Complications of replacing implantable devices in response to advisories: a single center experience.

Background: Advisories for implanted devices present a challenging management problem since no specific guidelines exist for device replacement under these circumstances. Since the rate and severity of complications is an important factor in the decision-making, we sought to review our experience with replacement of devices under advisory.

Methods: Medical records of patients with devices under advisory were reviewed.

Enhanced external counterpulsation in patients with heart failure: a multicenter feasibility study.

To assess the feasibility of using enhanced external counterpulsation to treat patients with heart failure, 26 patients with stable heart failure (New York Heart Association classes II-III), with a left ventricular ejection fraction at or below 35%, and without fluid overload, were treated with enhanced external counterpulsation (1 hour daily, 5 days a week, to a total of 35 hours). Patients were followed for 6 months after completing the course of enhanced external counterpulsation. The primary parameter was safety as reflected by adverse events or by changes in laboratory parameters.

Compensatory changes in Ca(2+) and myocardial O(2) consumption in beta-tropomyosin transgenic hearts.

Transgenic mice overexpressing beta-tropomyosin have increased myofilament Ca(2+) sensitivity that we hypothesized would result in altered relationships among pressure and heart rates, intracellular Ca(2+), and myocardial O(2) consumption. In perfused hearts from transgenic mice there was a marked negative force-frequency response between 6 and 10 Hz with a 30 +/- 3% reduction in peak-positive first derivative of pressure development over time (dP/dt) compared with 14 +/- 2% in wild-type mice (P < 0.001).

Exercise-related ventilatory abnormalities are more specific for functional impairment in chronic heart failure than reduction in peak exercise oxygen consumption.

Background: Impaired functional capacity during exercise is used to assess need for transplantation in congestive heart failure patients, although impaired capacity is present in several chronic illnesses. The purpose of this study was to test the hypothesis that ventilatory abnormalities during exercise, rather than functional capacity, are specific to congestive heart failure patients.

Methods: We compared exercise-related gas exchange among a group of congestive heart failure patients and a group of patients who had chronic liver disease and normal cardiac function, matched for functional impairment, and a group of normal controls.

Anti-tumor necrosis factor-alpha antibody limits heart failure in a transgenic model.

Background: - Tumor necrosis factor (TNF)-alpha has been implicated in the pathophysiology of congestive heart failure. A strain of transgenic mice (TNF1.6) with cardiac-specific overexpression of TNF-alpha develop congestive heart failure.

Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy.

Background: This prospective placebo-controlled trial was designed to determine whether intravenous immune globulin (IVIG) improves left ventricular ejection fraction (LVEF) in adults with recent onset of idiopathic dilated cardiomyopathy or myocarditis.

Methods And Results: Sixty-two patients (37 men, 25 women; mean age +/-SD 43.0+/-12.

Effects of soluble TNF receptor treatment on lipopolysaccharide-induced myocardial cytokine expression.

Tumor necrosis factor (TNF)-alpha plays a key role in the pathogenesis of septic shock syndrome, and myocardial TNF-alpha expression may contribute to this pathophysiology. We examined the myocardial expression of TNF-alpha-related cytokines and chemokines in mice exposed to lipopolysaccharide (LPS) and tested the effects of anti-TNF therapy on myocardial cytokine expression. Cytokine mRNA levels were measured by RNase protection assay, and protein levels in the plasma and myocardium were assessed by enzyme-linked immunosorbent assays.

Clinical overview of the novel inotropic agent toborinone.

Toborinone (OPC-18790, Otsuka Pharmaceutical Co. Ltd, 2(1H) -quinolone,6-[3-[ [3,4-dimethoxyphenyl)methyl] amino]-2-hydroxy prop oxyl]-,(.+-.

Sex-related survival differences in murine cardiomyopathy are associated with differences in TNF-receptor expression.

Epidemiological evidence suggests that the prognosis of heart failure in women is better than in men. In our murine model of dilated cardiomyopathy arising from cardiac-specific overexpression of TNF-alpha, the 6-month survival rate was significantly better in females than in males. Young female transgenic mice exhibited left ventricular wall thickening without dilatation, whereas age-matched male transgenic hearts were markedly dilated.

From clinical trials to clinical practice: what we know and do not know about beta-blockers and the heart.

In the early 1980s, several lines of evidence suggested the possibility that decreasing adrenergic drive could be beneficial in patients with chronic heart failure. Clinical trials conducted in the 1990s have unequivocally shown that beta-blockade improves left-ventricular ejection fraction (LVEF) in the failing heart. Beta-blockers represent the only medical treatment that has been shown to reverse the pathological myocardial remodeling observed in patients with chronic heart failure.

Trastuzumab in the treatment of metastatic breast cancer : anticancer therapy versus cardiotoxicity.

Trastuzumab, a monoclonal antibody against the HER2 receptor, was recently approved for the treatment of metastatic breast cancer. However, 28% of patients receiving both an anthracycline and trastuzumab developed heart failure. Although HER2 overexpression has been associated with the development of cancer, HER2 receptors seem to be cardioprotective because they mediate the activation of important cardiac survival pathways.

Effect of inotrope withdrawal on morbidity and mortality in patients with chronic heart failure: results of the vesnarinone trial withdrawal substudy. Vest Withdrawal Substudy Group.

Background: The use of inotropic agents in the therapy of patients with congestive heart failure (CHF) is controversial. One concern regarding inotropic therapy has been that drug withdrawal could be associated with a worsening of symptoms.

Methods And Results: We took advantage of the discontinuation of the recent trial of vesnarinone in the therapy of CHF to assess the effects of withdrawal of the inotropic agent, vesnarinone, in patients with chronic CHF who had been randomized to receive either placebo or 30 or 60 mg of vesnarinone.