Research Advances in Heart Failure

Abstract

W ithout question, the past half century has witnessed spectacular advances in cardiovascular medicine and surgery. In the United States, a full two thirds of the 6-year prolongation of life that has occurred has been a direct consequence of these advances 1 that did not spring forth simply from the heads of brilliant, insightful clinicians. Instead, most advances were based on preclinical research that were then translated into improvements in clinical care. 2 For instance, the microbiologists who connected streptococcal infection to acute rheumatic fever and, subsequently, the discovery of penicillin by a microbiologist, an experimental pathologist, and a biochemist led to the virtual elimination of acute rheumatic fever, which in turn was responsible for the marked reduction of chronic rheumatic valvular heart disease in large portions of the world. Almost all residual cases of the latter can now be corrected by open heart surgery or catheter-based techniques, which were made possible by the efforts of bioengineers, pharmacologists, and physiologists collaborating with surgeons and cardiologists. The striking reduction in mortality of acute myocardial infarction that has occurred since 1960 3 would not have been possible had physicists not previously developed the cathode ray oscilloscope, which enabled the continuous monitoring of the ECG, and if engineers had not developed the capacitors that store the electric charge required for ventricular defibrillation. Without pharmacologists and cell biologists, statins, which are enormously useful in preventing the development and progression of atherosclerosis, would not have been developed. These are just a few examples of the seminal scientific efforts that have provided the underpinnings of modern cardiology.However, despite the spectacular advances of the past half century, cardiovascular disease is still the most common cause of death and disability in industrialized nations, 4 and its prevalence is rising rapidly in developing nations. Almost one half of all cardiac deaths and disabilities are related to failure to apply well-established, evidence-based, guideline-approved therapies and preventive measures. These failures stem largely from inadequate access to care, poverty, and the disorganization of the medical care system in many countries, and they require political, economic, and societal changes. The remaining cardiovascular events, still a major problem in public health, result in large measure from the deficiencies in our understanding of cardiovascular pathobiology. Heart Failure Compendium© 2013 American Heart Association, Inc. One major disorder, heart failure (HF), remains a stubborn problem and is now considered to be the greatest challenge in cardiovascular medicine and surgery.5 From a clinical perspective, HF has been defined as "a complex syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. The cardinal manifestations of HF are dyspnea and fatigue, which may limit exercise tolerance a...

Biodegradable polymeric nanocapsules prevent cardiotoxicity of antitrypanosomal lychnopholide

“…The heart was able to eject a normal stroke volume but unable to accept a normal venous return, consistent with early concentric LV hypertrophy commonly seen in HF with preserved ejection fraction. This hypertrophic adaptation helps to maintain or enhance blood ejection but, at the same time, compromises chamber filling due to LV stiffness and, thereby, leads to a progressive deterioration of myocardial function until end-stage failure [26][27][28] . The ballooned apex of the heart was reminiscent of broken heart syndrome or drug-induced Tako-tsubo cardiomyopathy 13,14 .…”

Applying the Seattle Heart Failure Model in the Office Setting in the Era of Electronic Medical Records

“…13 Importantly, numerous other modifiable biomarkers with greater cardiac specificity are receiving increased attention as prognostic factors. 5, 34 We intentionally chose the office visit setting as the initial assessment point in an attempt to capture HF patients at a relatively stable phase of their disease, but we cannot exclude that some office visits were instigated as a response to early decompensation.…”

Concise Review: Mending a Broken Heart: The Evolution of Biological Therapeutics

“…Over the past decade, our understanding of the complex disease mechanisms underlying the pathogenesis of HF has significantly improved [51], and advances in molecular cardiology have identified key targets within the progression of HF. Gene therapy has emerged as a viable therapeutic strategy for specifically modulating underlying disease mechanisms, potentially replacing the symptomatic approach of existing treatments.…”