scholarly journals Erythropoietin: a new perspective in cardiovascular therapy

2016 ◽  
Vol 70 (4) ◽  
Author(s):  
Riccardo Raddino ◽  
Debora Robba ◽  
Giorgio Caretta ◽  
Ivano Bonadei ◽  
Melissa Teli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Failure ◽  
Systolic Function ◽  
Cardiovascular Pathology ◽  
Beneficial Effects ◽  
Therapeutic Benefits ◽  
Cardiovascular Therapy ◽  
New Perspective ◽  
Anaemia Correction ◽  
Cardiac Systolic Function

Erythropoietin is a hormone produced by the kidney, which regulates proliferation, differentiation and maturation of red cells. Recombinant human EPO (rH-EPO) is well known to correct anaemia in patients with chronic renal failure in terminal stage. However, recent studies showed the existence of several not haematopoietic effects of erythropoietin. EPO receptors have been found to be expressed in several tissues, included the cardiovascular system. An increase in cardiac systolic function has been observed in patients with chronic heart failure treated with EPO. Other beneficial effects appear to be related to the pro-angiogenic properties on endothelial cells and could be useful for treatment of ischemic heart disease. These findings suggest that EPO could provide potential therapeutic benefits in the management of cardiovascular diseases beyond anaemia correction. This review focuses its attention on the pleiotropic effects of EPO and its future promising applications in cardiovascular pathology.

scholarly journals Exercise intolerance in volume overload heart failure is associated with low carotid body mediated chemoreflex drive

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
David C. Andrade ◽  
Esteban Díaz-Jara ◽  
Camilo Toledo ◽  
Karla G. Schwarz ◽  
Katherin V. Pereyra ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Function ◽  
Training Program ◽  
Carotid Body ◽  
Exercise Tolerance ◽  
Systolic Function ◽  
Volume Overload ◽  
Exercise Intolerance ◽  
Ventilatory Responses ◽  
Cardiac Systolic Function

AbstractMounting an appropriate ventilatory response to exercise is crucial to meeting metabolic demands, and abnormal ventilatory responses may contribute to exercise-intolerance (EX-inT) in heart failure (HF) patients. We sought to determine if abnormal ventilatory chemoreflex control contributes to EX-inT in volume-overload HF rats. Cardiac function, hypercapnic (HCVR) and hypoxic (HVR) ventilatory responses, and exercise tolerance were assessed at the end of a 6 week exercise training program. At the conclusion of the training program, exercise tolerant HF rats (HF + EX-T) exhibited improvements in cardiac systolic function and reductions in HCVR, sympathetic tone, and arrhythmias. In contrast, HF rats that were exercise intolerant (HF + EX-inT) exhibited worse diastolic dysfunction, and showed no improvements in cardiac systolic function, HCVR, sympathetic tone, or arrhythmias at the conclusion of the training program. In addition, HF + EX-inT rats had impaired HVR which was associated with increased arrhythmia susceptibility and mortality during hypoxic challenges (~ 60% survival). Finally, we observed that exercise tolerance in HF rats was related to carotid body (CB) function as CB ablation resulted in impaired exercise capacity in HF + EX-T rats. Our results indicate that: (i) exercise may have detrimental effects on cardiac function in HF-EX-inT, and (ii) loss of CB chemoreflex sensitivity contributes to EX-inT in HF.

scholarly journals Antiarrhythmic Properties of Phenytoin

2021 ◽  
Author(s):  
Ehsan Mahmoodi ◽  
Stephen Brienesse ◽  
Andrew Boyle ◽  
Derek Laver ◽  
Nicholas Jackson
Keyword(s):  
Heart Failure ◽  
English Language ◽  
Systolic Function ◽  
Ryanodine Receptors ◽  
Cochrane Library ◽  
Premature Ventricular Contractions ◽  
Digitalis Toxicity ◽  
Full Text Review ◽  
Cardiac Systolic Function ◽  
Antiarrhythmic Effects

