International journal of cardiology
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Heart failure affects 1-2% of the Canadian population. The 1-year mortality rates in New York Heart Association Class III/IV heart failure patients range from 11 to 44%. This study evaluates costs associated with current management of Class III/IV heart failure and potential savings if morbidity and mortality are reduced. ⋯ The high level of morbidity and mortality in Class III/IV heart failure patients and costs associated with their care are an impetus for the development of new therapies such as cardiac resynchronization therapy, that could deliver long-term benefits including increased exercise tolerance, reduced hospitalizations, and improved quality of life. Successful therapies could provide substantial savings and present a favorable economic profile in the treatment of heart failure. In order to ensure that appropriate technologies are commercialized and marketed, prospective evaluation of new therapies should include critical assessment of direct medical costs in addition to evaluating morbidity, quality of life and survival.
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Dobutamine-inducible left ventricular obstruction lacks a sound clinical meaning. This phenomenon may be related to an abnormal response of the heart to the sympathetic stimulation, and head-up tilt would elicit intraventricular obstruction in patients known to develop it during dobutamine administration, through the synergistic effects of reduced preload, hypercontractility, and reflex increase in the cardiac sympathetic tone. ⋯ Reflex cardiovascular adaptive responses as those elicited by passive tilt are not involved in dynamic intraventricular obstruction in dobutamine-inducible obstruction patients, data indicating that left ventricular geometry and hypercontractility are not sufficient pathophysiological determinants.
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Proinflammatory cytokines such as tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-6, and IL-8 have been implicated in myocardial injury following cardiopulmonary bypass (CPB). However, little evidence is currently available to directly confirm such a relationship. We have previously documented that a newly discovered 'four and a half LIM-only protein 2' (FHL2) is exclusively expressed in myofibres. We hypothesized that the upregulation of FHL2 is proportional to the degree of myocardial injury and investigated the myocardial expression of FHL2 together with these cytokine messenger RNAs (mRNAs) during clinical CPB. ⋯ Our findings demonstrate for the first time that both IL-6 and IL-8 mRNAs are upregulated in human cardiac myocytes following CPB and these cytokines may be involved in myocardial ischemia-reperfusion injury, as reflected by their association with an increased expression of FHL2.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Safety and efficacy of valsartan versus enalapril in heart failure patients.
Although a cornerstone in the treatment of heart failure, angiotensin-converting enzyme inhibitors are under-used, partly due to side effects. If proven at least similarly efficacious to angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers may replace them due to their superior tolerability. We aimed to compare the efficacy and safety of valsartan and enalapril in heart failure patients stabilised on an angiotensin-converting enzyme inhibitor. ⋯ Left ventricular size (P<0.001) and function (P=0.048) improved significantly only in the valsartan group. Fewer patients experienced adverse events in the valsartan group (50%) than in the enalapril group (63%), although statistically non-significant. Valsartan is similarly efficacious and safe to enalapril in patients with stable, mild/moderate heart failure, previously stabilised on an angiotensin-converting enzyme inhibitor and directly switched to study medication.