 days followed by a 1-week rest. Trastuzumab was given as an intravenous infusion of 8 mg/kg on day 1 of the first cycle, followed by 6 mg/kg every 3 weeks. Chemotherapy was given every 3 weeks for eight cycles. Findings Between December 2011 and July 2013, 13 consecutive patients (seven with IHC 3+ and six with IHC 2+ and FISH+) with a median age of 79 years (range 75–92) were enrolled. Eastern Cooperative Oncology Group (ECOG) performance status was 0 in one patient, 1 in seven patients, and 2 in five patients. A total of 54 cycles of capecitabine plus trastuzumab were administered (median of three cycles; range 2–8). Of the 12 patients with measurable lesions, the overall response rate was 41.6% (95% confidence interval [CI] 13.7–69.5). Disease control was achieved in 75.0% of patients. Median progression-free survival was 8.2 months (95% CI 2.5–13.7) and median overall survival was 10.9 months (95% CI 1.4–20.4). Grade 3–4 toxicities were stomatitis (7.6%) and anaemia (7.6%). No treatment-related deaths or symptomatic congestive heart failure were observed. Interpretation Our findings suggest that low-dose capecitabine plus trastuzumab is effective and well tolerated in elderly patients with advanced HER2-positive gastric cancer who are considered ineligible for combination chemotherapy. Prospective trials investigating this regimen in elderly patients with advanced gastric cancer are warranted.

Clinical evaluation of heart failure: agreement among tests (648.4)

Congestive heart failure (CHF) is the most common cause of nonelective hospitalization of subjects over the age of 65 in the US. CHF clinical status is evaluated by ejection fraction (EF), symptoms, and exercise tolerance. Although difficult to apply clinically, a gold standard of left ventricular (LV) function is the rate of LV pressure development (+dP/dt). We tested the hypothesis that EF, symptoms, and exercise treadmill test (ETT) duration would correlate with each other and with +dP/dt. Subjects with symptomatic CHF (62 ± 2 yo; EF 30 ± 2%; n = 27) underwent measurement of EF, symptoms (Kansas City Cardiomyopathy Questionnaire Score, KCCQS), ETT duration, and +dP/dt (via cardiac catheterization). EF and +dP/dt were measured before and during dobutamine infusion. Results were compared using Pearson’s correlation analysis. Overall, tests correlated poorly. The only significant correlations were between KCCQS and +dP/dt. KCCQS correlated with both basal +dP/dt (r = ‐0.47, p = 0.021) and stimulated +dP/dt (r = ‐0.63, p &lt; 0.001). KCCQS and stimulated +dP/dt were correlated regardless of ischemic (r = ‐0.69, p = 0.026) or non‐ischemic etiology (r = ‐0.56, p = 0.038).Conclusion: EF, ETT, and symptoms are not correlated in CHF patients. Using +dP/dt as a gold standard, EF and ETT do not correlate as well with LV function as symptoms do. EF and ETT may be less effective measures of LV function than commonly believed.Grant Funding Source: Supported by National Institutes of Health grants (P01 HL66941, HL088426, HL081741, and HL107200)

Comparison of Tissue Doppler Imaging with MRI T2* and 24-Hour Rhythm Holter Heart Rate Variability for Diagnosing Early Cardiac Impairment in Thalassemia Major Patients

Objectives: Cardiology follow up is important in thalassemia major patients. The object of this study is to define parameters which can be used in the early detection of cardiac impairment. Material and Methods: Forty seven beta thalassemia major patients (mean age 16.3 ± 4.47 years; 22 boys, 25 girls) whose left ventricular systolic functions were normal and a healthy control group of fifty age and gender matched children were included in the study. M-mode echocardiographic measurements, systolic and diastolic functions with PW and tissue Doppler and heart rate variabilities (HRVs) were compared between the two groups. The patients were also grouped according to MRT2*, ferritin and left ventricular diastolic diameters (LVDds) to compare the echocardiographic and Holter parameters among them. Results: None of the children in the study group had symptomatic congestive heart failure. PW Doppler late diastolic forward flow in pulmonary artery was higher in the thalassemia group when compared with the control group (P = 0.01) indicating decreased compliance of the right ventricle. While the systolic and diastolic functions were normal, all the HRV parameters in the thalassemia group were significantly lower than the control group (P = 0.005). Conclusions: Significant decrease in HRV and increase in PW late diastolic forward flow in pulmonary artery in the absence of systolic or diastolic dysfunction, points out that these parameters can be useful in detection of early cardiac impairment.

