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Invasive hemodynamic assessment in heart failure.

Heart Fail Clin. 2009 Apr;5(2):217-28

Authors: Borlaug BA, Kass DA

Routine cardiac catheterization provides data on left heart, right heart, systemic and pulmonary arterial pressures, vascular resistances, cardiac output, and ejection fraction. These data are often then applied as markers of cardiac preload, afterload, and global function, although each of these parameters reflects more complex interactions between the heart and its internal and external loads. This article reviews more specific gold standard assessments of ventricular and arterial properties, and how these relate to the parameters reported and utilized in practice, and then discusses the re-emerging importance of invasive hemodynamics in the assessment and management of heart failure.

PMID: 19249690 [PubMed - indexed for MEDLINE]

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The role of echocardiography in hemodynamic assessment in heart failure.

Heart Fail Clin. 2009 Apr;5(2):191-208

Authors: Abraham J, Abraham TP

Echocardiography now is recommended as the most useful diagnostic test for routine evaluation and management of heart failure. This article reviews the role of echocardiography (M-mode, two-dimensional, spectral, and tissue Doppler) for qualitative and quantitative hemodynamic assessment of the patient who has heart failure. It highlights the echocardiographic parameters that have the most diagnostic and/or prognostic relevance for patients who have advanced heart failure. The importance of right heart failure and heart failure with preserved ejection fraction is increasingly recognized, and therefore the echocardiographic evaluation of these conditions is emphasized also.

PMID: 19249688 [PubMed - indexed for MEDLINE]

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Usefulness of B-type natriuretic peptide levels in predicting hemodynamic and clinical decompensation.

Heart Fail Clin. 2009 Apr;5(2):169-75

Authors: Taub PR, Daniels LB, Maisel AS

Pulmonary congestion can be challenging to diagnose because of nonspecific symptoms and the blunt nature of physical examination and radiographic findings. Assessing for euvolemia following treatment of congestion also can be difficult but can improve both the inpatient and outpatient care of patients who have heart failure. Tools such as the natriuretic peptides are important adjuncts to the physical examination and chest radiographs and often obviate the need for invasive hemodynamic assessment.

PMID: 19249686 [PubMed - indexed for MEDLINE]

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Special cases in acute heart failure syndromes: atrial fibrillation and wide complex tachycardia.

Heart Fail Clin. 2009 Jan;5(1):113-23, vii-viii

Authors: Pang PS, Gheorghiade M

Hospitalization for acute heart failure syndromes (AHFS) results in substantial in-hospital and postdischarge morbidity and mortality. Management of AHFS presents significant challenges, given the heterogeneity of the patient population and the differing etiologies underlying why patients present with acute decompensation. Arrhythmias in the setting of AHFS, such as atrial fibrillation and wide complex tachycardia, present additional challenges. Compounding this challenge is the paucity of evidence on which to base early management. General principles for the management of atrial fibrillation and wide complex tachycardia in the setting of emergency department AHFS are discussed.

PMID: 19026391 [PubMed - indexed for MEDLINE]

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Pathophysiology of acute decompensated heart failure.

Heart Fail Clin. 2009 Jan;5(1):9-17, v

Authors: Summers RL, Amsterdam E

This article provides a comprehensive review of acute decompensated heart failure (ADHF). It begins with a historical review, defines ADHF, and describes the many factors that may precipitate it.

PMID: 19026381 [PubMed - indexed for MEDLINE]

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Diagnosis of heart failure.

Heart Fail Clin. 2009 Jan;5(1):25-35, vi

Authors: Chang AM, Maisel AS, Hollander JE

The approach to the diagnosis of heart failure is complex, but the diagnostic armamentarium has increased significantly in the past decade. Diagnostic markers such as B-type natriuretic peptide and NT pro-B-type natriuretic peptide have proven value for the diagnosis of heart failure over and above the traditional tools that included only the history, physical examination, and chest radiography. Invasive and noninvasive impedance cardiography can be used to diagnose or even predict development of heart failure, but its role in clinical practice still needs to be better defined.

PMID: 19026383 [PubMed - indexed for MEDLINE]

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Emergency department stabilization of heart failure.

Heart Fail Clin. 2009 Jan;5(1):37-42, vi

Authors: Jois-Bilowich P, Diercks D

Optimizing heart failure management begins in the emergency department. Prompt recognition and treatment of underlying pathophysiology can improve patient outcomes. A review of therapeutic options is provided, with the goal of providing best practices in patient care.

PMID: 19026384 [PubMed - indexed for MEDLINE]

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Changes in kidney function following heart failure treatment: focus on renin-angiotensin system blockade.

