A J Burger

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..In this randomized, multicenter trial, we compared the safety and clinical effectiveness of the cardiac hormone nesiritide (human B-type natriuretic peptide) with dobutamine in hospitalized patients with decompensated CHF...

..Patients with congestive heart failure (CHF) have a high prevalence of ventricular ectopy. However, in the setting of CHF, it is not known whether sex-related or age-dependent differences exist in the susceptibility to arrhythmias...

..The possibility of subcutaneous injections of nesiritide has been studied in both animals and humans...

..We sought to examine the relationship between cardiac autonomic neuropathy as assessed by heart rate variability and overt nephropathy, with emphasis on the progression of renal dysfunction over 1 year...

..Altered neurohumoral physiology may underlie the poor prognosis of diabetic patients with heart failure...

..This association was initially based on small numbers of patients, limited data on dose and duration of drug therapy, and no correlation with matched controls...

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..The purpose of the current study was to evaluate the effect of beta-blockers on heart rate variability (HRV) in decompensated CHF...

..All are being actively investigated and many show significant promise as beneficial therapies in the treatment of heart failure...

..Improvement in heart rate variability is closely associated with improvement in heart failure, which may represent a decrease in sympathetic overactivity...

..Power spectral analysis of HRV allows early identification of potential reversibility as early as 1 year after the institution of strict glycemic control...

..This investigation sought to determine the effect of phentermine-fenfluramine (phen-fen) on the prevalence of valvular heart disease in 226 obese subjects enrolled in a prospective, strict weight loss, research protocol...

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..Furthermore, during increased sympathetic stimulation in the setting of heart failure, diabetes does not worsen parasympathetic withdrawal but may mitigate sympathetic activation...

..These abnormalities may attenuate the relative protection from coronary events during the afternoon and nighttime...

..6+/-1.5 vs. 19.0+/-5.3, P=0.04). CONCLUSIONS: beta-blockers improve the impaired cardiac autonomic regulation during high sympathetic stress of decompensated heart failure...

..The ability of long-term HRV parameters to reflect in part the activation of diverse hormonal systems may explain their greater prognostic power for risk stratification in patients with CHF...

..The precise mechanism of this phenomenon requires further investigation...

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..Current research suggests an important role for use of nesiritide in the treatment of decompensated heart failure...

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..We found that the association of PP with outcome in this setting is reversed, with low PP being an independent predictor of mortality...

..Similarly, an increase in serum creatinine (>0.5 mg/dl) in the hospital results in a significantly longer length of stay and has an independent effect on long-term mortality...

..In this setting, elevated blood urea nitrogen levels probably reflect the cumulative effects of hemodynamic and neurohormonal alterations that result in renal hypoperfusion...

..Dobutamine and possibly high-dose nesiritide can potentially lead to further deterioration of autonomic dysregulation...

..As a result, nesiritide quickly reduces clinical symptoms and improves mortality in patients with acute CHF...

..DM is common among patients admitted with decompensated HF, and diabetes-related biologic differences contribute to the progression of HF...

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..Together with previous studies, our findings suggest that indexes of overall HRV provide useful prognostic information in the full spectrum of CHF severity...

..Further understanding of the mechanisms involved in the protection conferred by the patient's sex would advance our understanding about arrhythmias in heart failure...

..This effect of beta-blockers may play an important protective role by preventing serious ventricular arrhythmias during transient increases in sympathetic activity...

..This ST elevation may be related to transient electrocardiographic repolarization changes in the hypertrophied ventricle in the presence of altered loading conditions and/or altered catecholamine influences rather than true ischemia...

..Proarrhythmic effects may account, in part, for the poor outcome associated with increased endothelin-1 levels in patients with decompensated CHF...

..These results suggest that cardiac K(ATP) channel activation may be involved in the genesis of ventricular arrhythmias in CHF...

..Results indicate that the acquisition cost of nesiritide is fully offset by decreased hospital costs...

..CONCLUSIONS: Among patients with unstable coronary syndromes and predominantly normal or mildly reduced GFR, an elevated BUN is associated with increased mortality, independent of sCr-based estimates of GFR and other biomarkers...