Continuously adjusting CRT therapy: clinical impact of adaptive cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) is a well-established therapy to reduce morbidity and mortality in patients with moderate and severe symptomatic congestive heart failure. Left ventricular (LV) pacing that fuses with intrinsic right ventricular (RV) conduction results in similar or even better cardiac performance compared to biventricular (Biv) pacing. Optimal programming of the atrio-ventricular (AV) and inter-ventricular (VV) delays is crucial to improve LV performance since suboptimal programming of AV and VV delays affect LV filling as well as cardiac output. CRT optimization using echocardiogram is resource-dependent and time consuming. Adaptive CRT (aCRT) algorithm provides a dynamic, automatic, ambulatory adjustment of CRT pacing configuration (Biv or LV pacing) and optimization of AV and VV delays. aCRT algorithm is safe and efficacious for CRT-indicated patients without permanent atrial fibrillation. It has been shown to improve CRT response and reduce morbidity and mortality for patients with normal AV conduction.

Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures

Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. The 2005-2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P < .001). After multivariable adjustment, laparoscopy seemed to have a protective effect against mortality (adjusted odds ratio, 0.45; P = .04), but no differences in other secondary endpoints. For patients with CHF, an open operative approach seems to be utilized more frequently in general surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in this population is necessary.

Uncommon Etiology of Abnormal Spikes on Electrocardiogram

A 75-year-old woman was referred to our pacemaker/implantable cardioverter-defibrillator (ICD) clinicwith anabnormal electrocardiogram(ECG).TheECG(Figure,A)showedabnormalspikescompared with a regular ECG (without spikes) (Figure, B) of the same patient performed3months earlier, prompting a referral for device interrogation. Clinical manifestations such as dizziness, lightheadedness, syncope, or signs and symptoms of congestive heart failure were absent. The patient’s vital signs were normal. Question: Do spikes on ECG resembling impulses produced by a cardiac implantable electronic device (CIED) necessarily indicate a cardiac etiology?

A pilot study of low-dose capecitabine plus trastuzumab as first-line treatment for patients older than 75 years with HER2-positive advanced gastric cancer.

165 Background: Elderly patients often present with concomitant co-morbidities and age-associated physiologic problems, such as impaired organ function and functional changes that make the selection of optimal treatment difficult. We report the treatment outcome in 13 elderly patients with HER2-positve advanced gastric cancer who treated with low-dose capecitabine plus trastuzumab. Methods: Patients older than 75 years with gastric cancer were eligible for inclusion if their tumors showed overexpression of HER2 protein by immunohistochemistry (IHC) (3+) or gene amplification by FISH and IHC 2+. Capecitabine 1000 mg/m2was given orally twice a day for 14 days followed by a 1-week rest. Trastuzumab was given by intravenous infusion as a dose of 8 mg/kg on day 1 of the first cycle, followed by 6 mg/kg every 3 weeks. Chemotherapy was given every 3 weeks for eight cycles. Results: Between December 2011 and July 2013, 13 consecutive patients (IHC 3+;7, IHC 2+ and FISH+;6) with a median age of 79 years (range, 75-92 years) were enrolled in this study. ECOG PS was 0/1/2:1/7/5, respectively. A total of 54 cycles of capecitabine plus trastuzumab were administered (median, three cycles; range, 2-8 cycles). Of the 12 patients with measurable lesions, the overall response rate was 41.6% (95% CI, 13.7 to 69.5%). Disease control was achieved in 75.0% of patients. Median progression-free survival was 8.2 months (95% CI, 2.5-13.7 months) and median overall survival was 10.9 months (95% CI, 1.4-20.4 months). Grade 3-4 toxicities were stomatitis (7.6%) and anemia (7.6%). No treatment-related deaths and symptomatic congestive heart failure were observed. Conclusions: Our findings suggest that low-dose capecitabine plus trastuzumab is effective and well tolerated in elderly patients with advanced HER2-positive gastric cancer who are considered ineligible for combination chemotherapy. Prospective trials investigating this regimen in elderly patients with advanced gastric cancer are warranted. Clinical trial information: Gachon University IRB.

Microwave System for the Early Stage Detection of Congestive Heart Failure

Fluid accumulation inside the lungs, known as cardiac pulmonary edema, is one of the main early symptoms of congestive heart failure (CHF). That accumulation causes significant changes in the electrical properties of the lung tissues, which in turn can be detected using microwave techniques. To that end, the design and implementation of an automated ultrahigh-frequency microwave-based system for CHF detection and monitoring is presented. The hardware of the system consists of a wideband folded antenna attached to a fully automated vertical scanning platform, compact microwave transceiver, and laptop. The system includes software in the form of operational control, signal processing, and visualizing algorithms. To detect CHF, the system is designed to vertically scan the rear side of the human torso in a monostatic radar approach. The collected data from the scanning is then visualized in the time domain using the inverse Fourier transform. These images show the intensity of the reflected signals from different parts of the torso. Using a differential based detection technique, a threshold is defined to differentiate between healthy and unhealthy cases. This paper includes details of developing the automated platform, designing the antenna with the required properties imposed by the system, developing a signal processing algorithm, and introducing differential detection technique besides investigating miscellaneous probable CHF cases.

