Redefining heart failure.
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Heart Failure↗
Biomedical subjects
Martin D Thomas
Publications and source records attributed to Martin D Thomas.
Time course for recovery of atrial mechanical and endocrine function post DC cardioversion for persistent atrial fibrillation.
We prospectively determined the time course of recovery of atrial mechanical and endocrine function in patients following DC cardioversion for persistent atrial fibrillation (AF). Twenty-three consecutive patients underwent successful DC cardioversion (mean age 64 years, 20 male). By 28 days, nine had reverted to atrial fibrillation. Recovery of atrial mechanical (peak A wave velocity) and endocrine function (atrial natriuretic peptide, ANP) were assessed at four time points: immediately pre-cardioversion, and then 4 h, 7 and 28 days post. The 14 patients maintaining sinus rhythm formed the success group. In this group, peak A wave velocity increased significantly over time from 0.28+/-0.03 m/s (mean+/-S.E.M.) at 4 h to 0.50+/-0.03 m/s at day 7 and 0.67+/-0.05 m/s at day 28 (p<0.001). Plasma ANP was 150+/-34 pg/ml immediately prior to DC cardioversion in the success group. This showed an initial dip at 4 h to 44+/-9 pg/ml (p<0.001). By day 7, plasma ANP had increased to 105+/-21 pg/ml (p<0.05 vs. baseline and 4 h) and then appeared to remain constant, being 102+/-19 pg/ml at day 28 (p=0.06 vs. baseline). A similar early reduction in ANP levels was seen in the group who subsequently reverted to atrial fibrillation. Baseline ANP levels did not predict subsequent successful maintenance of sinus rhythm. Initial "stunning" in both atrial mechanical and endocrine function occurs in patients following DC cardioversion for atrial fibrillation. Whilst endocrine function appears to fully recover by day 7, mechanical function continues to improve beyond day 7.
Aged↗
The epidemiological enigma of heart failure with preserved systolic function.
BACKGROUND: Current epidemiological evidence suggests that the prevalence of preserved systolic function in patients with heart failure varies widely from 13 to 74%. This inconsistency suggests a lack of consensus as to what this condition really is and how it has been characterised for epidemiological studies. AIMS: In this review, we summarise and discuss the current understanding of the epidemiology of heart failure with preserved systolic function and the challenges that this raises. METHODS: Studies were identified from Medline and Embase Literature Database searches using the subject headings heart failure, diastolic heart failure, epidemiology, incidence, prevalence, diagnosis, prognosis and mortality. RESULTS: Sixty-one studies of congestive heart failure with preserved systolic function were reviewed. There is great diversity in the criteria used to determine whether heart failure is present, the patient population, the setting of the study and methods of evaluating left ventricular function. This makes epidemiological studies of prevalence, morbidity and mortality impossible to compare. CONCLUSIONS: The diagnosis of this syndrome might be better defined in terms of symptoms, elevated neuro hormones and impaired cardiac workload. This would allow accurate identification of cases so that further research could be conducted to measure outcome and assess therapeutic benefit.
Blood Pressure↗