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At least 991 records · Page 55Linked to original sources
PubMed2006

Significance of combined angiotensin II receptor blocker and carvedilol therapy in patients with congestive heart failure and arginine variant.

OBJECTIVE: Angiotensin II receptor blockers (ARBs) and beta-blockers have contributed to longer life expectancies for patients with congestive heart failure. However, whether the use of ARBs is helpful for introducing carvedilol (beta-blocker) is unclear when patients with symptomatic congestive heart failure are admitted to the hospital. METHODS: In this retrospective study, 27 patients with symptomatic congestive heart failure were given carvedilol upon admission. Five patients received carvedilol monotherapy (group A), and 22 were treated with a combination of carvedilol and ARBs (group B). RESULTS: There was no difference in medication between the groups except for ARBs. In addition, there were no significant differences in the decrease in plasma brain natriuretic peptide, or the improvement of left ventricular ejection fraction upon carvedilol treatment between the groups. Although there was no significant difference in the maintenance dose of carvedilol between the groups, the gross dose of carvedilol in group B was significantly lower than that in group A. In addition, the improvement of left ventricular ejection fraction in group B was positively correlated with the maintenance dose of carvedilol in patients who had wild-type beta1-adrenergic receptor at amino acid 389 (arginine/arginine genotype). CONCLUSIONS: These results suggest that ARBs are helpful for introducing carvedilol in patients with the wild-type beta1-adrenergic receptor gene, and that treatment with combined treatment with ARB or analysis of the beta1-adrenergic receptor genotype may offer advantages to control congestive heart failure in the short-term.

Adrenergic beta-Antagonists↗
PubMed1988

The multifacetted role of angiotensin converting enzyme inhibitors in congestive heart failure.

The angiotensin converting enzyme (ACE) inhibitors constitute a major breakthrough in the medical management of congestive heart failure. The incidence of side effects with these agents is surprisingly low when they are used in the appropriate dosage. They produce sustained beneficial hemodynamic and symptomatic improvement in most patients with congestive heart failure and may produce greater symptomatic benefit than digoxin when given as second-line therapy to patients with heart failure on diuretics. Their neurohumoral effects generally are advantageous, resulting in normalization of sodium and potassium balance and a reduction in ventricular arrhythmias. The ACE inhibitors may improve survival in patients with congestive heart failure, and recent data suggest that they may prevent or delay the development of left ventricular dilatation and overt heart failure in patients with asymptomatic left ventricular dysfunction.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2004

Failure of recombinant human growth hormone treatment to improve congestive heart failure in hypopituitarism.

Growth hormone (GH) deficiency decreases left ventricular (LV) contractility, induces LV chamber dilatation and promotes progression to congestive heart failure. It is, however, controversial, whether GH replacement therapy in addition to standard medical heart failure therapy should be considered as routine treatment in GH deficient patients with heart failure. In the present report of a 64-year-old GH deficient patient with heart failure, we demonstrate by using Doppler echocardiography, magnetic resonance imaging and 31P NMR spectroscopy that even a 12 month period of GH replacement therapy had no sustained effect on morphometric or functional parameters of LV performance nor on clinical signs or symptoms of heart failure. It is concluded that GH replacement therapy should currently not be regarded as standard heart failure therapy in patients with GH deficiency and should only be employed under careful monitoring including close follow-up in a standardized way.

Echocardiography, Doppler↗
PubMed1999

A case of progressive congestive heart failure secondary to severe anemia in a patient presenting with uterine hemorrhage.

In this report, we present a 42-year-old female patient who was transferred to our emergency department due to symptoms of congestive heart failure. She presented with severe anemia (hemoglobin was 1.3 g dl(-1), and hematocrit was 6.0%) due to continuous uterine hemorrhage and metabolic acidosis, otherwise she seemed to be free from illness. We diagnosed that she was suffered from chronic severe anemia due to uterine hemorrhage and congestive heart failure. Monitoring her hemodynamic status, treatment of congestive heart failure using diuretics and inotropes in combination with blood transfusion brought her good recovery. We discussed this case from the mechanisms of development of congestive heart failure in a chronic severe anemic condition, and pointed out that distributive effects of sodium and water may develop congestive heart failure without myocardial dysfunction in such a condition.

Adult↗
PubMed1981

Effect of furosemide in congestive heart failure.

