Gut Microbiome and Precision Nutrition in Heart Failure: Hype or Hope?
AbstractPurpose of ReviewOver the past decade, the gut microbiome has been shown to play an important role in the pathogenesis of heart failure (HF) and serves as a mediator that links host genomes and environmental exposure (especially dietary intake) to the development and progression of HF. Given that alterations in gut microbial composition and metabolism are commonly seen in patients with HF, the use of gut microbial metabolites as diagnostic and prognostic biomarkers, as well as novel therapeutic targets for HF, is promising.Recent findingsAlterations in gut microbial composition and function have bidirectional relat...
Source: Current Heart Failure Reports - February 9, 2021 Category: Cardiology Source Type: research
Reverse Cardiac Remodeling and ARNI Therapy
AbstractPurpose of ReviewTo review reverse cardiac remodeling and guideline-directed medical and device therapy (GDMT) within the context of recent data on combined angiotensin receptor/neprilysin inhibitor (ARNI) therapy.Recent FindingsPreliminary data suggested that ARNI therapy led to significant reversal of deleterious cardiac remodeling. More definitive data regarding impact of ARNI therapy on remodeling parameters are now available from two prospective trials, PROVE-HF (Prospective Study of Biomarkers, Symptom Improvement, and Ventricular Remodeling During Sacubitril/Valsartan Therapy for Heart Failure) and EVALUATE-...
Source: Current Heart Failure Reports - January 22, 2021 Category: Cardiology Source Type: research
Clinical Outcomes, Trends in Weight, and Weight Loss Strategies in Patients With Obesity After Durable Ventricular Assist Device Implantation
AbstractPurpose of ReviewTo discuss clinical outcomes, changes in weight, and weight loss strategies of patients with obesity post left ventricular assist device (LVAD) implantation.Recent FindingsDespite increased complications in patients with obesity after LVAD implantation, survival is comparable to patients without obesity. A minority of patients with obesity lose significant weight and become eligible for heart transplantation after LVAD implantation. In fact, a great majority of such patients gain weight post-implantation.SummaryObesity by itself should not be considered prohibitive for LVAD therapy but, rather, sho...
Source: Current Heart Failure Reports - January 9, 2021 Category: Cardiology Source Type: research
Wireless Hemodynamic Monitoring in Patients with Heart Failure
AbstractPurpose of ReviewWireless hemodynamic monitoring in heart failure patients allows for volume assessment without the need for physical exam. Data obtained from these devices is used to assist patient management and avoid heart failure hospitalizations. In this review, we outline the various devices, mechanisms they utilize, and effects on heart failure patients.Recent FindingsNew applications of these devices to specific populations may expand the pool of patients that may benefit. In the COVID-19 pandemic with a growing emphasis on virtual visits, remote monitoring can add vital ancillary data.SummaryWireless hemod...
Source: Current Heart Failure Reports - January 9, 2021 Category: Cardiology Source Type: research
Markers of Immune Function in Heart Transplantation: Implications for Immunosuppression and Screening for Rejection
AbstractPurpose of ReviewRecent developments in high-throughput DNA and RNA sequencing technologies have facilitated the development of noninvasive assays to monitor heart transplant rejection. In this review, we summarize existing assays employed for the surveillance of allograft rejection, as well as promising future directions for such tests in the molecular biology field.Recent FindingsThe AlloMap genome expression profiling assay remains the only noninvasive test for rejection surveillance and is incorporated into the International Society of Heart and Lung Transplantation guidelines. Other efforts have focused on mes...
Source: Current Heart Failure Reports - January 5, 2021 Category: Cardiology Source Type: research
Human Induced Pluripotent Stem Cells as a Disease Model System for Heart Failure
AbstractPurpose of ReviewHeart failure is among the most prevalent disease complexes overall and is associated with high morbidity and mortality. The underlying aetiology is manifold including coronary artery disease, genetic alterations and mutations, viral infections, adverse immune responses, and cardiac toxicity. To date, no specific therapies have been developed despite notable efforts. This can especially be attributed to hurdles in translational research, mainly due to the lack of proficient models of heart failure limited translation of therapeutic approaches from bench to bedside.Recent FindingsHuman induced pluri...
Source: Current Heart Failure Reports - November 19, 2020 Category: Cardiology Source Type: research
The Stages of CS: Clinical and Translational Update
AbstractPurpose of ReviewWith improvements in cardiovascular care, and routine percutaneous coronary intervention for ST elevation myocardial infarction, more patients are surviving following acute coronary syndromes. However, a minority of patients develop cardiogenic shock which results in approximately 50% 30-day mortality. There are various ways to classify cardiogenic shock, and much has been written about this topic in recent years. This review will examine recent developments and put them in context.Recent FindingsThe large randomized trials of cardiogenic shock treatments such as the IABP-SHOCK II trial used a clin...
Source: Current Heart Failure Reports - November 14, 2020 Category: Cardiology Source Type: research
Palliative Care in Acute Heart Failure
We examined palliative care provision for those with acute heart failure, based on the recently updated National Consensus Project Clinical Practice Guidelines for Quality Palliative Care.Recent FindingsThe commonest reason for hospitalization in those> 65 years, acute heart failure admissions delineate crisis points on the unpredictable disease trajectory. Palliative care is underutilized, often perceived as limited to end-of-life care rather than determined by regular systematic needs assessment. No dominant paradigm of palliative care provis ion has emerged from the nascent evidence base related to this clinical ...
