Acromegaly and Heart Failure
In patients with acromegaly, chronic GH and IGF-I excess commonly causes a specific cardiomyopathy characterized by a concentric cardiac hypertrophy associated with diastolic dysfunction and, in later stages, with systolic dysfunction ending in heart failure in untreated and uncontrolled patients. Additional relevant cardiovascular complications are represented by arterial hypertension, valvulopathies, arrhythmias, and vascular endothelial dysfunction, which, together with the respiratory and metabolic complications, contribute to the development of cardiac disease and the increase cardiovascular risk in acromegaly. Diseas...
Source: Heart Failure Clinics - May 10, 2019 Category: Cardiology Authors: Annamaria Colao, Ludovica F.S. Grasso, Carolina Di Somma, Rosario Pivonello Source Type: research
Understanding the Pathophysiology to Improve the Therapeutic Management: Focus on Metabolic and Hormonal Comorbidities in Heart Failure
Heart failure (HF) is a leading cause of mortality and morbidity worldwide.1. Despite remarkable progress in the therapeutic management of HF, poor survival and high readmission rates are still observed.2 The presence of multiple comorbidities and, in particular, of metabolic and hormonal disorders, complicates the diagnostic and therapeutic management of HF patients and is responsible for a progression of the disease. Diabetes mellitus and insulin resistance are highly prevalent in HF patients and responsible for poor prognosis and for a typical HF phenotype. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - May 10, 2019 Category: Cardiology Authors: Pasquale Perrone Filardi, Eduardo Bossone Tags: Preface Source Type: research
Hormonal and Metabolic Abnormalities in Heart Failure Patients: Pathophysiological Insights and Clinical Relevance
HEART FAILURE CLINICS (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - May 10, 2019 Category: Cardiology Authors: Pasquale Perrone Filardi Source Type: research
Hormonal Replacement Therapy in Heart Failure
This article appraises the current evidence regarding growth hormone and testosterone deficiencies in HF and reviews novel findings about the treatment of these conditions in HF. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - April 6, 2019 Category: Cardiology Authors: Andrea Salzano, Roberta D ’Assante, Mark Lander, Michele Arcopinto, Eduardo Bossone, Toru Suzuki, Antonio Cittadini Source Type: research
β-Adrenergic Receptor Signaling and Heart Failure
This article summarizes novel encouraging preclinical strategies to r eactivate β-adrenergic receptor signaling in heart failure, including pharmacologic and gene therapy approaches, and attempts to translate acquired notions into the clinical setting. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - April 6, 2019 Category: Cardiology Authors: Leonardo Bencivenga, Daniela Liccardo, Carmen Napolitano, Lucia Visaggi, Giuseppe Rengo, Dario Leosco Source Type: research
Glucose Metabolism Abnormalities in Heart Failure Patients
Heart failure is a clinical syndrome characterized by left ventricular dysfunction and/or elevated intracardiac pressures, with a prevalence of about 1% to 2% in the general population. In the last decades, many metabolic disorders have been studied as linked with heart failure. Diabetes mellitus and insulin resistance are strictly related to heart failure, with a bidirectional link, where each can influence the other. The aim of this article is to report the role of glucose metabolism abnormalities in the development of heart failure, defining the epidemiology and assessing pathophysiology and prognosis of heart failure r...
Source: Heart Failure Clinics - April 5, 2019 Category: Cardiology Authors: Fabio Marsico, Paola Gargiulo, Alberto M. Marra, Antonio Parente, Stefania Paolillo Source Type: research
A strict bidirectional relationship exists between diabetes mellitus and heart failure. Diabetic cardiomyopathy is a specific cardiac manifestation of patients with diabetes characterized by left ventricular hypertrophy and diastolic dysfunction in the early phase up to overt heart failure with reduced systolic function in the advanced stages. The pathogenesis of this condition is multifactorial and recognizes as main promoting factors the presence of insulin resistance and hyperglycemia. Diabetic cardiomyopathy exerts a negative prognostic impact in affected patients and no target treatments are currently available. More ...
