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Park SM, Lee SY, Jung MH, Youn JC, Kim D, Cho JY, Cho DH, Hyun J, Cho HJ, Park SM, Choi JO, Chung WJ, Kang SM, Yoo BS. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Management of the Underlying Etiologies and Comorbidities of Heart Failure. INTERNATIONAL JOURNAL OF HEART FAILURE 2023; 5:127-145. [PMID: 37554691 PMCID: PMC10406556 DOI: 10.36628/ijhf.2023.0016] [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: 03/20/2023] [Revised: 07/01/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023]
Abstract
Most patients with heart failure (HF) have multiple comorbidities, which impact their quality of life, aggravate HF, and increase mortality. Cardiovascular comorbidities include systemic and pulmonary hypertension, ischemic and valvular heart diseases, and atrial fibrillation. Non-cardiovascular comorbidities include diabetes mellitus (DM), chronic kidney and pulmonary diseases, iron deficiency and anemia, and sleep apnea. In patients with HF with hypertension and left ventricular hypertrophy, renin-angiotensin system inhibitors combined with calcium channel blockers and/or diuretics is an effective treatment regimen. Measurement of pulmonary vascular resistance via right heart catheterization is recommended for patients with HF considered suitable for implantation of mechanical circulatory support devices or as heart transplantation candidates. Coronary angiography remains the gold standard for the diagnosis and reperfusion in patients with HF and angina pectoris refractory to antianginal medications. In patients with HF and atrial fibrillation, long-term anticoagulants are recommended according to the CHA2DS2-VASc scores. Valvular heart diseases should be treated medically and/or surgically. In patients with HF and DM, metformin is relatively safer; thiazolidinediones cause fluid retention and should be avoided in patients with HF and dyspnea. In renal insufficiency, both volume status and cardiac performance are important for therapy guidance. In patients with HF and pulmonary disease, beta-blockers are underused, which may be related to increased mortality. In patients with HF and anemia, iron supplementation can help improve symptoms. In obstructive sleep apnea, continuous positive airway pressure therapy helps avoid severe nocturnal hypoxia. Appropriate management of comorbidities is important for improving clinical outcomes in patients with HF.
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Affiliation(s)
- Sang Min Park
- Division of Cardiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Soo Youn Lee
- Department of Cardiology, Cardiovascular Center, Incheon Sejong Hospital, Incheon, Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medicine, Seoul, Korea
| | - Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Park SM, Lee SY, Jung MH, Youn JC, Kim D, Cho JY, Cho DH, Hyun J, Cho HJ, Park SM, Choi JO, Chung WJ, Kang SM, Yoo BS. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Management of the Underlying Etiologies and Comorbidities of Heart Failure. Korean Circ J 2023; 53:425-451. [PMID: 37525389 PMCID: PMC10406530 DOI: 10.4070/kcj.2023.0114] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/01/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023] Open
Abstract
Most patients with heart failure (HF) have multiple comorbidities, which impact their quality of life, aggravate HF, and increase mortality. Cardiovascular comorbidities include systemic and pulmonary hypertension, ischemic and valvular heart diseases, and atrial fibrillation. Non-cardiovascular comorbidities include diabetes mellitus (DM), chronic kidney and pulmonary diseases, iron deficiency and anemia, and sleep apnea. In patients with HF with hypertension and left ventricular hypertrophy, renin-angiotensin system inhibitors combined with calcium channel blockers and/or diuretics is an effective treatment regimen. Measurement of pulmonary vascular resistance via right heart catheterization is recommended for patients with HF considered suitable for implantation of mechanical circulatory support devices or as heart transplantation candidates. Coronary angiography remains the gold standard for the diagnosis and reperfusion in patients with HF and angina pectoris refractory to antianginal medications. In patients with HF and atrial fibrillation, long-term anticoagulants are recommended according to the CHA2DS2-VASc scores. Valvular heart diseases should be treated medically and/or surgically. In patients with HF and DM, metformin is relatively safer; thiazolidinediones cause fluid retention and should be avoided in patients with HF and dyspnea. In renal insufficiency, both volume status and cardiac performance are important for therapy guidance. In patients with HF and pulmonary disease, beta-blockers are underused, which may be related to increased mortality. In patients with HF and anemia, iron supplementation can help improve symptoms. In obstructive sleep apnea, continuous positive airway pressure therapy helps avoid severe nocturnal hypoxia. Appropriate management of comorbidities is important for improving clinical outcomes in patients with HF.
