‘Acute Heart Failure’: Should We Abandon the Term Altogether?
AbstractPurpose of ReviewThe distinction between ‘acute’ and ‘chronic’ heart failure persists. Our review aims to explore whether reclassifying heart failure decompensation more accurately as an event within the natural history of chronic heart failure has the potential to improve outcomes.Recent FindingsAlthough hospitalisation for worsening heart failure confers a poor prognosis, much of this reflects chronic disease severity. Most patients survive hospitalisation with most deaths occurring in the post-discharge ‘vulnerable phase’. Current evidence supports four classes of medications proven to reduce cardiov...
Source: Current Heart Failure Reports - September 27, 2022 Category: Cardiology Source Type: research
The Right Ventricle: From Embryologic Development to RV Failure
AbstractPurpose of ReviewThe right ventricle (RV) and left ventricle (LV) have different developmental origins, which likely plays a role in their chamber-specific response to physiological and pathological stress. RV dysfunction is encountered frequently in patients with congenital heart disease (CHD) and right heart abnormalities emerge from different causes than increased afterload alone as is observed in RV dysfunction due to pulmonary hypertension (PH). In this review, we describe the developmental, structural, and functional differences between ventricles while highlighting emerging therapies for RV dysfunction.Recen...
Source: Current Heart Failure Reports - September 23, 2022 Category: Cardiology Source Type: research
Comprehensive and Safe Decongestion in Acutely Decompensated Heart Failure
AbstractPurpose of the ReviewProgressive intravascular, interstitial, and alveolar fluid overload underlies the transition from compensated to acutely decompensated heart failure and loop diuretics are the mainstay of treatment. Adverse effects and resistance to loop diuretics received much attention while the contribution of a depressed cardiac output to diuretic resistance was downplayed.Recent FindingsAnalysis of experience with positive inotropic agents, especially dobutamine, indicates that enhancement of cardiac output is not consistently associated with increased renal blood flow. However, urinary output and renal s...
Source: Current Heart Failure Reports - September 1, 2022 Category: Cardiology Source Type: research
Right-Sided Mechanical Circulatory Support – A Hemodynamic Perspective
AbstractPurpose of ReviewRight ventricular (RV) failure is increasingly recognized as a major cause of morbidity and mortality. When RV failure is refractory to medical therapy, escalation to right-sided mechanical circulatory support (MCS) should be considered. In this review, we begin by recapitulating the hemodynamics of RV failure, then we delve into current and future right-sided MCS devices and describe their hemodynamic profiles.Recent FindingsThe field of temporary right-sided MCS continues to expand, with evolving strategies and new devices actively under development. All right-sided MCS devices bypass the RV, wit...
Source: Current Heart Failure Reports - August 22, 2022 Category: Cardiology Source Type: research
Cognitive Dysfunction in Heart Failure: Pathophysiology and Implications for Patient Management
AbstractPurpose of ReviewThere is increasing recognition of the prevalence and impact of cognitive dysfunction (CD) in heart failure (HF) patients. This contemporary review appraises the evidence for epidemiological association, direct pathophysiological links and emerging pharmacological and non-pharmacological interventions. Furthermore, we present evidence for care models that aim to mitigate the morbidity and poor quality of life associated with these dual processes and propose future work to improve outcomes.Recent FindingsCD disproportionately affects heart failure patients, even accounting for known comorbid risk fa...
Source: Current Heart Failure Reports - August 13, 2022 Category: Cardiology Source Type: research
Chronic Chagas Disease —the Potential Role of Reinfections in Cardiomyopathy Pathogenesis
AbstractPurpose of the ReviewChagas disease is a neglected anthropozoonosis of global importance with significant cardiovascular-associated mortality. This review focuses on theTrypanosoma cruzi reinfections ’ role in chronic Chagas cardiomyopathy pathogenesis. We discuss and summarize the available data related to pathology, pathogenesis, diagnosis, and treatment of reinfections.Recent FindingsReinfections influence the genetic and regional diversity ofT. cruzi, tissue tropism, modulation of the host ’s immune system response, clinical manifestations, the risk for congenital infections, differences in diagnostics perf...
