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Lasica R, Djukanovic L, Vukmirovic J, Zdravkovic M, Ristic A, Asanin M, Simic D. Clinical Review of Hypertensive Acute Heart Failure. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:133. [PMID: 38256394 PMCID: PMC10818732 DOI: 10.3390/medicina60010133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
Although acute heart failure (AHF) is a common disease associated with significant symptoms, morbidity and mortality, the diagnosis, risk stratification and treatment of patients with hypertensive acute heart failure (H-AHF) still remain a challenge in modern medicine. Despite great progress in diagnostic and therapeutic modalities, this disease is still accompanied by a high rate of both in-hospital (from 3.8% to 11%) and one-year (from 20% to 36%) mortality. Considering the high rate of rehospitalization (22% to 30% in the first three months), the treatment of this disease represents a major financial blow to the health system of each country. This disease is characterized by heterogeneity in precipitating factors, clinical presentation, therapeutic modalities and prognosis. Since heart decompensation usually occurs quickly (within a few hours) in patients with H-AHF, establishing a rapid diagnosis is of vital importance. In addition to establishing the diagnosis of heart failure itself, it is necessary to see the underlying cause that led to it, especially if it is de novo heart failure. Given that hypertension is a precipitating factor of AHF and in up to 11% of AHF patients, strict control of arterial blood pressure is necessary until target values are reached in order to prevent the occurrence of H-AHF, which is still accompanied by a high rate of both early and long-term mortality.
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Affiliation(s)
- Ratko Lasica
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (R.L.); (L.D.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (A.R.)
| | - Lazar Djukanovic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (R.L.); (L.D.); (M.A.)
| | - Jovanka Vukmirovic
- Faculty of Organizational Sciences, University of Belgrade, 11000 Belgrade, Serbia;
| | - Marija Zdravkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (A.R.)
- Clinical Center Bezanijska Kosa, 11000 Belgrade, Serbia
| | - Arsen Ristic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (A.R.)
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milika Asanin
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (R.L.); (L.D.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (A.R.)
| | - Dragan Simic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.Z.); (A.R.)
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Vogel KR, Ainslie GR, Walters DC, McConnell A, Dhamne SC, Rotenberg A, Roullet JB, Gibson KM. Succinic semialdehyde dehydrogenase deficiency, a disorder of GABA metabolism: an update on pharmacological and enzyme-replacement therapeutic strategies. J Inherit Metab Dis 2018; 41:699-708. [PMID: 29460030 PMCID: PMC6041169 DOI: 10.1007/s10545-018-0153-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 12/16/2022]
Abstract
We present an update to the status of research on succinic semialdehyde dehydrogenase (SSADH) deficiency (SSADHD), a rare disorder of GABA metabolism. This is an unusual disorder featuring the accumulation of both GABA and its neuromodulatory analog, gamma-hydroxybutyric acid (GHB), and recent studies have advanced the potential clinical application of NCS-382, a putative GHB receptor antagonist. Animal studies have provided proof-of-concept that enzyme replacement therapy could represent a long-term therapeutic option. The characterization of neuronal stem cells (NSCs) derived from aldehyde dehydrogenase 5a1-/- (aldh5a1-/-) mice, the murine model of SSADHD, has highlighted NSC utility as an in vitro system in which to study therapeutics and associated toxicological properties. Gene expression analyses have revealed that transcripts encoding GABAA receptors are down-regulated and may remain largely immature in aldh5a1-/- brain, characterized by excitatory as opposed to inhibitory outputs, the latter being the expected action in the mature central nervous system. This indicates that agents altering chloride channel activity may be therapeutically relevant in SSADHD. The most recent therapeutic prospects include mTOR (mechanistic target of rapamycin) inhibitors, drugs that have received attention with the elucidation of the effects of elevated GABA on autophagy. The outlook for novel therapeutic trials in SSADHD continues to improve.
