Periodic respiration in patients with heart failure

Summary Patients with heart failure are known to demonstrate periodic respiration (PR) during sleep. The factors causing PR are not well known. We therefore studied 20 patients (aged 18–66 years) with idiopathic dilated cardiomyopathy. Full-night polysomnography and evaluation of respiration and transcutaneous oxygen saturation were performed. Hypercapnic ventilatory response (HCVR) was evaluated during daytime. The patients showed PR for 25 ± 26% (mean ± standard deviation) of total sleep time. During PR, oxygen desaturated 7.1±4.6%. Sleep was impaired. HCVR was normal. Oxygen desaturation during PR was predicted by HCVR (r=0.47, P<0.05) and left atrial diameter (r=0.60, P<0.05). The time period of PR expressed as a fraction of total sleep time was correlated with HCVR (r=0.45, P<0.05) and left atrial diameter (r=0.51, P<0.05). In conclusion, PR with oxygen desaturation, arousals, and impaired sleep was observed in stable heart failure. HCVR and left heart dimensions were related to PR. These findings confirm the concept of a feedback loop describing respiratory control in PR.Abbreviations PR periodic respiration - HCVR hypercapnic ventilatory response - LA left atrial diameter - LVED left ventricular end-diastolic diameter - REM rapid eye movement     

Heart transplantation in patients with diuretic resistant heart failure

Advanced heart failure is becoming an increasing cause of mortality and morbidity in a large number of patients. Heart transplantation is the treatment of choice for many selected patients in this group. According to the clinical status at the time of transplant, patients may have a different outcome related to the early survival, while the late results are similar and not affected by the patient's initial clinical status. All surviving patients showed recovery of kidney function as soon the cardiac output was restored to normal values. High urine output was present in a large number of patients in the early postoperative period. However, in severely ill patients with cardiac index <2.5 l/min/m2, diuretic resistance and mortality were higher.     

Recognition of depression in medical patients with heart failure

The author examined physician and patient factors related to recognition of depression in depressed medical patients. Medical inpatients over age 50 were systematically identified with depressive disorder (N=1,000). Medical physicians (N=422) treating these patients were asked whether they believed patients had depression warranting specific treatment. Frequency of seeing and treating older depressed patients and attitudes toward treatment effectiveness were key factors related to physicians' recognition of depression. Patient factors were younger age, white race, female gender, and persistence of depression after discharge. Although physicians' intuition about depression course was often correct, persistent depression was not recognized in nearly 40% of patients.     

Current strategies for preventing renal dysfunction in patients with heart failure: a heart failure stage approach

Renal dysfunction is common during episodes of acute decompensated heart failure, and historical data indicate that the mean creatinine level at admission has risen in recent decades. Different mechanisms underlying this change over time have been proposed, such as demographic changes, hemodynamic and neurohumoral derangements and medical interventions. In this setting, various strategies have been proposed for the prevention of renal dysfunction with heterogeneous results. In the present article, we review and discuss the main aspects of renal dysfunction prevention according to the different stages of heart failure.     

New therapeutic options for patients with heart failure with reduced ejection fraction and acute decompensated heart failure

BackgroundPatients with acute decompensated heart failure (ADHF) are at severe risk of death and rehospitalization. Several clinical studies have been designed to evaluate the efficacy and safety of new molecules administered before discharge or shortly after ADHF. The aim of this article is to summarize current knowledge on recently published findings on treatment of patients with heart failure with reduced ejection fraction (HFrEF) and ADHF.MethodsWe performed a thorough search for literature pertaining to our review via the PubMed database.ResultsIn this review, we summarize original papers concerning the efficacy and safety of new molecules in patients with HFrEF and ADHF.ConclusionsPeri-discharge initiation of treatment with new molecules is possible and safe for patients with HFrEF and ADHF. New molecules, if administered before discharge or shortly after, reduce the risk of cardiovascular death or worsening heart failure within the vulnerable phase, and are also nephroprotective.     

Depression profile in patients with and without chronic heart failure

OBJECTIVE: Depression often goes undetected and untreated in patients with chronic heart failure (CHF). To investigate whether patients with CHF show a specific profile of depression symptoms, we compared depression symptoms in depressed patients with and without CHF. METHODS: Of a total of 921 patients from a CHF and a psychosomatic outpatient clinic, 137 met DSM-IV diagnostic criteria for major depressive disorder and 113 for other depressive disorders. Depressed patients with CHF (n=113) and without CHF (n=137) were compared with respect to severity of individual DSM-IV depressive symptoms, as measured with the PHQ-9. To stratify for depression severity, ANCOVAs with sociodemographic characteristics as covariates were performed separately for patients with major depressive disorder and other depressive disorders. RESULTS: Among the patients meeting the criteria for major depressive disorder, patients with CHF reported significantly lower levels of depressed mood (p=.006) and worthlessness/guilt (p=.019) than patients without CHF. In contrast, no significant group differences were found for any of the other depression symptoms. Group comparisons among the patients with other depressive disorders completely replicated these results (p< or =.001, and p=.04, respectively). LIMITATIONS: Our study population of CHF patients may not be representative for CHF patients recruited in the general population. CONCLUSIONS: The diagnostic features discriminating between depressed patients with and without CHF are the cognitive-emotional symptoms of depression, not the somatic symptoms. This finding may partially explain the low recognition rate of depression in patients with CHF. The different profile of depression symptoms in patients with and without CHF should be considered in diagnosis, treatment and medical education.