Treatment Of Severe Heart Failure Research Articles

Update on Nutritional Advice Post-Heart Transplant: A Cross-Sectional Study across French-Speaking European Centers.

Heart transplantation is the standard treatment for severe heart failure. Graft preservation and infectious risk secondary to immunosuppressive drugs lead healthcare teams to offer nutritional advice to patients upon discharge from the hospital. However, no consensus or recommendation is available. We conducted a study to review the practices in all 26 centers providing heart transplantation in French-speaking Europe. We requested and analyzed the written documents these centers provided to their patients. The same two dieticians categorized the highlighted pieces of advice into distinct, autonomous categories. We identified 116 pieces of advice, categorized into three areas: dietary restrictions for immunosuppressant/food interaction; environmental and food preparation guidelines and prevention of foodborne infections; and healthy and active lifestyle recommendations. Except for advice on immunosuppressant/food interaction, over one-third of the centers suggest discontinuing advice within 2 years post-transplant. General dietary advice covers lipids, carbohydrates, protein, calcium, sodium, and fiber but offers limited guidance on fatty acids despite their importance in cardiovascular risk prevention. This study represents a pioneering exploration of the nutritional advice provided to patients following cardiac transplantation. It underscores the critical necessity of establishing consensus-based clinical guidelines in this domain.

Management of aortic valve insufficiency in patients with continuous-flow left ventricular assist device: a republication of the review published in Japanese Journal of Artificial Organs.

Since 2011, implantable ventricular assist devices have been a standard treatment for severe heart failure alongside heart transplantation in Japan. However, the limited availability of donors has led to a prolonged wait for transplants, now averaging 1719days, intensifying the issue of aortic insufficiency in patients with continuous flow ventricular assist devices. These devices limit the opening of the aortic valve, leading to sustained closure and increased shear stress, which accelerates valve degradation. Risk factors for aortic insufficiency include having a smaller body surface area, being of advanced age, and the presence of mild aortic insufficiency prior to device implantation. In patients presenting with mild or moderate aortic regurgitation at the time of ventricular assist device implantation, interventions such as aortic valve repair or bioprosthetic valve replacement are performed with the aim of halting its progression. The choice of surgical procedure should be tailored to each patient's individual condition. The management of de novo aortic insufficiency in patients with continuous flow ventricular assist devices remains challenging, with no clear consensus on when to intervene. Interventions for significant aortic insufficiency typically consider the patient's symptoms and aortic insufficiency severity. De novo aortic insufficiency progression in continuous flow ventricular assist devices patients necessitates careful monitoring and intervention based on individual patient assessments and valve condition. This review was created based on a translation of the Japanese review written in the Japanese Journal of Artificial Organs in 2023 (Vol. 52, No. 1, pp. 77-80), with some modifications.

Impact of Levosimendan and Its Metabolites on Platelet Activation Mechanisms in Patients during Antiplatelet Therapy-Pilot Study.

Levosimendan is used for the short-term treatment of severe heart failure or other cardiac conditions. The area of existing clinical applications for levosimendan has increased significantly. This study aimed to assess whether levosimendan and its metabolites impact the mechanisms related to platelet activation. In this study, we included patients with coronary artery disease receiving antiplatelet therapy. We analyzed the pharmacodynamic profile using three independent methods to assess platelet activity. The results of the conducted studies indicate a mechanism of levosimendan that affects the function of platelets, causing higher inhibition of platelet receptors and, thus, their aggregation. It is essential to clarify whether levosimendan may affect platelets due to the need to maintain a balance between bleeding and thrombosis in patients treated with levosimendan. This is especially important in the case of perioperative bleeding. This study was conducted in vitro; the research should be continued and carried out in patients to check the complete pharmacokinetic and pharmacodynamic profile.

Establishment of a protocol to administer immunosuppressive drugs for iPS cell-derived cardiomyocyte patch transplantation in a rat myocardial infarction model

Transplantation of human allogeneic induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) is a new, promising treatment for severe heart failure. However, immunorejection is a significant concern in allogeneic hiPSC-CM transplantation, requiring the administration of several immunosuppressive agents. An appropriate protocol for the administration of immunosuppressants may substantially affect the efficacy of hiPSC-CM transplantation in case of heart failure owing to allogeneic transplantation. In this study, we investigated the effect of immunosuppressant administration duration on the efficacy and safety of allogenic hiPSC-CM patch transplantation. We used a rat model of myocardial infarction to evaluate cardiac function using echocardiography six months after the transplantation of hiPSC-CM patches with immunosuppressant administration for either two or four months and compared them to control rats (sham operation, no immunosuppressant administration). Histological analysis performed at 6 months after hiPSC-CM patch transplantation revealed significant improvement in cardiac function in immunosuppressant-treated rats compared with those in the control group. Moreover, fibrosis and cardiomyocyte size was significantly reduced and the number of structurally mature blood vessels was significantly increased in the immunosuppressant-treated rats compared to control rats. However, there were no significant differences between the two immunosuppressant-treated groups. Our results show that prolonged administration of immunosuppressive agents did not enhance the effectiveness of hiPSC-CM patch transplantation, and therefore, highlight the importance of an appropriate immunological regimen for the clinical application of such transplantation.

