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Biomedical subjects

Robin J Trupp

Publications and source records attributed to Robin J Trupp.

14 recordsLinked to original sources
PubMed2006

Utility of impedance cardiography for the identification of short-term risk of clinical decompensation in stable patients with chronic heart failure.

OBJECTIVES: This study sought to assess the potential utility of impedance cardiography (ICG) in predicting clinical deterioration in ambulatory patients with heart failure (HF). BACKGROUND: Impedance cardiography uses changes in thoracic electrical impedance to estimate hemodynamic variables, but its ability to predict clinical events has not been evaluated. METHODS: We prospectively evaluated 212 stable patients with HF and a recent episode of clinical decompensation who underwent serial clinical evaluation and blinded ICG testing every 2 weeks for 26 weeks and were followed up for the occurrence of death or worsening HF requiring hospitalization or emergent care. RESULTS: During the study, 59 patients experienced 104 episodes of decompensated HF (16 deaths, 78 hospitalizations, and 10 emergency visits). Multivariate analysis identified 6 clinical and ICG variables that independently predicted an event within 14 days of assessment. These included three clinical variables (visual analog score, New York Heart Association functional class, and systolic blood pressure) and three ICG parameters (velocity index, thoracic fluid content index, and left ventricular ejection time). The three ICG parameters combined into a composite score was a powerful predictor of an event during the next 14 days (p = 0.0002). Visits with a high-risk composite score had 2.5 times greater likelihood and those with a low-risk score had a 70% lower likelihood of a near-term event compared with visits at intermediate risk. CONCLUSIONS: These results suggest that when performed at regular intervals in stable patients with HF with a recent episode of clinical decompensation, ICG can identify patients at increased near-term risk of recurrent decompensation.

Adult↗
PubMed2003

Nonpharmacologic options for the management of heart failure.

Despite recent advances in treating symptoms and thwarting disease progression, heart failure remains the only cardiovascular disease that continues to rise in both incidence and prevalence. Even with recent advances in pharmacologic therapy, the 1- to 2-year mortality rate is approximately 35% to 50% for advanced heart failure, and the 4- to 5-year mortality rate ranges from 15% to 40% for those with asymptomatic left ventricular dysfunction, or only mild to moderate symptoms. A variety of nonpharmacologic approaches compliment drug therapy of heart failure, and many have been shown to improve patient quality of life and functional capacity, while reducing morbidity and mortality.

Cardiac Surgical Procedures↗
PubMed2003

Case studies in heart failure.

This article presents four case studies of patients with heart failure and the rationale for optimal treatment in each case.

Activities of Daily Living↗
PubMed2003

Future therapies for heart failure.

The treatment of heart failure has changed as the understanding of the disease evolves. Heart failure remains the only cardiovascular disease that continues to rise in both incidence and prevalence, despite recent advances in treating symptoms and thwarting disease progression. Many opportunities exist for improving patient outcomes with pharmaceutical agents and technologies available now or in the near future. This article discusses recently approved drugs and devices and clinical trials that may affect the management of this challenging disease.

Cardiac Pacing, Artificial↗
PubMed2003

Peripherally inserted veno-venous ultrafiltration for rapid treatment of volume overloaded patients.

BACKGROUND: Veno-venous ultrafiltration may benefit patients with acute or chronic circulatory volume overload. Use of conventional systems, however, may be cumbersome, requiring physician placement of a double-lumen central venous catheter and use of a dedicated dialysis technician and apparatus. METHODS: A simplified peripheral ultrafiltration system including a miniaturized disposable circuit was evaluated in patients with volume-overload states. Separate intravenous catheters (16-18 G) for withdrawal and return of blood (blood flow <or= 40 mL/min, ultrafiltrate <or= 500 mL/h) were placed by nonphysician personnel in upper extremity veins. Twenty-five treatments of up to 8 hours were performed in 21 patients. RESULTS: The primary endpoint of greater than 1 L fluid removal in less than 8 hours was achieved in 23 of 25 treatments. On average, 2611 +/- 1002 mL (maximum 3,725 mL) of ultrafiltrate was removed per treatment (treatment period 6:43 +/- 1:47 hours:minutes). Patient weight decreased from 91.9 +/- 17.5 to 89.3 +/- 17.3 kg (P <.0001) after ultrafiltration. No major adverse events occurred. CONCLUSIONS: Rapid removal of extracellular and intravascular fluid volume excess can be safely achieved via peripherally inserted ultrafiltration without the need for central venous catheter placement.

