Short-term treatments for acute cardiac care: inotropes and inodilators.
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ABSTRACT:
SUBMITTER: Guarracino F
PROVIDER: S-EPMC7225903 | biostudies-literature | 2020 May
REPOSITORIES: biostudies-literature
Publications
Short-term treatments for acute cardiac care: inotropes and inodilators.
Guarracino Fabio F Zima Endre E Pollesello Piero P Masip Josep J
European heart journal supplements : journal of the European Society of Cardiology 20200515 Suppl D
Acute heart failure (AHF) continues to be a substantial cause of illness and death, with in-hospital and 3-month mortality rates of 5% and 10%, respectively, and 6-month re-admission rates in excess of 50% in a range of clinical trials and registry studies; the European Society of Cardiology (ESC) Heart Failure Long-Term Registry recorded a 1-year death or rehospitalization rate of 36%. As regards the short-term treatment of AHF patients, evidence was collected in the ESC Heart Failure Long-Term ...[more]
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Project description:Pathological interplay between the heart and kidneys is widely encountered in heart failure (HF) and is linked to worse prognosis and quality of life. Inotropes, along with diuretics and vasodilators, are a core medical response to HF but decompensated patients who need inotropic support often present with an acute worsening of renal function. The impact of inotropes on renal function is thus potentially an important influence on the choice of therapy. There is currently relatively little objective data available to guide the selection of inotrope therapy but recent direct observations on the effects of levosimendan and milrinone on glomerular filtration favour levosimendan. Other lines of evidence indicate that in acute decompensated HF levosimendan has an immediate renoprotective effect by increasing renal blood flow through preferential vasodilation of the renal afferent arterioles and increases in glomerular filtration rate: potential for renal medullary ischaemia is avoided by an offsetting increase in renal oxygen delivery. These indications of a putative reno-protective action of levosimendan support the view that this calcium-sensitizing inodilator may be preferable to dobutamine or other adrenergic inotropes in some settings by virtue of its renal effects. Additional large studies will be required, however, to clarify the renal effects of levosimendan in this and other relevant clinical situations, such as cardiac surgery.
| S-EPMC7225871 | biostudies-literature
Project description:BackgroundCardiac magnetic resonance (CMR) can detect inflammatory myocardial alterations in patients suspected of having acute myocarditis. There is limited information regarding the degree of normalization of CMR parameters during the course of the disease and the time window during which quantitative CMR should be most reasonably implemented for diagnostic work-up.Methods and resultsTwenty-four patients with suspected acute myocarditis and 45 control subjects underwent CMR. Initial CMR was performed 2.6±1.9 days after admission. Myocarditis patients underwent CMR follow-up after 2.4±0.6, 5.5±1.3, and 16.2±9.9 weeks. The CMR protocol included assessment of standard Lake Louise criteria, T1 relaxation times, extracellular volume fraction, and T2 relaxation times. Group differences between myocarditis patients and control subjects were highest in the acute stage of the disease (P<0.001 for all parameters). There was a significant and consistent decrease in all inflammatory CMR parameters over the course of the disease (P<0.01 for all parameters). Myocardial T1 and T2 relaxation times-indicative of myocardial edema-were the only single parameters showing significant differences between myocarditis patients and control subjects on 5.5±1.3-week follow-up (T1: 986.5±44.4 ms versus 965.1±28.1 ms, P=0.022; T2: 55.5±3.2 ms versus 52.6±2.6 ms; P=0.001).ConclusionsIn patients with acute myocarditis, CMR markers of myocardial inflammation demonstrated a rapid and continuous decrease over several follow-up examinations. CMR diagnosis of myocarditis should therefore be attempted at an early stage of the disease. Myocardial T1 and T2 relaxation times were the only parameters of active inflammation/edema that could discriminate between myocarditis patients and control subjects even at a convalescent stage of the disease.