Severe heart failure with rapid arrhythmia: Treatment with amiodarone and esmolol and its effect on TGF-β1, APN and PIIINP

Rapid arrhythmia (RA) is a major complication of severe heart failure (SHF). Treatment with anti-arrhythmic drug amiodarone though improves the myocardial blood supply and suppress arrhthmia, its clinical application is unsatisfactory. Amiodarone combined with another class II antiarrhythmic drug, esmolol shows rapid onset and good efficacy. Here, we studied the effects of amiodarone and esmolol in severe heart failure (SHF) with rapid arrhythmia (RA) and its effect on TGF-β1, APN and PIIINP. A total of 180 SHF patients with RA treated at Zhejiang Provincial Hospital of Traditional Chinese Medicine were selected and divided into experimental group (n = 90) and control group (n = 90) according to the random number table method. The control group was given routine therapy + amiodarone therapy, and the experimental group was given routine therapy + amiodarone + esmolol therapy. Cardiac function measures including cardiac index (CI), mean arterial pressure (MAP) and ejection fraction (LVEF), diastolic blood pressure (DBP), systolic blood pressure (SBP) and heart rate (HR), serum TGF-β1, APN and PIIINP levels were observed in both groups before and 48 h after treatment. After treatment, the CI, MAP and LVEF of the experimental group were greater than those of the control group (P<0.05); DBP, SBP and HR were greater (or higher) in the experimental group than in the control group (P<0.05); serum TGF-β1 and PIIINP levels in experimental groups were all lower than in control group and serum APN levels were higher (P<0.05) than in control group. The total effective rate of the experimental group was less than that of the control group (P<0.05). There was no difference in the incidence of adverse effects between the two groups (P>0.05). The results indicate that treatment of severe heart failure (SHF) with rapid arrhythmia (RA) by amiodarone and esmolol may safely enhance cardiac function, blood pressure and heart rate, improve efficacy, inhibit the progression of myocardial fibrosis, and improve serum TGF-β1, APN and PIIINP levels.

Discussion on the Clinical Efficacy of Integrated Traditional Chinese Medicine and Western Medicine in the Treatment of Severe Heart Failure in Emergency Internal Medicine

Discussion on the Clinical Efficacy of Integrated Traditional Chinese Medicine and Western Medicine in the Treatment of Severe Heart Failure in Emergency Internal Medicine

Review of Implantable Left Ventricular Assist Devices.

Mechanical circulatory support has been an indispensable treatment for severe heart failure. While the development of a total artificial heart has failed, left ventricular assist devices (LVAD) have evolved from extracorporeal to implantable types. The first generation implantable LVAD (pulsatile device) was used as a bridge to transplantation, and demonstrated improvement in survival rate and activity of daily living. The evolution from the first-generation (pulsatile device) to the second-generation (continuous flow device: axial flow pump and centrifugal pump) has resulted in many clinical benefits by reducing mechanical failures and minimizing device size. Furthermore, third-generation devices, which use a moving impeller suspended by magnetic and/or hydrodynamic forces, have improved overall device reliability and durability. Unfortunately, there are still many device-related complications, and further device development and improvement of patient management methods are required. However, we expect to see further development of implantable VADs, including for destination therapy, in future.

The Cardiac Mineralocorticoid Receptor (MR): A Therapeutic Target Against Ventricular Arrhythmias.

Mineralocorticoid antagonists have been shown to be useful in the treatment of severe heart failure and may even save lives in this context. However, the reason for the beneficial action of these drugs, as well as the physiological role played by the cardiac mineralocorticoid receptor (MR), are still poorly understood. While the proinflammatory action of aldosterone on the heart and the resulting fibrosis partly explain the improvement due to the anti-mineralocorticoid therapy, the reduction in sudden death is probably related to a lower occurrence of ventricular arrhythmias. In this review, the author explains the physiological mechanism linking the positive chronotropic response induced by aldosterone observed in vitro with isolated ventricular cardiomyocytes and the increased risk of ventricular arrhythmias reported in vivo in hyperaldosteronism. He describes the molecular steps involved between MR activation and acceleration of spontaneous myocyte contractions, including expression of a specific micro RNA (miR204), down-regulation of a silencing transcription factor (NRSF), and re-expression of a fetal gene encoding a low threshold voltage-gated calcium channel (CaV3.2). Finally, he provides evidence suggesting aldosterone-independent and redox-sensitive mechanisms of MR activation in cardiac myocytes. Taken together, this information suggests that the use of anti-mineralocorticoid therapy could benefit the heart by preventing ventricular arrhythmias, not only in established hyperaldosteronism, but also in various pathological situations such as Cushing’s disease, oxidative stress, or even diabetes mellitus.