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Affiliation(s)
- Sang Min Park
- Division of Cardiology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Soo Youn Lee
- Department of Cardiology, Cardiovascular Center, Incheon Sejong Hospital, Incheon, Korea
| | - Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medicine, Seoul, Korea
| | - Junho Hyun
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
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Maher VMG, Kitano Y, Neuwirth C, Davies GJ, Maseri A, Thompson GR, Andreotti F. Plasminogen activator inhibitor-1 removal using dextran sulphate columns. Evidence of PAI-1 homeostasis. J Thromb Thrombolysis 2008; 28:166-72. [DOI: 10.1007/s11239-008-0260-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Accepted: 07/14/2008] [Indexed: 11/29/2022]
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Verheugt FWA. New anticoagulants in ischemic heart disease. Presse Med 2005; 34:1325-9. [PMID: 16269997 DOI: 10.1016/s0755-4982(05)84181-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Fibrinolysis is the reference treatment for most myocardial infarctions with ST-segment elevation; alternatives are angioplasty, with or without stent. The earlier fibrinolysis is performed (preferably before hospitalization), the more effective it is. It can be optimized by adjuvant antiplatelet therapy, such as aspirin, and probably by anticoagulant treatment as well. Because fibrinolytic therapy is accompanied by intensive thrombin generation and activation, immediate and continuous adjunctive simultaneous heparin therapy is recommended. The efficacy of subcutaneous low-molecular-weight heparin (LMWH) HBPM) is at least equivalent to that of intravenous unfractionated heparin (UFH), but its risk of severe (but not cerebral) hemorrhage is greater. Bolus LMWH on the other hand is associated with an increased risk of cerebral hemorrhage. Antithrombotic treatment thus appears optimal with bolus UFH at fibrinolysis and for at least 48 hours afterwards. An alternative after this bolus might be subcutaneous enoxaparin until discharge. Because the major drawback of both types of heparin is their rebound activation of thrombosis, oral anticoagulants are recommended thereafter. The combination of anticoagulant treatment + (low-dose) aspirin is not superior to aspirin alone when the target INR is below 2. Adequate anticoagulation with INRs greater than 2.0 consistently improves angiographic and clinical outcome. Bleeding (except intracerebral) is significantly increased whether the INR is greater than or less than 2.0. Other treatments are being investigated. Pentasaccharide (anti-Xa) combined with fibrinolysis seems to reduce reocclusion more effectively than UFH. Oral postinfarction treatment with ximelagatran (a thrombin inhibitor), combined with aspirin, is associated with fewer cardiovascular events than aspirin alone. More studies are needed.
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Affiliation(s)
- F W A Verheugt
- Department of Cardiology, University Medical Center St Radboud, Nijmegen, The Netherlands.
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Stuveling EM, Bakker SJL, Hillege HL, de Jong PE, Gans ROB, de Zeeuw D. Biochemical risk markers: a novel area for better prediction of renal risk? Nephrol Dial Transplant 2005; 20:497-508. [PMID: 15735241 DOI: 10.1093/ndt/gfh680] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Arntz HR, Müller-Nordhorn J, Willich SN. Cold Monday mornings prove dangerous: epidemiology of sudden cardiac death. Curr Opin Crit Care 2001; 7:139-44. [PMID: 11436519 DOI: 10.1097/00075198-200106000-00001] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sudden cardiac death is the leading cause of death in industrialized countries, accounting for 10 to 20% of total mortality. Several studies have demonstrated a circadian variation of sudden death with a primary peak in the morning hours after awakening and a secondary peak in the late afternoon. Weekly and seasonal variations have been observed, with more frequent occurrence of sudden death on Mondays and in the winter compared with other days of the week and seasons, respectively. These patterns of disease occurrence indicate the presence of identifiable triggering factors. Interestingly, the circadian pattern of sudden death appears to be more pronounced in older patients and to be attenuated by beta-blocker therapy. Rupture of an atherosclerotic plaque with subsequent coronary thrombosis is the most common underlying pathophysiologic mechanism of sudden death. The variation in disease occurrence may reflect endogenous physiologic rhythms and the importance of external events (e.g., exertional physical activity) that trigger changes (e.g., surges in blood pressure) that lead to coronary plaque rupture. To reduce the long-term risk of sudden death, strategies of primary and secondary prevention must be further developed. To reduce short-term risk of sudden death, patients at risk for sudden death may require additional behavior modification and pharmacological intervention.