Catheterization, Peripheral↗
PubMed2002

Cardiac resynchronization in chronic heart failure.

BACKGROUND: Previous studies have suggested that cardiac resynchronization achieved through atrial-synchronized biventricular pacing produces clinical benefits in patients with heart failure who have an intraventricular conduction delay. We conducted a double-blind trial to evaluate this therapeutic approach. METHODS: Four hundred fifty-three patients with moderate-to-severe symptoms of heart failure associated with an ejection fraction of 35 percent or less and a QRS interval of 130 msec or more were randomly assigned to a cardiac-resynchronization group (228 patients) or to a control group (225 patients) for six months, while conventional therapy for heart failure was maintained. The primary end points were the New York Heart Association functional class, quality of life, and the distance walked in six minutes. RESULTS: As compared with the control group, patients assigned to cardiac resynchronization experienced an improvement in the distance walked in six minutes (+39 vs. +10 m, P=0.005), functional class (P<0.001), quality of life (-18.0 vs. -9.0 points, P= 0.001), time on the treadmill during exercise testing (+81 vs. +19 sec, P=0.001), and ejection fraction (+4.6 percent vs. -0.2 percent, P<0.001). In addition, fewer patients in the group assigned to cardiac resynchronization than control patients required hospitalization (8 percent vs. 15 percent) or intravenous medications (7 percent vs. 15 percent) for the treatment of heart failure (P<0.05 for both comparisons). Implantation of the device was unsuccessful in 8 percent of patients and was complicated by refractory hypotension, bradycardia, or asystole in four patients (two of whom died) and by perforation of the coronary sinus requiring pericardiocentesis in two others. CONCLUSIONS: Cardiac resynchronization results in significant clinical improvement in patients who have moderate-to-severe heart failure and an intraventricular conduction delay.

Aged↗
PubMedDate not supplied

Cardiac resynchronization therapy: optimizing the device, optimizing the patient.

Heart failure is a major health problem in the United States, associated with high morbidity, mortality, and economic burden. Despite recent advances in pharmacological treatments to attenuate disease progression, medications become relatively ineffective, resulting in worsening congestive symptoms and increased exercise intolerance. Cardiac resynchronization therapy provides a new adjunct for heart failure patients who remain symptomatic despite optimized medical therapies. This article discusses cardiac resynchronization therapy and measures that should be considered to ensure proper functioning of the device and improved quality of life for patients.

Activities of Daily Living↗
PubMedDate not supplied

The heart of sleep: sleep-disordered breathing and heart failure.

Heart failure is associated with high rates of hospitalization and mortality as well as great economic burden in the United States. Recent data show that a high percentage of patients with depressed left ventricular ejection fractions suffer from sleep-disordered breathing, contributing to this incidence of morbidity and mortality. Since the signs and symptoms associated with sleep disorders do not differ significantly from chronic heart failure signs and symptoms, detection and recognition of sleep-disordered breathing is a clinical challenge. Thus clinicians frequently fail to recognize it as a possible contributor to the development of heart failure or as a consequence of the disease. This article discusses sleep, sleep-disordered breathing, its effects and consequences on the cardiovascular system, strategies for identifying at-risk individuals, and treatment options.

Diagnosis, Differential↗
PubMedDate not supplied

Prevention: the key to reducing cardiovascular disease risk in women.

More than 500,000 US women die of cardiovascular disease (CVD) annually, exceeding deaths for cancer, accidents, and diabetes combined. Yet women are largely unaware of this and fear breast cancer more. One way of changing this number is to change the way we approach CVD, that is, to practice preventive healthcare. Until recently, guidelines for women with CVD were derived largely from research conducted primarily on white middle-aged men. Although evidence-based medicine is still lacking, guidelines and recommendations specifically for women are now available and include aggressive management of the risk factors of smoking, hypertension, dyslipidemia, diabetes mellitus, and obesity. Unless women are educated regarding these risk factors and are enabled to make lifestyle changes, their chances of modifying and reducing their risks are severely impaired.

