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Advances in the pathophysiology and treatment of heart failure with preserved ejection fraction.

PURPOSE OF REVIEW: With the failure of multiple trials to identify a successful therapy for heart failure with preserved ejection fraction (HFpEF), attention has shifted to defining specific phenotypes within the HFpEF spectrum in an effort to develop a targeted approach to treatment. Here we summarize the most recent studies investigating the pathophysiology and clinical features of HFpEF, and discuss recent clinical trials in the context of developing treatments that look toward the underlying cause of this disorder. RECENT FINDINGS: Advances in basic science and clinical research have furt

[The rare case of Bland-White-Garland syndrome in adult patient].

We present analysis of a case history of a patient with rare congenital heart disorder - Bland-White-Garland syndrome. The 25 years old women was first diagnosed with this disorder during an examination in the cardiological department of the Moscow clinical hospital No83. The paper contains discussion of difficulties of diagnosis and peculiarities of management of adults with this pathology as well as of a problem of the choice of further therapeutic approaches.

Acute decompensated heart failure in a North Indian community hospital: Demographics, clinical characteristics, comorbidities and adherence to therapy.

BACKGROUND: Acute decompensated heart failure (ADHF) is a growing public health problem in the community. Limited and often contradictory da … %), beta-adrenergic receptor blocking agents in 53%, mineralocorticoid receptor antagonists in 34%, ivabradine in 21%, and digoxin in 5%. Angiotensin-neprilysin inhibitor was prescribed to 21% patients at discharge. Ferric carboxymaltose use was in 7.5% of all despite a high prevalence of anemia (54%). Vaccination status at discharge was not available in maj …

Rethinking heart rate modulation in heart failure: physiological basis, clinical evidence, and individualized targets: a narrative review.

BACKGROUND AND OBJECTIVE: Heart rate (HR) is a key determinant of cardiovascular performance and an established prognostic marker in heart f … laxation-frequency relationship render tachycardia maladaptive, and HR reduction with β-blockers or ivabradine is associated with improved outcomes. However, optimal HR targets have not been prospectively defined, and achieved HR thresholds are largely derived from post hoc analyses. In AF, the relationship between HR and prognosis is inconsistent, and HR re …

How do we define high and low dose intensity of heart failure medications: a scoping review.

BACKGROUND: Older adults with heart failure often experience adverse drug events with high doses of heart failure medications. Recognizing w … bout angiotensin receptor-neprilysin inhibitor (ARNI). For hydralazine with isosorbide dinitrate or ivabradine, we could not identify any eligible articles. We identified 40 medications with most frequently used definitions of dose intensity. Four medications (nadolol, pindolol, cilazapril, and torsemide) did not reach consensus in definitions. Most of the B …

[Treatment of Patients With Stable Ischemic Heart Disease in Real Clinical Practice in Russia. The CHOICE-2 Program].

OBJECTIVE: in the framework of an open post-marketing observational national program CHOICE-2 to assess correspondence between recommendatio … sed prescribing of the following drugs: statins (from 74 to 92%), beta-blockers (from 84 to 92.7%), ivabradine (from 4.7 to 8.8%), renin-angiotensin system inhibitors (from 85 to 95.4%), trimetazidine (from 13 to 100%). This led to a significant reduction of BP (from 147.1+/-14.3/88.1+/-9.0 to 127.4+/-9.0/78.4+/-6.5 mm Hg), HR (from 75,6+/-9,6 to 65.8+/-6.1 …

Patterns of Evidence-Based Medication Use in Older Adults with Chronic Heart Failure in Slovakia: A Population-Based Study Using the National Health Information Center Database.

BACKGROUND: Prescribing of evidence-based heart failure (HF) medications in older adults varies across settings, and population-level data f … alocorticoid receptor antagonists in 41.1% (95% CI 40.8-41.4), digoxin in 13.5% (95% CI 13.3-13.7), ivabradine in 3.8% (95% CI 3.7-3.9) and sodium-glucose cotransporter-2 (SGLT2) inhibitors in 3.7% (95% CI 3.6-3.8) of patients. Specialisation of the physicians in internal medicine/cardiology, or in diabetology in the case of SGLT2 inhibitors, showed the stro …

Navigating Heart Failure: Unveiling Sex Disparities in Guideline-Directed Medical Therapy Combinations.

Major heart failure (HF) trials remain insufficient in terms of assessing the differences in clinical characteristics, biomarkers, treatment … ers, mineralocorticoid receptor antagonists, sodium/glucose cotransporter 2 inhibitor (SGLT2i), and ivabradine were more commonly prescribed in male patients, whereas loop diuretics, digoxin, and ferric carboxymaltose were more frequent in female patients. Male patients had higher rates of cardiac resynchronization therapy and implantable cardioverter defibr …

Heart Failure With Reduced Ejection Fraction: A Review.