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Affiliation(s)
- Kara R Vogel
- Department of Neuroscience, University of Wisconsin, Madison, WI, USA
| | | | - Dana C Walters
- Department of Pharmacotherapy, College of Pharmacy, Washington State University, 412 E. Spokane Falls Blvd, Health Sciences Building Room 210, Spokane, WA, 99204, USA
| | | | - Sameer C Dhamne
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexander Rotenberg
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jean-Baptiste Roullet
- Department of Pharmacotherapy, College of Pharmacy, Washington State University, 412 E. Spokane Falls Blvd, Health Sciences Building Room 210, Spokane, WA, 99204, USA
| | - K Michael Gibson
- Department of Pharmacotherapy, College of Pharmacy, Washington State University, 412 E. Spokane Falls Blvd, Health Sciences Building Room 210, Spokane, WA, 99204, USA.
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Chetboul V, Pouchelon J, Menard J, Blanc J, Desquilbet L, Petit A, Rougier S, Lucats L, Woehrle F. Short-Term Efficacy and Safety of Torasemide and Furosemide in 366 Dogs with Degenerative Mitral Valve Disease: The TEST Study. J Vet Intern Med 2017; 31:1629-1642. [PMID: 28975664 PMCID: PMC5697186 DOI: 10.1111/jvim.14841] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 07/05/2017] [Accepted: 08/23/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Furosemide is the only loop diuretic recommended by the ACVIM consensus guidelines for treatment of congestive heart failure (CHF) in dogs related to degenerative mitral valve disease (DMVD). Torasemide is another potent loop diuretic with a longer half-life and a higher bioavailability. OBJECTIVES (1) To demonstrate that torasemide given once a day (q24h) is noninferior to furosemide given twice a day (q12h) for treating dogs with CHF; (2) and to compare the effect of the 2 drugs on the time to reach a composite cardiac endpoint "spontaneous cardiac death, euthanasia due to heart failure or CHF class worsening." ANIMALS A total of 366 dogs with CHF attributable to DMVD. METHODS Analysis of 2 prospective randomized single-blinded reference-controlled trials was performed. Dogs orally received either torasemide q24h (n = 180) or furosemide q12h (n = 186) in addition to standard CHF therapy over 3 months. The primary efficacy criterion was the percentage of dogs with treatment success assessed in each study. The time to reach the composite cardiac endpoint was used as secondary criterion in the overall population. RESULTS Torasemide was noninferior to furosemide (Ptorasemide - Pfurosemide = +7%; 95% CI [-8%; +22%] and Ptorasemide - Pfurosemide = +1%; 95% CI [-12%; +14%], respectively, in Study 1 and Study 2). Torasemide (median dose = 0.24 mg/kg/d q24h; range = 0.10-0.69 mg/kg/d) was associated with a 2-fold reduction in the risk of reaching the composite cardiac endpoint (adjusted HR = 0.47; 95% CI = 0.27-0.82; P = 0.0077) as compared with furosemide (median dose = 1.39 mg/kg q12h; range = 0.70-6.30 mg/kg q12h). CONCLUSIONS AND CLINICAL IMPORTANCE Torasemide q24h is an effective oral diuretic in dogs with CHF.
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Affiliation(s)
- V. Chetboul
- Alfort Cardiology UnitUniversité Paris‐EstEcole Nationale Vétérinaire d'AlfortMaisons‐Alfort CedexFrance
- INSERM U955Equipe 03Créteil CedexFrance
| | - J.‐L. Pouchelon
- Alfort Cardiology UnitUniversité Paris‐EstEcole Nationale Vétérinaire d'AlfortMaisons‐Alfort CedexFrance
- INSERM U955Equipe 03Créteil CedexFrance
| | | | | | - L. Desquilbet
- Department of Biostatistics and Clinical EpidemiologyUniversité Paris‐EstEcole Nationale Vétérinaire d'AlfortMaisons‐Alfort CedexFrance
| | - A. Petit
- Alfort Cardiology UnitUniversité Paris‐EstEcole Nationale Vétérinaire d'AlfortMaisons‐Alfort CedexFrance
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Ayaz SI, Sharkey CM, Kwiatkowski GM, Wilson SS, John RS, Tolomello R, Mahajan A, Millis S, Levy PD. Intravenous enalaprilat for treatment of acute hypertensive heart failure in the emergency department. Int J Emerg Med 2016; 9:28. [PMID: 28032307 PMCID: PMC5195922 DOI: 10.1186/s12245-016-0125-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/01/2016] [Indexed: 11/28/2022] Open
Abstract
