Left Ventricular Assist Device as Destination Therapy: a State of the Science and Art of Long-Term Mechanical Circulatory Support
AbstractPurpose of ReviewThe purpose of this review is to synthesize and summarize recent developments in the care of patients with end-stage heart failure being managed with a left ventricular assist device (LVAD) as destination therapy.Recent FindingsAlthough the survival of patients treated with LVAD continues to improve, the rates of LVAD-associated complication, such as right ventricular failure, bleeding complications, and major infection, remain high, and management of these patients remains challenging.SummaryThe durability and hemocompatibility of LVAD support have greatly increased in recent years as a result of ...
Source: Current Heart Failure Reports - October 21, 2019 Category: Cardiology Source Type: research

Anabolism to Catabolism: Serologic Clues to Nutritional Status in Heart Failure
AbstractPurpose of ReviewMalnutrition, sarcopenia, and cachexia are areas of increasing interest in the management of patients with heart failure (HF). This review aims to examine the serological markers useful in guiding the physician in identification of these patients.Recent FindingsTraditional nutritional biomarkers including albumin/prealbumin, iron, and vitamin D deficiencies predict poor prognosis in malnutrition and HF. Novel biomarkers including ghrelin, myostatin, C-terminal agrin fragment, and adiponectin have been identified as possible substrates and/or therapeutic targets in cardiac patients with sarcopenia a...
Source: Current Heart Failure Reports - October 12, 2019 Category: Cardiology Source Type: research

Impact of Genetic Testing in Transthyretin (ATTR) Cardiac Amyloidosis
AbstractPurpose of ReviewThe review ’s main focus centers on the genetics of hereditary cardiac amyloidosis, highlighting the opportunities and challenges posed by the widespread availability of genetic screening and diagnostic cardiac imaging.Recent FindingsAdvancements in cardiac imaging, heightened awareness of the ATTR amyloidosis diagnosis, and greater access to genetic testing have all led to an increased appreciation of the prevalence of ATTR cardiac amyloidosis. Elucidation of the TTR molecular structure and effect of mutations on TTR function have allowed for novel TTR therapy development leading to clinical...
Source: Current Heart Failure Reports - September 13, 2019 Category: Cardiology Source Type: research

Introduction to Topical Collection on Updates in Advanced Heart Failure
(Source: Current Heart Failure Reports)
Source: Current Heart Failure Reports - September 5, 2019 Category: Cardiology Source Type: research

Pulmonary Hypertension in Advanced Heart Failure: Assessment and Management of the Failing RV and LV
AbstractPurpose of ReviewIn patients with heart failure with reduced ejection fraction, the presence of pulmonary hypertension (PH-LHD) has a significant impact on their prognosis. The purpose of this review is to explain the methods of diagnosing PH-LHD and then discuss the available therapeutic options.Recent FindingsWe begin by examining the methods of assessment of PH-LHD —echocardiography, cardiopulmonary exercise testing, and right heart catheterization—with a particular focus on the importance of accurate measurement to ensure the proper determination of PH-LHD. We then focus primarily on management of P...
Source: Current Heart Failure Reports - July 10, 2019 Category: Cardiology Source Type: research

Identifying Stage D Heart Failure: Data From the Most Recent Registries
AbstractPurpose of ReviewImproving outcomes with durable mechanical circulatory support have led to expanding interest in the earlier recognition of patients destined to develop refractory heart failure (HF). The recognition of advanced HF has received increasing attention.Recent FindingsThe Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registry developed patient profiles of advanced HF to describe the spectrum of patients with refractory HF undergoing mechanical circulatory support. These patient profiles have been extended to advanced HF patients on medical therapy and used to align outco...
Source: Current Heart Failure Reports - June 27, 2019 Category: Cardiology Source Type: research

