No abstract available.
Defibrillators* ; Heart Failure, Systolic* ; Humans

The prevalence of heart failure (HF) has been steadily increasing and it now creates an enormous social and economic burden. HF is a syndrome characterized by a high mortality rate, frequent hospitalization, a reduced quality of life, and a complex therapeutic regimen. In the last three decades, major progress in both the diagnosis and management of HF has taken place, and the pharmacologic and non-pharmacologic advances have led to a significant improvement in survival and symptoms in HF patients. After an accurate diagnosis, a proper HF management plan requires a multi-level team approach comprised of the correct combination of drug therapy, device therapy, and surgery, including heart transplantation. In this review, we focused on the pharmacologic and non-pharmacologic treatment strategies for HF with reduced ejection fraction. The goal was to develop treatment guidelines based on significant evidence derived from large clinical trials.
Diagnosis ; Drug Therapy ; Heart Failure* ; Heart Failure, Systolic ; Heart Transplantation ; Hospitalization ; Humans ; Mortality ; Prevalence ; Quality of Life

Bortezomib (Velcade(R)) came into the spotlight as a target therapy for multiple myeloma. It acts through reversible inhibition of intracellular proteasomes, which triggers apoptosis, with relative selectivity for malignant cells. It has been hypothesized that the accumulation of damaged proteins in myocytes impairs cardiac function. Cardiotoxicity is a rare side effect of bortezomib treatment. We report a case of reversible systolic heart failure that probably occurred after bortezomib treatment in a patient with multiple myeloma. Patients being treated with bortezomib who have previously had cardiac comorbidities should undergo routine cardiac monitoring.
Apoptosis ; Comorbidity ; Heart Failure* ; Heart Failure, Systolic ; Humans ; Multiple Myeloma* ; Muscle Cells ; Bortezomib

A left ventricular assist device (LVAD) is a mechanical circulation support implanted for patients with end-stage heart failure. It may be used either as a bridge to cardiac transplantation or as a destination therapy. The health of a 75-year-old man with a medical history of systolic heart failure worsened. Therefore, he was recommended to have implanted a LVAD (Thoratec Corp.) as a destination therapy. After the surgery, he was enrolled in patient cardiac rehabilitation for the improvement of dyspnea and exercise capacity. In results, there is an improvement on his exercise capacity and quality of life. For the first time in Korea, we reported a benefit of exercise therapy after being implanted with a LVAD.
Aged ; Dyspnea ; Exercise Therapy* ; Heart Failure ; Heart Failure, Systolic ; Heart Transplantation ; Heart-Assist Devices* ; Humans ; Korea ; Quality of Life ; Rehabilitation

BACKGROUNDStudies have shown that increased levels of serum uric acid (SUA) are associated with atrial fibrillation (AF). However, less is known about the prognostic value of SUA levels for AF in patients with chronic heart failure (CHF). The aim of the study was to examine the prognostic value of SUA levels for AF in patients with CHF.

METHODSSixteen thousand six hundred and eighty-one patients diagnosed with CHF from 12 hospitals were analyzed. Patients were categorized into AF group and non-AF group, death group, and survival group according to the results of the patients' medical records and follow-up. Univariate and multivariate Cox proportional hazards analyses were performed to examine the risk of AF. The sensitivity and specificity of SUA level in predicting the prognosis were examined by multivariate Cox models and receiver operating characteristic (ROC) curves.

RESULTSThe results of univariate predictors in overall patients showed that the higher SUA level was associated with AF. SUA level (HR, 1.084; 95%CI, 1.017 - 1.144; P < 0.001), diuretics (HR, 1.549; 95%CI, 1.246 - 1.854; P < 0.001), and New York Heart Association (NYHA) (HR, 1.237; 95%CI, 1.168 - 1.306; P < 0.001) function class were the independent risk factors for AF. The sensitivity and specificity of the models were 29.6% and 83.8% respectively for predicting AF. When SUA level was added to these models, it remained significant (Wald c(2), 1494.88; P < 0.001 for AF); 58.8% (95%CI, 57.7% - 60.0%) of the observed results were concordant with the separate model.

CONCLUSIONHigher SUA level is associated strongly with AF in patients with CHF. SUA level can increase the sensitivity and specificity in predicting AF.