Cardiac sarcoidosis: the Christchurch experience

To present an overview of the diagnosis, treatment and outcomes of patients with cardiac sarcoidosis managed in Christchurch Hospital, New Zealand. A retrospective review of patients with cardiac sarcoidosis at Christchurch Hospital from January 2005 to December 2012. Eighteen patients were identified with cardiac sarcoidosis. All the 12 patients that underwent cardiac magnetic resonance imaging (CMR) had abnormal scans. Angiotensin-converting enzyme (ACE) levels were elevated in 4 of 16 patients and troponin (cTn) was elevated in 5 of 15 patients. Endomyocardial biopsies were diagnostic in two of six patients. The principal causes for presentation related to symptomatic high-grade atrioventricular conduction block and congestive heart failure with six patients in each of these groups. In addition, three patients presented with ventricular tachycardia and the remaining three patients presented with atrial fibrillation, recurrent presyncope without proven heart block and an asymptomatic persistent elevation of cardiac troponin. Seven patients had pre-existing, extra-cardiac sarcoidosis and a concomitant diagnosis was made in a further eight cases. Three patients had isolated cardiac involvement at presentation. Sixteen patients received immunosuppressive therapy. Twelve patients had cardiac devices implanted; five pacemakers, five defibrillators and two resynchronising pacemaker defibrillators. During follow up for 0.1-30.8 years, median 4.8 years, two patients died. In our patients CMR demonstrated high diagnostic sensitivity, while biomarkers (ACE and cTn) were frequently within the normal reference range. Cardiac sarcoidodis caused major arrhythmias or heart failure in the majority of patients. Most patients were treated with immunosuppression and cardiac device therapy. Long-term mortality was lower than previously reported.

Three-Dimensional Open-Ended Slot Antenna for Heart Failure Detection System Employing Differential Technique

The design of a folded open-ended slot antenna for an early-stage congestive heart failure (CHF) detection system operating at ultra-high frequency (UHF) is presented. The antenna is formed using a three-dimensional open-ended slot with a compact size of 0.24 λ <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">0</sub> × 0.09λ <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">0</sub> × 0.04 λ <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">0</sub> (λ <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">0</sub> is the lowest operating frequency of the antenna), and a slotted microstrip feeder used to achieve wide operating bandwidth of 58% (550-1000 MHz). A CHF detection system is then built using the proposed antenna, a compact microwave sensor, and a differential detection technique. The main objective of such a system is to map the torso area searching for any fluid accumulation in the lungs as the main symptom of CHF. To that end, a pair of the proposed antenna is attached to an adjustable platform to vertically scan the torso. A differential detection technique is applied on the backscattered signals to map the scattering profile of the torso and detect any changes in the electrical properties of the lungs caused by fluid accumulation. A detection threshold is applied to differentiate between healthy and unhealthy cases. The obtained images have a pixel resolution of 0.1 cm in depth and 1 cm in height. The experimental results on an artificial torso indicate that the system can detect fluid differences as small as 4 mL, with a measurement error of less than 3%.

Novel technology for non-invasive thoracic fluid measurement: an animal model comparative study

Approximately 15 million people worldwide suffer from congestive heart failure (CHF). The most severe symptom of CHF is pulmonary congestion - an acute increase in extravascular lung fluid due to acute decompensation of heart failure. To date, no direct, reliable, simple and non-invasive method is available for assessment of thoracic fluids. Continuous dependable monitoring of pulmonary edema for hospital patients can improve management and reduce duration of hospitalization. KYMA's solution is based on a matchboxsized monitoring device, which monitors thoracic fluid content and trends. The μCor monitor transmits and receives electromagnetic signals that are propagated through tissue layers. Conduction is highly related to the amount of accumulated fluids in tissues. This trial investigated the correlation between KYMA's lung water index (LWI) and directly assessed extravascular lung water (EVLW) in the scenario of acute pulmonary edema induced in seven sheep.

Cardiotoxicity of mitoxantrone treatment in a german cohort of 639 multiple sclerosis patients.