From Hypertrophy to Heart Failure: What Is New in Genetic Cardiomyopathies
AbstractPurposeThe purpose of this review is to provide an update on the recent advances in the research and clinical care of patients with the major phenotypes of inherited cardiomyopathies —hypertrophic, dilated, and arrhythmogenic. Developments in genetics, risk stratification, therapies, and disease modeling will be discussed.RecentDiagnostic, prognostic, and therapeutic tools which incorporate genetic and genomic data are being steadily incorporated into the routine clinical care of patients with genetic cardiomyopathies. Human pluripotent stem cells are a breakthrough model system for the study of genetic varia...
Source: Current Heart Failure Reports - June 26, 2019 Category: Cardiology Source Type: research

Updates on Heart Transplantation
AbstractPurpose of ReviewThe purpose of this review is to provide a comprehensive update on recent advances in heart transplantation.Recent FindingsHeart transplantation is now an established therapy for end-stage heart failure, though challenges still exist. However, multiple advances over the past few years will improve the survival and quality of life of heart transplant recipients. These advances include acceptance of previously considered marginal donor hearts, revisions to the donor heart allocation policy, advances in desensitization regimens, tailoring of immunosuppression regimens, and improvement in the diagnosis...
Source: Current Heart Failure Reports - June 25, 2019 Category: Cardiology Source Type: research

Patient Selection for Destination LVAD Therapy: Predicting Success in the Short and Long Term
AbstractPurpose of ReviewIn this review, we discuss risk assessment of advanced heart failure (HF) patients as a referral guide for advanced HF therapies, including left ventricular assist device (LVAD) support and cardiac transplant.Recent FindingsThe frequency of LVAD implantation for the purpose of permanent “destination” therapy is growing and survival on LVAD support is now approximating 50% at 5 years. Ambulatory HF patients with HF functional limitations, end-organ dysfunction, inability to tolerate HF medications, frequent cardiac admissions, and ventricular dysrhythmias are at high risk for m orta...
Source: Current Heart Failure Reports - June 25, 2019 Category: Cardiology Source Type: research

Morphine Use in the Treatment of Acute Cardiogenic Pulmonary Edema and Its Effects on Patient Outcome: A Systematic Review
AbstractPurpose of ReviewTo analyze whether the use of morphine, as initial treatment in acute cardiogenic pulmonary edema (ACPE), has an impact in clinical outcomes and mortality. A systematic review of the literature was performed, including all the studies comparing clinical outcomes in patients with ACPE who were treated or not with morphine.Recent FindingsSeven studies were selected, none of which were a randomized trial focused on answering the aim of this systematic review. The studies consisted of clinical trial secondary analysis assessing non-invasive ventilation in ACPE, one open non-randomized trial, two propen...
Source: Current Heart Failure Reports - June 10, 2019 Category: Cardiology Source Type: research

Exercise in Heart Failure —What Is the Optimal Dose to Improve Pathophysiology and Exercise Capacity?
AbstractPurpose of ReviewIn this review, our aim is to summarize the evidence of exercise interventions in heart failure. Addressing pathophysiology, we discuss training modalities and optimal dose finding in exercising patients with reduced (HFrEF) and preserved ejection fraction (HFpEF).Recent FindingsWhile smaller studies showed a trend towards improved exercise capacity by high-intensity interval training in comparison with moderate continuous training in HFrEF, recent multicenter randomized trials were unable to confirm these findings. Considering the lack of effective drug therapies in HFpEF, exercise training plays ...
Source: Current Heart Failure Reports - June 3, 2019 Category: Cardiology Source Type: research

Noninvasive Ventilation in Acute Heart Failure
AbstractPurpose of ReviewTo assess the role of noninvasive ventilation (NIV) in acute heart failure (AHF).Recent FindingsNIV rapidly improves the respiratory distress and reduces the need for intubation and even mortality in patients with acute cardiogenic pulmonary edema (ACPE). Therefore, NIV is indicated as first line therapy in ACPE. NIV may also be considered in some cases of cardiogenic shock after stabilization. CPAP is an easier and cheaper technique that is recommended as first-line therapy, particularly in pre-hospital or low-equipped areas. Noninvasive pressure support ventilation is equally effective in these s...
Source: Current Heart Failure Reports - May 30, 2019 Category: Cardiology Source Type: research

