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 […]
Tag: Heart Failure
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 […]
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 […]
BNP-based screening for heart failure
The increasing prevalence of heart failure emphasises the need for effective prevention strategies; brain-type natriuretic peptide (BNP) has been found to identify those at highest risk of cardiovascular events and heart failure. Therefore the purpose of this study was to determine whether using BNP and collaborative care could reduced newly diagnosed heart failure cases and […]
CELLWAVE: bone marrow cells improve ventricular function
In patients with chronic postinfarction heart failure, bone marrow-derived mononuclear cell (BMC) therapy has demonstrated mixed results to date. One possible reason for this is that cell retention by the heart is more difficult in the stable setting in comparison to therapies given following acute myocardial infarction, however a recent discovery found that extracorporeal application […]
Erythropoietin fails to improve outcomes in heart failure
Anaemia is common in patients with systolic heart failure and is associated with lower functional capacity, worse quality of life, and higher rates of hospitalization and death. The cause of anaemia in these patients is often unclear but may be related to an absolute or relative deficiency of, or resistance to, erythropoietin. In this study […]
Sildenafil shows no benefit in HFPEF
Heart failure with preserved ejection fraction (HFPEF) is now felt to be the most common form of heart failure in the community, and is associated with significant morbidity and mortality. Currently, effective therapies are needed as trials of traditional renin-angiotensin antagonists have failed to show an improvement in outcomes or clinical status. Experimental work has […]
Berlin heart beats ECMO for childhood heart failure
Heart failure is uncommon in children but carries a poor prognosis with 46% of children with severe systolic dysfunction dying or undergoing transplantation within five years. Survival among children after heart transplantation is 83% at 3 years, but the limited availability of donor hearts prolongs the waiting period, resulting in a high rate of death […]