Source: Current Heart Failure Reports - October 29, 2020 Category: Cardiology Source Type: research
Inotropic Agents and Vasopressors in the Treatment of Cardiogenic Shock
This article aims to review the current evidence on the management of CS with a major focus on the use of inotropes and vasopressors.MethodA literature review was conducted analysing published literature from the following databases: PubMed, MedLine, Cochrane Library and Embase, as well as a manual search of articles that were deemed relevant. Relevant articles were identified by using keywords such as “cardiogenic shock”.ResultsLiterature was assessed to review the use of inotropes and vasopressors in CS. Dopamine and adrenaline were associated with increased mortality and arrhythmias. Dobutamine was associated with a...
Source: Current Heart Failure Reports - October 26, 2020 Category: Cardiology Source Type: research
Venoarterial Extracorporeal Membrane Oxygenation as a Bridge to Recovery or Bridge to Heart Replacement Therapy in Refractory Cardiogenic Shock
AbstractPurpose of the ReviewThe purpose of this review is to describe the outcomes following refractory cardiogenic shock (CS) requiring mechanical circulatory support and factors associated with successful and unsuccessful weaning from VA-ECMO. Based on the presented data, we will propose a weaning and bridging algorithm with the aim of facilitating this complex process.Recent FindingsRefractory CS requiring VA-ECMO support is associated with high early mortality. Approximately 1/3 of the patients weaned from ECMO do not survive until hospital discharge. When evaluating the ability to wean from ECMO etiology of CS, hemod...
Source: Current Heart Failure Reports - October 24, 2020 Category: Cardiology Source Type: research
The Complex Management of Atrial Fibrillation and Cancer in the COVID-19 Era: Drug Interactions, Thromboembolic Risk, and Proarrhythmia
AbstractPurpose of ReviewCardiotoxicity by anticancer agents has emerged as a multifaceted issue and is expected to affect both mortality and morbidity. This review summarizes clinical challenges in the management of oncological patients requiring anticoagulants for atrial fibrillation (AF) also considering the current outbreak of the COVID-19 (coronavirus disease 2019) pandemic, since this infection can add challenges to the management of both conditions. Specifically, the aims are manyfold: (1) describe the evolving use of direct oral anticoagulants (DOACs) in AF patients with cancer; (2) critically appraise the risk of ...
Source: Current Heart Failure Reports - October 5, 2020 Category: Cardiology Source Type: research
Sex Differences in Cardiovascular Aging and Heart Failure
AbstractPurpose of the ReviewThis review summarizes sex-related changes in the heart and vasculature that occur with aging, both in the presence and absence of cardiovascular disease (CVD).Recent FindingsIn the presence of CVD risk factors and/or overt CVD, sex-specific changes in the number of cardiomyocytes, extent of the myocardial extracellular matrix, and myocellular hypertrophy promote unique patterns of LV remodeling in men and women. In addition, age- and sex-specific vascular stiffening is also well established, driven by changes in endothelial dysfunction, elastin –collagen content, microvascular dysfunction, a...
Source: Current Heart Failure Reports - September 27, 2020 Category: Cardiology Source Type: research
Current Role of Echocardiography in Cardiac Resynchronization Therapy: from Cardiac Mechanics to Flow Dynamics Analysis
AbstractPurpose of ReviewThe aim of this review is to summarily explain what LV synchrony, coordination, myocardial work, and flow dynamics are, trying to clarify their advantages and limitations in the treatment of heart failure patients undergoing or with implanted cardiac resynchronization therapy (CRT).Recent FindingsCRT is an established treatment for patients with heart failure and left ventricular systolic dysfunction. In the current guidelines, CRT implant indications rely only on electrical dyssynchrony, but in the last years, many aspects of cardiac mechanics (including contractile synchrony, coordination, propag...
Source: Current Heart Failure Reports - September 25, 2020 Category: Cardiology Source Type: research
Prevention, Detection, and Management of Heart Failure in Patients Treated for Breast Cancer
AbstractPurpose of ReviewLong-term survival has increased significantly in breast cancer patients, and cardiovascular side effects are surpassing cancer-related mortality. We summarize risk factors, prevention strategies, detection, and management of cardiotoxicity, with focus on left ventricular dysfunction and heart failure, during breast cancer treatment.Recent FindingsBaseline treatment of cardiovascular risk factors is recommended. Anthracycline and trastuzumab treatment constitute a substantial risk of developing cardiotoxicity. There is growing evidence that this can be treated with beta blockers and angiotensin ant...
Source: Current Heart Failure Reports - September 25, 2020 Category: Cardiology Source Type: research
Temporary Circulatory Support With Ventricular Assist Devices: Update on Surgical and Percutaneous Strategies
AbstractPurpose of ReviewThe available platforms for temporary circulatory support (TCS) have expanded to include impeller technologies in addition to the traditional approaches with centrifugal pumps and intra-aortic counterpulsation. We review the evidence for competing technologies, relative risk, and benefit of individual TCS platforms and provide a consensus opinion in the context of our institutional experience.Recent FindingsTrans-aortic axial flow devices (Impella) have significantly impacted the support of patients with cardiogenic shock. Despite the absence of prospective randomized data, the use of both percutan...
Source: Current Heart Failure Reports - September 22, 2020 Category: Cardiology Source Type: research