Source: Heart Failure Clinics - April 5, 2019 Category: Cardiology Authors: Stefania Paolillo, Fabio Marsico, Maria Prastaro, Francesco Renga, Luca Esposito, Fabiana De Martino, Pierfrancesco Di Napoli, Immacolata Esposito, Antonio Ambrosio, Monica Ianniruberto, Rosa Mennella, Roberta Paolillo, Paola Gargiulo Source Type: research
Metabolic Syndrome in Heart Failure
The interplay between metabolic syndrome (MetS) and heart failure (HF) is intricate. Population studies show that MetS confers an increased risk to develop HF and this effect is mediated by insulin resistance (IR). However, obesity, a key component in MetS and common partner of IR, is protective in patients with established HF, although IR confers an increased risk of dying by HF. Such phenomenon, known as “obesity paradox,” accounts for the complexity of the HF-MetS relationship. Because IR impacts more on outcomes than MetS itself, the former may be considered the actual target for MetS in HF patients. (Sourc...
Source: Heart Failure Clinics - April 5, 2019 Category: Cardiology Authors: Michele Arcopinto, Alessandra Schiavo, Andrea Salzano, Eduardo Bossone, Roberta D ’Assante, Fabio Marsico, Pablo Demelo-Rodriguez, Ragavendra R. Baliga, Antonio Cittadini, Alberto M. Marra Source Type: research
Anemia and Iron Deficiency in Heart Failure
Anemia and iron deficiency (ID) represent 2 prevalent, often interrelated, comorbidities in heart failure (HF). Both of them are significantly related to functional capacity and are undoubted predictors of poor prognosis in patients with HF. Although anemia and ID both have “global” detrimental effects, these 2 conditions are too often overlooked in cardiology daily clinical practice. The present review sought to summarize briefly the prevalence and the underlying pathophysiologic mechanisms of anemia and ID as regards HF severity (ie, exercise capacity) and progno sis. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - April 5, 2019 Category: Cardiology Authors: Damiano Magr ì, Fabiana De Martino, Federica Moscucci, Piergiuseppe Agostoni, Susanna Sciomer Source Type: research
Prognostic Value of Hormonal Abnormalities in Heart Failure Patients
The model used to explain the pathophysiologic substrate and progressive worsening in chronic heart failure (CHF) is based on the hyperactivity of renin-angiotensin-aldosterone system and adrenergic pathway. Although the neurohormonal medical approach has many advantages, it has several pitfalls, as demonstrated by high rates of CHF mortality and hospitalization. A growing body of evidence has led to the hypothesis that CHF is a multiple hormone deficiency syndrome, characterized by a reduced anabolic drive that has relevant functional and prognostic implications. The aim of this review is to summarize the evidence of redu...
Source: Heart Failure Clinics - April 5, 2019 Category: Cardiology Authors: Paola Gargiulo, Stefania Paolillo, Francesca Ferrazzano, Maria Prastaro, Lucia La Mura, Anna Maria De Roberto, Gaetano Diana, Simona Dell ’Aversana, Cristina Contiello, Maria Cristina Vozzella, Luca Bardi, Fabio Marsico Source Type: research
The Management of Thyroid Abnormalities in Chronic Heart Failure
The cardiovascular system is one of the main targets of thyroid hormone action, and triiodothyronine deficiency has crucial consequences on cardiac structure and function. Patients with overt or subclinical hypothyroidism should be treated with levothyroxine to improve their cardiovascular function and the potential risk of heart failure. Even patients with thyroid hormone deficiency and heart failure should receive replacement doses of levothyroxine to improve their prognosis and worsening of the cardiovascular function. An innovative therapeutic multifactorial approach could improve the progression of heart failure. Ther...