Clinical trials in cardiac xenotransplantation: Are we ready to overcome barriers?

Heart allotransplantation has become one of the methods of choice in the treatment of severe heart failure. In the face of its difficulties, such as the unmet balance between organ supply and demand, the use of xenotransplantation (XTx) might be an attractive option shortly, even more with the ongoing progress achieved regarding the avoidance of hyperacute rejection and primary organ disfunction, maintenance of xenograft function and control of xenograft growth. To make possible this translational challenge, some points must be taken into account indeed, and they are the equipoise of human benefit and animal suffering, the risk of unknown infections, a well prepared informed consent, ethical and religious beliefs, and the role of cardiac XTx in a ventricular assistance device era.

SUPPORTING DEVICES IN THE TREATMENT OF CHRONIC HEART FAILURE IN ELDERLY AND OLD PATIENTS

Chronic heart failure (CHF) is a widespread disease associated with high rates of disability and mortality, as well as a decrease in the quality of life. Moreover, the vast majority of patients are elderly and senile. Modern surgical methods of treating heart failure are able to increase the duration and quality of life of such patients, however, the need far exceeds the volume of this care, and some highly effective methods common in Western countries are still not used in Russian clinical practice.
 Elderly age is a risk factor for the development of senile asthenia (frailty) and concomitant pathology. Large abdominal surgery is often contraindicated for patients with signs of senile asthenia, and the method of choice in patients with severe heart failure is the implantation of devices for long-term mechanical circulatory support (LT-MCS). After implantation of LT-MCS, a regression of signs of senile asthenia may be observed.
 The topic of an integrated approach to non-drug treatment of heart failure in elderly and senile patients in Russia has not been studied enough. In particular, the implantation of LT-MCS is not used in Russian clinical practice, while in many Western countries for many years it has been the main and most effective treatment for severe heart failure. Systematization of the available up-to-date information on this topic could help increase the duration and quality of life of patients with severe heart failure.

Methodology for measuring the gap size using a fiber-optic displacement sensor exemplified by a centrifugal blood pump

In order to avoid blood clotting, in the second generation of rotary blood pumps the impeller is suspended without mechanical bearing, using balance of magnetic and hydrodynamic forces. Reaching single tens of microns gap between pump housing and impeller is crucial for level of blood traumatization by the pump. In this paper we would like to present the method of physical measurement of this gap on a running pump with the use of commercial fiber-optic proximity sensor on the example of Polish rotary blood pump ReligaHeart ROT. We also discussed technical requirements of the construction of laboratory stand. Full Text: PDF ReferencesS. Westaby, "Rotary blood pumps as definitive treatment for severe heart failure", Future Cardiol. 9, 2 (2013). CrossRef R. Delgado, M. Bergheim, "HeartMate® II left ventricular assist device: a new device for advanced heart failure", Epert Rev. Med. Devices, 2, 5 (2005). CrossRef M. Ozban, T. Yagdi, C. Engin et al, Transplant proc., 44, 6 (2012). CrossRef A.T. Lanfear, M. Hamandi, J. Fan et al., "Trends in HeartMate 3: What we know so far", J. Card. Surg., 35, 1 (2020). CrossRef Ch. Zengsheng, S. Anqiang, W. Hongyu, "Non-physiological shear stress-induced blood damage in ventricular assist device", Medicine in Novel Technology and Devices, 3 (2019). CrossRef A. M. Robertson, A. Sequeira, R. G. Owens, Rheological models of blood In: L. Formaggia, A. Quarteroni, A Veneziani (eds) Cardiovascular Mathematics (Milano, Springer-Verlag 2009) CrossRef M. Gawlikowski et al., "Necessity of telemonitoring in patients treated by means of cardiac assist systems on the example of Polish rotary blood pump ReligaHeart ROT", Advances in Intelligent Systems and Computing, 925 (2019). CrossRef R. Kustosz, et al., "The tin coating utilisation as blood contact surface modification in implantable rotary left ventricle assist device religaheart ROT", Arch. Matall. Mater., 60, 3 (2015). CrossRef S. S. Patil, A. D. Shaligram, "Analytical study of performance variations of fiber optic micro-displacement sensor configurations using mathematical modeling and an experimental test jig", IJSER, 4, 11 (2013). DirectLink Philtec Application Note, 6, 25 (2017) CrossRef

New treatment strategy for severe heart failure: combination of ventricular assist device and regenerative therapy.