Source: Current Heart Failure Reports - August 11, 2022 Category: Cardiology Source Type: research
Complications in Device Therapy: Spectrum, Prevalence, and Management
AbstractPurpose of ReviewCardiac implantable electronic device implant numbers are continually increasing due to the expanding indications and ageing population. This review explores the complications associated with device therapy and discusses ways to minimise and manage such complications.Recent FindingsComplications related to device therapy contribute to mortality and morbidity. Recent publications have detailed clear guidelines for appropriate cardiac device selection, as well as consensus documents discussing care quality and optimal implantation techniques. There have also been advances in device technologies that ...
Source: Current Heart Failure Reports - August 6, 2022 Category: Cardiology Source Type: research
Update on Disease-Specific Biomarkers in Transthyretin Cardiac Amyloidosis
AbstractPurpose of ReviewTransthyretin cardiac amyloidosis (ATTR-CM) is an infiltrative cardiomyopathy and an increasingly recognized cause of morbidity and mortality. There remains substantial delay between initial symptoms and diagnosis. With the recent emergence of various targeted therapies proven to reduce morbidity and mortality, there is an imperative to diagnose subclinical disease. Biomarkers may be well-suited for this role.Recent FindingsConventional markers of heart failure, such as natriuretic peptides and cardiac troponins, and estimated glomerular filtration rate are associated with risk in ATTR-CM. Circulat...
Source: Current Heart Failure Reports - August 5, 2022 Category: Cardiology Source Type: research
Targeting Myocardial Substrate Metabolism in the Failing Heart: Ready for Prime Time?
AbstractPurpose of ReviewWe review the clinical benefits of altering myocardial substrate metabolism in heart failure.Recent FindingsModulation of cardiac substrates (fatty acid, glucose, or ketone metabolism) offers a wide range of therapeutic possibilities which may be applicable to heart failure. Augmenting ketone oxidation seems to offer great promise as a new therapeutic modality in heart failure.SummaryThe heart has long been recognized as metabolic omnivore, meaning it can utilize a variety of energy substrates to maintain adequate ATP production. The adult heart uses fatty acid as a major fuel source, but it can al...
Source: Current Heart Failure Reports - August 1, 2022 Category: Cardiology Source Type: research
Biomarker-Based Assessment for Infectious Risk Before and After Heart Transplantation
AbstractPurpose of ReviewSurvival outcomes for heart transplant recipients have improved in recent decades, but infection remains a significant cause of morbidity and mortality. In this review, we discuss several biological markers, or biomarkers, that may be used to monitor immunologic status in this patient population.Recent FindingsWhile modest, data on the utility of immune biomarkers in heart transplant recipients suggest correlation between low level of immune response and increased infection risk. More novel assays, such as the detection of circulating levels of pathogen cell-free DNA in plasma and the use of Torque...
Source: Current Heart Failure Reports - August 1, 2022 Category: Cardiology Source Type: research
Missed Opportunities in the Diagnosis of Heart Failure: Evaluation of Pathways to Determine Sources of Delay to Specialist Evaluation
AbstractMissed opportunities are incidents where different actions by those involved could have resulted in more desirable events. Heart failure is a complex clinical syndrome presenting as symptoms and signs common to other diagnoses, in patients frequently with multiple co-morbidities. Heart failure itself is not a diagnosis, but is the common clinical presentation of a variety of cardiac conditions. Correct diagnosis involves amalgamation of the clinical presentation, the results of general and specific investigations, and the clinician ’s ability to synthesize the overall picture. It is not surprising therefore that ...
Source: Current Heart Failure Reports - August 1, 2022 Category: Cardiology Source Type: research