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Affiliation(s)
- H R Arntz
- Department of Cardiopulmology, Benjamin Franklin Medical Center, Free University Berlin, Hindenburgdamm 30, 12200 Berlin, Germany.
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Cleland JG, Alamgir F, Nikitin NP, Clark AL, Norell M. What is the optimal medical management of ischemic heart failure? Prog Cardiovasc Dis 2001; 43:433-55. [PMID: 11251129 DOI: 10.1053/pcad.2001.20670] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ischemic heart disease is an important and common contributor to the development of heart failure. Theoretically, all patients with heart failure may benefit from treatment designed to retard progressive ventricular dysfunction and arrhythmias. Patients with ischemic heart disease may also theoretically benefit from the relief of ischemia, the prevention of coronary occlusion, and revascularization. However, there is little evidence to show that the presence or absence of coronary disease modifies the benefits of effective treatments such as angiotensin-converting enzyme inhibitors and beta-blockers. Moreover, there is no evidence that treatment directed specifically at myocardial ischemia or coronary disease alters outcome in patients with heart failure. Treatments aimed at relieving painless myocardial ischemia have not been shown to alter prognosis. Lipid-lowering therapy is theoretically attractive for patients with heart failure and coronary disease; however, theoretical concerns also exist about the safety of such agents, and patients with heart failure have been excluded from large outcome studies very effectively. Some agents, such as aspirin, designed to reduce the risk of coronary occlusion seem ineffective or harmful in patients with heart failure, although warfarin may be safe and possibly effective. There is no evidence yet that revascularization improves prognosis in patients with heart failure, even in patients who are shown to have extensive myocardial hibernation. On current evidence, revascularization should be reserved for the relief of angina. Large-scale, randomized controlled trials are currently underway that are investigating the role of specific treatments targeted at coronary syndromes. The Carvedilol Hibernation Reversible Ischemia Trial: Marker of Success study is investigating the effects of carvedilol in a large cohort of patients with and without hibernating myocardium. The Warfarin and Antiplatelet Therapy in Chronic Heart Failure study is comparing the efficacy of aspirin, clopidogrel, and warfarin. The Heart Revascularization Trial-United Kingdom study is assessing the effect of revascularization on mortality in patients with heart failure and myocardial hibernation. Smaller scale studies are assessing the safety and efficacy of statin therapy in patients with heart failure. Only once the outcomes to these and other planned trials are known can the medical community know how best to treat their patients.
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Affiliation(s)
- J G Cleland
- Department of Cardiology, Castle Hill Hospital, University of Hull, Cottingham, Kingston upon Hull, United Kingdom
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Abstract
Ischaemic heart disease is probably the most important cause of heart failure. All patients with heart failure may benefit from treatment designed to retard progressive ventricular dysfunction and arrhythmias. Patients with heart failure due to ischaemic heart disease may also, theoretically, benefit from treatments designed to relieve ischaemia and prevent coronary occlusion and from revascularisation. However, there is little evidence to show that effective treatments, such as angiotensin converting enzyme (ACE) inhibitors and beta-blockers, exert different effects in patients with heart failure with or without coronary disease. Moreover, there is no evidence that treatment directed specifically at myocardial ischaemia, whether or not symptomatic, or coronary disease alters outcome in patients with heart failure. Some agents, such as aspirin, designed to reduce the risk of coronary occlusion appear ineffective or harmful in patients with heart failure. There is no evidence, yet, that revascularisation improves prognosis in patients with heart failure, even in patients who are demonstrated to have extensive myocardial hibernation. On current evidence, revascularisation should be reserved for the relief of angina. Large-scale, randomised controlled trials are currently underway investigating the role of specific treatments targeted at coronary syndromes in patients who have heart failure. The CHRISTMAS study is investigating the effects of carvedilol in a large cohort of patients with and without hibernating myocardium. The WATCH study is comparing the efficacy of aspirin, clopidogrel and warfarin. The HEART-UK study is assessing the effect of revascularisation on mortality in patients with heart failure and myocardial hibernation. Smaller scale studies are currently assessing the safety and efficacy of statin therapy in patients with heart failure. Only when the results of these and other studies are known will it be possible to come to firm conclusions about whether patients with heart failure and coronary disease should be treated differently from other patients with heart failure due to left ventricular systolic dysfunction.