IMPORTANCE: Worldwide, the burden of heart failure has increased to an estimated 23 million people, and approximately 50% of cases are HF wi … apy, with addition of a mineralocorticoid receptor antagonist in patients with persistent symptoms. Ivabradine and hydralazine/isosorbide dinitrate also have a role in the care of certain patients with HFrEF. More recently, sodium-glucose cotransporter 2 (SGLT2) inhibitors have further improved disease outcomes, significantly reducing cardiovascular and all- …

[Status of β-blocker use and heart rate control in Chinese patients with stable coronary artery disease].

OBJECTIVE: To observe the current status of β-blocker (BB) use and heart rate control in Chinese patients with stable coronary artery diseas … rapamil or diltiazem, and 1.8% (47 cases) with amiodarone or dronedarone and 0.1%(2 cases) received ivabradine. BB use was similar among 3 HR groups(P>0.05). The independent risk factors associated with HR≥70 bpm were diabetes(OR=1.31), current smoker(OR=1.57), chronic heart failure(CHF) with NYHA Ⅲ (OR=2.13) and increased diastolic blood pressure (OR=1.30). …

Organic Cation Transporter-Mediated Clearance of Cardiovascular Drugs: A Pharmacological Perspective.

There exist a number of mechanisms to clear xenobiotics from human circulation. For cationic drugs, clearance is performed by human organic cation transporters 1 and 2 (hOCT1 and hOCT2), which are expressed in the liver and kidney, respectively. Given the prevalence of patients taking cardiovascular drugs, the present review focuses on the elimination of circulating cardiovascular drugs by organic cation transporters (OCTs). A significant number of cardiovascular drugs compete for transport by OCT1 or OCT2, introducing the potential to alter the pharmacokinetic profile of other concomitantly a

Conventional management of inappropriate sinus tachycardia.

Inappropriate sinus tachycardia is a challenging problem to manage. There are limited data on the best method to evaluate and treat the problem. Here, we consider a conventional approach to inappropriate sinus tachycardia.

Heart Failure with Preserved Ejection Fraction.

Heart failure (HF) is a clinical syndrome of diverse etiologies and can be associated with preserved, reduced, or mid-range ejection fraction (EF). In the community, heart failure with preserved ejection fraction (HFpEF) is emerging as the most common form of HF. There remains considerable uncertainty regarding its pathogenesis, diagnosis, and optimal therapeutic approach. Hypotheses have been advanced to explain the underlying pathophysiology responsible for HFpEF, but to date, no specific therapy based on these hypotheses has been proven to improve outcomes in HFpEF. We provide a clinically

Exploring Resting Sinus Tachycardia in Cancer Care: A Comprehensive Review.

Resting sinus tachycardia is frequently encountered in cancer patients. It affects a wide variety of cancer patients and is associated with distressing symptoms. Cancer-associated resting sinus tachycardia varies in its underlying mechanism. It can stem from the tumor burden or the side effects of chemotherapy/radiotherapy, or it can be secondary to paraneoplastic syndrome or the sequalae of cancer itself (infection, anemia, thrombosis, etc.). The clinical significance of resting sinus tachycardia extends beyond mere symptomatology, as it can potentially indicate severe complications which may

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… However, research is challenging due to Ivabradine’s interactions with some chemotherapy agents and prophylactic antifungal drugs. … Implication of ivabradine in patients with acute heart failure and sinus tachycardia following allogenic hematopoietic cell transplantation. Intern. Med. 2023;62:813. doi: 10.2169/internalmedicine.9818-22. 61. Scagliola R., Brunelli C. More on ivabradine in tachycardia with paraganglioma. …

Omecamtiv Mecarbil: A Novel Mechanistic and Therapeutic Approach to Chronic Heart Failure Management.

Heart failure (HF) is a major public health problem in the United States as well as worldwide. Chronic heart failure is a syndrome of reduce … modalities have included loop diuretics, digoxin, the hydralazine-isosorbide dinitrate combination, ivabradine, the inotropes, dobutamine, milrinone, and dopamine. Decreased cardiac contractility is central to the systolic HF. Therapeutic agents employed to increase cardiac contractility in HF are limited because of their mechanistic-related adverse effect p …

[Heart rate: clinical variable and risk marker].

Heart rate is an easily accessible clinical variable with wide-ranging prognostic impact. Elevated resting heart rate predicts an elevated cardiovascular risk. Epidemiological studies demonstrate a relevant association between heart rate and survival in individuals without diagnosed cardiovascular disease and with cardiovascular disease like hypertension, coronary artery disease (CAD) and heart failure. Whereas a goal directed pharmacological heart rate reduction is not supported by clinical evidence for primary prevention it plays a prognostic role for patients with CAD  and chronic heart fai

Postural Orthostatic Tachycardia Syndrome (POTS): A Review.

IMPORTANCE: Postural orthostatic tachycardia syndrome (POTS) is a chronic autonomic disorder characterized by excessive orthostatic tachycar … ed aerobic training. Pharmacological therapies should be individualized and may include β-blockers, ivabradine, midodrine, fludrocortisone, and pyridostigmine, although evidence supporting many therapeutic interventions is limited by small studies and lack of large, randomized trials. CONCLUSIONS AND RELEVANCE: POTS is a chronic autonomic disorder associate …