Atrial Fibrillation in Heart Failure —Diagnostic, Therapeutic, and Prognostic Relevance
AbstractPurpose of ReviewAtrial fibrillation (AF) and heart failure (HF) commonly coexist and are associated with an increased risk of hospitalization, morbidity, and mortality. Both conditions develop into epidemics due to the ageing of the population and lead to poorer prognosis for the individual patients. Therapeutic strategies include treatment with oral anticoagulation, and rate and rhythm control concepts to prevent stroke and improve the cardiovascular outcome.Recent FindingsEspecially in HF patients, data suggest that catheter ablation of AF is superior to medical treatment. In patients with both AF and HF undergo...
Source: Current Heart Failure Reports - May 29, 2019 Category: Cardiology Source Type: research

Acute Management of Hyperkalemia
AbstractPurpose of the ReviewHyperkalemia is a common electrolyte abnormality that can lead to life-threatening cardiac arrhythmia. Medical management of acute hyperkalemia revolves around three strategies —stabilizing the myocardium, intracellular shifting of serum potassium, and enhancing elimination of total body potassium via urinary or fecal excretion. In this review, we outline the current evidence behind the acute medical management of hyperkalemia.Recent FindingsTwo new oral potassium-binding agents, patiromer and sodium zirconium cyclosilicate, show promise in the management of hyperkalemia. Their role in th...
Source: Current Heart Failure Reports - April 11, 2019 Category: Cardiology Source Type: research

Have Traditional Heart Failure Management Programs Reached Their “Use by” Date? Time to Apply More Nuanced Care
AbstractPurpose of ReviewTo determine the current evidence supporting the otherwise proven heart failure management programs (HFMPs) in the setting of an increasingly older and more complex patient population.Recent FindingsAttempts to replace proven face-to-face, multidisciplinary management of HF with remote management techniques (including telemedicine and implantable remote monitoring devices) have yielded mixed results. This may well reflect theclinical cascade effect of greater surveillance paradoxically leading to worse health outcomes as well as a narrow focus on HF alone in patients with clinically significant mul...
Source: Current Heart Failure Reports - March 20, 2019 Category: Cardiology Source Type: research

Early Treatment in Emergency Department Patients with Acute Heart Failure: Does Time Matter?
AbstractPurpose of ReviewAcute heart failure accounts for over one million hospital discharges annually. Current guidelines suggest treatments for AHF should begin “without delay” but this time interval has not been clearly defined.Recent FindingsData suggest that certain treatments such as earlier treatment with diuretics and vasodilators may improve patient symptom relief, morbidity, and mortality. Secondary analyses of clinical trials of novel treatments under development have not shown similar results.SummaryThe data are equivocal regarding the impact of early treatment in AHF on in-hospital and long-term m...
Source: Current Heart Failure Reports - March 4, 2019 Category: Cardiology Source Type: research

His Bundle Pacing in Heart Failure —Concept and Current Data
AbstractPurpose of ReviewHis bundle pacing (HBP) has continued to emerge as a viable alternative to both right ventricular pacing (RVP) and cardiac resynchronization therapy. In recent years, a considerable amount of research has been published with regard to using HBP to treat congestive heart failure (CHF) and this article presents a concise yet comprehensive review of this literature.Recent FindingsStudies have demonstrated that HBP is useful for CHF patients who are non-responders to biventricular pacing (BiVP) or have a history of previously failed coronary sinus lead placement, right/left bundle branch block cardiomy...
Source: Current Heart Failure Reports - February 28, 2019 Category: Cardiology Source Type: research

Diuretic Resistance in Heart Failure
AbstractPurpose of ReviewDiuretic resistance (DR) occurs along a spectrum of relative severity and contributes to worsening of acute heart failure (AHF) during an inpatient stay. This review gives an overview of mechanisms of DR with a focus on loop diuretics and summarizes the current literature regarding the prognostic value of diuretic efficiency and predictors of natriuretic response in AHF.Recent FindingsThe pharmacokinetics of diuretics are impaired in chronic heart failure, but little is known about mechanisms of DR in AHF. Almost all diuresis after administration of a loop diuretic dose occurs in the first few hour...
Source: Current Heart Failure Reports - February 14, 2019 Category: Cardiology Source Type: research

