scholarly journals The Diagnostic and Therapeutic Value of Multimarker Analysis in Heart Failure. An Approach to Biomarker-Targeted Therapy

2020 ◽  
Vol 7 ◽  
Author(s):  
Albert Topf ◽  
Moritz Mirna ◽  
Bernhard Ohnewein ◽  
Peter Jirak ◽  
Kristen Kopp ◽  
...  
Keyword(s):  
Heart Failure ◽  
Morbidity And Mortality ◽  
Therapeutic Interventions ◽  
Stress Axis ◽  
High Morbidity ◽  
Matrix Remodeling ◽  
Therapeutic Approaches ◽  
Therapeutic Setting ◽  
Therapeutic Value

Background: Heart failure is a pathophysiological state, which is still associated with high morbidity and mortality despite established therapies. Diverse well-known biomarkers fail to assess the variety of individual pathophysiology in the context of heart failure.Methods: An analysis of prospective, multimarker-specific therapeutic approaches to heart failure based on studies in current literature was performed. A total of 159 screened publications in the field of biomarkers in heart failure were hand-selected and found to be eligible for this study by a team of experts.Results: Established biomarkers of the inflammatory axis, matrix remodeling, fibrosis and oxidative stress axis, as well as potential therapeutic interventions were investigated. Interaction with end organs, such as cardio-hepatic, cardio-renal and cardio-gastrointestinal interactions show the complexity of the syndrome and could be of further therapeutic value. MicroRNAs are involved in a wide variety of physiologic and pathophysiologic processes in heart failure and could be useful in diagnostic as well as therapeutic setting.Conclusion: Based on our analysis by a biomarker-driven approach in heart failure therapy, patients could be treated more specifically in long term with a consideration of different aspects of heart failure. New studies evaluating a multimarker – based therapeutic approach could lead in a decrease in the morbidity and mortality of heart failure patients.

scholarly journals Creatinine Levels at Admission as Predictors of In-Hospital Major Adverse Cardiovascular Events in Acute Heart Failure Patient

2020 ◽  
Vol 6 (1) ◽  
pp. 16-22
Author(s):  
Farida Hanum Margolang ◽  
Refli Hasan ◽  
Abdul Halim Raynaldo ◽  
Harris Hasan ◽  
Ali Nafiah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Roc Curve ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
High Morbidity ◽  
Roc Curve Analysis ◽  
Heart Failure Patients ◽  
Long Term Prognosis

Background: Acute heart failure is a global health problem with high morbidity and mortality. Short term and long term prognosis of these patients is poor. Therefore, early identification of patients at high risk for major adverse cardiovascular events (MACEs) during hospitalization was needed to improve outcome. Creatinine levels at admission could be used as predictors of major adverse cardiovascular events in acute heart failure patients because creatinine is a simple and routine biomarker of renal function examined in patients with acute heart failure. This study aimed to determine whether creatinine can be used as a predictor of major adverse adverse cardiovascular events in patients with acute heart failure.Methods: This study is a prospective cohort study of 108 acute heart failure patients treated at H. Adam Malik Hospital from July 2018 to January 2019. Creatinine cut-off points were determined using the ROC curve, then bivariate and multivariate analyzes were performed to determine predictors of major adverse cardiovascular events during hospitalization.Results: From 108 study subjects, 24 (22.2%) subjects experienced major adverse cardiovascular events during hospitalization. The subjects who died were 20 people (83.4%), subjects with arrhythmia were 2 people (8.3%), and those who had stroke were 2 people (8.3 %). Through the ROC curve analysis, we found creatinine cut-off values of ≥1.7 mg / dl (AUC 0.899, 95% CI 0.840- 0.957, p <0.05). Creatinine ≥1.7 mg/dl could predict major adverse cardiovascular events with a sensitivity of 87.5% and specificity of 79.5%. Multivariate analysis showed that creatinine ≥1.7 mg / dl was an independent factor to predict MACEs during hospitalization in this study (OR 18,310, p 0.001) as well as creatinine clearance and heart rate.Conclusion: Creatinine levels at admission is an independent predictor for major adverse cardiovascular events during hospitalization in acute heart failure patients.

