Therapies that improve outcomes are lacking for heart failure with preserved ejection fraction (HFpEF). The impact of exercise and diet interventions on HFpEF patients has not been studied. In this single center study of 100 patients, the effect of caloric restriction (~400 kcal/day) and or aerobic exercise training (3x a week hour long supervised sessions) […]
Category: Heart Failure
Adaptive servo-ventilation increases mortality in systolic heart failure
Central sleep-apnea (CSA) with associated Cheyne-Stokes breathing patterns effects up to 40% of patients with low ejection fraction heart failure. Given that CSA is an independent marker for poor prognosis and mortality, treatment of CSA has been identified as a potential target to improve heart failure outcomes. This study randomized 1325 patients with low ejection […]
Quality of Life following Coronary Artery Bypass Graft Surgery versus Guideline-based Medical Therapy in Ischemic Cardiomyopathy
It remains uncertain if surgical revascularization improves patient outcomes in the setting of coronary artery disease with reduced systolic function. This is particularly true in light of the STICH trial, a contemporary randomized control trial of coronary artery bypass graft surgery (CABG) with optimal medical therapy compared to optimal medical therapy alone in patients with […]
Beta-blockers in heart failure – what is the impact of concurrent atrial fibrillation?
Beta-blockers form an essential cornerstone of therapy for heart failure with reduced ejection fraction. However, the benefits of beta-blockade for heart failure in patients with concurrent atrial fibrillation are less certain. In this meta-analysis of individual-patient data from 10 randomized control trials comparing beta-blockers to placebo for systolic heart failure, investigators assessed the impact of […]
A new PARADIGM in heart failure treatment?
Natriuretic peptides are released in response to cardiac-wall stress and other stimuli of heart failure. These potent natriuretic and vasodilatory peptides also inhibit the renin-angiotensin system and sympathetic drive. The neutral endopeptidase neprilysin is responsible for the degradation of several of these natriuretic peptides. Inhibition of neprilysin increases the level of these natriuretic peptides, thus […]
Spironolactone for heart failure with preserved ejection fraction
Nearly half of all patients presenting with heart failure have normal or near normal left ventricular systolic function. Optimal treatment strategies for this large patient group remain unclear. Small mechanistic studies have suggested diastolic function may be improved by mineralocorticoid-receptor antagonists. Whether this mechanistic benefit translates into better patient outcomes is not known. In the […]
Mesenchymal stem cells may improve quality of life for patients with ischemic cardiomyopathy
In this study, patients with chronic ischemic cardiomyopathy and EF <50% on optimal medical therapy were randomized to autologous culture expanded mesenchymal cells (=22), autologous bone marrow mononuclear cells (n=22) or placebo vehicle (n=21) delivered by transendocardial stem cell injection (TESI). There were no serious adverse events among any patients undergoing a TESI procedure. Rates […]
No renal protection with low-dose dopamine or nesiritide in acute heart failure
Diuresis to decongest patients with acute heart failure (AHF) is particularly challenging in the setting of renal dysfunction, as these patients are at risk of worsening renal function. Small studies have suggested that low-dose dopamine or nesiritide may increase urine output and maintain renal function in such patients. The Renal Optimization Strategies Evaluation (ROSE) trial […]
Sudden increase in LVAD thrombosis rates
The left ventricular assist device (LVAD) has rapidly been incorporated into the management of patients with advanced heart failure. In response to an internal audit demonstrating a rapid increase in the incidence of pump thrombosis following implantation of HeartMate II LVADs, the authors pooled data from additional centers to investigate this trend. The resultant retrospective […]
No Benefit from Cardiac Resynchronization Therapy in Patients with a Narrow QRS Complex
Cardiac-resynchronization therapy (CRT) has known benefits in patients with severe left ventricular systolic dysfunction and prolonged QRS duration (>120 ms). However, up to half of patients with systolic dysfunction appear to have left ventricular dyssynchrony by echocardiographic measures, despite a QRS duration of less than 120 ms. As a result, CRT is often used for […]