Background Afterload reduction with bolus enalaprilat is used by some for management of acute hypertensive heart failure (HF) but existing data on the safety and effectiveness of this practice are limited. The purpose of this study was to evaluate the clinical effects of bolus enalaprilat when administered to patients with acute hypertensive heart failure. Findings We performed an IRB-approved retrospective cohort study of patients who presented to the emergency department of a large urban academic hospital. Patients were identified by pharmacy record and included if they received enalaprilat intravenous (IV) bolus in the setting of acute hypertensive HF. A total of 103 patients were included. Patients were hypertensive on presentation (systolic blood pressure [SBP] = 195.2 [SD ± 32.3] mmHg) with significantly elevated mean NT-proBNP levels (3797.8 [SD ± 6523.2] pg/ml). The mean dose of enalaprilat was 1.3 [SD ± 0.7] mg, with most patients (76.7%) receiving a single 1.25 mg bolus. By 3 h postenalaprilat, SBP had decreased substantially (−30.5 mmHg) with only 2 patients (1.9%) developing hypotension. Renal function was unaffected, with no significant change in serum creatinine by 72 h. In the 30 days post-admission, patients spent an average of 23 [SD ± 7.5] days alive and out of hospital. Conclusions In this retrospective cohort of acute hypertensive HF patients, bolus IV enalaprilat resulted in a substantial reduction in systolic BP without adverse effect.
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Affiliation(s)
- Syed Imran Ayaz
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA.
| | - Craig M Sharkey
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA
| | | | | | - Reba S John
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA
| | - Rosa Tolomello
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA
| | - Arushi Mahajan
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA
| | - Scott Millis
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA
| | - Phillip D Levy
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, UHC-6G, Detroit, MI, 48201, USA.,Detroit Receiving Hospital, 4201 St. Antoine, Detroit, MI, 48201, USA.,Cardiovascular Research Institute, Wayne State University School of Medicine, 540 East Canfield, Detroit, MI, 48201, USA
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Nakada Y, Okayama S, Nakano T, Ueda T, Onoue K, Takeda Y, Kawakami R, Horii M, Uemura S, Fujimoto S, Saito Y. Echocardiographic characteristics of patients with acute heart failure requiring tolvaptan: a retrospective study. Cardiovasc Ultrasound 2015; 13:27. [PMID: 26049727 PMCID: PMC4458340 DOI: 10.1186/s12947-015-0022-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 06/01/2015] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND No study has investigated the admission echocardiographic characteristics of acute heart failure (AHF) patients who are resistant to conventional diuretics and require tolvaptan. METHODS We retrospectively analyzed the echocardiographic characteristics of AHF patients who were resistant to conventional diuretics and took tolvaptan (tolvaptan group: 26 patients), and compared them to those who were sensitive to conventional diuretics (conventional group: 180 patients). RESULTS The tolvaptan group had a higher left atrial volume index (96.0 ± 85.0 mL/m2 vs. 45.8 ± 25.9 mL/m2, p < 0.0001), maximum inferior vena cava diameter (20.7 ± 6.9 mm vs. 18.1 ± 4.2 mm, p < 0.01), and higher tricuspid regurgitation grade (1.1 ± 0.8 vs. 0.8 ± 0.6, p < 0.05) than the conventional group. However, the left ventricular ejection fraction and end diastolic diameter were similar between the groups. Responders of tolvaptan had no significant echocardiographic differences compared to the non-responders. CONCLUSIONS The admission echocardiographic characteristics of AHF patients requiring tolvaptan included a larger left atrium, inferior vena cava, and more severe tricuspid regurgitation. Echocardiography may provide useful information for the early and appropriate initiation of tolvaptan.
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Affiliation(s)
- Yasuki Nakada
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Satoshi Okayama
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Tomoya Nakano
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tomoya Ueda
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kenji Onoue
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yukiji Takeda
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Rika Kawakami
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Manabu Horii
- Department of Cardiovascular Internal Medicine, Nara City Hospital, Nara, Japan
| | - Shiro Uemura
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | | | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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