scholarly journals Health-related quality of life and long-term morbidity and mortality in patients hospitalised with systolic heart failure

2014 ◽  
Vol 3 ◽  
pp. 204800401454873 ◽  
Author(s):  
Jenny Berg ◽  
Peter Lindgren ◽  
Thomas Kahan ◽  
Owe Schill ◽  
Hans Persson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Systolic Heart Failure ◽  
Morbidity And Mortality ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

scholarly journals Cardiovascular and Metabolic Consequences of Liver Transplantation: A Review

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 489
Author(s):  
Plotogea ◽  
Ilie ◽  
Sandru ◽  
Chiotoroiu ◽  
Bratu ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Liver Transplantation ◽  
De Novo ◽  
Current Knowledge ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Term Survival ◽  
The Metabolic Syndrome ◽  
Acute Liver Disease

Liver transplantation (LT) is considered the curative treatment option for selected patients who suffer from end-stage or acute liver disease or hepatic malignancy (primary). After LT, patients should be carefully monitored for complications that may appear, partially due to immunosuppressive therapy, but not entirely. Cardiovascular diseases are frequently encountered in patients with LT, being responsible for high morbidity and mortality. Patients with underlying cardiovascular and metabolic pathologies are prone to complications after the transplant, but these complications can also appear de novo, mostly associated with immunosuppressants. Metabolic syndrome, defined by obesity, hypertension, dyslipidemia, and hyperglycemia, is diagnosed among LT recipients and is aggravated after LT, influencing the long-term survival. In this review, our purpose was to summarize the current knowledge regarding cardiovascular (CV) diseases and the metabolic syndrome associated with LT and to assess their impact on short and long-term morbidity and mortality.

Sex Therapy

1991 ◽  
Vol 19 (1) ◽  
pp. 131-136 ◽  
Author(s):  
Keith Hawton
Keyword(s):  
Cognitive Processes ◽  
Sex Therapy ◽  
Therapeutic Interventions ◽  
Long Term Results ◽  
Weekly Schedule ◽  
Therapeutic Approaches ◽  
New Therapeutic Approaches ◽  
Low Sexual Desire ◽  
Methods Of Treatment

The introduction of sex therapy two decades ago was accompanied by largely uncritical enthusiasm, with the result that too few careful evaluative studies were conducted. Those that were indicated that a weekly or twice weekly schedule of treatment sessions was best and that treatment by individual therapists was as effective as co-therapy. Some of the major prognostic factors and the long-term results of sex therapy have now been elucidated. Low sexual desire has emerged as a problem for which our now traditional methods of treatment are often inadequate and new therapeutic approaches are required. Current efforts to explore the beliefs and cognitive processes associated with erectile dysfunction are proving rewarding and are likely to enrich therapeutic interventions in the future. Attention should now be paid to the beliefs and cognitions associated with other sexual dysfunctions, both male and female.

Morbidity and Mortality of C2 Fractures in the Elderly

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1055-1059 ◽  
Author(s):  
Yi-Ren Chen ◽  
Maxwell Boakye ◽  
Robert T. Arrigo ◽  
Paul S. A. Kalanithi ◽  
Ivan Cheng ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
Treatment Modality ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Complication Rates ◽  
Term Survival ◽  
Cord Injury

Abstract BACKGROUND: Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients. OBJECTIVE: To compare outcomes for elderly patients with closed C2 fractures by treatment modality. METHODS: We retrospectively reviewed 28 surgically and 28 nonsurgically treated cases of closed C2 fractures without spinal cord injury in patients aged 65 years of age or older treated at Stanford Hospital between January 2000 and July 2010. Comorbidities, fracture characteristics, and treatment details were recorded; primary outcomes were 30-day mortality and complication rates; secondary outcomes were length of hospital stay and long-term survival. RESULTS: Surgically treated patients tended to have more severe fractures with larger displacement. Charlson comorbidity scores were similar in both groups. Thirty-day mortality was 3.6% in the surgical group and 7.1% in the nonsurgical group, and the 30-day complication rates were 17.9% and 25.0%, respectively; these differences were not statistically significant. Surgical patients had significantly longer lengths of hospital stay than nonsurgical patients (11.8 days vs 4.4 days). Long-term median survival was not significantly different between groups. CONCLUSION: The 30-day mortality and complication rates in surgically and nonsurgically treated patients were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone does not appear to be a contraindication to surgical fixation of C2 fractures.

