News Update on Heart Failure Research: Jan – 2020

HFSA 2010 Comprehensive Heart Failure Practice Guideline.

Heart failure (HF) may be a syndrome characterized by high mortality, frequent hospitalization, reduced quality of life, and a posh therapeutic regimen. Knowledge about HF is accumulating so rapidly that individual clinicians could also be unable to readily and adequately synthesize new information into effective strategies of look after patients with this syndrome. Trial data, though valuable, often don’t give direction for individual patient management. These characteristics make HF a perfect candidate for practice guidelines. The 2010 coronary failure Society of America comprehensive practice guideline addresses the complete range of evaluation, care, and management of patients with HF. [1]

Epidemiology of heart failure

Analysis of 34 years of follow-up of Framingham Study data provides clinically relevant insights into the prevalence, incidence, secular trends, prognosis, and modifiable risk factors for the occurrence of coronary failure during a general population sample. coronary failure was found to be highly prevalent, affecting about 1% of persons in their 50s and rising progressively with age to afflict 10% of persons in their 80s. The annual incidence also increased with age, from about 0.2% in persons 45 to 54 years, to 4.0% in men 85 to 94 years, with the incidence approximately doubling with each decade aged. Women lagged slightly behind men in incidence in the least ages. Male predominance was due to a better rate of coronary heart condition, which confers a fourfold increased risk of coronary failure. coronary failure , once manifest, was highly lethal, with 37% of men and 33% of girls dying within 2 years of diagnosis. [2]

Cardiac Resynchronization in Chronic Heart Failure

BACKGROUND: Previous studies have suggested that cardiac resynchronization achieved through atrial-synchronized biventricular pacing produces clinical benefits in patients with coronary failure who have an intraventricular conduction delay. We conducted a double-blind trial to guage this therapeutic approach.

METHODS: Four hundred fifty-three patients with moderate-to-severe symptoms of coronary failure related to an ejection fraction of 35 percent or less and a QRS interval of 130 msec or more were randomly assigned to a cardiac-resynchronization group (228 patients) or to an impact group (225 patients) for 6 months, while conventional therapy for coronary failure was maintained. the first end points were the ny Heart Association functional class, quality of life, and therefore the distance walked in six minutes. [3]

Relationship of extracellular volume assessed on cardiac magnetic resonance and serum cardiac troponins and natriuretic peptides with heart failure outcomes

Measures of serum cardiac troponins and natriuretic peptides became established as prognostic coronary failure risk markers. additionally to detecting myocardial fibrosis through late gadolinium enhancement (LGE), extracellular volume fraction (ECV) measures by cardiac resonance (CMR) have emerged as a phenotypic imaging risk marker for incident coronary failure outcomes. We sought to look at the connection between cardiac troponins, natriuretic peptides, ECV and their associations with incident coronary failure events during a CMR referral base. Mid short axis T1 maps were divided into 6 cardiac segments, each classified as LGE absent or present. Global ECV was derived from T1 maps using the area-weighted average of only LGE-absent segments. ECV was considered elevated if measured >30%, the upper 95% bounds of a reference healthy group without known cardiac disease (n = 28). Patients were dichotomized by presence of elevated ECV. [4]

Dipeptidyl Peptidase-4 Inhibitors and Cardiovascular Risk: Retrospective Study of 50 Type 2 Diabetic Patients with Chronic Heart Failure

Objectives: the selection of antidiabetics in patients with coronary failure may be a major clinical concern. Some antidiabetic agents like thiazolidinediones, more or less sulfonamides and insulin increase the danger of exacerbation of coronary failure . there’s controversy with reference to the cardiovascular risk related to dipeptidyl peptidase-4 (DPP-4) inhibitors. The aim of this study was to guage the cardiovascular risk in patients with diabetes and coronary failure treated with these medications.

Patients and methods: A retrospective study was administered from January 2014 to April 2015 at the Centre Hospitalier de Haguenau. The frequency of re-hospitalizations was studied (primary endpoint), because the duration of hospitalization and death in patients with type 2 diabetes and coronary failure . Patients were divided into 2 groups, those treated with DPP-4 inhibitors (cases) and people not treated with DPP-4 inhibitors (controls). [5]

Reference

[1] Lindenfeld, J., Albert, N.M., Boehmer, J.P., Collins, S.P., Ezekowitz, J.A., Givertz, M.M., Katz, S.D., Klapholz, M., Moser, D.K., Rogers, J.G. and Starling, R.C., 2010. HFSA 2010 comprehensive heart failure practice guideline. Journal of cardiac failure, 16(6), (Web Link)

[2] Kannel, W.B. and Belanger, A.J., 1991. Epidemiology of heart failure. American heart journal, 121(3), (Web Link)

[3] Abraham, W.T., Fisher, W.G., Smith, A.L., Delurgio, D.B., Leon, A.R., Loh, E., Kocovic, D.Z., Packer, M., Clavell, A.L., Hayes, D.L. and Ellestad, M., 2002. Cardiac resynchronization in chronic heart failure. New England Journal of Medicine, 346(24), (Web Link)

[4] Relationship of extracellular volume assessed on cardiac magnetic resonance and serum cardiac troponins and natriuretic peptides with heart failure outcomes
Eric Y. Yang, Mohammad A. Khan, Edward A. Graviss, Duc T. Nguyen, Arvind Bhimaraj, Vijay Nambi, Ron C. Hoogeveen, Christie M. Ballantyne, William A. Zoghbi & Dipan J. Shah
Scientific Reports volume 9, (Web Link)

[5] Assene, N., Hassler, P., Deharvengt, C., Jingi, A., Gladin, M. and Andrès, E. (2017) “Dipeptidyl Peptidase-4 Inhibitors and Cardiovascular Risk: Retrospective Study of 50 Type 2 Diabetic Patients with Chronic Heart Failure”, Journal of Advances in Medicine and Medical Research, 20(11), (Web Link)