Source: Heart Failure Clinics - April 5, 2019 Category: Cardiology Authors: Bernadette Biondi Source Type: research
Evaluation of Cardiac Metabolism by Magnetic Resonance Spectroscopy in Heart Failure
Alterations in myocardial energy metabolism as demonstrated by magnetic resonance spectroscopy (MRS) are critically involved in heart failure development. 1H-MRS allows investigation of the role of myocardial lipid accumulation in the pathophysiology of heart failure. With 31P-MRS, the most useful parameter is the cardiac adenosine triphosphate to phosphocreatine ratio, which is typically reduced in the failing heart and correlates with cardiac functional status. Currently, MRS is mostly limited to the research setting, but recent technical and methodological developments might substantially improve its clinical applicabil...
Source: Heart Failure Clinics - April 5, 2019 Category: Cardiology Authors: Santo Dellegrottaglie, Alessandra Scatteia, Carmine Emanuele Pascale, Francesco Renga, Pasquale Perrone-Filardi Source Type: research
Ventricular Stiffness and Ventricular-Arterial Coupling in Heart Failure
The heart and blood vessels are constantly interfering with each other in a closed system. For a few decades, the concept of ventricular-arterial coupling has been considered as a key pathogenesis of heart failure especially in heart failure with preserved ejection fraction. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - March 4, 2019 Category: Cardiology Authors: Chi Young Shim, Geu-Ru Hong, Jong-Won Ha Source Type: research
Heart failure is a clinical syndrome with a broad spectrum of presentations. Cardiovascular imaging techniques such as echocardiography, cardiovascular magnetic resonance, computed tomography, and nuclear imaging play a crucial role in diagnosis, guiding management, and providing prognostic information. Each of these imaging modalities has their own respective strengths and weaknesses. Cardiac imaging can help differentiate between ischemic and nonischemic cardiomyopathies. Additionally, imaging techniques can display disease-specific findings, aiding in diagnosis of nonischemic cardiomyopathies and can provide a means to ...
Source: Heart Failure Clinics - March 4, 2019 Category: Cardiology Authors: Kate Rankin, Babitha Thampinathan, Paaladinesh Thavendiranathan Source Type: research
Imaging Heart Failure
Imaging heart failure (HF) syndrome continues to be a hot topic because it challenges the imager to provide the best diagnostic and prognostic information in a cost-effective manner. The most common indication for an imaging test in the hospitalized patient is HF. In the ambulatory population, HF is either a close second or equals chest pain syndrome (including coronary artery disease) as the most indication for an imaging test. The increasing use of device therapy in HF has further tasked the imager to formulate an integrated pathway that yields comprehensive data relevant not only to diagnosis and prognosis but also to a...
Source: Heart Failure Clinics - March 4, 2019 Category: Cardiology Authors: Mani A. Vannan, Eduardo Bossone Tags: Preface Source Type: research
Hormonal and Metabolic Abnormalities in Heart Failure Patients: Pathophysiological Insights and Clinical Relevance (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - March 4, 2019 Category: Cardiology Source Type: research
Ultrasound of the Lungs
Lung ultrasound B-lines are the sonographic pattern of partial deaeration of the lung. In patients with pulmonary edema they are detected as multiple, diffuse, and bilateral, by placing the ultrasound probe in the intercostal spaces. B-lines can be used for bedside monitoring of pulmonary decongestion, and can guide diuretic therapy. Persistent pulmonary congestion after hospitalization for acute heart failure increases the risk of being rehospitalized in the following months. Adding B-lines assessment to echocardiography in an integrated cardiopulmonary ultrasound is of great value in establishing the kind and degree of m...
Source: Heart Failure Clinics - February 9, 2019 Category: Cardiology Authors: Luna Gargani Source Type: research
Imaging Device Therapy
This article discusses in detail various imaging techniques and key clinical points relating to several cardiac devices used in the treatment of patients with heart failure. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - February 9, 2019 Category: Cardiology Authors: Thura T. Harfi, Michael Wesley Milks, David A. Orsinelli, Subha V. Raman, William T. Abraham, Rami Kahwash Source Type: research
Left Ventricular Mass and Thickness
Several left ventricular geometric patterns have been described both in healthy and pathologic hearts. Left ventricular mass, wall thickness, and the ratio of wall thickness to radius are important measures to characterize the spectrum of left ventricular geometry. For clinicians, an increase in left ventricular mass is the hallmark of left ventricular hypertrophy. Although pathologic hypertrophy initially can be compensatory, eventually it may become maladaptive and evolve toward progressive left ventricular dysfunction and heart failure. In particular, patients who show left ventricular dilation and hypertrophy in associ...