Abstract 14489: Physician Perspectives on the Diagnosis and Management of Heart Failure With Preserved Ejection Fraction (HFpEF)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michelle Padarath ◽  
Daniel Ngui ◽  
Justin Ezekowitz ◽  
Michelle Padarath ◽  
Alan Bell
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Ejection Fraction ◽  
Primary Care Physicians ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Evidence Based ◽  
Preserved Ejection Fraction ◽  
Diagnosis And Management ◽  
Evidence Based Treatments

Introduction: Heart failure with preserved ejection fraction (HFpEF) carries high morbidity and mortality. Compared to heart failure with reduced ejection fraction (HFrEF), HFpEF is more difficult to diagnose and lacks in evidence-based treatments. We assessed the perceptions of CV specialists and primary care physicians (PCP) regarding HFpEF diagnosis and management. Methods: The online survey targeted 200 specialists and 200 (PCPs), offering a token honorarium. A total of 159 cardiologists (C), 59 internists (I), and 200 PCPs completed the survey. Results: All provinces were represented. The perceived prevalence of HFpEF vs HFrEF was similar across physician types (58% HFrEF, 42% HFpEF). Roughly 25% of PCPs did not differentiate between HF types. All physician types ranked symptom and mortality reduction as treatment priorities. The majority of specialists felt that HFpEF is best co-managed by primary and specialty care. One fifth of PCPs felt that HFpEF should be managed by primary care alone. Compared to specialists, PCPs were more likely to underestimate HFpEF mortality vs. HFrEF, less aware of gender differences, and less able to identify clinical findings of HFpEF vs. HFrEF. Fewer PCPs (33%) than specialists (50%) use natriuretic peptide (NP) levels for diagnosis, with PCPs expressing more uncertainty with NP utility. All physician types listed cost and limited availability as restrictions to use of NP testing. For evidence-based treatments in HF (ACEi/ARB, beta blockers, loop diuretics, mineralocorticoid receptor antagonists), >50% of PCPs incorrectly identified all agents as effective for HFpEF, with <10% stating that none improved outcomes. Cardiologists were more likely than internists to identify the lack of evidence-based treatments. Conclusions: This survey reveals substantial knowledge and treatment gaps in the diagnosis and management of HFpEF, specifically amongst PCPs. Given the prevalence of HFpEF in primary care, and its substantial morbidity and mortality, strategies are required to reduce these gaps. All physician types recognized the need for increased availability of NP testing for HFpEF diagnosis.

scholarly journals Heart Failure with Perserved Ejection Fraction Current Diagnostic and Therapeutic Approaches

2021 ◽  
Vol 17 (3) ◽  
pp. 476-483
Author(s):  
A. A. Shchendrygina ◽  
K. A. Zhbanov ◽  
E. V. Privalova ◽  
A. O. Yusupova ◽  
Yu. A. Danilogorskaya ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
High Morbidity ◽  
Therapeutic Approaches ◽  
Diagnostic Score ◽  
Diagnostic Approaches ◽  
Randomized Control ◽  
Underlying Mechanisms ◽  
Phase Ii And Iii ◽  
Score Systems

Heart failure with preserved ejection fraction (HFpEF) is a syndrome associated with high morbidity and mortality rates. Little progress has been in the treatment of this condition since its introduction some 30 years ago. It's accepted that HFpEF is heterogeneous in many ways, ethologically and phenotypically. The underlying mechanisms of the syndrome are not clear. Recently, it has been shown that the diagnostic criteria for HFpEF lacks sensitivity and specificity. Novel treatment approaches, which were developed based on current HFpEF pathophysiological concepts, did not show either clinical or prognostic benefit for patients. Therefore, there is an urgent need to revise current diagnostic approaches and to further investigate the underlying mechanisms. Recently, two novel diagnostic score systems were proposed: H2PEF and HFA-PEFF. Recently, a number of phase II and III randomized control trials have been completed. Here, the authors discuss the potential novel diagnostic approaches to HFpEF and treatment perspectives.

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