Heart transplantation and ventricular assist device for the patients with end-stage heart failure are limited by availability and durability due to limited donor or device-related complication. Thus, complementation or a new alternative is needed for the treatment of severe heart failure. Based on the results of basic experiments, we applied skeletal myoblast cell sheet transplantation in a clinical setting using cell-sheet methods with temperature-responsive dish for the treatment of heart failure patient from 2007. After confirming the safety of this treatment, we started a clinical trial of myoblast cell sheet transplantation as sole therapy. According to these results, in 2015, myoblast cell sheet transplantation with ischemic cardiomyopathy was approved by the Japanese government and now this treatment was covered by Japanese health insurance. Here we report our approach and future perspective of cardiac regenerative therapy using this new treatment method for severe heart failure including new strategy incorporating regenerative therapy in the conventional treatment of heart failure including VAD and heart transplantation.

A narrative review on the management of Acute Heart Failure in Emergency Medicine Department.

The main urgent symptom presented to an emergency department is acute heart failure (AHF). In that considerable risksof morbidity and mortality, it is important to plan precision medicine to achieve the most suitable outcomes. The object of this review is to provide a summary of contemporary management procedures of emergency medicine in a department of acute heart failure. Heart failure could be presented with a broad range of symptoms, in particular a sudden worsening of those of Chronic Obstructive Pulmonary Disease. The treatment should focus on acute and chronic underlying disorders with instructions focusing on haemodynamics and blood pressure status. Treatment of patients suffering with worsening symptoms of AHF mainly focuses on intravenous diuretics. In emergency situations, patients suffering with AHF with low blood pressure must receive emergency consultation and a primary fluid bolus therapy (range 250–500 mL) followed by inotropic therapy with or without antihypotensive agents. For treatment of severe heart failure and cardiogenic shock in patients treated with noradrenalin, when blood pressure support is required, a direct-acting inotropic agent, dobutamine, could be applied effectively. When non-invasive positive pressure ventilation is needed, suppliers must track for any possibility of sudden worsening, i.e., for acute decompensated heart failure. When cardiac output is high the disorder could be treated with vasopressors.

Generation of a large-scale vascular bed for the invitro creation of three-dimensional cardiac tissue.

IntroductionThe definitive treatment for severe heart failure is transplantation. However, only a small number of heart transplants are performed each year due to donor shortages. Therefore, novel treatment approaches based on artificial organs or regenerative therapy are being developed as alternatives. We have developed a technology known as cell sheet-based tissue engineering that enables the fabrication of functional three-dimensional (3D) tissue. Here, we report a new technique for engineering human cardiac tissue with perfusable blood vessels. Our method involved the layering of cardiac cell sheets derived from human induced pluripotent stem cells (hiPSCs) on a vascular bed derived from porcine small intestinal tissue.MethodsFor the vascular bed, a segment of porcine small intestine was harvested together with a branch of the superior mesenteric artery and a branch of the superior mesenteric vein. The small intestinal tissue was incised longitudinally, and the mucosa was resected. Human cardiomyocytes derived from hiPSCs were co-cultured with endothelial cells and fibroblasts on a temperature-responsive dish and harvested as a cardiac cell sheet. A triple-layer of cardiac cell sheets was placed onto the vascular bed, and the resulting construct was subjected to perfusion culture in a bioreactor system.ResultsThe cardiac tissue on the vascular bed pulsated spontaneously and synchronously after one day of perfusion culture. Electrophysiological recordings revealed regular action potentials and a beating rate of 105 ± 13/min (n = 8). Furthermore, immunostaining experiments detected partial connection of the blood vessels between the vascular bed and cardiac cell sheets.ConclusionsWe succeeded in engineering spontaneously beating 3D cardiac tissue in vitro using human cardiac cell sheets and a vascular bed derived from porcine small intestine. Further development of this method might allow the fabrication of functional cardiac tissue that could be used in the treatment of severe heart failure.

