Short-term intravenous sodium nitrite infusion improves cardiac and pulmonary hemodynamics in heart failure patients.

Background: Nitrite exhibits hypoxia-dependent vasodilator properties, selectively dilating capacitance vessels in healthy subjects. Unlike organic nitrates, it seems not to be subject to the development of tolerance. Currently, therapeutic options for decompensated heart failure (HF) are limited.

Improvement in cardiac energetics by perhexiline in heart failure due to dilated cardiomyopathy.

Objectives: The aim of this study was to determine whether short-term treatment with perhexiline improves cardiac energetics, left ventricular function, and symptoms of heart failure by altering cardiac substrate utilization.

Background: Perhexiline improves exercise capacity and left ventricular ejection fraction (LVEF) in patients with heart failure (HF). (31)P cardiac magnetic resonance spectroscopy can be used to quantify the myocardial phosphocreatine/adenosine triphosphate ratio.

Randomized double-blind placebo-controlled trial of perhexiline in heart failure with preserved ejection fraction syndrome.

Recently heart failure with preserved ejection fraction (HFpEF) has emerged as a huge epidemic. Increasing evidence shows the role of energy deficiency in the pathophysiology of HFpEF. In the current study, we hypothesize that the use of metabolic modulator perhexiline would correct myocardial energy deficiency and improve exercise capacity and diastolic abnormalities in patients with this syndrome.

Kussmaul physiology in patients with heart failure.

Background: A paradoxical inspiratory rise in right atrial pressure (in contrast to the normal fall during inspiration), Kussmaul sign, has been described in congestive heart failure (CHF). However, the clinical and hemodynamic characteristics and clinical outcomes of patients with CHF and Kussmaul physiology have not been studied.

Methods And Results: This is a single-center study of consecutive ambulant patients with CHF (New York Heart Association class III/IV) referred for assessment for heart transplantation between November 2011 and April 2013.

Metabolic manipulation in chronic heart failure: study protocol for a randomised controlled trial.

Background: Heart failure is a major cause of morbidity and mortality in society. Current medical therapy centres on neurohormonal modulation with angiotensin converting enzyme inhibitors and β-blockers. There is growing evidence for the use of metabolic manipulating agents as adjunctive therapy in patients with heart failure.

Device therapy in hypertrophic cardiomyopathy.

With increasing awareness of the condition and particular attention being paid to family screening, the number of patients being diagnosed with hypertrophic cardiomyopathy is increasing. Although the majority of patients remain at low risk for sudden cardiac death, all patients need to undergo rigorous and ongoing risk factor stratification in order to best identify those at high risk. Although implantable cardioverter-defibrillators have proven to be effective in the prevention of sudden cardiac death, careful consideration of device implantation in high-risk patients is necessary in view of the potential for device complications and their impact on quality of life.

Drug-implantable cardioverter-defibrillator interactions.

Antiarrhythmic drugs are commonly used synergistically with implantable cardioverter defibrillators in the management of ventricular and supraventricular arrhythmias. However, these drugs may directly or indirectly interact with device function. In addition, expanding indications for implantable cardioverter defibrillators, particularly in patients with multiple comorbidities, further increases the potential for drug-device interactions.

Modification of myocardial substrate utilisation: a new therapeutic paradigm in cardiovascular disease.

Therapies that aim to modify cardiac substrate utilisation are designed to increase metabolic efficiency. Although the main energy supply for the heart is generally provided by the oxidation of fatty acids, the heart is a metabolic omnivore and able to consume glucose as well as lactate and amino acids in varying proportions. A shift from fatty acid oxidation to glucose oxidation leads to lower oxygen consumption per unit of ATP produced.

Magnetic resonance spectroscopy in myocardial disease.

31-phosphorous ((31)P) magnetic resonance spectroscopy (MRS) is a technique that allows the noninvasive characterization of the biochemical and metabolic state of the myocardium in vivo. MRS is a pure form of molecular imaging using magnetic resonance signals from nuclei with nuclear spin to assess cardiac metabolism without the need for external radioactive tracers. (31)P MRS provides information on the underlying metabolic abnormalities that are fundamental to common conditions including ischemic heart disease, cardiomyopathy, hypertrophy and valvular disease.

Death and dying in heart failure with normal ejection fraction.

The overall mortality rate in patients with heart failure with normal ejection fraction (HFNEF) appears to be comparable to that in patients with heart failure with reduced ejection fraction. In contrast to the latter group of patients, randomized trials with neurohumoral blockade in patients with HFNEF have failed to demonstrate reduction in mortality. This is at least in part related to the lower proportion of heart failure-related death in the overall population of patients with HFNEF.