Aged ; Atrial Fibrillation ; blood ; Female ; Heart Failure, Systolic ; blood ; Humans ; Male ; Middle Aged ; Uric Acid ; blood

BACKGROUND: Dyspnea is the subjective symptom that means breathing difficulty or discomfort. Clinical evaluation to etiology of dyspnea in elderly patient may be difficult because of underlying disease and physiological change. NT-pro BNP is noted that is good clinical marker to diagnose congestive heart failure and then evaluated clinical efficiency in elderly dyspnea patients. METHODS: Medical records, echocardiogram and laboratoty result including NT-pro BNP were analysed in elderly patients who were admitted due to dyspnea from January 2004 to July 2005 that were finally diagnosed as systolic or diastolic heart failure and exacerbation of chronic obstructive lung disease. RESULTS: The patents were divided into three groups; group 1(systolic heart failure), group 2(diastolic heart failure), group 3 (exacerbation of chronic obstructive lung disease). The mean age and study number were 78.5+/-7.7 yrs(group 1; 24), 79.0+/-8.0 yrs(group 2; 22), 73.8+/-6.7 yrs(group 3; 18). The ejection fraction and left atrial size of group 1, 2, 3 were 42.9+/-7.5%, 69.7+/-9.1%. 66.19.5%(p<0.001) and 4.2+/-0.9 cm, 4.6+/-1.0 cm, 3.7+/-0.7cm(p=0.005). The value of NT-pro BNP were 12912.0+/-13179.9 pg/mL(group 1), 2842.8+/-2014.8pg/mL(group 2) and 168.2+/-148.8pg/mL(group 3)(p<0.001). CONCLUSION: NT-pro BNP can be used to evaluate etiologic disease as systolic heart failure in elderly patients who complain dyspnea as like echocardiogram although more large study is needed to evaluate clinical significance of NT-pro BNP.
Aged* ; Biomarkers ; Dyspnea* ; Heart ; Heart Failure ; Heart Failure, Diastolic ; Heart Failure, Systolic ; Humans ; Lung ; Medical Records ; Pulmonary Disease, Chronic Obstructive ; Respiration

BACKGROUND: Exercise intolerance is a common symptom of heart failure and has a detrimental impact on the quality of life. Skeletal muscle atrophy has been considered an important contributor to exercise intolerance; however, most studies have been conducted in patients with advanced systolic heart failure. METHODS: We studied 39 ambulatory heart failure patients (age, 77.9+/-6.5; male, 17 [43.6%]) and 39 age and gender-matched, community-dwelling, elderly subjects. Clinical, laboratory, and echocardiographic evaluations were performed. Dual-energy X-ray absorptiometry was performed to assess the body composition. Exercise capacity was measured by a six-minute walk test. Comprehensive geriatric assessments were also performed to evaluate comorbidity, medication, physical function, cognitive function, and nutritional status. RESULTS: Skeletal muscle mass of heart failure patients showed no differences when compared with that of age- and gender-matched control subjects in any part of the body or in the whole body. Although diastolic heart failure patients showed lower levels of skeletal muscle mass than systolic heart failure patients, no significant difference was identified in either systolic or diastolic heart failure patients compared with respective age- and gender-matched control groups. The six-minute walk distances showed no difference between the groups (257.2+/-117.8 m in the diastolic heart failure group versus 302.7+/-109.4 m in the systolic heart failure group, p=0.226). CONCLUSION: Although skeletal muscle mass has been known to be an independent factor associated with exercise capacity in advanced heart failure patients, skeletal muscle mass was not decreased in ambulatory, elderly heart failure patients when comparing age- and gender-matched control subjects.
Absorptiometry, Photon ; Aged ; Atrophy ; Body Composition ; Comorbidity ; Geriatric Assessment ; Heart ; Heart Failure ; Heart Failure, Diastolic ; Heart Failure, Systolic ; Humans ; Male ; Muscle, Skeletal ; Quality of Life

