Patients with Marfan syndrome have a tall stature, which could be associated with low orthostatic tolerance. Fatigue, a common complaint of these patients, is also related to orthostatic intolerance. Treatment with beta-blockers, to prevent aortic complications, could be a reinforcing factor of both. This study aimed to investigate (1) the ...

AIM: We conducted a study to investigate whether patients with somatization disorders (ICD-10, F45.0) show abnormal values in autonomic testing. METHOD: 35 patients with a diagnosis of somatization disorder (SP) were matched to 35 healthy volunteers (HV). International standardized autonomic testing based on heart rate variation and continuously measured blood ...

OBJECTIVES: This study evaluated whether a xanthine oxidase (XO) inhibitor, oxypurinol, produces clinical benefits in patients with New York Heart Association functional class III to IV heart failure due to systolic dysfunction receiving optimal medical therapy. BACKGROUND: Increased XO activity may contribute to heart failure pathophysiology. METHODS: Patients (n = ...

Cardiac dysfunction, including congestive heart failure and fatal arrhythmia, is a frequent cause of death among children with thalassemia major (TM). Autonomic nervous system activity typically is measured by a series of cardiovascular autonomic function tests, but these tests are unsuitable for young patients because they are invasive or complex. ...

CONTEXT: Hospitalization for heart failure is associated with high postdischarge mortality and morbidity. The predictive value of the QRS duration during admission for heart failure has not been well studied. OBJECTIVE: To investigate the predictive value of the QRS duration in patients hospitalized for heart failure with reduced left ventricular ...

BACKGROUND: Chronic heart failure (CHF) is a widespread disease with severe quality of life impairment and a poor prognosis. Beta-blockers are the mainstay of CHF therapy; yet they are under-prescribed and under-dosed in clinical practice. This is particularly evident in elderly patients, which may be due to a fear of ...

PURPOSE: The purpose of this review was to summarize the literature on the relationship between obesity and survival in persons with heart failure (HF). In particular, the article examines the ways in which studies define body size/composition (body mass index [BMI], body composition, weight, cachexia, fluid retention, or albumin) and ...

Chest pain is one of the most common causes of presentation to the emergency room. The diagnosis of non-ST-elevation acute coronary syndrome typically causes uncertainty. Classical considerations for risk stratification are History, ECG, Age, Risk factors and Troponin (HEART). Each can be scored with zero, one or two points, depending ...

BACKGROUND: Early identification of acute coronary syndrome (ACS) in the emergency room is still a difficult task. The objective of this study is to estimate the reliability of heart-type fatty acid binding protein (H-FABP) in identifying ACS in the early stage of chest pain onset. METHODS: In a prospective multicentre ...

Congestive heart failure (HF), an exceedingly common and costly disease, is frequently seen in association with central sleep apnea (CSA), which often manifests as a periodic breathing rhythm referred to as Cheyne-Stokes respiration. CSA has historically been considered to be a marker of heart disease, since improvement in cardiac status ...

The goal of the Society of Chest Pain Centers Heart Failure Discharge Recommendations Committee was to review the available literature and currently published guidelines to provide recommendations for acute heart failure providers regarding observation unit discharge criteria. Explicit and validated criteria for discharging patients from the emergency department or observation ...

BACKGROUND: Ultrafiltration (UF) can rapidly and predictably remove extracellular and intravascular fluid volume. To date, assessment of UF in patients with cardiovascular disease has been confined to short- and medium-term studies in patients with a principal diagnosis of acute heart failure. METHODS: In-hospital and long-term outcomes were reviewed from consecutive ...

High CRP levels are associated with adverse outcomes in cardiovascular diseases. hsCRP levels increase with the severity of CHF in patients with diastolic HF as well as in systolic HF. This supports a potential role for CRP in immune activation not only in systolic but also in diastolic HF. The ...

Approximately one third of patients with chronic heart failure have left bundle branch block (LBBB) on their 12-lead ECG. 1418 consecutive patients (average (SD) age 70.5 (10.4) years; 74% male) first seen in a community heart failure clinic between December 2001 and June 2006 had a 12 lead electrocardiogram (ECG). ...

Many studies have shown that a one-time 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphic study during a stable period is useful for determining the prognosis of patients with chronic heart failure (CHF). However, the findings from this imaging modality are well known to be improved by medical treatment for heart failure. Accordingly, this study ...

The patients with heart failure (HF) often exhibit some degree of muscle wasting restricted to the lower limbs. This loss of tissue may become more extensive in some patients, usually when their HF is more advanced, and may affect all body compartments. The underlying metabolic causes are very complex and ...

BACKGROUND: Abnormal heart rate turbulence (HRT) has been documented as a strong predictor of total mortality and sudden death in postinfarction patients, but data in patients with congestive heart failure (CHF) are limited. OBJECTIVE: The aim of this study was to evaluate the prognostic significance of HRT for predicting mortality ...