| S-EPMC5015395 | biostudies-literature
Project description:BACKGROUND: Periostin was proved to play an important role in extra-cellular matrix remodeling after acute myocardial infarction (AMI). Myocardial periostin was markedly up-regulated after AMI and participated in the maladaptive process of cardiac remodeling. However, few researches focused on the circulating periostin and its significance. This study aims to investigate the association of serum periostin level with cardiac function and short-term prognosis in AMI patients. METHODOLOGY/PRINCIPAL FINDINGS: We totally recruited 50 patients diagnosed as ST-elevation myocardial infarction. Blood samples were taken within 12 hours after the onset of AMI before emergency coronary revascularization procedures. Serum periostin was measured using enzyme-linked immunosorbent assay. All patients received echocardiography examination within one week after hospitalization. Correlations of serum periostin with echocardiography parameters, Killip class and myocardium injury biomarkers (CK-MB/troponin T) were investigated. AMI patients were divided into two groups by serum periostin level (higher/lower periostin group) and followed up for six months. Primary endpoints included cardiovascular mortality, nonfatal stroke/transient ischemic attack, chest pain occurrence and re-hospitalization. Secondary endpoint referred to composite cardiovascular events including all the primary endpoints. RESULT: Serum periostin was in negative association with left ventricular ejection fraction (LVEF) (r = -0.472, *p<0.01) and left atrium diameter (LAD) (r = -0.328, *p<0.05). Positive correlation was found between serum periostin level and Killip class (r = 0.395, *p<0.01). There was no association between serum periostin and CK-MB or troponin T (p>0.05). After six months follow up, patients in higher periostin group showed increased composite cardiovascular events (*p<0.05). Patients showed no significant difference in primary endpoints between the two groups. CONCLUSIONS/SIGNIFICANCE: Serum periostin was in negative correlation with LVEF and LAD, in positive association with Killip class and higher serum periostin level may be predictive for worse short-term disease prognosis indicated as more composite cardiovascular events six months post AMI.
| S-EPMC3931651 | biostudies-other
Project description:Background: It has been shown that a new Tissue Doppler index, E/ (E’×S’), is able to predict a high level of left ventricular (LV) end-diastolic pressure (E = early diastolic transmitral velocity, E’ = early diastolic mitral annular velocity and S’ = systolic mitral annular velocity). The purpose of our study was to investigate whether E/ (E’×S’) could be a predictor of cardiac death in patients hospitalized with acute decompensated heart failure (ADHF). Methods: We determined E/ (E’×S’) in 131 consecutive patients hospitalized with ADHF, in sinus rhythm, after appropriate medical treatment. The average of the velocities from the septal and lateral mitral annular sites was used. Patients with inadequate echocardiographic images, congenital heart disease, paced rhythm, significant primary valvular heart disease, acute coronary syndrome, coronary revascularization during follow-up, severe pulmonary disease, malignant neoplasia, renal failure, were excluded. Only 105 patients formed our study group. The primary study end-point was definite as cardiac death. Results: In our study group, the mean LV ejection fraction was 38 ± 14%. During the follow-up period (36.5 ± 12.7 months) cardiac death occurred in 17 patients (16.1%). Mean E/ (E’×S’) was 3.81 ± 0.79 in these patients, while it was 1.58 ± 0.86 in the rest (p < 0.001). The optimal E/ (E’×S’) cut-off to predict future cardiac death was 2.9 (81% sensitivity, 87% specificity). Cardiac death was significantly higher in the group of patients with E/ (E’×S’) > 2.9 than in the rest with E/ (E’×S’) ?2.9 [13 (50%) vs. 4 (5.1%), p < 0.001]. On multivariate Cox analysis including the variables that predicted cardiac death on univariate analysis [N-terminal pro-brain natriuretic peptide levels, severe mitral regurgitation, LV ejection fraction, left atrial volume index, E/A (A = peak late diastolic transmitral flow), S’, E’, E/E’ ratio, E/ (E’×S’) >2.9, LV ejection fraction ?40% combined with E/E’ >15, and restrictive pattern], the E/ (E’×S’) index >2.9 was the only independent predictor of cardiac death (HR = 7.3; 95%CI = 1.4-26.3; p = 0.002). Conclusions: In patients with ADHF, E/ (E’×S’) >2.9 is an important independent long-term prognostic index of cardiac death.
| S-EPMC3760571 | biostudies-literature
Project description:Increased ultraviolet B (UVB) radiation due to global change can affect plant growth and metabolism. Here, we evaluated the capacity of quinoa to resist under short acute UVB irradiation. Quinoa was daily exposed for 30 or 60?min to 1.69?W m-2 UVB. The results showed that 30?min exposure in 9 d-course did not cause severe alterations on photosynthetic pigments and flavonoids, but a significant increase of antioxidant capacity was observed. Otherwise, 60?min UVB in 5 d-course reduced almost all these parameters except for an increase in the de-epoxidation of xanthophyll cycle pigments and led to the death of the plants. Further studies of gas exchange and fluorescence measurements showed that 30?min UVB dramatically decrease stomatal conductance, probably associated to reactive oxygen species (ROS) production. Inhibition of photosynthetic electron transport was also observed, which could be a response to reduce ROS. Otherwise, irreversible damage to the photosynthetic apparatus was found with 60?min UVB probably due to severe ROS overproduction that decompensates the redox balance inducing UVB non-specific signaling. Moreover, 60?min UVB compromised Rubisco carboxylase activity and photosynthetic electron transport. Overall, these data suggest that quinoa modulates different response mechanisms depending on the UVB irradiation dosage.
