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Carazo M. Medical Therapy for Heart Failure in Adult Congenital Heart Disease Patients. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100297. [PMID: 39100588 PMCID: PMC11294834 DOI: 10.1016/j.shj.2024.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 08/06/2024]
Abstract
There is an increasing recognition of heart failure among adults with congenital heart disease as a result of the advancements in medical, interventional, and surgical care. The long-term consequences of palliative therapy in infancy, childhood, and adulthood are incompletely understood. Medical therapy, including pharmacologic and device therapies, have been used for the treatment of heart failure. This review summarizes care strategies that have been applied within the spectrum of adults with congenital heart disease, including failing systemic ventricles, single ventricles, and Eisenmenger physiology.
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Affiliation(s)
- Matthew Carazo
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
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Sharma R, Kashyap J, Olanrewaju OA, Jabbar A, Someshwar F, Saeed H, Varrassi G, Qadeer HA, Kumar S, Cheema AY, Khatri M, Wazir M, Ullah F. Cardio-Oncology: Managing Cardiovascular Complications of Cancer Therapies. Cureus 2023; 15:e51038. [PMID: 38269231 PMCID: PMC10806352 DOI: 10.7759/cureus.51038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 01/26/2024] Open
Abstract
This narrative review explores the complex relationship between cancer medicines and cardiovascular health in the junction of oncology and cardiology, known as cardio-oncology. The study examines the historical development of cancer treatments and highlights the growing importance of cardiovascular problems in patient care. This text delves into the topic of cardiotoxicity, examining both conventional chemotherapeutic drugs like anthracyclines and more recent tyrosine kinase and immune checkpoint inhibitors. The complex molecular and cellular mechanisms that control cardiovascular problems are explained, including an understanding of how genetic predisposition influences an individual's sensitivity. The narrative expands into the crucial realm of risk stratification and evaluation, revealing advanced instruments for identifying cardiovascular risk in cancer patients. The importance of non-invasive imaging methods and biomarkers in early detection and continuous monitoring is emphasized. The prioritization of preventive tactics emphasizes the need to take proactive measures incorporating therapies to protect the heart throughout cancer treatment. It also highlights the significance of making lifestyle improvements to reduce risk factors. The narrative emphasizes the changing collaborative treatment environment, advocating for merging oncologists and cardiologists in a coordinated endeavor to maximize patient outcomes. In addition to clinical factors, the review explores the critical domain of patient education and support, acknowledging its crucial role in promoting informed decision-making and improving overall patient well-being. The latter portions of the text anticipate and consider upcoming treatments and existing research efforts that offer the potential for the future of cardio-oncology. This review seeks to provide a detailed viewpoint on the intricate connection between cancer treatments and cardiovascular well-being. Its objective is to encourage a more profound comprehension of the subject and prompt careful contemplation regarding the comprehensive care of cancer patients who confront the intricate difficulties presented by their treatment plans.
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Affiliation(s)
- Roshan Sharma
- Medicine, Sanjay Gandhi Memorial Hospital, Delhi, IND
| | - Jyoti Kashyap
- Medicine, Sri Balaji Action Medical Institute, Delhi, IND
| | - Olusegun A Olanrewaju
- Pure and Applied Biology, Ladoke Akintola University of Technology, Ogbomoso, NGA
- General Medicine, Stavropol State Medical University, Stavropol, RUS
| | - Abdul Jabbar
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Fnu Someshwar
- Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Hira Saeed
- Medicine, Federal Medical College, Islamabad, PAK
| | | | | | - Satish Kumar
- Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Asfand Yar Cheema
- Medicine, Services Hospital Lahore, Lahore, PAK
- Internal Medicine, Lahore Medical & Dental College, Lahore, PAK
| | - Mahima Khatri
- Internal Medicine/Cardiology, Dow University of Health Sciences, Karachi, PAK
| | - Maha Wazir
- Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Farhan Ullah
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
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Abd Alla J, Langer A, Wolf S, Fu X, Rageh MA, Quitterer U. BBLN triggers CAMK2D pathology in mice under cardiac pressure overload and potentially in unrepaired hearts with tetralogy of Fallot. NATURE CARDIOVASCULAR RESEARCH 2023; 2:1044-1059. [PMID: 38666071 PMCID: PMC11041739 DOI: 10.1038/s44161-023-00351-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/21/2023] [Indexed: 04/28/2024]
Abstract
Tetralogy of Fallot (TOF) is one of the most prevalent congenital heart defects, with adverse cardiac remodeling and long-term cardiac complications. Here, searching for pathomechanisms, we find upregulated bublin coiled-coil protein (BBLN) in heart specimens of TOF patients with cyanosis, which positively correlates with cardiac remodeling pathways. Human BBLN, a protein with largely unknown function, promoted heart failure features, with increased mortality when overexpressed in mice, in a protein dosage-dependent manner. BBLN enhanced cardiac inflammation, fibrosis and necroptosis by calcium/calmodulin-dependent protein kinase II delta (CAMK2D) activation, whereas a BBLN mutant with impaired CAMK2D binding was inert. Downregulation of CAMK2D by an interfering RNA retarded BBLN-induced symptoms of heart failure. Endogenous BBLN was induced by hypoxia as a major TOF feature in human patients and by chronic pressure overload in mice, and its downregulation decreased CAMK2D hyperactivity, necroptosis and cardiovascular dysfunction. Thus, BBLN promotes CAMK2D-induced pathways to pathological cardiac remodeling, which are triggered by hypoxia in TOF.
