Optimizing treatment and outcomes in acute heart failure: beyond initial triage

Tumstatin (69-88) alleviates heart failure via attenuating oxidative stress in rats with myocardial infarction

Background

This study aimed to elucidate the effects of tumstatin (69–88) on heart failure and the underlying mechanism.

Materials and methods

Myocardial infarction (MI) was induced by ligating the left coronary artery in rats to trigger heart failure.

Results

Tumstatin (69–88) can reduce cardiac insufficiency in rats with heart failure. The increased cardiac fibrosis in MI rat was attenuated by tumstatin (69–88). Increase of cardiac atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in rats with myocardial infarction, and Ang II-treated NRCMs or H9C2 cells was inhibited by tumstatin (69–88). In the heart of MI rats, and Ang II-treated NRCMs or H9C2 cells, the superoxide anions and NADPH oxidase (Nox) activity rose and the superoxide dismutase (SOD) activity was reduced, which was inhibited by tumstatin (69–88). Diethyldithiocarbamate, an SOD inhibitor, increased the ANP and BNP in NRCMs or H9C2 cells. Tumstatin (69–88) inhibited the Ang II-induced raises of ANP and BNP in NRCMs or H9C2 cells, which was reversed by DETC.

Conclusions

These results indicate that tumstatin (69–88) alleviates cardiac dysfunction of heart failure. Tumstatin (69–88) improves the hypertrophy of cardiomyocytes via attenuation of oxidative stress. Tumstatin (69–88) may be a potential drug for heart failure in the future.

Northern Territory Heart Failure Initiative-Clinical Audit (NTHFI-CA)-a prospective database on the quality of care and outcomes for acute decompensated heart failure admission in the Northern Territory: study design and rationale

INTRODUCTION

Congestive heart failure is a significant cause of morbidity and mortality in Australia. Accurate data for the Northern Territory and Indigenous Australians are not presently available. The economic burden of this chronic cardiovascular disease is felt by all funding bodies and it still remains unclear what impact current measures have on preventing the ongoing disease burden and how much of this filters down to more remote areas. Clear differentials also exist in rural areas including a larger Indigenous community, greater disease burden, differing aetiologies for heart failure as well as service and infrastructure discrepancies. It is becoming increasingly clear that urban solutions will not affect regional outcomes. To understand regional issues relevant to heart failure management, an understanding of the key performance indicators in that setting is critical.

METHODS AND ANALYSIS

The Northern Territory Heart Failure Initiative-Clinical Audit (NTHFI-CA) is a prospective registry of acute heart failure admissions over a 12-month period across the two main Northern Territory tertiary hospitals. The study collects information across six domains and five dimensions of healthcare. The study aims to set in place an evidenced and reproducible audit system for heart failure and inform the developing heart failure disease management programme. The findings, is believed, will assist the development of solutions to narrow the outcomes divide between remote and urban Australia and between Indigenous and Non-Indigenous Australians, in case they exist. A combination of descriptive statistics and mixed effects modelling will be used to analyse the data.

ETHICS AND DISSEMINATION

This study has been approved by respective ethics committees of both the admitting institutions. All participants will be provided a written informed consent which will be completed prior to enrolment in the study. The study results will be disseminated through local and international health conferences and peer reviewed manuscripts.

Early emergency management of acute decompensated heart failure

PURPOSE OF REVIEW

Acute decompensated heart failure (ADHF) is characterized by a complex spectrum of pathophysiology that emerges as a common clinical disease state, which manifests as a failure of the circulation to provide for the needs of the body systems. Whereas ADHF is often characterized by the findings of pulmonary congestion and dyspnea, a variety of clinical presentations are possible, with each requiring differing management strategies. This review examines the approach of the four-quadrant clinical profile for differentiation of the ADHF patient during the emergent resuscitative phase of the decompensation.

RECENT FINDINGS

Clinical and diagnostic information can be used to determine the relative degree of pulmonary congestion and peripheral tissue perfusion in patients suspected of ADHF. This information can be used in a four-quadrant approach to differentiate patients into pathophysiologic categories. These profiles can then be translated into management strategies from a physiology based perspective in which the specific mechanisms of the failure are targeted.

SUMMARY

ADHF can present in a variety of clinical forms in the emergent setting. Categorization of the ADHF patient according to their individual hemodynamic profile can assist in management decisions during the emergent resuscitative phase of the decompensation based upon an approach that targets causative pathophysiologic mechanisms.

Diastolic dysfunction in pediatric cardiac patients: evaluation and management

OPINION STATEMENT

The heart is a complex and sophisticated pump that cycles between two phases: diastole, during which a compliant chamber (ventricle) allows the blood to fill from a reservoir chamber (atrium) of low pressure, and systole, during which a stiff chamber with rapidly rising pressure ejects the blood into an arterial circuit of high pressure. However, the systolic and diastolic cycles are not dichotomous. They have complex interactions with interrelated segments of the cardiac cycle. Although the entity of "diastolic heart failure with preserved systolic function" has been applied in adult patients, a discrete diagnosis of systolic and diastolic heart failure may be difficult to apply in pediatric patients. Advances in echocardiography have helped decipher the morphologic and physiologic expression of congenital and acquired heart disease and have increased our understanding the diastolic function and dysfunction. The evolving concept of systolic and diastolic heart failure is helping us develop a strategy for its management in pediatric patients with complex heart diseases.