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Project description:IntroductionCritically ill Covid-19 pneumonia patients are likely to develop the sequence of acute pulmonary hypertension, right ventricular (RV) strain, and eventually RV failure due to known pathophysiology (endothelial inflammation plus thrombo-embolism) that promotes increased pulmonary vascular resistance and pulmonary artery pressure. This study aimed to investigate the occurrence of acute pulmonary hypertension (aPH) as per established trans-thoracic echocardiography (TTE) criteria in Covid-19 patients receiving intensive care and to explore whether short-term outcomes are affected by the presence of aPH.MethodsMedical records were reviewed for patients treated in the intensive care units at a tertiary university hospital over a month. The presence of aPH on the TTE was noted, and plasma NTproBNP and troponin were measured as markers of cardiac failure and myocardial injury, respectively. Follow-up data were collected 21 d after the performance of TTE.ResultsIn total, 26 of 67 patients (39%) had an assessed systolic pulmonary artery pressure of > 35 mmHg (group aPH), meeting the TTE definition of aPH. NTproBNP levels (median [range]: 1430 [102-30 300] vs. 470 [45-29 600] ng L-1 ; P = .0007), troponin T levels (63 [22-352] vs. 15 [5-407] ng L-1 ; P = .0002), and the 21-d mortality rate (46% vs. 7%; P < .001) were substantially higher in patients with aPH compared to patients not meeting aPH criteria.ConclusionTTE-defined acute pulmonary hypertension was frequently observed in severely ill Covid-19 patients. Furthermore, aPH was linked to biomarker-defined myocardial injury and cardiac failure, as well as an almost sevenfold increase in 21-d mortality.
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Project description:BackgroundAs digital technologies and especially artificial intelligence (AI) become increasingly important in health care, it is essential to determine whether and why potential users intend to use related health information systems (HIS). Several theories exist, but they focus mainly on aspects of health care or information systems, in addition to general psychological theories, and hence provide a small number of variables to explain future behavior. Thus, research that provides a larger number of variables by combining several theories from health care, information systems, and psychology is necessary.ObjectiveThis study aims to investigate the intention to use new HIS for decisions concerning short- and long-term medical treatments using an integrated approach with several variables to explain future behavior.MethodsWe developed an integrated theoretical model based on theories from health care, information systems, and psychology that allowed us to analyze the duality approach of adaptive and nonadaptive appraisals and their influence on the intention to use HIS. We applied the integrated theoretical model to the short-term treatment using AI-based HIS for surgery and the long-term treatment of diabetes tracking using survey data with structured equation modeling. To differentiate between certain levels of AI involvement, we used several scenarios that include treatments by physicians only, physicians with AI support, and AI only to understand how individuals perceive the influence of AI.ResultsOur results showed that for short- and long-term treatments, the variables perceived threats, fear (disease), perceived efficacy, attitude (HIS), and perceived norms are important to consider when determining the intention to use AI-based HIS. Furthermore, the results revealed that perceived efficacy and attitude (HIS) are the most important variables to determine intention to use for all treatments and scenarios. In contrast, abilities (HIS) were important for short-term treatments only. For our 9 scenarios, adaptive and nonadaptive appraisals were both important to determine intention to use, depending on whether the treatment is known. Furthermore, we determined R² values that varied between 57.9% and 81.7% for our scenarios, which showed that the explanation power of our model is medium to good.ConclusionsWe contribute to HIS literature by highlighting the importance of integrating disease- and technology-related factors and by providing an integrated theoretical model. As such, we show how adaptive and nonadaptive appraisals should be arranged to report on medical decisions in the future, especially in the short and long terms. Physicians and HIS developers can use our insights to identify promising rationale for HIS adoption concerning short- and long-term treatments and adapt and develop HIS accordingly. Specifically, HIS developers should ensure that future HIS act in terms of HIS functions, as our study shows that efficient HIS lead to a positive attitude toward the HIS and ultimately to a higher intention to use.
