Heart failure education in the emergency department markedly reduces readmissions in un- and under-insured patients.

Background: Heart failure (HF) readmissions are a longstanding national healthcare issue for both hospitals and patients. Our purpose was to evaluate the efficacy of a structured, educational intervention targeted towards un- and under-insured emergency department (ED) HF patients.

Methods: HF patients presenting to the ED for care were enrolled between July and December 2015 as part of an open label, interventional study, using a parallel observational control group.

Lifestyle Modification with Diet and Exercise in Obese Patients with Heart Failure - A Pilot Study.

OBJECTIVE: There is a paucity of data regarding intentional weight loss in obese heart failure patients. This study sought to ascertain the safety and effectiveness of a lifestyle modification program in patients with systolic heart failure and metabolic syndrome. METHODS: Patients (n=20) with systolic heart failure (ejection fraction < 50%) and metabolic syndrome were randomized to standard medical therapy (Control) versus medical therapy and lifestyle modification (Lifestyle) and followed prospectively for 3 months.

Worsening renal function is not associated with response to treatment in acute heart failure.

Background: About a fourth of acute decompensated heart failure (ADHF) patients develop renal dysfunction during their admission. To date, the association of ADHF treatment with the development of worsening renal function (WRF) remains contentious. Thus, we examined the association of WRF with changes in BNP levels and with mortality.

Segmental analysis of carotid arterial strain using speckle-tracking.

Background: Increased arterial stiffness has been shown to be associated with aging and cardiovascular risk factors. Speckle-tracking algorithms are being used to measure myocardial strain. The aims of this study were to evaluate whether speckle-tracking could be used to measure carotid arterial strain (CAS) reproducibly in healthy volunteers and to determine if CAS was lesser in individuals with diabetes.

Association of systolic blood pressure with mortality in patients with heart failure with reduced ejection fraction: a complex relationship.

Background: In ambulatory patients with heart failure with reduced ejection fraction (HFrEF), high systolic blood pressure (SBP) is associated with better outcomes. However, it is not known whether there is a ceiling beyond which high SBP has a detrimental effect. Thus, our aim was to assess the linearity of association between SBP and mortality.

Reduction in BNP levels with treatment of decompensated heart failure and future clinical events.

Background: Brain natriuretic peptide (BNP) levels correlate with outcomes in patients with heart failure (HF). We sought to compare the relationship between absolute and relative changes in BNP with future clinical events, and whether serial BNP measurements add prognostic information in patients treated for decompensated HF.

Methods And Results: In 203 patients treated for HF, increasing tertiles of BNP levels after treatment had a hazard ratio of 1.

The metabolic syndrome and mortality in an ethnically diverse heart failure population.

Background: In the general population, 27% of adults have the metabolic syndrome (MetS) and is associated with increased mortality. Similar data are not available for a heart failure (HF) population. This study sought to determine the prevalence of the MetS and its effect on mortality in a HF population.

Comprehensive imaging including three-dimensional echocardiography of an infected, ruptured sinus of valsalva aneurysm.

A 30-year-old man presented with fevers and fatigue. Blood cultures grew Streptococcus mitis in 4/4 bottles. Transthoracic three-dimensional echocardiography revealed an anterior coronary sinus of Valsalva (SOV) aneurysm with fistula formation into the right ventricle with vegetation on the fistulous tract, and a bicuspid aortic valve without vegetation.

The impact of thiazolidinedione use on outcomes in ambulatory patients with diabetes mellitus and heart failure.

Objectives: This study sought to examine the relationship between thiazolidinedione (TZD) use and outcomes in ambulatory patients with diabetes and heart failure (HF).

Background: Thiazolidinediones have been relatively contraindicated in diabetic patients with HF.

Methods: We conducted a retrospective study of a national cohort of veterans with HF and diabetes treated in ambulatory clinics at Veterans Affairs medical centers.

Cardiac-specific attenuation of natriuretic peptide A receptor activity accentuates adverse cardiac remodeling and mortality in response to pressure overload.

Atrial (ANP) and brain (BNP) natriuretic peptides are hormones of myocardial cell origin. These hormones bind to the natriuretic peptide A receptor (NPRA) throughout the body, stimulating cGMP production and playing a key role in blood pressure control. Because NPRA receptors are present on cardiomyocytes, we hypothesized that natriuretic peptides may have direct autocrine or paracrine effects on cardiomyocytes or adjacent cardiac cells.

Treatment of the metabolic syndrome: the impact of lifestyle modification.

Along with the increasing prevalence of obesity comes a constellation of metabolic derangements: dyslipidemias, hypertension, insulin resistance, and glucose intolerance, as well as increased prothrombotic and inflammatory markers. The association of these factors has been termed the "metabolic syndrome" and increases the risk of developing cardiovascular disease. Aside from pharmaceutical therapy, lifestyle modification is necessary to aggressively treat this syndrome in its entirety.

Diastolic dysfunction and left atrial volume: a population-based study.

Objectives: We examined the association between diastolic function and left atrial volume indexed to body surface area (LAVi) in a population-based study.

Background: Atrial enlargement has been suggested as a marker of the severity and duration of diastolic dysfunction (DD). However, the association between DD and atrial enlargement and their individual prognostic implications in the population is poorly defined.

Neurohormonal Therapy for Congestive Heart Failure.

Guidelines for heart failure management have been published by the American College of Cardiology and the American Heart Association in 2001. These guidelines recommend the use of angiotensin-converting enzyme inhibitors and beta blockers to improve the symptoms and prognosis of heart failure. Despite being advocated as the cornerstone of medical management, these agents remain underutilized.

Left atrial volume as an index of left atrial size: a population-based study.

Objectives: We studied left atrial volume (LAV) as an index of atrial size.

Background: Increased left atrial dimension (LAD) measured by M-mode echocardiography is a risk factor for atrial fibrillation, stroke, and death.

Methods: A random sample of residents of Olmsted County, Minnesota, age > or =45 years (n = 2,042) underwent Doppler echocardiography with assessment of LAD and LAV.

Valvular heart disease in patients taking pergolide.

Objective: To determine whether an association exists between pergolide and valvular heart disease.

Patients And Methods: Three patients with severe, unexplained tricuspid regurgitation were examined at our institution from September 2000 to April 2002. Echocardiography and histology of surgically explanted valves revealed abnormalities suggestive of carcinoid involvement, methysergide or ergotamine treatment, or use of fenfluramine and dexfenfluramine.

Beta-blockers: new standard therapy for heart failure.

Despite recent advances in the diagnosis and treatment of cardiovascular disease, the prevalence of heart failure, a highly morbid and lethal condition, is increasing. Because of recent advances in basic and clinical research, beta-blockade is now established as a highly effective therapy that reduces morbidity and mortality dramatically in patients with heart failure associated with reduced systolic function. The new guidelines from the American College of Cardiology-American Heart Association recommend use of beta-blockers in all patients with symptomatic left ventricular systolic dysfunction.