Application of cream formula in treatment of severe heart failure

Cream formula has been mostly used to treat deficiency syndrome. Currently,it has been used to recuperate the body,promote health against aging,and prevent and treat chronic disease. In modern medicine,there are only treatment concepts and methods of diseases,but lack of concepts of " deficiency syndrome" and " restoring deficiency". The concepts of " deficiency syndrome" and " restoring deficiency" could effectively supplement and improve the diagnosis and treatment scheme of some modern diseases. Refractory heart failure,dilated cardiomyopathy,ischemic cardiomyopathy,and valvular heart disease belong to the traditional category of " consumptive disease". The cream formula with the efficacy of restoring deficiency can not only alleviate symptoms and improve the quality of life,but also improve the structure and function of the heart,reduce the dosage of diuretics and the number of hospitalizations,and achieve the purpose of secondary prevention in the treatment of severe heart failure,dilated cardiomyopathy,ischemic cardiomyopathy and valvular heart disease. The cream formula for treating chronic heart failure include Shenqi Pills,Zhenwu Decoction,Yougui Pills,Wuling Powder,Linggui Zhugan Decoction,Danggui Shaoyao Powder,Lizhong Decoction,Buzhong Yiqi Decoction,Guipi Decoction,Yupingfeng Powder,Guizhi Decoction. Long-term administration of cream formula could not only resist aging,but also play an irreplaceable role in the secondary prevention of acute and critical diseases.

The Potential of Human iPS Cell-Derived Three-Dimensional Tissue Therapy as a New Paradigm of Surgical Treatment for Severe Heart Failure

The Potential of Human iPS Cell-Derived Three-Dimensional Tissue Therapy as a New Paradigm of Surgical Treatment for Severe Heart Failure

Cardiac regeneration with pluripotent stem cell-derived cardiomyocytes and direct cardiac reprogramming.

Cardiovascular disease is the leading cause of death globally. Cardiomyocytes (CMs) have poor regenerative capacity, and pharmacological therapies have limited efficacy in severe heart failure. Currently, there are several promising strategies for cardiac regeneration. The most promising approach to remuscularize failing hearts is cell transplantation therapy using newly generated CMs from exogenous sources, such as pluripotent stem cells. Alternatively, approaches to generate new CMs from endogenous cell sources in situ may also repair the injured heart and improve cardiac function. Direct cardiac reprogramming has emerged as a novel therapeutic approach to regenerate injured hearts by directly converting endogenous cardiac fibroblasts into CM-like cells. Through cell transplantation and direct cardiac reprogramming, new CMs can be generated and scar tissue reduced to improve cardiac function; therefore, cardiac regeneration may serve as a powerful strategy for treatment of severe heart failure. While substantial progress has been made in these two strategies for cardiac regeneration over the past several years, challenges remain for clinical translation. This review provide an overview of previous reports and current challenges in this field.

Concise Review: Genetic and Epigenetic Regulation of Cardiac Differentiation from Human Pluripotent Stem Cells.

Human pluripotent stem cells (hPSCs), including both embryonic stem cells and induced pluripotent stem cells, are the ideal cell sources for disease modeling, drug discovery, and regenerative medicine. In particular, regenerative therapy with hPSC-derived cardiomyocytes (CMs) is an unmet medical need for the treatment of severe heart failure. Cardiac differentiation protocols from hPSCs are made on the basis of cardiac development in vivo. However, current protocols have yet to yield 100% pure CMs, and their maturity is low. Cardiac development is regulated by the cardiac gene network, including transcription factors (TFs). According to our current understanding of cardiac development, cardiac TFs are sequentially expressed during cardiac commitment in hPSCs. Expression levels of each gene are strictly regulated by epigenetic modifications. DNA methylation, histone modification, and noncoding RNAs significantly influence cardiac differentiation. These complex circuits of genetic and epigenetic factors dynamically affect protein expression and metabolic changes in cardiac differentiation and maturation. Here, we review cardiac differentiation protocols and their molecular machinery, closing with a discussion of the future challenges for producing hPSC-derived CMs. Stem Cells 2019;37:992-1002.

Left ventricular assist devices exchange: why, when and how to do it—experience from experts

Left ventricular assist devices (LVAD) became a routine instrument in the treatment of severe heart failure with constantly increasing number of patients treated with LVAD (1). Continuous technical development and large empirical knowledge in this field has led to a very high reliability and excellent long-term results (MOMENTUM III). Recently published results for the first time reported even better 2-year survival in LVAD compared to heart transplantation (HTx) (2). However, there is an inevitable risk of device failure alongside which may result in the need for device exchange. Mainly three causes are associated with the need for exchange, specifically (in the order of frequency) (I) device thrombosis, (II) infection and (III) device malfunction.

Surgical treatment of severe heart failure caused by dysfunction of mitral valve prosthesis

Surgical treatment of severe heart failure caused by dysfunction of mitral valve prosthesis