Regenerative Stem Cell Therapy Optimization via Tissue Engineering in Heart Failure with Reduced Ejection Fraction.

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.

A perspective on diuretic resistance in chronic congestive heart failure.

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.

Aerobic vs anaerobic exercise training effects on the cardiovascular system.

Physical exercise is one of the most effective methods to help prevent cardiovascular (CV) disease and to promote CV health. Aerobic and anaerobic exercises are two types of exercise that differ based on the intensity, interval and types of muscle fibers incorporated. In this article, we aim to further elaborate on these two categories of physical exercise and to help decipher which provides the most effective means of promoting CV health.

Morbidity and Mortality of Congestive Heart Failure in Trauma Patients.

BACKGROUND: Cardiovascular morbidity and mortality in heart failure (HF) patients comprise a major health and economic burden, especially when readmission rate and length of stay (LOS) are considered. With increasing average life expectancy, HF prevalence continues to rise. Diseases such as diabetes mellitus, hypertension and ischemic heart disease continue to be the leading causes of HF. Current data suggest that HF is the most common cause for hospital admission in patients older than 65 years. OBJECTIVE: In this study, we sought out to compare the 30-day readmission rate in trauma patients who have a preexisting history of HF to those who do not have a history of HF. Additionally, we emphasized the effect of different cardiac variables in the HF group such as the pathophysiology of HF (HF with preserved ejection fraction [HFpEF] versus HF with reduced ejection fraction [HFrEF]) and the etiology of HFrEF (ischemic versus nonischemic). METHODS: A retrospective chart analysis of 8,137 patients who were admitted to our hospital between 2005 and 2013 secondary to trauma with an Injury Severity Score <30. Data were extracted using International Classification of Diseases, Ninth Revision codes. Neurotrauma patients were excluded. RESULTS: Of 8,137 trauma patients, 334 had preexisting HF, of which 169 had HFpEF while 165 had HFrEF). Of the 165 HFrEF cases, 121 were ischemic in etiology versus 44 nonischemic. Of 334 HF patients, 81 patients (24%) were readmitted within 30 days versus 1,068 (14%) of the non-HF patients (95% CI: 1.52-2.25, relative risk: 1.85, P < 0.0001). Of the 81 readmitted HF patients, 64 had HFpEF while 35 had HFrEF. There was no statistical significance observed in any of the endpoints in the HFpEF versus HFrEF groups. Mortality, 30-day readmission and LOS were all significantly higher in the ischemic versus nonischemic HFrEF group. CONCLUSIONS: In our trauma population, HF patients had a significantly higher 30-day readmission rate when compared to non-HF patients. The pathophysiology of HF (HFpEF versus HFrEF) did not seem to play a role. However, after subgroup analysis of the HFrEF group based on etiology, all endpoints including mortality, readmission and LOS were significantly higher in the ischemic HFrEF subgroup rendering this entity higher importance when treating trauma patients with preexisting HF.

A perspective on sympathetic renal denervation in chronic congestive heart failure.

Medical therapy has indisputably been the mainstay of management for chronic congestive heart failure. However, a significant percentage of patients continue to experience worsening heart failure (HF) symptoms despite treatment with multiple therapeutic agents. Recently, catheter-based interventional strategies that interrupt the renal sympathetic nervous system have shown promising results in providing better symptom control in patients with HF. In this article, we will review the pathophysiology of HF for better understanding of the interplay between the cardiovascular system and the kidney. Subsequently, we will briefly discuss pivotal renal denervation (RDN) therapy trials in patients with resistant hypertension and then present the available evidence on the role of RDN in HF therapy.

Coronary Artery Disease in Young Adults.

Coronary heart disease (CHD) sustains a significant negative impact on hospital admissions and deaths worldwide. The prevalence of CHD in young adults is difficult to establish accurately, as these asymptomatic patients typically do not undergo diagnostic studies. In this article, the authors will focus on young adults with CHD emphasizing common and uncommon risk factors, current management and review of previous studies.

Lipid Interventions in Aortic Valvular Disease.

Aortic valve stenosis is the most common valvular disease in the elderly population. Presently, there is increasing evidence that aortic stenosis (AS) is an active process of lipid deposition, inflammation, fibrosis and calcium deposition. The pathogenesis of AS shares many similarities to that of atherosclerosis; therefore, it was hypothesized that certain lipid interventions could prevent or slow the progression of aortic valve stenosis. Despite the early enthusiasm that statins may slow the progression of AS, recent large clinical trials did not consistently demonstrate a decrease in the progression of AS. However, some researchers believe that statins may have a benefit early on in the disease process, where inflammation (and not calcification) is the predominant process, in contrast to severe or advanced AS, where calcification (and not inflammation) predominates. Positron emission tomography using 18F-fluorodeoxyglucose and 18F-sodium fluoride can demonstrate the relative contributions of valvular calcification and inflammation in AS, and thus this method might potentially be useful in providing the answer as to whether lipid interventions at the earlier stages of AS would be more effective in slowing the progression of the disease. Currently, there is a strong interest in recombinant apolipoprotein A-1 Milano and in the development of new pharmacological agents, targeting reduction of lipoprotein (a) levels and possibly reduction of the expression of lipoprotein-associated phospholipase A2, as potential means to slow the progression of aortic valvular stenosis.

Reversible Cardiomyopathies.

Cardiomyopathies (CMs) have many etiological factors that can result in severe structural and functional dysregulation. Fortunately, there are several potentially reversible CMs that are known to improve when the root etiological factor is addressed. In this article, we discuss several of these reversible CMs, including tachycardia-induced, peripartum, inflammatory, hyperthyroidism, Takotsubo, and chronic illness-induced CMs. Our discussion also includes a review on their respective pathophysiology, as well as possible management solutions.

Complications of Continuous-Flow Mechanical Circulatory Support Devices.

Left ventricular assist devices (LVADs), more importantly the continuous-flow subclass, have revolutionized the medical field by improving New York Heart Association (NYHA) functional class status, quality of life, and survival rates in patients with advanced systolic heart failure. From the first pulsatile device to modern day continuous-flow devices, LVADs have continued to improve, but they are still associated with several complications. These complications include infection, bleeding, thrombosis, hemolysis, aortic valvular dysfunction, right heart failure, and ventricular arrhythmias. In this article, we aim to review these complications to understand the most appropriate approach for their prevention and to discuss the available therapeutic modalities.

Cardiac Magnetic Resonance Imaging Might Complement Two-Dimensional Echocardiography in the Detection of a Reversible Nonischemic Cardiomyopathy.

We report a case of reversible nonischemic dilated cardiomyopathy in a male in his 60s who presented with an acute heart failure syndrome. Both conventional two-dimensional echocardiography and cardiac magnetic resonance imaging (cMRI) demonstrated severe left ventricular systolic dysfunction; however, both modalities were devoid of significant valvular heart disease as well as the presence of fibrosis, infiltration, inflammation, and scar. After six months of aggressive neurohumoral modulation, there was complete reverse remodeling and normalization of left ventricular function, which highlights the role of cMRI as an adjunct to two-dimensional echocardiography in the detection of a potentially reversible nonischemic cardiomyopathy.