BACKGROUND: Published studies of patients with heart failure may not include details about the challenges in the recruitment process. OBJECTIVES: To describe the recruitment process during the first 18 months of a study being conducted to evaluate cognitive deficits in patients with chronic heart failure. METHODS: Details of the recruitment ...

PURPOSE: The presence of age-related pulmonary crackles (rales) might interfere with a physician's clinical management of patients with suspected heart failure. We examined the characteristics of pulmonary crackles among patients with stage A cardiovascular disease (American College of Cardiology/American Heart Association heart failure staging criteria), stratiffed by decade, because little ...

OBJECTIVE: To evaluate the efficacy and safety of oral transmucosal fentanyl citrate (OTFC) in terminally ill patients experiencing dyspnea. METHODS: Nonblinded, non-controlled observational study of patients admitted to the hospice/palliative care unit for dyspnea from May 2006 to March 2007. Eligible patients were older than 18 years of age with ...

Excess body weight increases the risk for many disorders including cardiovascular disease and such patients have a greater risk for developing heart failure (HF). Despite evidence demonstrating the adverse effects of excess weight, the relationship between body mass index (BMI) and mortality in HF patients remains controversial. Paradoxically, several large ...

PURPOSE: The use of ventricular assist devices (VADs) in patients with chronic end-stage or acute heart failure has led to improved survival. We present our experience since 1987. SUBJECTS AND METHODS: Between July 1987 and December 2006, 1026 VADs were implanted in 970 patients. Most of them were men (81.9%). ...

BACKGROUND: Renal insufficiency in patients with ischemic heart disease and acquired heart failure is associated with higher mortality and morbidity. We studied the prevalence of renal dysfunction in adult patients with congenital heart disease (ACHD) and its relation to outcome. METHODS AND RESULTS: A total of 1102 adult patients with ...

BACKGROUND: Heart failure (HF) is one of the leading causes of morbidity and mortality among Americans. Despite increased interest in end-of-life care, the implications of do-not-resuscitate (DNR) orders in acutely ill patients with HF remain unclear. The goals of this observational study were to describe the use of DNR orders ...

BACKGROUND: In patients with heart failure, the degree of intraventricular mechanical dyssynchrony (intra-VMD) at baseline may predict reversal of cardiac remodeling with cardiac resynchronization therapy (CRT). OBJECTIVE: The purpose of this study was to determine the prevalence and clinical significance of intra-VMD in patients admitted for advanced decompensated heart failure ...

BACKGROUND: Changes in the demographics and epidemiology of patients with cardiovascular comorbidities who undergo major noncardiac surgery require an updated assessment of which patients are at greater risk of mortality or readmission. The authors evaluated short-term outcomes among patients with heart failure, coronary artery disease (CAD), or neither who underwent ...

Evaluation and management of medical comorbidities in the perioperative period can help improve surgical morbidity and mortality. Perioperative evaluation essentially is risk assessment and minimization. Patients undergoing orthopaedic treatment may benefit from temporizing measures to reduce systemic complications associated with some procedures. Patients at increased risk of cardiac ischemia should ...

OBJECTIVE: Chronic angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) therapy has been reported to result in intraoperative hypotension in patients undergoing general anesthesia. This study evaluated the association between ACE-I/ARB therapy and the hemodynamics of patients undergoing noncardiac surgery using a large patient dataset. DESIGN AND SETTING: A ...

Heart failure caused by systolic dysfunction affects more than 5 million adults in the United States and is a common source of outpatient visits to primary care physicians. Mortality rates are high, yet a number of pharmacologic interventions may improve outcomes. Other interventions, including patient education, counseling, and regular self-monitoring, ...

AIMS: Myocardial infarction (MI) is a common cause of heart failure (HF), which may develop early and persist or resolve, or develop late. The cumulative incidence, persistence, and resolution of HF after MI are poorly described. The aim of this study is to describe the natural history and prognosis of ...

Recent studies have suggested that body mass index (BMI) may be an independent prognostic factor in patients with chronic heart failure (HF). It is unknown whether or not BMI has the same predictive value in acute decompensated heart failure. We studied 489 patients with the previous diagnosis of HF (84% ...

Biomarkers of endothelial dysfunction, such as soluble E-selectin, and von Willebrand factor (vWf) are elevated in patients with chronic heart failure (CHF). The impact of diabetes mellitus (DM) on these biomarkers, and their relation to prognosis remains unknown. to investigate the impact of DM on plasma levels and the prognostic ...

Vitamin D receptor knockout mice develop typical signs of congestive heart failure (CHF). In approximately 20% of stable CHF patients, frankly low concentrations of the vitamin D hormone calcitriol are found. We investigated whether serum calcitriol concentrations predict clinical outcome in end-stage CHF. We collected blood samples in 383 end-stage ...