Heart Fail Clin. 2008 Oct;4(4):425-38

Authors: Blankstein R, Bakris GL

This article begins with a brief overview of the therapeutic agents used in the treatment of heart failure, with a special emphasis on pharmacologic agents that block the renin-angiotensin system (RAS). The discussion then builds upon the basic pathophysiology concepts introduced earlier in this issue to explain how therapies commonly used in heart failure affect kidney function. Against this background, a few of the common clinical dilemmas that clinicians often encounter when treating patients with agents that block the RAS system are discussed.

PMID: 18760754 [PubMed - indexed for MEDLINE]

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B-type natriuretic peptide: beyond a diagnostic.

Heart Fail Clin. 2008 Oct;4(4):449-54

Authors: Martin FL, Chen HH, Cataliotti A, Burnett JC

The concept of the heart as an endocrine organ has been attractive since the discovery of atrial natriuretic peptide. This review focuses on the second discovered natriuretic peptide from the heart – B-type natriuretic peptide (BNP), widely used as a tool in the diagnosis of heart failure (HF). Controversy remains regarding its use as a therapeutic agent in HF. This article places into perspective some of the debate and provides insights into the therapeutics of BNP and the importance of its second messenger 3’5′ cyclic guanosine monophosphate, which also is the second messenger for nitric oxide and is modulated by renal phosphodiesterases.

PMID: 18760756 [PubMed - indexed for MEDLINE]

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Management of heart failure with renal artery ischemia.

Heart Fail Clin. 2008 Oct;4(4):465-78

Authors: Rao MV, Murray P, Yancy CW

With improved treatment, patients are surviving longer with impaired ventricular function. Hypertension results in ventricular remodeling in many patients. More than 5 million people have heart failure and are likely to have one or more co-existent diseases associated with aging, one of which is chronic kidney disease (CKD). Renal artery stenosis is fraught with varying opinions. Nephrologists, cardiologists, and interventional radiologists all manage these diseases with different strategies. This article outlines renovascular disease as it relates to CKD, the pathophysiology of development of renovascular disease and effects leading to congestive heart failure, treatment modalities, and outcomes of treatment regimens.

PMID: 18760758 [PubMed - indexed for MEDLINE]

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Ultrafiltration for volume control in decompensated heart failure.

Heart Fail Clin. 2008 Oct;4(4):519-34

Authors: Haas GJ, Pestritto VM, Abraham WT

Although ultrafiltration is currently reserved in most centers for the patient who has not responded to standard intravenous diuretic therapy with advanced congestion, its implementation earlier in the hospitalization may have definite advantages. This approach, however, will require further investigation with specific emphasis on safety and costs.

PMID: 18760762 [PubMed - indexed for MEDLINE]

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A new look at diastole.

Heart Fail Clin. 2008 Jul;4(3):347-60

Authors: Hoffman JI, Mahajan A, Coghlan C, Saleh S, Buckberg GD

The isovolumic period following systolic ejection is associated with untwisting of the apex that follows systolic torsion of the left ventricle, with simultaneous generation of negative pressures in the left ventricle. Previous studies have described this period as isovolumic relaxation, and have regarded the untwisting as entirely caused by restoring elastic forces. However, evidence from several sources indicates that some ventricular muscle is still contracting during this period, and that this muscle is subepicardial muscle or the ascending spiral segment of the ventricular myocardial band that extends from the apex up along the left ventricular epicardium and the right ventricular side of the septum to the root of the aorta. It is possible that diastolic dysfunction is due to defective incoordination of muscle contraction between the ascending and descending segments of this band rather than to defective passive restoring forces.

PMID: 18598986 [PubMed - indexed for MEDLINE]

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Heart failure with preserved ejection fraction: hypertension, diabetes, obesity/sleep apnea, and hypertrophic and infiltrative cardiomyopathy.

Heart Fail Clin. 2008 Jan;4(1):87-97

Authors: Desai A, Fang JC

The detailed pathophysiology of heart failure with preserved ejection fraction (HF-PEF) remains an area of active research and controversy; however, abnormalities of diastolic function are generally believed to play an important role. Most commonly, diastolic dysfunction occurs as a consequence of myocyte hypertrophy, endomyocardial fibrosis, and abnormalities of intracellular calcium handling that are related to normal myocardial aging and accelerated by comorbidities such as hypertension, diabetes, coronary artery disease, and obesity. In this article, three fundamental risk factors are considered for “secondary” diastolic dysfunction and HF-hypertension, diabetes, and obesity-with an emphasis on the clinical epidemiology, pathophysiologic mechanisms, and treatment implications of each. The article concludes with a brief discussion of “primary” diastolic HF due to infiltrative or restrictive cardiomyopathies.

PMID: 18313627 [PubMed - indexed for MEDLINE]

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