The diuretic effect of furosemide was studied in 18 patients with congestive heart failure. Subjects were divided into two groups, group I consisting of eight patients with moderate and group II of 10 patients with advanced congestive heart failure. Six hours after bolus injection of furosemide (40 mg), mean urinary sodium was 120.5 +/- 36.7 mEq in group I and 68.2 +/- 25.8 mEq in group II (p less than 0.01), mean urine volume was 1,100 +/- 281 and 764 +/- 257 ml (p less than 0.05), mean urinary furosemide excretion was 28.08 +/- 2.60 and 24.00 +/- 0.74 mg (p less than 0.05), and mean furosemide renal clearance was 73.4 +/- 16.6 and 42.3 +/- 11.5 ml/min (p less than 0.001). Diuretic effect and furosemide renal clearance, as well as urinary furosemide excretion, correlated positively. The diuretic effect of furosemide with and without hydralazine (0.2 mg/kg) was compared in eight patients in group II. Urinary sodium excretion 6 hr after furosemide rose from 77.2 +/- 31.0 to 122.8 +/- 42.5 mEq after furosemide with hydralazine (p less than 0.01). Urine volume rose from 854 +/- 278 to 1,279 +/- 359 ml (p less than 0.001), urinary furosemide excretion rose from 23.64 +/- 2.03 to 26.94 +/- 2.30 mg (p less than 0.01), and furosemide renal clearance rose from 46.3 +/- 12.2 to 62.5 +/- 18.6 ml/min (p less than 0.01).

Adult↗
PubMed1987

A double-blind comparison of lisinopril with captopril in patients with symptomatic congestive heart failure.

Angiotensin-converting enzyme (ACE) inhibition with captopril is accepted therapy for the treatment of symptomatic congestive heart failure. In this trial, we compared the new ACE inhibitor, lisinopril, to captopril during a 12-week randomized double-blind study. One hundred twenty-nine patients with New York Heart Association class II, III, or IV congestive heart failure were randomized to receive either lisinopril 5 mg/day (n = 64) or captopril 37.5 mg/day (n = 65) in 15 centers. Drug doses could be titrated upwards every 4 weeks. The primary measure of drug efficacy was improvement in treadmill exercise time using a modified Naughton protocol. Secondary measures of efficacy and the development of adverse effects were also examined. Lisinopril improved exercise time (following 12 weeks of therapy) more than captopril [from 500 +/- 30 to 682 +/- 34 sec (mean +/- SEM) with lisinopril versus 480 +/- 26 to 600 +/- 35 sec with captopril; difference between groups, p less than 0.05]. Adverse drug effects were unusual and similar in frequency in the two groups, although an increase in blood urea nitrogen was more common with lisinopril than with captopril (p less than 0.05). These results indicate that using the doses and treatment regimens studied, lisinopril is more effective than captopril for the treatment of symptomatic congestive heart failure. Adverse experiences with lisinopril were infrequent and similar in incidence to those observed with captopril.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1989

Pathophysiologic and prognostic considerations in circulatory insufficiency in congestive heart failure: receptor function.

We measured plasma concentrations of norepinephrine, cyclic AMP, cyclic GMP, atrial natriuretic peptides (ANP) and beta-adrenoceptor density (Bmax) and affinity (Kd) of lymphocytes in patients with congestive heart failure and correlated these parameters with symptoms and hemodynamic indices. Plasma concentration of norepinephrine, cyclic AMP, cyclic GMP and ANP significantly increased in patients with congestive heart failure. Plasma concentrations of norepinephrine were related to the severity of the heart failure, plasma cyclic AMP concentrations, and pulmonary artery pressures. Cyclic AMP concentrations fell rapidly after treatment of acute left ventricular failure. Peripheral blood lymphocytes were stimulated by isoproterenol, and cyclic AMP level in lymphocytes was assayed. In normal subjects the generation of cyclic AMP after stimulation decreased with age. The response of lymphocytes in patients of NYHA classes III and IV was significantly lower than in the normal age-matched controls. A significant correlation between plasma norepinephrine concentration and increase of lymphocyte cyclic AMP was demonstrated. From these results it was suggested that beta-adrenergic receptors in congestive heart failure were desensitized. Beta receptor numbers of lymphocytes significantly decreased in NYHA class III and IV, but did not decrease in class I and II. There was no significant difference in Kd associated with congestive heart failure. Plasma concentrations of cyclic GMP also depended on the severity of heart failure and the pulmonary artery pressure, and decreased sharply with treatment, although remaining at a high value. A significant correlation between the cyclic GMP and ANP concentration was found in patients with congestive heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group.

