Acute Decompensated Heart Failure: Evolving Literature and Implications for Future Practice

Cicci, Jonathan D.; Reed, Brent N.; McNeely, Elizabeth B.; Oni‐Orisan, Akinyemi; Patterson, J. Herbert; Rodgers, Jo E.

doi:10.1002/phar.1369

Cited by 3 publications

(3 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These patients typically exhibit reduced cardiac reserve and are therefore vulnerable to decompensated AHF after acute stimulus 5. There is clinical evidence that the hemodynamic characteristics of AHF patients may be somewhat different from those with chronic heart failure 6.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Intravenous Urapidil for Older Hypertensive Patients with Acute Heart Failure: A Multicenter Randomized Controlled Trial

Yang

Zhou

et al. 2017

Yonsei Med J

View full text Add to dashboard Cite

PurposeUrapidil is putatively effective for patients with hypertension and acute heart failure, although randomized controlled trials thereon are lacking. We investigated the efficacy and safety of intravenous urapidil relative to that of nitroglycerin in older patients with hypertension and heart failure in a randomized controlled trial.Materials and MethodsPatients (>60 y) with hypertension and heart failure were randomly assigned to receive intravenous urapidil (n=89) or nitroglycerin (n=91) for 7 days. Hemodynamic parameters, cardiac function, and safety outcomes were compared.ResultsPatients in the urapidil group had significantly lower mean systolic blood pressure (110.1±6.5 mm Hg) than those given nitroglycerin (126.4±8.1 mm Hg, p=0.022), without changes in heart rate. Urapidil was associated with improved cardiac function as reflected by lower N terminal-pro B type natriuretic peptide after 7 days (3311.4±546.1 ng/mL vs. 4879.1±325.7 ng/mL, p=0.027) and improved left ventricular ejection fraction (62.2±3.4% vs. 51.0±2.4%, p=0.032). Patients given urapidil had fewer associated adverse events, specifically headache (p=0.025) and tachycardia (p=0.004). The one-month rehospitalization and all-cause mortality rates were similar.ConclusionIntravenous administration of urapidil, compared with nitroglycerin, was associated with better control of blood pressure and preserved cardiac function, as well as fewer adverse events, for elderly patients with hypertension and acute heart failure.

show abstract

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Intravenous Urapidil for Older Hypertensive Patients with Acute Heart Failure: A Multicenter Randomized Controlled Trial

Yang

Zhou

et al. 2017

Yonsei Med J

View full text Add to dashboard Cite

show abstract

“…The majority of ADHF cases are complicated by elevated blood pressure, which may cause overloading of the heart and increased peripheral vascular resistance, thereby exacerbating the hemodynamic conditions ( 6 , 20 ). Vasodilators have been recommended as the first-line medication for patients with ADHF, which may be due to their ability to stabilize the hemodynamic status ( 4 , 9 ). The present study demonstrated that intravenous administration of urapidil and nitroglycerin conferred similar blood pressure-lowering effects in elderly patients with ADHF and hypertension, without having adverse effects on HR.…”

Section: Discussionmentioning

confidence: 99%

“…Despite significant improvements in the diagnosis and treatment of heart failure (HF), the mortality and morbidity rates for patients with HF remain high ( 1 – 3 ). For patients with hypertension, in particular elderly patients, the long-term overload of the heart caused by increased afterload, as well as reduced preservation of cardiac function, increases their susceptibility to cardiac insufficiency, which manifests clinically as acute decompensated HF (ADHF) ( 4 ). The hemodynamic characteristics of patients with ADHF have been shown to be different from those of patients with chronic HF (CHF) ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Therapeutic effects of intravenous urapidil in elderly patients with hypertension and acute decompensated heart failure: A pilot clinical trial

Yang

Zhou

et al. 2016

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

Urapidil has been proposed to be an effective vasodilator for the treatment of acute decompensated heart failure (ADHF); however, its effect on cardiac function, as compared with that of nitroglycerin, in elderly patients with hypertension and ADHF has yet to be determined. In the present study, a multicenter, open-label clinical trial was performed, in which 120 elderly patients with hypertension and ADHF were randomly assigned to the treatment (50–400 µg/min intravenous urapidil) or control group (5–40 µg/min intravenous nitroglycerin). The dosages of the medications were adjusted according to the blood pressure of the patients. The systolic and diastolic blood pressure, heart rate and serum level of N-terminal pro B-type natriuretic peptide (NT-proBNP) were evaluated at hospital admission and at days 1, 2, 3 and 7 after treatment. In addition, the left ventricular function was assessed by measuring the left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume at hospital admission and at days 2 and 7 after treatment. The results indicated that intravenous administration of urapidil and nitroglycerin were effective in lowering the blood pressure and heart rate within 7 days, with no significant differences observed between the two groups (P>0.05). By contrast, greater reduction in the serum NT-proBNP level (2,410.4±546.1 vs. 4,234.1±876.4 pg/ml; P<0.05) and greater improvement in the LVEF (55.3±3.4 vs. 45.2±2.4%; P<0.05) were observed in the urapidil-treated group, as compared with the nitroglycerin-treated group. No adverse events were reported during the treatment period in the two groups. The clinical outcomes at 6 months following discharge were evaluated and were not found to be significantly different between the two groups. In conclusion, the present results of the present study suggested that urapidil was as effective as nitroglycerin in controlling blood pressure and heart rate and was more effective in improving cardiac systolic function in elderly patients with hypertension and ADHF.

show abstract

Algebraic formulas characterizing an alternative to Guyton’s graphical analysis relevant for heart failure

Stiles

Rodriguez

Mohiuddin

et al. 2021

American Journal of Physiology-Regulatory, Integrative and Comp

View full text Add to dashboard Cite

Although Guyton's graphical analysis of cardiac output-venous return has become a ubiquitous tool for explaining how circulatory equilibrium emerges from heart‑vascular interactions, this classical model relies on a formula for venous return that contains unphysiological assumptions. Furthermore, Guyton's graphical analysis does not predict pulmonary venous pressure, which is a critical variable for evaluating heart failure patients' risk of pulmonary edema. Therefore, the purpose of present work was to use a minimal closed‑loop mathematical model to develop an alternative to Guyton's analysis. Limitations inherent in Guyton's model were addressed by 1) partitioning the cardiovascular system differently to isolate left ventricular function and lump all blood volumes together, 2) linearizing end‑diastolic pressure-volume relationships to obtain algebraic solutions, and 3) treating arterial pressures as constants. This approach yielded three advances. First, variables related to morbidities associated with left ventricular failure were predicted. Second, an algebraic formula predicting left ventricular function was derived in terms of ventricular properties. Third, an algebraic formula predicting flow through the portion of the system isolated from the left ventricle was derived in terms of mechanical properties without neglecting redistribution of blood between systemic and pulmonary circulations. Although complexities were neglected, approximations necessary to obtain algebraic formulas resulted in minimal error, and predicted variables were consistent with reported values.

show abstract

Acute Decompensated Heart Failure: Evolving Literature and Implications for Future Practice

Cited by 3 publications

References 66 publications

Efficacy and Safety of Intravenous Urapidil for Older Hypertensive Patients with Acute Heart Failure: A Multicenter Randomized Controlled Trial

Efficacy and Safety of Intravenous Urapidil for Older Hypertensive Patients with Acute Heart Failure: A Multicenter Randomized Controlled Trial

Therapeutic effects of intravenous urapidil in elderly patients with hypertension and acute decompensated heart failure: A pilot clinical trial

Algebraic formulas characterizing an alternative to Guyton’s graphical analysis relevant for heart failure

Contact Info

Product

Resources

About