The Role of Troponin for Acute Heart Failure
AbstractPurpose of ReviewTo review the mechanisms, clinical interpretation, prognostic role, and future research regarding cardiac troponin (cTn) in the assessment of acute heart failure (AHF) patients presenting to the emergency department (ED).Recent FindingscTn has become a necessary component of the evaluation of AHF patients in the ED, largely because of its independently predictive value as a prognosticator of poor outcome. High-sensitivity assays (hs-cTn) may add risk stratification value beyond conventional assays, specifically with regard to identifying low-risk AHF patients. Moreover, as the complex mechanisms of...
Source: Current Heart Failure Reports - February 14, 2019 Category: Cardiology Source Type: research

Cardiac Contractility Modulation and Baroreflex Activation Therapy in Heart Failure Patients
AbstractPurpose of ReviewDespite advances in medical therapy, heart failure with reduced ejection fraction (HFrEF) is still a leading cause of mortality, hospitalizations, and healthcare costs. In this review, we describe two novel, implantable devices for the treatment of patients with HFrEF, cardiac contractility modulation (CCM), and baroreflex activation therapy (BAT), and summarize literature regarding these devices from the last 5  years.Recent FindingsCCM improves quality of life and functional capacity as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, 6-min hall walk test (6MH...
Source: Current Heart Failure Reports - February 14, 2019 Category: Cardiology Source Type: research

Vasodilator Therapies in the Treatment of Acute Heart Failure
AbstractPurpose of ReviewVasodilators are commonly recommended to treat acute heart failure (AHF), yet they are infrequently used. This review aims to evaluate the clinical utility of traditional, historical, and novel vasodilators in the treatment of AHF.Recent FindingsNo traditional vasodilator (i.e., nitroglycerin) therapy definitely improves short- or long-term outcomes. Despite repeated efforts to develop new pharmacologic treatments, no novel therapy outperforms traditional management. At the present time, we continue to recommend traditional vasodilators, such as nitroglycerin.SummaryThe use of select vasodilators i...
Source: Current Heart Failure Reports - February 14, 2019 Category: Cardiology Source Type: research

Quality Measures in Heart Failure: the Past, the Present, and the Future
AbstractPurpose of ReviewThis paper reviews performance measure in health, their importance, and methodologic issues, focusing on metrics for health failure patients. Quality measures are instruments to assess structural aspects or processes of care aiming to guarantee that optimal patient outcomes are achieved. As heart failure is a chronic condition in which established therapies reduce mortality and hospital admissions, there are quite a lot of initiatives that aim to monitor for quality of care and to coordinate the disease management.Recent FindingsSeveral performance measures were validated for these patients, from p...
Source: Current Heart Failure Reports - February 2, 2019 Category: Cardiology Source Type: research

Implementation of Heart Transplantation Program to Advanced Heart Failure Patients in Brazil
AbstractPurposeHeart transplantation is the gold standard treatment for advanced heart failure. Left ventricular assist devices (LVADs), despite being a good option for these patients, are not quite available in developing countries. Time spent in heart transplant waiting list has increased lately even in regions where the number of transplants has also risen showing that a new strategy should be sought.Recent FindingsTransplant process organization combined with multidisciplinary work are linked to better outcomes while improvement in donor ’s care and in pre-transplant evaluation might be opportunities to change th...
Source: Current Heart Failure Reports - February 2, 2019 Category: Cardiology Source Type: research

Hyperkalaemia in Heart Failure —Pathophysiology, Implications and Therapeutic Perspectives
AbstractPurpose of ReviewHyperkalaemia is a frequent and sometimes life-threatening condition that may be associated with arrhythmia and cardiac dysfunction. Evaluating the prevalence of hyperkalaemia in patients with heart failure (HF) and potential treatments of this condition is essential for patients using renin –angiotensin–aldosterone system inhibitors or angiotensin receptor–neprilysin inhibitor and mineralocorticoid receptor antagonists, which represent the cornerstone and highly proven life-saving therapy.Recent FindingsNovel findings from the past few years include data regarding the epidemiolog...
Source: Current Heart Failure Reports - November 12, 2018 Category: Cardiology Source Type: research

