Implantable hemodynamic monitor may help manage diastolic heart failure



In a study that could have significant consequences for neural tissue transplantation strategies, researchers at the Salk Institute for Biological Studies report that inactivating a specific gene in adult neural stem cells makes nerve cells emerging from those precursors form connections in the wrong part of the adult brain. In a paper published in the

Full Post: Newborn neurons in the adult brain can settle in the wrong neighborhood

An implantable hemodynamic monitor (IHM) may help to guide medical treatment in a large subgroup of patients with heart failure-those with diastolic heart failure (DHF), reports a study in the December Journal of Cardiac Failure, published by Elsevier.

Led by Michael R. Zile, M.D., of Medical University of South Carolina, Charleston, the researchers analyzed data on DHF patients enrolled in a larger randomized trial evaluating the IHM for heart failure. The IHM is a surgically implanted device that continuously records data on heart function and other key variables. The data can then be downloaded for analysis by health care professionals, who can use it to make adjustments in medical therapy. The goal is to avoid sudden drops in heart function, called acute decompensation.

The main “COMPASS-HF” study included 274 patients with all types of heart failure. The original results showed that the risk of heart failure events was reduced by about 20 percent in patients treated with the IHM, although the difference was not statistically significant.

The new analysis focused on the subgroup of patients with DHF. In DHF, the heart still has normal pumping function (ejection fraction), but no longer relaxes sufficiently to fill with blood normally. In the COMPASS-HF study, 70 patients with DHF were randomly assigned to receive the IHM, while the rest were managed without the IHM.

As in the main study, DHF patients who received the IHM device had a 20 percent reduction in heart failure events, although the difference was not significant. A 29 percent reduction in the risk of hospitalization for heart failure was also nonsignificant.

The IHM did lead to some significant changes in patient management, including more frequent adjustments in the dose of diuretics-a key part of treatment for heart failure. As in the larger study, the IHM device was safe in DHF patients, with a low complication rate.

Patients with chronic heart failure need careful medical management to avoid episodes of acute decompensation. Few studies have focused on patients with DHF, even though they account for about half of all patients with heart failure.

Based on the new analysis, there is as yet no evidence that using the IHM device to guide treatment reduces the risk of decompensation and heart failure events in patients with DHF. The IHM does appear safe for patients with heart failure, with a very low risk of complications. In addition, DHF patients receiving the IHM device show a trend toward lower rates of heart failure events, including hospitalization related to heart failure.

“This is very important study and the trends make sense,” comments Barry M. Massie, M.D., Editor-in-Chief of Journal of Cardiac Failure. “Worsening of HF leading to hospitalization, usually as a result of pulmonary congestion and rising blood pressure, is often more abrupt in patients with preserved ejection fraction. Hemodynamic monitoring may provide an early clue and facilitate relatively simple and effective interventions.”

http://www.elsevier.com/locate/cardfail

Link




Heart failure is reaching epidemic levels among seniors in the United States, according to research presented at the American Heart Association’s Scientific Sessions 2008. “Both the number of patients hospitalized with a primary diagnosis of heart failure and age-adjusted hospitalization rates for heart failure have increased dramatically over the past 27 years,” said Longjian Liu,

Full Post: Heart failure hospitalization rates rise among nation’s seniors



Exercise training is safe in heart failure patients, does not significantly reduce hospitalization or death, but is associated with several improved clinical outcomes, even in those already receiving optimal medical care, researchers reported at the American Heart Association’s Scientific Sessions 2008. The Heart Failure and A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) was

Full Post: Exercise training safe in heart failure patients - offer clinical benefit



Adults with severe heart failure see almost three times as many Medicare providers each year compared to a typical beneficiary, according to research presented at the American Heart Association’s Scientific Sessions 2008. An analysis conducted by researchers at the University of Colorado and Scios, Inc. showed that: Adults with severe heart failure see an

Full Post: Adults with severe heart failure have more doctor visits, medications than others on Medicare



UC San Diego Medical Center is currently enrolling patients in a Phase 2 clinical trial of an investigational drug for the treatment of advanced heart failure. The “Calcium Up-Regulation by Percutaneous Administration of Gene Therapy in Cardiac Disease,” or CUPID, study is evaluating a new gene-based therapy designed to stimulate production of an enzyme that

Full Post: Trial of investigational drug for treatment of advanced heart failure



Long-term gene therapy resulted in improved cardiac function and reversed deterioration of the heart in rats with heart failure, according to a recent study conducted by researchers at Thomas Jefferson University’s Center for Translational Medicine. The study was published online in Circulation . The rats were treated with a gene that generates a peptide called

Full Post: Long-term gene therapy used to reverse heart damage in heart failure