Source: Heart Failure Clinics - February 9, 2019 Category: Cardiology Authors: Frank Lloyd Dini, Gian Giacomo Galeotti, Giuseppe Terlizzese, Iacopo Fabiani, Nicola Riccardo Pugliese, Ilaria Rovai Source Type: research
Valve Disease in Heart Failure
Secondary regurgitation caused by the remodeling and dysfunction of the left or right heart chamber may complicate heart failure, worsening both symptoms and prognosis. Outcome studies have shown that patients ’ prognosis worsened as the severity of secondary regurgitation increases. Imaging and more specifically echocardiography plays a central role for diagnosis and serial assessment of secondary regurgitation as well as for timing the intervention and guiding the procedure. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - February 9, 2019 Category: Cardiology Authors: Patrizio Lancellotti, Raluca Dulgheru, Stella Marchetta, C écile Oury, Madalina Garbi Source Type: research
Right Ventricular Size and Function in Chronic Heart Failure
A comprehensive multi-imaging evaluation of the right heart structure, function, and pressures represents an essential step in the diagnostic and prognostic algorithm of patients with heart failure. Furthermore, it provides important information for detecting early signs of right ventricular unfavorable remodeling, and consequently, guiding appropriate therapeutic interventions. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - February 9, 2019 Category: Cardiology Authors: Xiao Zhou, Francesco Ferrara, Carla Contaldi, Eduardo Bossone Source Type: research
Importance of the Left Atrium
Left atrial size and function parameters are associated with adverse outcomes in multiple disease states, including heart failure with reduced and preserved ejection fraction. Recent data suggest that phasic left atrial function and left atrial stain measurements also hold prognostic information. Three-dimensional echocardiography provides more accurate and reproducible quantification of left atrial volumes than 2-dimensional echocardiography when compared with cardiac magnetic resonance reference standards. Greater accessibility to these advanced imaging techniques allows for the integration of these parameters into routi...
Source: Heart Failure Clinics - February 2, 2019 Category: Cardiology Authors: Kalie Y. Kebed, Karima Addetia, Roberto M. Lang Source Type: research
Myocardial Strain and Dyssynchrony
Heart failure (HF) has evolved in an epidemic manner and constitutes a major public health issue. Currently, several prognostic markers and treatment options exist to guide treatment of HF with reduced ejection fraction, but echocardiographic deformation imaging suggests novel pathophysiologic aspects that could help optimize treatment further. Even though no formal treatment options currently exist for patients with HF with preserved ejection fraction, some HF medication does seem to attenuate strain measures. Speckle tracking has furthermore helped characterize this condition and to confer prognostic information. Thus, s...
Source: Heart Failure Clinics - February 2, 2019 Category: Cardiology Authors: Flemming J. Olsen, Tor Biering-S ørensen Source Type: research
Resting and Exercise Doppler Hemodynamics
Exercise intolerance is the clinical hallmark of the failing heart. Evidence of hemodynamic derangement is not always present at rest, often necessitating dynamic challenges to accentuate abnormalities. Although cardiac catheterization, particularly with exercise, remains the gold standard method for hemodynamic assessment, it is limited by practicality, access, risk, and its invasive nature; consequently, there is a need to better understand noninvasive measures. Echocardiography and cardiac MRI offer promising modalities to quantify ventriculo-vascular interactions. Significant heterogeneity exists around exercise protoc...