Cardiovascular Diseases↗
PubMedDate not supplied

Prevalence of sleep disordered breathing in a heart failure program.

Recent data show that a high percentage of patients with systolic left ventricular dysfunction have sleep-disordered breathing (SDB), contributing to the incidence of morbidity and mortality in heart failure. This study examines the prevalence of sleep disorders in stable heart failure patients regardless of ejection fraction. On three consecutive days in a heart failure clinic, all patients were asked to participate in a screening for SDB. This screening involved the placement of an outpatient device (ClearPath, Nexan, Inc., Alpharetta, GA), which collects thoracic impedance, oxyhemoglobin saturation, and 2-lead electrocardiogram data. Sixteen patients (42%) had moderate or severe SDB, and 22 patients (55%) had mild or no significant SDB. Fourteen of the 16 patients with moderate or severe SDB subsequently received treatment by confirming SDB and the continuous positive airway pressure in a sleep lab. Forty-two percent of patients with stable heart failure presenting to a heart failure clinic screened positive for SDB, despite receiving optimal standard of care.

Ambulatory Care Facilities↗
PubMedDate not supplied

Cardiac resynchronization therapy: a practical guide for device optimization, part I.

This is the first part of a two-part series on strategies for optimizing the delivery of cardiac resynchronization therapy (CRT), focusing on device-related aspects. There is overwhelming evidence from prospective randomized controlled trials providing consistent and concordant support for CRT in patients with symptomatic heart failure and ventricular dyssynchrony. CRT has consistently improved quality of life, cardiac structure and function, and survival in the majority of patients enrolled in these trials. No longer a consideration for select individuals with heart failure, the 2005 American College of Cardiology/American Heart Association Guidelines for Managing Adults with Chronic Heart Failure now consider CRT a class IA recommendation for stage C patients (QRS duration > or = 120 milliseconds, left ventricular ejection fraction < or = 35%) who remain symptomatic despite optimal medical therapy. However, not everyone experiences clinical improvement from CRT. This article discusses measures that should be considered to ensure proper functioning of a CRT device. A subsequent article will present strategies to optimize patients' responses to CRT.

Calibration↗
PubMedDate not supplied

Cardiac resynchronization therapy: a practical guide for patient management after device implantation, part II.

This is the second of a two-part series on strategies for optimizing the delivery of cardiac resynchronization therapy (CRT). A previous article presented strategies to optimize CRT device functioning. This article focuses on patient-related aspects. The 2005 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for Managing Adults with Chronic Heart Failure now designate CRT as a class IA recommendation for stage C patients (QRS duration, > or = 120 milliseconds; left ventricular ejection fraction, < or = 35%) who remain symptomatic despite optimal medical therapy. While the evidence from prospective randomized controlled trials demonstrates consistent and concordant support for CRT in patients with symptomatic heart failure and ventricular dyssynchrony, a substantial minority of patients do not experience clinical improvement from CRT. In addition to device optimization, optimizing individual patient responses is essential. This article discusses measures for enhancing the patient's response to a CRT device.

Cardiac Pacing, Artificial↗
PubMedDate not supplied

Validation and clinical utility of a simple in-home testing tool for sleep-disordered breathing and arrhythmias in heart failure: results of the Sleep Events, Arrhythmias, and Respiratory Analysis in Congestive Heart Failure (SEARCH) study.

Fifty patients with New York Heart Association class III systolic heart failure were enrolled in this prospective multicenter study that compared the diagnostic accuracy of a home-based cardiorespiratory testing system with standard attended polysomnography. Patients underwent at least 2 nights of evaluation and were scored by blinded observers. At diagnostic cutoff points of > or =5, > or =10, and > or =15 events per hour for respiratory disturbance severity, polysomnography demonstrated a sleep-disordered breathing prevalence of 69%, 59%, and 49%, respectively. Compared with polysomnography, the cardiorespiratory testing system demonstrated predictive accuracies of 73%, 73%, and 75%, which improved to 87%, 87%, and 83%, respectively, when analysis of covariance suggested reanalysis omitting one site's data. The system accurately identified both suspected and unsuspected arrhythmias. The device was judged by 80% of patients to be easy or very easy to use, and 74% of patients expressed a preference for the in-home system. Therefore, this system represents a reasonable home testing device in these patients.

Adult↗