AIM: This paper is a report of a study to examine the effects of a Roy Adaptation Model-based experimental education, exercise and social support programme on adaptation in persons with heart failure. BACKGROUND: In the past 20 years, a large number of studies have evaluated heart failure. Several studies of ...

BACKGROUND: To determine the impact of heart failure (HF), with preserved or decreased left ventricular function (LVF), on outcome in patients with acute ischemic stroke (AIS). METHODS: We studied 503 unselected ischemic stroke patients. Poor outcome was defined as moderate-severe disability or death at 90 days. We analyzed the association ...

Endothelial function measured with brachial ultrasound (BU) is a validated prognostic factor in heart failure patients. LVAD (left ventricle assist device) application is a promising surgical technique to treat refractory heart failure patients both as a bridge to heart transplantation or as destination therapy. Clinical recovery in such patients may ...

Heart failure (HF) with normal ejection fraction (EF) is an increasingly common presentation of acute decompensated HF. Differences between patients with HF and truly normal EF and those with mildly impaired EF have not been described. The Acute Decompensated Heart Failure Registry (ADHERE) contains information on >100,000 HF hospitalizations and ...

The aim of this study was to assess (1) the incidence of patent foramen ovale (PFO) in carcinoid syndrome (CS) and (2) the feasibility of percutaneous closure procedure in selected patients with CS. One hundred eight patients were prospectively studied: 54 with CS and an age- and gender-matched control group. ...

The topic of heart failure (HF) in the emergency department is today relevant, since there are new serum markers and imaging techniques that may help in the diagnosis of this disease. Natriuretic peptides have now entered the flowchart for etiologic diagnosis in patients with acute dyspnea, when technical facilities are ...

We describe the baseline characteristics of subjects randomised in the largest placebo-controlled, morbidity-mortality trial to date in patients with heart failure and preserved ejection fraction - the irbesartan in heart failure with preserved systolic function trial (I-PRESERVE). 4133 patients with a mean age of 72 years (a third were 75 ...

BACKGROUND: Renal insufficiency is common in patients with chronic heart failure (CHF), so to improve the prognosis of patients with cardiovascular risks clinical guidelines recommend estimating the glomerular filtration rate (GFR), which detects chronic kidney disease more accurately than does the serum creatinine level alone. However, the clinical usefulness of ...

Renal function is a powerful prognostic variable in patients with heart failure (HF). Hospitalisations for acute HF (AHF) may be associated with further worsening of renal function (WRF). We analysed the clinical significance of WRF in 318 consecutive patients admitted at our institute for AHF. WRF was defined as the ...

OBJECTIVE: To evaluate the cost-effectiveness of a telephonic disease management (DM) intervention in heart failure (HF). STUDY DESIGN: Randomized controlled trial of telephonic DM among 1069 community-dwelling patients with systolic HF (SHF) and diastolic HF performed between 1999 and 2003. The enrollment period was 18 months per subject. METHODS: Bootstrap-resampled ...

The survival of patients with congenital heart disease (CHD) has increased immensely and nowadays, most children reach adulthood. The long-term outcome is hampered by the occurrence of late complications such as arrhythmias. Supraventricular and ventricular arrhythmias have an impact notably not only on morbidity but also on mortality in patients ...

There is a growing population of adult patients with congenital heart defects in the developed world. Most have been repaired, but few have been cured. Many have myocardial dysfunction. Most have exercise intolerance. Some have heart failure. As a group, they show neurohormonal activation similar to that seen in an ...

Previous studies suggest that hyponatraemia is a marker of neurohormonal activation and increased mortality in patients with acute heart failure (AHF). Although diabetes is a common co-morbidity in heart failure, no prior study has considered the impact of serum glucose on this relationship. Over four consecutive months we prospectively registered ...

This study investigated whether heart rate variability predicts haemodynamic events in high risk patients, defined as Revised Cardiac Risk Index score = 3, scheduled for general anaesthesia. Fifty patients underwent baseline measurement of heart rate variability and were then assigned according to haemodynamic events (hypotension or bradycardia) after standardised induction ...

OBJECTIVE: To evaluate the safety and efficacy of heart rate reduction by intravenous esmolol in patients who are assigned for coronary angiography with 64-slice computed tomography (CT). METHODS: Five hundred consecutive patients were prospectively analyzed. Patients with an initial heart rate less than 65 beats per minute (bpm) did not ...

Multiple clinical trials have demonstrated beta-blockers improving survival after myocardial infarction (MI). Patients with "bradycardia-related" contraindications to beta-blockers, such as those with asymptomatic bradycardia or AV conduction abnormalities, have been excluded from clinical trials of beta-blockers and continue to be excluded from post-MI beta-blocker therapy in routine clinical practice. These ...

Hypoalbuminemia is associated with poor prognosis in patients with certain chronic diseases, such as end-stage renal disease and cancer. Although low serum albumin is common in patients with heart failure (HF), the relationship between albumin and HF prognosis has not been well characterized. This study investigated the effect of serum ...