Mihai Gheorghiade

..Identification of hemodynamic congestion, before the clinical manifestations appear, may potentially prevent hospitalization and slow the progression of HF by allowing life-saving interventions to be implemented sooner...

..We examined the hemodynamic, echocardiographic, and neurohormonal effects of intravenous istaroxime in patients hospitalized with heart failure (HF)...

..We review the use of these therapies in AHFS with added insights from recent clinical trials and registry data...

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..The aim of the COMPOSE programme was to investigate the safety and efficacy of fixed, low doses of intravenous cinaciguat (<200 µg/h for 24-48 h) as add-on to standard therapy in adults hospitalized with AHFS...

..Identifying these abnormalities may facilitate efforts to reduce post-discharge mortality and re-hospitalization...

..Additional research to determine barriers to use of target doses of HF medications may be necessary...

..In placebo-controlled trials in the inpatient and outpatient setting, the AVP receptor antagonist tolvaptan reduced body weight and edema and normalized serum sodium in patients with heart failure...

..The predictive value of hyponatraemia has not been evaluated in unselected patients hospitalized with heart failure...

..Accordingly, therapies for AHFS that are aimed at improving hemodynamics may affect long-term prognosis by either injuring or salvaging myocardium...

..Heart failure causes more than 1 million US hospitalizations yearly, mostly related to congestion. Tolvaptan, an oral, nonpeptide, selective vasopressin V2-receptor antagonist, shows promise in this condition...

..To our knowledge, the association of hyponatremia with outcomes has not been evaluated in the context of in-hospital clinical course including central hemodynamics and changes in serum sodium level...

..Therefore, by using novel mechanisms of action, these agents may provide new opportunities for helping patients with AHFS...

..Accordingly, the assessment and management of pulmonary and systemic congestion in these patients require reevaluation...

..No differences in adverse events were observed between the groups. In conclusion, tolvaptan appears to be more effective than fluid restriction at correcting hyponatremia in hospitalized subjects, without an increase in adverse events...

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..These trials have defined the benefits of pharmacologic management and device therapy in patients who survive an MI in the presence of LVSD...

..The goals of therapy for AHFS should be not only to improve symptoms and hemodynamics, but also to preserve or improve renal function and prevent myocardial damage...

..Additional recent studies suggest that carvedilol may be useful in managing postsurgical atrial fibrillation and also may prevent recurrence of atrial fibrillation among patients who undergo cardioversion...

..Although intravenous inotropic therapy usually produces beneficial hemodynamic effects and is labeled for use in the care of such patients, the effect of such therapy on intermediate-term clinical outcomes is uncertain...

..The oral, direct Factor Xa inhibitor, rivaroxaban, has not been studied in patients with HF. We hypothesized that rivaroxaban would also reduce biomarkers of hypercoagulability in patients with HF...

..The aim of the Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT) study is to evaluate the effect of aliskiren on cardiovascular death and HF in AHFS patients...

..HF trials in 2010 contributed to the advancement of outpatient management, whereas the development of novel therapies with a survival benefit remains an unmet need in acute HF syndromes...

..In this brief report, we outline the T1 or translational phase of research for AHFS clinical development as an important first step toward greater success in AHFS clinical trials...

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..However, further clinical trials are needed to determine the optimal dosing, proper monitoring and adequate precautions for the use of vaptans in this patient population...

..In this study, we evaluated the effects of tolvaptan (OPC-41061), a novel, oral, nonpeptide vasopressin V2-receptor antagonist in patients with chronic heart failure (CHF)...

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..In contrast to diuretics, the vasopressin antagonist tolvaptan may increase net volume loss in heart failure without adversely affecting electrolytes and renal function...

..This report represents a summary of the presentation at this meeting...

..We speculate that high-dose statin therapy had a significant role in improving the ventricular function in our patient by improving the endothelial flow. This hypothesis is presently being tested in a larger prospective trial...

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..The results of EVEREST will determine whether these effects translate into improved clinical outcomes...

..Deidentified clinical data from the medical records of a planned 43,000 patients from 160 US cardiology practices will be included in this study...

..In the first 60 to 90 days after hospital discharge, little up-titration in beta-blocker dosing occurs. Further efforts are needed to help understand and overcome this beta-blocker titration gap...

..Vasopressin mediates fluid retention in heart failure. Tolvaptan, a vasopressin V2 receptor blocker, shows promise for management of heart failure...

..Few data exist to characterize the delivery of evidence-based medical therapy for outpatients with heart failure who have received implantable cardioverter-defibrillators or cardiac resynchronization therapy (CRT) for systolic dysfunction...

..We sought to evaluate the characteristics, treatments, and outcomes of patients with preserved and reduced systolic function heart failure (HF)...

..These findings may have important therapeutic implications because characteristics and outcomes differ greatly among patients with heart failure with varying SBP...

..This study evaluated the association between precipitating factors identified at the time of HF hospital admission and subsequent clinical outcomes...