Abstract BACKGROUND: Phenytoin has long been used to treat epilepsy and for some time as an antiarrhythmic drug (AAD). It is known that the diastolic calcium leakage through dysfunctional cardiac ryanodine receptors (RyR2) is a mechanism for arrhythmias in heart failure. Recent evidence suggests that phenytoin inhibits dysfunctional RyR2, reduces the calcium leak during diastole in heart failure, and may improve cardiac systolic function. This indicates the potential for repurposing phenytoin as an AAD in patients with heart failure.METHODS: A systematic search of MEDLINE, Embase, and the Cochrane Library databases was performed in March 2019. The search was limited to the studies published in the English language from 1946 to 2019. Studies on the antiarrhythmic effects of phenytoin in adults compared to no treatment or other AADs were included. Studies were excluded if there was insufficient clinical data regarding antiarrhythmic effects, dosing and administration of phenytoin and other ADDs. Conference abstracts, editorials, case studies and review articles were also excluded. RESULTS: A total of 157 non-duplicate titles were screened, and 25 articles underwent full-text review. 13 studies met the inclusion criteria, representing a total of 985 patients. Phenytoin was found to be effective in treating arrhythmias associated with digitalis toxicity, and in suppressing premature ventricular contractions (PVCs). In a recent animal study, phenytoin inhibited diastolic calcium leak through dysfunctional RyR2 in failing sheep hearts and improved cardiac systolic function without affecting normal functional RyR2.CONCLUSION: Phenytoin has an acceptable safety profile when used as an AAD. It has some utility in treating digitalis-induced arrhythmias and suppressing PVCs, however, further study is needed to determine its efficacy as an antiarrhythmic in heart failure patients given new evidence of its RyR2 stabilising properties.TRIAL REGISTRATION NUMBER: PROSPERO database (CRD42019129125).

Potential Therapeutic Benefits of Sodium-Glucose Cotransporter 2 Inhibitors in the Context of Ischemic Heart Failure: A State-Of-The-Art Review

2021 ◽  
Vol 19 ◽  
Author(s):  
Mauro Gitto ◽  
Dimitrios A. Vrachatis ◽  
Gianluigi Condorelli ◽  
Konstantinos Papathanasiou ◽  
Bernhard Reimers ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Function ◽  
Coronary Revascularization ◽  
Deep Understanding ◽  
Active Role ◽  
Left Ventricular ◽  
Sglt2 Inhibitors ◽  
Reduced Ejection Fraction ◽  
Therapeutic Benefits ◽  
Sodium Glucose Cotransporter

: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a class of anti-diabetic agents that block the reabsorption of glucose in the proximal convoluted tubule of the nephron, thereby contributing to glycosuria and lowering blood glucose levels. SGLT2 inhibitors have been associated with improved cardiovascular outcomes in patients with diabetes, including a reduced risk of cardiovascular death and hospitalizations for heart failure. Recently, DAPA-HF and EMPEROR REDUCED trials showed the beneficial cardiovascular effect of SGLT2 inhibitors in patients with heart failure with consistently reduced ejection fraction (HFrEF) regardless of the presence of diabetes. Moreover, some exploratory studies suggested that these drugs improve Left Ventricular (LV) systolic function and oppose LV adverse remodeling in patients with HFrEF. However, the exact mechanisms that mediated for this benefit are not fully understood. Beyond glycemic control, enhanced natriuresis, increased erythropoiesis, improved endothelial function, changes in myocardial metabolism, anti-inflammatory and anti-oxidative properties may all play an active role in SGLT2 inhibitors’ cardiovascular benefits. A deep understanding of the pathophysiological interplay is key to define which HF phenotype could benefit more from SGLT2 inhibitors. Current clinical evidence on the comparison of different HF etiologies is limited to posthoc subgroup analysis of DAPA-HF and EMPEROR-REDUCED, which showed similar outcomes in patients with or without ischemic HF. On the other hand, in earlier studies of patients suffering from diabetes, rates of classic ischemic endpoints, such as myocardial infarction, stroke or coronary revascularization, did not differ between patients treated with SGLT2 inhibitors or placebo. The aim of this review is to discuss whether SGLT2 inhibitors may improve prognosis in patients with ischemic HF, not only in terms of reducing re-hospitalizations and improving left ventricular function but also by limiting coronary artery disease progression and ischemic burden.

scholarly journals Index of microcirculatory resistance predicts long term cardiac systolic function in patients with STEMI undergoing primary PCI

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yu Qi ◽  
Rong Gu ◽  
Jiamin Xu ◽  
Lina Kang ◽  
Yihai Liu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Systolic Function ◽  
Anterior Wall ◽  
Left Ventricular Ejection ◽  
Primary Pci ◽  
St Segment ◽  
Index Of Microcirculatory Resistance ◽  
Cardiac Systolic Function

