Beta-blockers such as metoprolol, carvedilol, and bisoprolol are indicated for the treatment of patients with reduced ejection fraction heart failure. Heart failure treatment guidelines call for titration of these medications to specific target doses for morbidity and mortality benefit. Hepatic enzymes are responsible for metabolizing these medications; however, these enzymes are subject to genetic variations (polymorphisms) that can increase or decrease enzyme activity. Metoprolol relies almost exclusively on this enzyme for degradation to inactive metabolites, whereas carvedilol relies on this enzyme only partially for metabolism, and the portion of drug that is metabolized by CYP2D6 becomes active metabolites. The clinical significance of genetic variations in CYP2D6 in heart failure patients requiring treatment with carvedilol and metoprolol remains unclear, and further research is needed before any strong recommendations on treatment approach can be made. However, based on what is known regarding the incidence of genetic variations of this enzyme, it is reasonable to conclude that heart failure patients of European and Asian ancestry may be at a greater risk of intolerance to guideline-directed doses of metoprolol. Patients of North African ancestry may be at a lower risk of intolerance to metoprolol, although limited data are available to conclude. Additionally, due to the significant prevalence of CYP2D6 enzyme variations among all ethnicities, it may be reasonable to consider switching to carvedilol for patients who are unable to fully titrate metoprolol.
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http://dx.doi.org/10.1177/0897190018782794 | DOI Listing |
Pacing Clin Electrophysiol
December 2024
Servei de Cardiologia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
Introduction: Right ventricular (RV) pacing can impair left ventricular function and cause heart failure, known as pacing-induced cardiomyopathy (PICM). Upgrade to cardiac resynchronization (CRT) is its usual treatment; recently left bundle branch area pacing (LBBAP) has emerged as a potential alternative. Deep septal pacing (DSP), a simplified alternative to LBBAP, is still able to achieve narrower paced QRS than during conventional RV pacing.
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December 2024
Department of Cardiology, Cardinal Wyszynski Hospital in Lublin, Lublin, Poland.
Background: Cardiac implantable devices (CIED) such as pacemakers, implantable cardioverter-defibrillators, or cardiac resynchronization devices are implanted in selected patients with bradyarrhythmia and advanced heart failure. The invasive character of these procedures poses a risk of early complications such as pneumothorax, bleeding, infections, or dislocations.
Aims: There are no available data that analyzed the impact of the organization of procedures on the early complications risk after permanent pacing procedures.
Circ Heart Fail
December 2024
Department of Cardiology, Aarhus University Hospital, Denmark. (K.B.-H., N.G., K.H.C., R.N., K.L., H.W.).
J Exp Biol
December 2024
Alfred Wegener Institute Helmholtz Center for Polar and Marine Research, Sections Integrative Ecophysiology and Deep-Sea Ecology & Technology, Am Handelshafen 12, 27515 Bremerhaven, Germany.
Increasing frequencies of heatwaves threaten marine ectotherm species but not all alike. In exposed habitats, some species rely on a higher capacity for passive tolerance at higher temperatures, thereby extending time-dependent survival limits. Here we assess how the involvement of the cardiovascular system in extended tolerance at the margins of the thermal performance curve is dependent on warming rate.
View Article and Find Full Text PDFAm Heart J Plus
December 2024
National Institute of Cardiology Ignacio Chavez, Coronary Care Unit, Mexico City, Mexico.
Background And Aims: Heart failure with preserved ejection fraction (HFpEF) is an increasingly common clinical syndrome, estimated to constitute approximately 50 % of all heart failure (HF) cases. Nonetheless, registries from specific geographic areas, as Latin America, are lacking. The present study aims to report the underlying causes, comorbidities, treatment patterns and outcomes of patients with HFpEF in a large cardiovascular center in Mexico City.
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