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Affiliation(s)
- J G Cleland
- Department of Cardiology, Castle Hill Hospital and Hull Royal Infirmary, Kingston upon Hull, UK
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α and β-adrenergic influences on the tissue and urokinase plasminogen activator systems. ACTA ACUST UNITED AC 1999. [DOI: 10.1016/s0268-9499(99)90068-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cleland JG, McGowan J. Heart failure due to ischaemic heart disease: epidemiology, pathophysiology and progression. J Cardiovasc Pharmacol 1999; 33 Suppl 3:S17-29. [PMID: 10442681 DOI: 10.1097/00005344-199906003-00003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Ischaemic heart disease is the most common underlying cause of heart failure in industrialised countries. Its manifestations are protean with myocardial infarction being only one important facet. The prognosis of patients with heart failure due to ischaemic heart disease also appears to be worse than that associated with many other aetiologies. The presence of ischaemic heart disease may influence both the efficacy and choice of treatment. Agents such as digoxin and amlodipine appear less effective in patients with ischaemic heart disease while ACE inhibitors and beta-blockers appear as or more effective in patients with ischaemic heart disease. Many have expressed an opinion about how coronary disease should be managed in the patient with heart failure supported by little or no evidence. There are major theoretical and practical concerns about the use of anti-coagulant, anti-platelet and statin therapy in patients with heart failure as well as major theoretical benefits. Only randomised controlled trials will resolve these issues. The same may be said of revascularisation. Fortunately trials addressing all these areas are under way. This should put the management of coronary disease in patients with heart failure on a firm evidence-based footing.
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Affiliation(s)
- J G Cleland
- Department of Cardiology, Castle Hill Hospital, University of Hull, Kingston upon Hull, UK
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Fernhall B, Szymanski LM, Gorman PA, Milani J, Paup DC, Kessler CM. Fibrinolytic activity is similar in physically active men with and without a history of myocardial infarction. Arterioscler Thromb Vasc Biol 1997; 17:1106-13. [PMID: 9194761 DOI: 10.1161/01.atv.17.6.1106] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to evaluate fibrinolytic potential at rest and after a fibrinolytic stressor in men with a history of myocardial infarction (MI) compared with an age- and activity-matched group of men without coronary artery disease (CAD). All men were currently enrolled in exercise programs. Tissue-type plasminogen activator (TPA) and plasminogen activator inhibitor 1 (PAI-1) activity and antigen levels were measured at rest and after a maximal exercise test. A 2 x 2 (group x time) ANOVA with repeated measures was used to evaluate fibrinolytic potential. Bivariate regressions were conducted to evaluate relations between fibrinolytic potential and maximal oxygen uptake (VO2max). Age was similar between groups (CAD, 57.5 +/- 6.6; non-CAD, 58.1 +/- 7.3 years); however, VO2max was higher in non-CAD subjects (36.2 +/- 6.2 vs 27.5 +/- 5.9 mL.kg-1.min-1). Mean +/- SEM resting TPA and PAI-1 activities were similar between CAD and non-CAD subjects (TPA, 2.8 +/- 0.2 vs 2.8 +/- 0.2 IU/mL; PAI-1, 15.9 +/- 3.1 vs 13.1 +/- 4.1 AU/mL). Both groups showed similar significant increases in TPA activity with exercise (P < .05), and postexercise TPA activity was also similar (CAD, 9.1 +/- 2.0 IU/mL; non-CAD, 11.7 +/- 2.6 IU/mL). Both groups also showed similar significant decreases in PAI-1 activity with exercise (P < .05) and no differences in postexercise PAI-1 activity (CAD, 13.2 +/- 2.5 AU/mL; non-CAD, 10.4 +/- 3.6 AU/mL). Significantly higher resting TPA antigen levels were seen in CAD (14.8 ng/mL) than non-CAD (10.2 ng/mL) subjects (P < .05), but neither group showed significant changes with exercise (CAD, 12.9 ng/mL; non-CAD, 11.8 ng/mL). Resting PAI-1 antigen was similar in the two groups (CAD, 71.4 ng/mL; non-CAD, 74.2 ng/mL) and did not significantly change with exercise (CAD, 77.9 ng/mL; non-CAD, 72.3 ng/mL). VO2max was positively correlated with postexercise TPA activity (r = .52, P < .05) and negatively correlated with resting TPA antigen (r = -.43, P < .05). Resting TPA antigen was also directly correlated with body mass index (r = .63, P < .05). The finding that functional fibrinolytic activity was not different in physically active men with and without CAD contrasts with previous reports. This suggests that matching subjects on the bases of age and habitual physical activity status and controlling exercise intensity are important factors to consider when evaluating fibrinolytic potential.
