ABSTRACT
Heart failure (HF) is recognized as one of the leading causes of morbidity and mortality worldwide. Every year about 500,000 new cases of HF are diagnosed in the United States. The predominant etiology of death in HF patients include sudden cardiac death (SCD) and pump failure. Prediction of mode of death may help in devising management decisions. In patients with HF, the presence of myocardial fibrosis has been a known risk factor for SCD and thus it could be used as a criterion in risk stratification for SCD. However, the underlying pathophysiology of SCD is uncertain and controversial, which makes it necessary to develop newer tools to enhance SCD risk stratification. The newer tools should be innovative enough either to complement or to replace the currently available tools. In this scoping review, we highlighted the utilization of novel biomarkers galectin-3 (gal-3) and soluble ST2 (sST2) and discussed that how they might complement currently available tools such as, cardiac MRI (CMR) for SCD risk stratification in HF patients.
Subject(s)
Arthritis, Rheumatoid/drug therapy , Cardiomyopathies , Cardiotoxicity/diagnosis , Hydroxychloroquine/adverse effects , Antirheumatic Agents/administration & dosage , Antirheumatic Agents/adverse effects , Biopsy/methods , Cardiomyopathies/chemically induced , Cardiomyopathies/diagnosis , Cardiomyopathies/physiopathology , Cardiomyopathies/therapy , Disease Progression , Echocardiography/methods , Humans , Hydroxychloroquine/administration & dosage , Magnetic Resonance Imaging, Cine/methods , Male , Middle Aged , Myocardium/pathology , Withholding TreatmentABSTRACT
The prevalence of heart failure (HF) is continuously rising in both the industrialized and non-industrialized nations. Despite current therapeutic advances, prognosis of HF patients remains poor. Presently, therapeutic pharmacological and device strategies for HF with reduced ejection fraction (HFrEF) are mostly palliative and do not induce regeneration of lost myocardial tissue. Stem cell therapy has demonstrated promising results in clinical studies by promoting myocardial restoration in HFrEF subjects. Despite decades of investigation, many challenges remain unanswered to the widespread clinical application of stem cell therapy for HFrEF. This review will describe the foundational work already accomplished in cardiac stem cell therapy, advantages and limitations of the various candidates for tissue restoration, their presumed mechanisms of action, the role of scaffolding materials as well as the challenges that exist for widespread clinical application.
Subject(s)
Heart Failure/therapy , Stem Cell Transplantation/methods , Tissue Engineering/methods , Adipose Tissue/cytology , Animals , Bone Marrow Cells/physiology , Embryonic Stem Cells/transplantation , Humans , Induced Pluripotent Stem Cells/transplantation , Myocardium/cytology , Regeneration , Tissue ScaffoldsABSTRACT
Chronic congestive heart failure (CHF) is a complex disorder characterized by inability of the heart to keep up the demands on it, followed by the progressive pump failure and fluid accumulation. Although the loop diuretics are widely used in heart failure (HF) patients, both pharmacodynamic and pharmacokinetic alterations are thought to be responsible for diuretic resistance in these patients. Strategies to overcome diuretic resistance include sodium intake restriction, changes in diuretic dose and route of administration and sequential nephron diuretic therapy. In this review, we discuss the definition, prevalence, mechanism of development and management strategies of diuretic resistance in HF patients.