CONTEXT: Results from recent studies on the effects of beta1-blockade in patients with heart failure demonstrated a 34% reduction in total mortality. However, the effect of beta1-blockade on the frequency of hospitalizations, symptoms, and quality of life in patients with heart failure has not been fully explored. OBJECTIVE: To examine the effects of the beta1-blocker controlled-release/extended-release metoprolol succinate (metoprolol CR/XL) on mortality, hospitalization, symptoms, and quality of life in patients with heart failure. DESIGN: Randomized, double-blind controlled trial, preceded by a 2-week single-blind placebo run-in period, conducted from February 14, 1997, to October 31, 1998, with a mean follow-up of 1 year. SETTING: Three hundred thirteen sites in 14 countries. PARTICIPANTS: Patients (n = 3991) with chronic heart failure, New York Heart Association (NYHA) functional class II to IV, and ejection fraction of 0.40 or less who were stabilized with optimum standard therapy. INTERVENTIONS: Patients were randomized to metoprolol CR/XL, 25 mg once per day (NYHA class II), or 12.5 mg once per day (NYHA class III or IV), titrated for 6 to 8 weeks up to a target dosage of 200 mg once per day (n = 1990); or matching placebo (n = 2001). MAIN OUTCOME MEASURES: Total mortality or any hospitalization (time to first event), number of hospitalizations for worsening heart failure, and change in NYHA class, by intervention group; quality of life was assessed in a substudy of 741 patients. RESULTS: The incidence of all predefined end points was lower in the metoprolol CR/XL group than in the placebo group, including total mortality or all-cause hospitalizations (the prespecified second primary end point; 641 vs 767 events; risk reduction, 19%; 95% confidence interval [CI], 10%-27%; P<.001); total mortality or hospitalizations due to worsening heart failure (311 vs 439 events; risk reduction, 31%; 95% CI, 20%-40%; P<.001), number of hospitalizations due to worsening heart failure (317 vs 451; P<.001); and number of days in hospital due to worsening heart failure (3401 vs 5303 days; P<.001). NYHA functional class, assessed by physicians, and McMaster Overall Treatment Evaluation score, assessed by patients, both improved in the metoprolol CR/XL group compared with the placebo group (P = .003 and P = .009, respectively). CONCLUSIONS: In this study of patients with symptomatic heartfailure, metoprolol CR/XL improved survival, reduced the need for hospitalizations due to worsening heart failure, improved NYHA functional class, and had beneficial effects on patient well-being.

Adrenergic beta-Antagonists↗
PubMed2000

Doppler-derived dP/dt and -dP/dt predict survival in congestive heart failure.

OBJECTIVES: The purpose of this study was to evaluate the ability of novel Doppler indices of left ventricular (LV) systolic and diastolic function to predict survival in patients with congestive heart failure (CHF). BACKGROUND: Congestive heart failure is associated with an increased risk of death or cardiac transplantation, yet techniques to predict survival are limited. METHODS: Doppler-derived dP/dt and - dP/dt were determined prospectively from the continuous-wave Doppler spectrum of the mitral regurgitation jet (dP/dt = 32/time between 1 and 3 m/s; -dP/dt = 32/time between 3 and 1 m/s) in 56 patients with chronic CHF (age, 60 +/- 15 years; LV ejection fraction, 23 +/- 9%). Baseline clinical and echocardiographic variables were also obtained, and clinical follow-up was performed in all patients. RESULTS: Twenty-four patients experienced a primary event of cardiac death (n = 15), United Network for Organ Sharing status I (inotrope-dependent) heart transplant (n = 3) or urgent implantation of a LV assist device (n = 6). Doppler-derived dP/dt (dichotomized to > or = or <600 mm Hg/s; p = 0.0002) and -dP/dt (trichotomized to <450, 450 to 550 and >550 mm Hg/s; p = 0.0001) predicted event-free survival, as did Doppler-derived risk groups determined by the combination of the two (low risk, dP/dt > or = 600; intermediate risk, dP/dt < 600 and -dP/dt > or = 450; high risk, dP/dt < 600 and -dP/dt < 450; p = 0.0001). Multivariable analysis revealed Doppler-derived risk groups, intravenous inotrope requirement and blood urea nitrogen as significant independent predictors of outcome. CONCLUSION: New Doppler indices of dP/dt, - dP/dt and risk groups defined by the combination of dP/dt and -dP/dt predict event-free survival in patients with CHF.

Adult↗