Abstract Background To evaluate the predictive value of the index of microcirculatory resistance (IMR) for long-term cardiac systolic function after primary percutaneous coronary intervention (pPCI) in patients with acute anterior wall ST-segment elevation myocardial infarction (STEMI). Methods A total of 53 acute anterior wall STEMI patients were included and followed up within 1-year. IMR was measured to evaluate the immediate intraoperative reperfusion. IMR > 40 U was defined as the high IMR group and ≤ 40 U was defined as the low IMR group. Left ventricular ejection fraction (LVEF) was measured by echocardiography at 24 h, 1 month, 3 months, and 1 year after PCI to analyze the correlation between IMR and cardiac systolic function. Heart failure was estimated according to classification within one year. Results The ratio of TMPG (TIMI myocardial perfusion grade) 3 (85.7% vs. 52%, p = 0.015) and STR (ST-segment resolution) > 70% (82.1% vs. 48%, p = 0.019) were significantly higher in the low IMR group. The LVEF in the low IMR group was significantly higher than that in the high IMR group at 3 months (43.06 ± 2.63% vs. 40.20 ± 2.67%, p < 0.001) and 1 year (44.16 ± 2.40% vs. 40.13 ± 3.48%, p < 0.001). IMR was negatively correlated with LVEF at 3 months (r = − 0.1014, p = 0.0040) and 1 year (r = − 0.1754, p < 0.0001). Conclusions The IMR showed significant negative correlation with the LVEF value after primary PCI. The high IMR is a strong predictor of heart failure within 1 year after anterior myocardial infarction.

Diuretics

1992 ◽  
Vol 3 (2) ◽  
pp. 472-482
Author(s):  
Kenneth A. Kellick
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Renal Failure ◽  
Diuretic Therapy ◽  
Nutrient Interactions ◽  
Nursing Assessment ◽  
Beneficial Effects ◽  
Patient Teaching ◽  
Treatment Of Hypertension ◽  
Major Drug

Diuretics are the mainstay of therapies for many diseases, including hypertension congestive heart failure. While their use can be beneficial, many side effects and interactions are attributed to diuretic therapy. This chapter reviews the mechanism of action for the various diuretics and elucidates differences between classes. Major drug-drug and drug-nutrient interactions are examined with information on intervention and patient teaching. Several therapeutic dilemmas in the treatment of hypertension, renal failure, congestive heart failure, and pulmonary edemas are reviewed. With proper nursing assessment and intervention, the diuretics can have beneficial effects in hypertension therapies and the treatment of edema and cause a minimum of adverse drug experiences

Exercise training improves the net balance of cardiac Ca2+ handling protein expression in heart failure

2007 ◽  
Vol 29 (3) ◽  
pp. 246-252 ◽  
Author(s):  
Natale P. L. Rolim ◽  
Alessandra Medeiros ◽  
Kaleizu T. Rosa ◽  
Katt C. Mattos ◽  
Maria C. Irigoyen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Training ◽  
Cardiac Myocyte ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Exercise Intolerance ◽  
Computer Assisted ◽  
Wild Type ◽  
Beneficial Effects ◽  
Ventricular Fibrosis

The molecular basis of the beneficial effects associated with exercise training (ET) on overall ventricular function (VF) in heart failure (HF) remains unclear. We investigated potential Ca2+ handling abnormalities and whether ET would improve VF of mice lacking α2A- and α2C-adrenoceptors (α2A/α2CARKO) that have sympathetic hyperactivity-induced HF. A cohort of male wild-type (WT) and congenic α2A/α2CARKO mice in a C57BL/J genetic background (5–7 mo of age) was randomly assigned into untrained and trained groups. VF was assessed by two-dimensional guided M-mode echocardiography. Cardiac myocyte width and ventricular fibrosis were evaluated with a computer-assisted morphometric system. Sarcoplasmic reticulum Ca2+ ATPase (SERCA2), phospholamban (PLN), phospho-Ser16-PLN, phospho-Thr17-PLN, phosphatase 1 (PP1), and Na+-Ca2+ exchanger (NCX) were analyzed by Western blotting. ET consisted of 8-wk running sessions of 60 min, 5 days/wk. α2A/α2CARKO mice displayed exercise intolerance, systolic dysfunction, increased cardiac myocyte width, and ventricular fibrosis paralleled by decreased SERCA2 and increased NCX expression levels. ET in α2A/α2CARKO mice improved exercise tolerance and systolic function. ET slightly reduced cardiac myocyte width, but unchanged ventricular fibrosis in α2A/α2CARKO mice. ET significantly increased the expression of SERCA2 (20%) and phospho-Ser16-PLN (63%), phospho-Thr17-PLN (211%) in α2A/α2CARKO mice. Furthermore, ET restored NCX and PP1 expression in α2A/α2CARKO to untrained WT mice levels. Thus, we provide evidence that Ca2+ handling is impaired in this HF model and that overall VF improved upon ET, which was associated to changes in the net balance of cardiac Ca2+ handling proteins.

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