BACKGROUND AND OBJECTIVES: Plasma B-type natriuretic peptide (BNP) can be increased in patients with renal insufficiency (RI). The aim of this study was to evaluate the diagnostic value of BNP for systolic heart failure (HF) in patients with moderate to severe RI. SUBJECTS AND METHODS: Between Aug 2002 and May 2004, 433 patients found to have systolic HF or moderate to severe RI were included. The patients were divided into 3 groups (group I; only HF, group II; only RI, group III; HF and RI). The severity of RI was graded according to the calculated creatinine clearance (Ccr); moderate 30< or =Ccr<60, severe 15< or =Ccr<30 or end stage renal disease (ESRD) Ccr<15 mL/min. RESULTS: The mean age of the patients was 67.6+/-12, and 49% were male. There were significant differences in the mean BNP levels between group III and the other two groups (p<0.001); group I (n=65, 837.3+/-884), group II (n=137, 1049.4+/-1332) and group III (n=231, 1738.3+/-1501 pg/mL). A weak negative correlation was note between BNP and Ccr (r=-0.335, p<0.001) in patients with RI. As the renal function deteriorated, the mean BNP of groups II and III was found to be elevated (moderate 625.5+/-574, 1183.0+/-1056; severe 760.5+/-1211, 2205.4+/-1470; ESRD 2157.6+/-1831, 3209.9+/-1900 pg/mL, p<0.05), with the mean BNP of group III being higher than that of group II for each grade (p<0.05). From the ROC curve, the optimal cut-off point of BNP for the diagnosis of systolic HF in patients with RI was 829 pg/mL (accuracy 68%, sensitivity 66% and specificity 70%, p<0.001). CONCLUSION: In the case of patients with moderate to severe RI, a higher BNP cut-off point for the diagnosis of systolic HF and a relatively lower diagnostic accuracy of BNP should be considered.
Creatinine ; Diagnosis ; Heart Failure ; Heart Failure, Systolic* ; Humans ; Kidney Failure, Chronic ; Male ; Natriuretic Peptide, Brain ; Plasma ; Renal Insufficiency* ; ROC Curve ; Sensitivity and Specificity

PURPOSE: Obesity is often associated with better clinical outcomes in heart failure (HF). This so-called obesity paradox remains controversial. The aim of present study was to investigate the prognostic value of obesity in patients hospitalized for systolic HF. MATERIALS AND METHODS: We performed a pooled analysis of data from two multicenter, observational HF studies. Patients hospitalized for systolic HF were eligible for the present study. We divided the subjects into two groups, a normal body mass index (BMI) group and a high BMI group. Study endpoints included all-cause mortality and any re-hospitalization within 1 year. RESULTS: We enrolled 3145 patients (male, 1824; female, 1321). The high BMI group was significantly associated with lower 1-year mortality rate [odds ratio (OR), 0.543; 95% confidence interval (CI), 0.355−0.832] after adjusting for age, hypertension, diabetes, ischemic HF, previous myocardial infarction, serum creatinine level, anemia, and ejection fraction in men. After adjustment for clinical characteristics, high BMI was not significantly associated with 1-year mortality (OR, 0.739; 95% CI, 0.450−1.216) or 1-year re-hospitalization (OR, 0.958; 95% CI, 0.696−1.319) in women. CONCLUSION: In pooled analysis of data from two Korean HF registries, the high BMI group was independently associated with lower 1-year mortality rate from systolic HF, especially in men.
Aged ; Body Mass Index ; Demography ; Endpoint Determination ; Female ; Heart Failure, Systolic/complications ; Heart Failure, Systolic/epidemiology ; Humans ; Incidence ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Obesity/complications ; Obesity/epidemiology ; Sex Characteristics ; Treatment Outcome

The insertion of implantable cardioverter-defibrillators (ICD) in patients with non-ischemic cardiomyopathy (NICM) has been recommended by recent guidelines. However, current evidence shows limited benefits to inserting ICDs in patients with NICM. Recently, the defibrillator implantation in patients with non-ischemic systolic heart failure (DANISH) trial, a large randomized trial of more than 1,100 patients with NICM, was conducted to compare the primary prevention of all-cause mortality between optimal medical therapy, cardiac resynchronization therapy, and ICD implantation. The DANISH trial revealed no differences in all-cause mortality between the groups after 5 years. However, in patients younger than 68 years of age, the rate of death from any cause was significantly lower in the ICD group compared to the control group. In addition, the rate of sudden cardiac death was lower in the ICD group compared to the control group in patients under 68 years. The results of DANISH will likely change guidelines about the insertion of ICD in patients with NICM, and encourage the use of ICD in patients with NICM.
Cardiac Resynchronization Therapy ; Cardiomyopathies* ; Death, Sudden, Cardiac* ; Defibrillators ; Defibrillators, Implantable* ; Heart Failure, Systolic ; Humans ; Mortality ; Primary Prevention*