Who Benefits From a Defibrillator —Balancing the Risk of Sudden Versus Non-sudden Death
AbstractPurpose of ReviewTreatment with a defibrillator can reduce the risk of sudden death by terminating ventricular arrhythmias. The identification of patient groups in whom this function reduces overall mortality is challenging. In this review, we summarise the evidence for who benefits from a defibrillator.Recent FindingsRecent evidence suggests that contemporary pharmacologic and non-defibrillator device therapies are altering the potential risks and benefits of a defibrillator.SummaryWho benefits from a defibrillator is determined by both the risk of sudden death and the competing risk of other, non-sudden causes of...
Source: Current Heart Failure Reports - November 10, 2018 Category: Cardiology Source Type: research

Depression, Anxiety, and Cognitive Impairment
AbstractPurpose of ReviewDepression, anxiety, and cognitive impairment constitute established risk markers for incident cardiovascular disease (CVD) and are associated with impaired life expectancy and quality of life and high hospitalization rates and healthcare expenditure. This review summarizes current knowledge about mental health disorders in patients with CVD and heart failure (HF).Recent FindingsEmerging evidence suggests various shared pathophysiological mechanisms between psychological comorbidities and CVD (e.g., systemic inflammation and autonomic dysfunction). Bi-directional interactions involving the central ...
Source: Current Heart Failure Reports - November 6, 2018 Category: Cardiology Source Type: research

Role of the Wearable Defibrillator in Newly Diagnosed Heart Failure
AbstractPurpose of ReviewThe wearable defibrillator (WCD) was shown to be safe and effective in detecting and terminating ventricular tachyarrhythmias and therefore allows temporary protection from sudden cardiac death. This review gives an overview of the current data on WCD in newly diagnosed cardiomyopathy.Recent FindingsPatients with newly diagnosed heart failure and reduced LVEF appear to have an increased risk of ventricular tachyarrhythmias, which may decrease over time when heart failure medication is optimized and left ventricular function improves. This was shown to apply for patients with ischemic and non-ischem...
Source: Current Heart Failure Reports - October 23, 2018 Category: Cardiology Source Type: research

Peripartum Cardiomyopathy: an Update
AbstractPurpose of ReviewPeripartum cardiomyopathy (PPCM) is an idiopathic disorder defined as heart failure occurring in women during the last month of pregnancy and up to 5  months postpartum. In this review, we outline recent reports about the disease pathogenesis and management and highlight the use of diagnosis and prognosis biomarkers.Recent FindingsNovel data strengthen the implication of endothelial function in PPCM pathogenesis. The first international registry showed that patient presentations were similar globally, with heterogeneity in patient management and outcome.SummaryDespite large improvement in pati...
Source: Current Heart Failure Reports - October 1, 2018 Category: Cardiology Source Type: research

Heart Failure and Stroke
AbstractPurposeIschemic stroke significantly contributes to morbidity and mortality in heart failure (HF). The risk of stroke increases significantly, with coexisting atrial fibrillation (AF). An aggravating factor could be asymptomatic paroxysms of AF (so-called silent AF), and therefore, the risk stratification in these patients remains difficult. This review provides an overview of stroke risk in HF, its risk stratification, and stroke prevention in these patients.Recent FindingsStroke risk stratification in HF patients remains an important issue. Recently, the CHA2DS2-VASc score, originally developed to predict stroke ...
Source: Current Heart Failure Reports - October 1, 2018 Category: Cardiology Source Type: research

Cardiorenal Interactions Revisited: How to Improve Heart Failure Outcomes in Patients With Chronic Kidney Disease
AbstractPurpose of the ReviewTo summarize current advances in the understanding and management of heart failure (HF) in patients with advanced chronic kidney disease (CKD).Recent FindingsDiagnosis of HF and treatment of congestion are crucial in the management of patients with advanced CKD to reduce symptoms, preserve organ function, and improve outcomes. Echocardiography and cardiovascular biomarkers may help to differentiate cardiac from non-cardiac components of overhydration. Renal replacement therapy or ultrafiltration may be required to treat congestion. Furthermore, patients with advanced CKD are frequently undertre...
Source: Current Heart Failure Reports - October 1, 2018 Category: Cardiology Source Type: research