Source: Heart Failure Clinics - February 2, 2019 Category: Cardiology Authors: Shane Nanayakkara, David M. Kaye, Thomas H. Marwick Source Type: research
The Role of Echocardiography in Heart Failure with Preserved Ejection Fraction
This article provides a critical appraisal of the role of echocardiography in the diagnosis and evaluation of HFpEF. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - February 2, 2019 Category: Cardiology Authors: Masaru Obokata, Yogesh N.V. Reddy, Barry A. Borlaug Source Type: research
Patients with heart failure show myocardial, valvular, and electrical dysfunction, which results in enlarged cardiac chambers and increased intracardiac volume and pressure. Intracardiac flow analysis can provide information regarding the shape and wall properties, chamber dimensions, and flow efficiency throughout the cardiac cycle. There is increasing interest in vortex flow analysis for patients with heart failure to overcome limitations of conventional parameters. In conjunction with the conventional structural and functional parameters, vortex flow analysis –guided treatment in heart failure might be a novel opt...
Source: Heart Failure Clinics - February 2, 2019 Category: Cardiology Authors: In-Cheol Kim, Geu-Ru Hong Source Type: research
Biomarkers and Imaging
Heart failure is a life-threatening disease. Its prevalence is characterized by a slow, steady increase, with unacceptable high mortality. Slowing disease progression is imperative. One of the most active field is the development of novel biomarkers. Biomarkers are used in routine clinical care for diagnosis, monitoring (response to treatment), and risk stratification of patients with heart failure. In this review, we consider in 2 different sections: blood-derived and imaging biomarkers. Finally, we analyze the effect of combining these 2 categories of biomarkers available in heart failure, aiming at understanding whether...
Source: Heart Failure Clinics - February 2, 2019 Category: Cardiology Authors: Andrea Salzano, Alberto M. Marra, Roberta D ’Assante, Michele Arcopinto, Eduardo Bossone, Toru Suzuki, Antonio Cittadini Source Type: research
Myocardial Scar and Fibrosis
The cardiology community lacks a taxonomy to prioritize the origins of the complex myocardial pathology underlying heart failure. The key question, “Why does heart muscle fail?”, remains unanswered. A large body of literature indicates that myocardial fibrosis represents a principal pathway mediating outcomes in heart failure. Cardiac amyloidosis illustrates how excess protein in the myocardial interstitium culminates in severe heart failur e with a dismal prognosis. Robust methods now exist to quantify myocardial fibrosis. Investigators possess the tools to finally establish unequivocally that myocardial fibro...
Source: Heart Failure Clinics - February 2, 2019 Category: Cardiology Authors: Erik B. Schelbert Source Type: research
Left Ventricular Size and Ejection Fraction
Despite the rapid development of emerging imaging technologies, left ventricular ejection fraction represents the cornerstone of diagnosis, choice of treatment, and prognosis in heart failure. However, true myocardial function often remains underestimated or overestimated in different conditions underlying this heterogeneous syndrome. Changes in left ventricular size and left ventricular ejection fraction, termed reverse remodeling, are among the main goals of treatment in heart failure, aimed at halting or attenuating disease progression. The lack of effective therapeutic approaches in nearly one-half of the heart failure...
Source: Heart Failure Clinics - February 2, 2019 Category: Cardiology Authors: Dora Fabijanovic, Davor Milicic, Maja Cikes Source Type: research
Heart Failure with Preserved Ejection Fraction in Women
Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent condition, particularly in women. Comorbidities, including older age, obesity, diabetes mellitus, hypertension, and hyperlipidemia, are risk factors and define phenotypic profiles of HFpEF in women. The condition has a relatively high burden of morbidity and mortality, with phenotypic profiles potentially characterizing risk of hospitalization and mortality. Based on limited data, nonpharmacologic and pharmacologic treatments may provide benefit; however, compelling evidence-based, disease-modifying treatments are needed. Many unanswered qu...