| S-EPMC11294784 | biostudies-literature
Project description:Acute symptomatic seizures caused by either diffuse or focal perinatal hypoxic-ischemic insults and intracranial hemorrhage in term newborns make up the large majority of all neonatal seizures. Acute seizures are one of the most common neurological disorders in term newborns who require admission to the neonatal intensive care unit. Despite elucidation of seizure pathogenesis in this population using animal models, treatment is limited by a lack of good evidence-based guidelines because of a paucity of rigorously conducted clinical trials or prospective studies in human newborns. A result of this knowledge gap is that management, particularly drug choice, is guided by clinical experience rather than by data informing drug efficacy and safety. This review summarizes the common etiologies and pathogenesis of acute symptomatic seizures, and the current data informing their treatment, including potential novel drugs, together with a suggested treatment algorithm.
| S-EPMC6026476 | biostudies-literature
Project description:BACKGROUND:With some Medicaid state programs still restricting patient access to hepatitis C (HCV) treatment, it is important to demonstrate how states could expand treatment access to a broader Medicaid population and balance short-term budget concerns. METHODS:We used the HCV Transmission and Progression (TaP) Markov model to quantify the impact of removing restrictions to HCV treatment access on the infected populations, expenditures, and net social value for the North Carolina (NC), Oregon (OR), and Wisconsin (WI) Medicaid programs. Four HCV treatment access scenarios were modeled: 1) Baseline: Patients were treated according to Medicaid disease severity and sobriety requirements in 2015; 2) Remove Sobriety Restrictions: Disease severity restrictions were maintained, but people who inject drugs (PWID) were given access to treatment; 3) Treat Early: All patients, except for PWIDs, regardless of disease severity, were eligible for treatment and the diagnosis rate increased from 50 to 66%; and 4) Remove Access Restrictions: all patients, regardless of disease severity and sobriety, were eligible for treatment. Our key model outputs were: number of infected Medicaid beneficiaries, HCV-related medical and treatment expenditures, total social value, and state Medicaid spending over 10?years. RESULTS:Across all three states, removing access restrictions resulted in the greatest benefits over 10?years (net social value relative to baseline?=?$408?M in NC; $408?M in OR; $271?M in WI) and the smallest infected population (5200 in NC; 2000 in OR; 614 in WI). Reduced disease transmission resulted in lower health care expenditures (-$66?M in NC; -$50?M in OR; -$54?M in WI). All of the expanded treatment access policies achieved break-even costs-where total treatment and health care expenditures fell below those of Baseline-in 4 to 8?years. Removing access restrictions yielded the greatest improvement in social value (net of medical expenditures and treatment costs, QALYs valued at $150?K per QALY). CONCLUSIONS:While increasing treatment access in Medicaid will raise short-term costs, it will also provide clear benefits relatively quickly by saving money and improving health within a 10-year window. Patients and taxpayers would benefit by considering these gains and taking a more expansive and long-term view of HCV treatment policies.
| S-EPMC6394005 | biostudies-literature
Project description:ObjectivesTo 1) analyze the short-term biochemical improvements and clinical outcomes following treatment of children with post-severe acute respiratory syndrome coronavirus-2 inflammatory syndrome (multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2) admitted to U.K. PICUs and 2) collate current treatment guidance from U.K. PICUs.DesignMulticenter observational study.SettingTwenty-one U.K. PICUs.PatientsChildren (< 18 yr) admitted to U.K. PICUs between April 1, 2020, and May 10, 2020, fulfilling the U.K. case definition of pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2.InterventionsNone.Measurements and main resultsRoutinely collected, deidentified data were analyzed. Propensity score and linear mixed effects models were used to analyze the effect of steroids, IV immunoglobulin, and biologic agents on changes in C-reactive protein, platelet counts, and lymphocyte counts over the course of PICU stay. Treatment recommendations from U.K. clinical guidelines were analyzed. Over the 6-week study period, 59 of 78 children (76%) received IV immunoglobulin, 57 of 78 (73%) steroids, and 18 of 78 (24%) a biologic agent. We found no evidence of a difference in response in clinical markers of inflammation between patients with multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 who were treated with IV immunoglobulin, steroids, or biologics, compared with those who were not. By the end of the study period, most patients had received immunomodulation. The 12 patients who did not receive any immunomodulators had similar decrease in inflammatory markers as those treated. Of the 14 guidelines analyzed, the use of IV immunoglobulin, steroids, and biologics was universally recommended.ConclusionsWe were unable to identify any short-term benefit from any of the treatments, or treatment combinations, administered. Despite a lack of evidence, treatment guidelines for multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 have become very similar in advising step-wise treatments. Retaining clinical equipoise regarding treatment will allow clinicians to enroll children in robust clinical trials to determine the optimal treatment for this novel important condition.
| S-EPMC8096187 | biostudies-literature