Non-response to Cardiac Resynchronization Therapy
AbstractPurpose of ReviewCardiac resynchronization therapy (CRT) is an effective treatment option for therapy-refractory mild to severe heart failure (HF) patients with reduced ejection fraction and left ventricular (LV) conduction delay. Multiple clinical trials have shown that CRT improves cardiac function and overall quality of life, as well as reduces HF hospitalizations, health care costs, and mortality.Recent FindingsDespite its effectiveness, the “non-response” rate to CRT is around 30%, remaining a major challenge that faces electrophysiologists and researchers. It has been recently suggested that the e...
Source: Current Heart Failure Reports - October 1, 2018 Category: Cardiology Source Type: research

Clinical Implications of Serum Biomarkers of Cardiac Stress in Aortic Stenosis
AbstractPurpose of ReviewThe purpose of this review is to outline the relationship between serum biomarkers of cardiac stress and the pathophysiologic progression of aortic stenosis, to identify studies exploring the utility of biomarkers in the risk stratification and management of patients with aortic stenosis, and to highlight the biomarkers most practical to management of patients with aortic stenosis.Recent FindingsSeveral biomarkers have been identified that reflect various aspects of the pathogenesis of calcific aortic stenosis, subsequent hemodynamic obstruction leading to myocardial remodeling, oxidative stress an...
Source: Current Heart Failure Reports - October 1, 2018 Category: Cardiology Source Type: research

Setting Up a Heart Failure Program in 2018: Moving Towards New Paradigm(s)
AbstractPurpose of ReviewHeart failure (HF) is the first cause of hospitalization in the elderly in Western countries, generating tremendous healthcare costs. Despite the spread of multidisciplinary post-discharge programs, readmission rates have remained unchanged over time. We review the recent developments in this setting.Recent FindingsRecent data plead for global reorganization of HF care, specifically targeting patients at high risk for further readmission, as well as a stronger involvement of primary care providers (PCP) in patients ’ care plan. Besides, tools, devices, and new interdisciplinary expertise have...
Source: Current Heart Failure Reports - September 24, 2018 Category: Cardiology Source Type: research

Gene Therapy for Heart Failure: New Perspectives
AbstractPurpose of ReviewThe current knowledge of pathophysiological and molecular mechanisms responsible for the genesis and development of heart failure (HF) is absolutely vast. Nonetheless, the hiatus between experimental findings and therapeutic options remains too deep, while the available pharmacological treatments are mostly seasoned and display limited efficacy. The necessity to identify new, non-pharmacological strategies to target molecular alterations led investigators, already many years ago, to propose gene therapy for HF. Here, we will review some of the strategies proposed over the past years to target major...
Source: Current Heart Failure Reports - September 20, 2018 Category: Cardiology Source Type: research

Improving Provider Adherence to Guideline Recommendations in Heart Failure
AbstractPurpose of ReviewHeart failure clinical practice guidelines are fundamental and serve as framework for providers to deliver evidence-based care that correlates with enhanced patient outcomes. However, adherence, particularly to guideline-directed medical therapy, remains suboptimal for a multitude of reasons.Recent FindingsDespite robust clinical trials, updated guidelines and an expert consensus statement from American Heart Association, American College of Cardiology, and Heart Failure Society of America registry data signal that heart failure patients do not receive appropriate pharmacotherapy and may receive an...
Source: Current Heart Failure Reports - September 20, 2018 Category: Cardiology Source Type: research