Source: Heart Failure Clinics - November 16, 2018 Category: Cardiology Authors: Anjan Tibrewala, Clyde W. Yancy Source Type: research
Stress-induced cardiomyopathy is characterized by reversible myocardial injury with distinctive regional wall motion abnormalities of the left ventricle, usually precipitated by an emotional or physical stressor. This condition has a strong predilection for older women and has a trend of increasing incidence. The diagnosis can be made based on symptoms, biomarkers, electrocardiogram, coronary angiogram, and noninvasive imaging. It is frequently complicated by acute heart failure, cardiogenic shock, arrhythmias, left ventricular outflow tract obstruction, and ventricular thrombi. Evidence of the treatment of stress-induced ...
Source: Heart Failure Clinics - November 16, 2018 Category: Cardiology Authors: Lili Zhang, Ileana L. Pi ña Source Type: research
Breast Cancer and Heart Failure
Heart failure and breast cancer have shared risks and morbidities. Multimodality therapies for breast cancer, including conventional chemotherapy, targeted therapeutics, radiation therapy, and hormonal agents, may make patients more susceptible to asymptomatic left ventricular dysfunction and clinical heart failure during and after treatment. New or preexisting left ventricular dysfunction may lead to interruptions in cancer treatment and limit options of breast cancer systemic therapy, leading to adverse outcomes. Early recognition and management of cardiovascular risk factors before, during, and after cancer treatment ar...
Source: Heart Failure Clinics - November 16, 2018 Category: Cardiology Authors: Zakaria Almuwaqqat, Jane L. Meisel, Ana Barac, Susmita Parashar Source Type: research
Valvular Heart Disease and Heart Failure in Women
Valvular heart disease and heart failure remain important causes of cardiovascular disease among women in the United States. Mitral regurgitation, aortic stenosis, and tricuspid regurgitation are the most common valvular lesions among men and women. This review focuses on gender differences in the epidemiology, treatment, and outcomes of mitral regurgitation, aortic stenosis, and tricuspid regurgitation. The authors also review the unique management of valvular heart disease in pregnancy. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - November 16, 2018 Category: Cardiology Authors: Daniela R. Crousillat, Malissa J. Wood Source Type: research
Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy in Women
This article reviews the literature on these devices with a focus on gender differences and proposes reasons for why they exist. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - November 16, 2018 Category: Cardiology Authors: Maya T. Ignaszewski, Stacie L. Daugherty, Andrea M. Russo Source Type: research
Heart Failure in Women
HEART FAILURE CLINICS (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - November 16, 2018 Category: Cardiology Authors: Gina Price Lundberg, Laxmi S. Mehta Source Type: research
Heart Failure in Women: An Increasing Health Concern
Cardiovascular disease is the number one cause of mortality in women the United States.1 Much focus has been placed on coronary heart disease awareness, treatment, and prevention in women, yet heart failure is an equal and growing concern for morbidity and mortality among American men and women. Approximately 6.5 million US adults have heart failure, of which 3.6 million of them are women. In addition, an estimated 505,000 new cases of heart failure will occur annually in women, and the overall prevalence of heart failure among men and women continues to rise in the United States. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - November 16, 2018 Category: Cardiology Authors: Gina Price Lundberg, Eduardo Bossone, Laxmi S. Mehta Tags: Preface Source Type: research
This article reviews the progress that h as been made regarding understanding of the cause, management, and natural history of PPCM. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - October 25, 2018 Category: Cardiology Authors: Kathryn J. Lindley, Amanda K. Verma, Lori A. Blauwet Source Type: research
Sex-Specific Differences in Risk Factors for Development of Heart Failure in Women
This article reviews sex-specific risk factors associated with development of HF. These risk factors include current smoking, diabetes, hypertension, and myocardial infarction. Other risks for HF are toxins, inflammation, and other chronic conditions, such as sleep breathing disorders, anemia, obesity, and renal insufficiency. Some of these risks factors present risk reduction opportunities that may improve outcomes. (Source: Heart Failure Clinics)
Source: Heart Failure Clinics - October 24, 2018 Category: Cardiology Authors: Gina Lundberg, Mary Norine Walsh, Laxmi Mehta Source Type: research