Background and PurposeThe aim of this study was to elucidate the role of therapy-related cardiotoxicity in multiple sclerosis (MS) patients treated with mitoxantrone and to identify potential predictors for individual risk assessment.MethodsWithin a multicenter retrospective cohort design, cardiac side effects attributed to mitoxantrone were analyzed in 639 MS patients at 2 MS centers in Germany. Demographic, disease, treatment, and follow-up data were collected from hospital records. Patients regularly received cardiac monitoring during the treatment phase.ResultsNone of the patients developed symptomatic congestive heart failure. However, the frequency of patients experiencing cardiac dysfunction of milder forms after mitoxantrone therapy was 4.1% (26 patients) among all patients. Analyses of the risk for cardiotoxicity revealed that cumulative dose exposure was the only statistically relevant risk factor associated with cardiac dysfunction.ConclusionsThe number of patients developing subclinical cardiac dysfunction below the maximum recommended cumulative dose is higher than was initially assumed. Interestingly, a subgroup of patients was identified who experienced cardiac dysfunction shortly after initiation of mitoxantrone and who received a low cumulative dose. Therefore, each administration of mitoxantrone should include monitoring of cardiac function to enhance the treatment safety for patients and to allow for early detection of any side effects, especially in potential high-risk subgroups (as determined genetically).

Safety and tolerability of docetaxel, cyclophosphamide, and trastuzumab compared to standard trastuzumab-based chemotherapy regimens for early-stage human epidermal growth factor receptor 2-positive breast cancer.

PurposeWe evaluated the tolerability and cardiac safety of docetaxel, cyclophosphamide, and trastuzumab (TCyH) for the treatment of early-stage human epidermal growth factor receptor 2 (HER2)-positive breast cancer and compared to the standard trastuzumab-based chemotherapy regimens doxorubicin with cyclophosphamide followed by paclitaxel and trastuzumab (AC-TH) and docetaxel, carboplatin, and trastuzumab (TCaH).MethodsWe retrospectively reviewed early-stage, resectable, HER2-positive breast cancer patients treated with trastuzumab-based chemotherapy at a single comprehensive cancer center between 2004 and 2011. Patient characteristics, comorbidities, relative dose intensity (RDI) of each regimen, tolerability, and cardiac toxicity were evaluated.ResultsOne hundred seventy-seven patients were included in the study (AC-TH, n=114; TCaH, n=39; TCyH, n=24). TCyH was solely administered in the adjuvant setting, whereas two-thirds of the AC-TH and TCaH groups were administered postoperatively. Patients treated with TCyH tended to have a more significant underlying cardiac history, higher Charlson comorbidity index, and were of an earlier stage. All patients treated with TCyH received granulocyte colony stimulating factor primary prophylaxis. No febrile neutropenia or grade ≥3 hematologic toxicity was observed in the TCyH group as compared to the AC-TH and TCaH groups. There were no significant differences in the rates of early termination, hospitalization, dose reduction, or RDI between the regimens. The symptomatic congestive heart failure rate between AC-TH, TCaH, and TCyH groups was not significantly different (4.4% vs. 2.6% vs. 8.3%, respectively, p=0.57). There was also no significant difference in the rate of early trastuzumab termination between patients treated with each regimen.ConclusionTCyH is well tolerated and should be investigated as an alternative adjuvant chemotherapy option for patients who are not candidates for standard trastuzumab-containing regimens. Larger clinical trials are necessary to support the wider use of TCyH as an adjuvant regimen.

Dilated cardiomyopathy secondary to rickets-related hypocalcaemia: eight case reports and a review of the literature

Dilated cardiomyopathy is usually idiopathic and may arise secondary to infections or metabolic or genetic causes. Another rare cause is hypocalcaemia. Owing to the fact that calcium plays an essential role in excitation and contraction of myocardial muscle, myocardial contractility may decline in patients with hypocalcaemia. Patients with symptoms of congestive heart failure and rickets-related hypocalcaemia were assessed clinically and by echocardiography in a paediatric cardiology clinic. Echocardiography was performed for all patients. Rickets was diagnosed according to the clinical, laboratory, and radiologic findings. Maternal lifestyle and living conditions were investigated, and the maternal 25-OH vitamin D3 blood level was measured. We evaluated eight patients who developed heart failure as a result of severe hypocalcaemia associated with rickets between August, 1999 and June, 2012. The age distribution of the patients was 3-12 months. Laboratory results were consistent with advanced-stage rickets. Severe hypocalcaemia was detected in all patients. The maternal 25-OH vitamin D3 levels were low. Echocardiography revealed increased pre-treatment left ventricle end-systolic and end-diastolic diameters for age and reduced ejection fraction and fractional shortening. After clinical improvement, the patients were discharged. Severe hypocalcaemia associated with rickets must always be kept in mind among the causes of dilated cardiomyopathy and impaired cardiac function in infants. If diagnosed and treated in time, dilated cardiomyopathy and severe heart failure related to rickets respond well.