Gene Therapy for Heart Failure: New Perspectives
AbstractPurpose of ReviewThe current knowledge of pathophysiological and molecular mechanisms responsible for the genesis and development of heart failure (HF) is absolutely vast. Nonetheless, the hiatus between experimental findings and therapeutic options remains too deep, while the available pharmacological treatments are mostly seasoned and display limited efficacy. The necessity to identify new, non-pharmacological strategies to target molecular alterations led investigators, already many years ago, to propose gene therapy for HF. Here, we will review some of the strategies proposed over the past years to target major...
Source: Current Heart Failure Reports - September 20, 2018 Category: Cardiology Source Type: research

Improving Provider Adherence to Guideline Recommendations in Heart Failure
AbstractPurpose of ReviewHeart failure clinical practice guidelines are fundamental and serve as framework for providers to deliver evidence-based care that correlates with enhanced patient outcomes. However, adherence, particularly to guideline-directed medical therapy, remains suboptimal for a multitude of reasons.Recent FindingsDespite robust clinical trials, updated guidelines and an expert consensus statement from American Heart Association, American College of Cardiology, and Heart Failure Society of America registry data signal that heart failure patients do not receive appropriate pharmacotherapy and may receive an...
Source: Current Heart Failure Reports - September 20, 2018 Category: Cardiology Source Type: research

Impaired Exercise Tolerance in Heart Failure: Role of Skeletal Muscle Morphology and Function
AbstractPurpose of ReviewTo discuss the impact of deleterious changes in skeletal muscle morphology and function on exercise intolerance in patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), as well as the utility of exercise training and the potential of novel treatment strategies to preserve or improve skeletal muscle morphology and function.Recent FindingsBoth HFrEF and HFpEF patients exhibit a reduction in percent of type I (oxidative) muscle fibers and oxidative enzymes coupled with abnormal mitochondrial respiration. These skeletal muscle abn...
Source: Current Heart Failure Reports - September 3, 2018 Category: Cardiology Source Type: research

Diastolic Stress Testing Along the Heart Failure Continuum
AbstractPurpose of ReviewThis review summarizes recent developments highlighting the clinical utility of diastolic stress testing along the heart failure continuum.Recent FindingsInvasive hemodynamic assessment of cardiac filling pressures during physiological stress is the gold-standard technique for unmasking diastolic dysfunction. Non-invasive surrogate techniques, such as Doppler ultrasound, have shown excellent agreement with invasive approaches and are now recommended by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. While cycle exercise is often advocated, recent evi...
Source: Current Heart Failure Reports - September 1, 2018 Category: Cardiology Source Type: research

Cardiorenal Interactions Revisited: How to Improve Heart Failure Outcomes in Patients With Chronic Kidney Disease
AbstractPurpose of the ReviewTo summarize current advances in the understanding and management of heart failure (HF) in patients with advanced chronic kidney disease (CKD).Recent FindingsDiagnosis of HF and treatment of congestion are crucial in the management of patients with advanced CKD to reduce symptoms, preserve organ function, and improve outcomes. Echocardiography and cardiovascular biomarkers may help to differentiate cardiac from non-cardiac components of overhydration. Renal replacement therapy or ultrafiltration may be required to treat congestion. Furthermore, patients with advanced CKD are frequently undertre...
Source: Current Heart Failure Reports - August 20, 2018 Category: Cardiology Source Type: research

Non-response to Cardiac Resynchronization Therapy
AbstractPurpose of ReviewCardiac resynchronization therapy (CRT) is an effective treatment option for therapy-refractory mild to severe heart failure (HF) patients with reduced ejection fraction and left ventricular (LV) conduction delay. Multiple clinical trials have shown that CRT improves cardiac function and overall quality of life, as well as reduces HF hospitalizations, health care costs, and mortality.Recent FindingsDespite its effectiveness, the “non-response” rate to CRT is around 30%, remaining a major challenge that faces electrophysiologists and researchers. It has been recently suggested that the e...
Source: Current Heart Failure Reports - August 10, 2018 Category: Cardiology Source Type: research