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Affiliation(s)
- Joshua Abd Alla
- Molecular Pharmacology, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Andreas Langer
- Molecular Pharmacology, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Stefan Wolf
- Molecular Pharmacology, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Xuebin Fu
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- Department of Cardiovascular–Thoracic Surgery, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL USA
| | - Mohamed Abdelfattah Rageh
- Ain Shams University Hospitals, Cairo, Egypt
- Present Address: Dalhousie University of Canada, Halifax, Nova Scotia Canada
| | - Ursula Quitterer
- Molecular Pharmacology, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
- Department of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
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Sapna F, Raveena F, Chandio M, Bai K, Sayyar M, Varrassi G, Khatri M, Kumar S, Mohamad T. Advancements in Heart Failure Management: A Comprehensive Narrative Review of Emerging Therapies. Cureus 2023; 15:e46486. [PMID: 37927716 PMCID: PMC10623504 DOI: 10.7759/cureus.46486] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Heart failure is a substantial and escalating global health challenge, affecting millions worldwide. This complex syndrome arises from diverse etiologies, encompassing ischemic heart disease, hypertension, valvular abnormalities, and cardiomyopathies. Heart failure is characterized by the heart's inability to pump blood efficiently to meet the body's metabolic demands, leading to debilitating symptoms, frequent hospitalizations, and high mortality rates. Traditionally, the management of Heart failure has focused on alleviating symptoms, reducing fluid retention, and enhancing cardiac contractility. These goals have been achieved through a combination of pharmacological therapies such as angiotensin-converting enzyme inhibitors, beta-blockers, and diuretics, often complemented by device-based interventions like implantable cardioverter-defibrillators and cardiac resynchronization therapy. However, despite these advances, the relentless progression of heart failure remains a significant clinical challenge. Neurohormonal activation, cardiac fibrosis, and cellular remodeling are just a few of the intricate processes contributing to the disease's progression. In recent years, researchers and clinicians have embarked on a quest to identify novel therapeutic approaches that address these underlying mechanisms. One such avenue of exploration involves the revolutionary field of gene therapy, with promising gene-editing techniques, such as CRISPR-Cas9, offering potential routes for correcting genetic mutations that contribute to heart failure. Additionally, regenerative medicine approaches, including stem cell therapy and tissue engineering, hold significant promise for repairing damaged cardiac tissue and restoring function. Furthermore, precision medicine initiatives have gained traction, aiming to tailor heart failure therapies to individual patient profiles, taking into account genetics, biomarkers, and comorbidities. Integrating artificial intelligence and machine learning in heart failure management has also enabled the development of predictive models for early intervention, risk stratification, and personalized treatment recommendations. This narrative review navigates the intricate landscape of emerging therapies for heart failure, emphasizing their potential to revolutionize the field by targeting the disease's fundamental mechanisms. By exploring these innovative approaches, we aspire to provide a comprehensive perspective on the evolving paradigm of heart failure management, fostering a hopeful outlook for patients and clinicians alike.
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Affiliation(s)
- Fnu Sapna
- Pathology, Albert Einstein College of Medicine, New York, USA
| | - Fnu Raveena
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Maria Chandio
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Karoona Bai
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Tamam Mohamad
- Cardiovascular Medicine, Wayne State University, Detroit, USA
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Taner T, Hilscher MB, Broda CR, Drenth JPH. Issues in multi-organ transplantation of the liver with kidney or heart in polycystic liver-kidney disease or congenital heart disease: Current practices and immunological aspects. J Hepatol 2023; 78:1157-1168. [PMID: 37208103 DOI: 10.1016/j.jhep.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 05/21/2023]
Abstract
Solid organ transplantation has become an integral part of the management of patients with end-stage diseases of the kidney, liver, heart and lungs. Most procedures occur in isolation, but multi-organ transplantation of the liver with either the kidney or heart has become an option. As more patients with congenital heart disease and cardiac cirrhosis survive into adulthood, particularly after the Fontan procedure, liver transplant teams are expected to face questions regarding multi-organ (heart-liver) transplantation. Similarly, patients with polycystic kidneys and livers may be managed by multi-organ transplantation. Herein, we review the indications and outcomes of simultaneous liver-kidney transplantation for polycystic liver-kidney disease, and discuss the indications, timing and procedural aspects of combined heart-liver transplantation. We also summarise the evidence for, and potential mechanisms underlying, the immunoprotective impact of liver allografts on the simultaneously transplanted organs.
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Affiliation(s)
- Timucin Taner
- Departments of Surgery & Immunology, Mayo Clinic, Rochester, MN, USA.
| | - Moira B Hilscher
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher R Broda
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University, Nijmegen, the Netherlands
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Longitudinal family caregiving experiences in heart failure: Secondary qualitative analysis of interviews. Heart Lung 2021; 50:627-633. [PMID: 34091108 DOI: 10.1016/j.hrtlng.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Considering the potential impacts of family caregivers on heart failure management and the costs of healthcare, health professionals need to pay attention to the challenges faced by family caregivers. OBJECTIVE This study longitudinally explored the caregiving experiences of family caregivers of persons with heart failure. METHODS Serial interview scripts collected from 53 family caregivers were analyzed using a content analysis method. RESULTS The following themes emerged: (1) accumulating knowledge and skills for caregiving; (2) losing a sense of control; (3) balancing an unstable life; (4) constructing illness memory; (5) centering the patient in daily life; (6) accepting the loss of a family member; (7) coping with grief by drawing on social support; (8) facing financial responsibility; and (9) rethinking hospice care. CONCLUSION Family caregivers experience concern about unpredictable caregiving years, disease's fluctuating symptoms and poor prognosis. More educational opportunities, financial counseling programs, and palliative care consultations should be provided.
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The success and failure of the adult congenital heart. Heart Fail Rev 2020; 25:553-554. [PMID: 32130569 DOI: 10.1007/s10741-020-09941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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