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Affiliation(s)
- B Fernhall
- Exercise Science Programs, George Washington University Medical Center, Washington, DC 20052, USA.
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Wolpert C, Jung W, Spehl S, Korte T, Lüderitz B. [Circadian variation of ventricular tachyarrhythmias in patients with an implantable cardioverter-defibrillator]. Herzschrittmacherther Elektrophysiol 1997; 8:46-52. [PMID: 19495677 DOI: 10.1007/bf03042477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/1996] [Accepted: 12/16/1996] [Indexed: 05/27/2023]
Abstract
For the acute myocardial infarction and sudden cardiac death a circadian variation can be observed. There are several, mostly epidemiological studies that demonstrate this non-uniform distribution of events in different day-time periods. These studies are in the vast majority based on eye-witness reports, medical documents and retrospective evaluation of the timing of the event. Moreover, they represent only singular observations in a heterogeneous population. With the introduction of implantable cardioverter-defibrillators which provide extensive diagnostic features such as stored RR-intervals, endocardial electrograms of each episode and internal time storage, an exact analysis of the circadian variation of malignant ventricular tachyarrhythmias became feasible. Ventricular tachyarrhythmias follow a different circadian distribution with increased number of events at certain day-time periods. For patients with a coronary artery disease a significantly higher risk to experience a potentially fatal arrhythmia could be shown for the mid-morning hours and a secondary peak occurrence for the late afternoon and the early evening. Patients with idiopathic dilated cardiomyopathy tend to have a higher probability of events in the evening hours. With respect to beta-blockers and other antiarrhythmic drugs most of the studies failed to confirm a blunting influence on the degree of variability for fast arrhythmias. Others showed similar patterns for fast and slow tachycardias. Another clinical parameter, the degree of congestive heart failure was in some studies found to influence the pattern in the sense of causing a distinct difference in occurrence frequency. A higher vairation was determined for lower NYHA classes < III. Other studies were contrary to these findings. The activity level before the onset of arrhythmias has yet been only insufficiently analyzed regarding the day-time-variability. But first results make believe, that patients younger than 50 years and still involved in the working process seem to follow a more varying circadian distribution. More substudies will have to be performed to compare working and nonworking patients and patients with different structural heart diseases. Furthermore ther influence of antiarrhythmic agents on the day-time-variation of ventricular tachyarrhythmias should be assessed. Finally, there, should be systematic prospective studies that evaluate the influence of drug administration on triggers of ventricular tachyarrhythmias such as sympathoadrenergic activity, premature ventricular beats, reduction of heart rate variability and others with respect to their day-time-variability.
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Affiliation(s)
- C Wolpert
- Medizinische Universitätsklinik und Poliklinik, Sigmund-Freud-Strasse 25, 53105, Bonn
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Andreotti F, Prevost R, Lupi A, Hamilton J, de Bart A, Huisman L, Maseri A, Kluft C. Circadian patterns of plasma t-PA and PAI-1 antigen levels in patients with severe peripheral atherosclerosis. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/s0268-9499(96)80076-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- A Takada
- Department of Physiology, Hamamatsu University School of Medicine, Shizuoka-ken, Japan
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Andreotti F, Kluft C, Hamilton J, Hopkins N, Davies G, Maseri A. Effect of age, time of day and arterial disease on the relation between tissue-type plasminogen activator and plasminogen activator inhibitor-1 in plasma. ACTA ACUST UNITED AC 1992. [DOI: 10.1016/0268-9499(92)90018-d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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