Decompensated Heart Failure and Renal Failure: What Is the Current Evidence?
AbstractPurpose of ReviewAcute decompensated heart failure (ADHF) is one of the biggest challenges in the management of chronic heart failure. Despite several advances in medical and device therapy, high readmission and mortality rates continue to be a burden on healthcare systems worldwide. The aim of the current review is to provide an overview on current as well as future approaches in cardiorenal interactions in patients with ADHF.Recent FindingsOne of the strongest predictors of adverse outcomes in ADHF is renal dysfunction, referred to as cardiorenal syndromes (CRS) or cardiorenal interactions. Patients with ADHF fre...
Source: Current Heart Failure Reports - August 1, 2018 Category: Cardiology Source Type: research

Pharmacologic Management of Cancer Therapeutics-Induced Cardiomyopathy in Adult Cancer Survivors
AbstractPurpose of ReviewThe number of cancer survivors is exponentially increasing worldwide, due to both advances in cancer detection and treatment strategies, as well as the aging and growth of the population. This decrease in cancer mortality has brought forth a concurrent increase of non-ischemic (toxic) dilated cardiomyopathy in the survivor population, also known as cancer therapeutics-induced cardiomyopathy (CTIC). The optimal pharmacological management for this condition is still elusive, and hence, the focus of this work.Recent FindingsOur review of the literature did not identify any prospective randomized clini...
Source: Current Heart Failure Reports - August 1, 2018 Category: Cardiology Source Type: research

The Effect of Left Ventricular Assist Device Therapy on Cardiac Biomarkers: Implications for the Identification of Myocardial Recovery
AbstractPurpose of ReviewLeft ventricular assist device (LVAD) therapy serves as mainstay therapy for bridge to transplantation and destination therapy. Evidence is now mounting on the role of LVAD therapy as bridge to recovery. In the current review, we will summarize the data on biomarkers of myocardial recovery following LVAD implantation.Recent FindingsMyocardial recovery can occur spontaneously, following pharmacological intervention and in the setting of mechanical circulatory support such as LVAD. Several biomarkers such as B-type natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), ST2,...
Source: Current Heart Failure Reports - August 1, 2018 Category: Cardiology Source Type: research

Identifying and Managing Hibernating Myocardium: What ’s New and What Remains Unknown?
AbstractPurpose of ReviewHibernation is an important and reversible cause of myocardial dysfunction in ischaemic heart failure.Recent FindingsHibernation is an adaptive process that promotes myocyte survival over maintaining contractile function. It is innate to mammalian physiology, sharing features with physiological hibernation in other species. Advanced imaging methods have reasonable accuracy in identifying hibernating myocardium. Novel superior hybrid methods may provide diagnostic potential. New evidence supports the role of surgical revascularisation in ischaemic heart failure, but the role of viability tests in pl...
Source: Current Heart Failure Reports - August 1, 2018 Category: Cardiology Source Type: research

Prevention of Cardiotoxicities With Traditional and Novel Chemotherapeutic Agents
AbstractPurpose of ReviewThis review will discuss strategies to prevent cardiotoxicity associated with chemotherapeutics. Forty years ago, investigators identified dose-dependent cardiotoxicity related to anthracycline-based regimens. Over recent decades, the development of more selective, mechanism-based chemotherapeutics has been associated with both on-target and off-target adverse cardiovascular sequelae.Recent FindingsStrategies to prevent or attenuate cardiotoxicities include limitation of anthracycline dose, appropriate patient selection, referral/access to cardio-oncology programs, early recognition of cardiac side...
Source: Current Heart Failure Reports - August 1, 2018 Category: Cardiology Source Type: research

The Confounding Effects of Non-cardiac Pathologies on the Interpretation of Cardiac Biomarkers
AbstractPurpose of ReviewCardiac biomarkers play important roles in routine evaluation of cardiac patients. But while these biomarkers can be extremely valuable, none of them should ever be used by themselves —without adding the clinical context. This paper explores the non-cardiac pathologies that can be seen with the cardiac biomarkers most commonly used.Recent FindingsHigh-sensitivity troponin assay gained FDA approval for use in the USA, and studies demonstrated its diagnostic utility can be extended to patients with renal impairment. Gender-specific cut points may be utilized for high-sensitivity troponin assays...
Source: Current Heart Failure Reports - August 1, 2018 Category: Cardiology Source Type: research