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..The aim of this study was to develop a clinical model predictive of in-hospital mortality in a broad hospitalized heart failure (HF) patient population...

..We sought to evaluate the effect of a national hospital-based initiative on quality of care in patients hospitalized with HF...

..We sought to determine the short-term hemodynamic effects of tolvaptan in this high-risk population...

..Prospective studies of the assessment and treatment of CAD in patients with AHFS are urgently needed...

..This study sought to assess the acute hemodynamic effect of vasopressin V(2) receptor antagonism...

..This study aimed to ascertain the relationship between smoking and clinical outcomes in patients hospitalized with heart failure (HF)...

..CONCLUSIONS: In patients hospitalized for worsening heart failure, admission serum sodium is an independent predictor of increased number of days hospitalized for cardiovascular causes and increased mortality within 60 days of discharge...

..The objective of this study was to prospectively evaluate beta-blocker use at hospital discharge as an indicator of quality of care and outcomes in patients with heart failure (HF)...

..Less is known about the changes and relationships among these variables and the postdischarge survival rate...

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..IMPROVE HF is a prospective cohort study designed to characterize current management of patients with chronic HF and ejection fraction < or =35% in a national registry of 167 US outpatient cardiology practices...

..This study ascertains the relationship between continuation or withdrawal of beta-blocker therapy and clinical outcomes in patients hospitalized with systolic heart failure (HF)...

..Coronary artery disease (CAD) is frequent among patients hospitalized with acute heart failure syndromes (AHFS)...

..This article reviews a selection of current and investigational agents for the treatment of AHFS, with a main focus on the high-risk patient population with AHFS/LO...

..The ultimate aim of this program is to improve the standard of HF care in the hospital and outpatient settings and increase the use of evidence-based therapeutic strategies to save lives...

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..We explore the relationship between change in BW after hospitalization for worsening HF and risk for repeat hospitalization and mortality in the EVEREST trial...

..The trial data will determine if in-hospital initiation of beta-blocker therapy is effective at improving the long-term use of pharmacologic agents proven to reduce morbidity and mortality...

..These results also suggest that caution should be taken when withdrawing beta blockade in this population...

..Predischarge initiation may be one approach to improve beta-blocker use in this population...

..Given the unique metabolic needs of the failing heart, the role of micronutrients in combination with standard therapy warrants further investigation...

..Finally, anticoagulation is recommended only in patients who have concomitant atrial fibrillation or a previous history of cerebral or systemic emboli...

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..Further investigations are needed to confirm and expand the effectiveness and safety of these agents in patients with acute heart failure and low cardiac output...

..This review summarizes the evidence from published scientific literature regarding the use of levosimendan in various clinical settings...

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..Using baseline data from the HF-ACTION (Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing) study, we examined this relationship...

..007), and LV end-systolic volume index (P< or =0.0001). CONCLUSIONS: For heart failure patients treated with beta-blockers, gadolinium-enhanced CMR predicts the response in LV function and remodeling...

..These results suggest that istaroxime may be a unique positive luso-inotropic agent for the treatment of patients with ADHF...

..Yet, the long-term effects of chronic diuretic use in HF are largely unknown. We retrospectively analysed the Digitalis Investigation Group (DIG) data to determine the effects of diuretics on HF outcomes...

..Hyponatremia predicts poor outcome in patients with acute heart failure syndromes. This study evaluated the relationship between baseline serum sodium, change in serum sodium, and 60-day mortality in hospitalized heart failure patients...

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..Given the considerable evidence from randomized clinical trials, the use of beta-blockers is recommended in all post-MI patients without a contraindication, particularly in those with left ventricular systolic dysfunction...

..It is plausible that early identification of hemodynamic congestion, before the clinical manifestations are present, could reduce the need for hospital admission and readmission...

..This article proposes such a paradigm shift in acute heart failure syndrome care and discusses areas of further research that are necessary to promote this change in approach...

..CR predicts a greater early response in IC, whereas it predicts a greater response at all time periods in IDC. However, even patients without CR showed improvement in LV function at 14 months...

..This article examines the role of neurohormonal modulators in the management of DHF...

..The 60-day rate of death or rehospitalization was high despite the use of evidence-based therapies. New treatments for this population are needed to decrease the morbidity and mortality associated with decompensated heart failure...

..This review describes the current modalities for assessing the key pathophysiologic targets in post-MI patients with LVD and the effects of systemic factors on cardiac disease severity...

..In conclusion, this study showed a high prevalence of coronary risk factors and unknown moderate to severe CAD in patients with end-stage liver disease being referred for LT...

..A lower sensitivity of noninvasive screening tools for the detection of coronary atherosclerosis is likely the result of the interaction of the hyperdynamic circulation with the performance of these tests...

..This offers an excellent opportunity to study potential heart failure survival improvements for a general patient population...

..In the USA, this includes only the treatment of euvolemic hyponatremia...