Showing posts with label Failure. Show all posts
Showing posts with label Failure. Show all posts

Saturday, October 12, 2013

Can age-related heart failure be reversed?

Posted July 04, 2013, 2:00 am Stethoscpe

My husband has congestive heart failure. The doctor says it is caused by his age, and that there is no treatment. I read about a new discovery that age-related heart failure can be reversed in mice. Could that help my husband?

There are different kinds of congestive heart failure, and there are effective treatments for many. Your husband may have a common kind called age-related diastolic dysfunction. There is no specific treatment that prevents or reverses this condition. But you are right that a remarkable treatment was recently reported for a similar condition in mice.

Congestive heart failure occurs when the heart cannot pump efficiently enough to meet the body’s need for blood. In a young, healthy heart, when blood enters the main pumping chambers (the ventricles), their walls stretch and the chambers expand to receive all the blood.

In age-related diastolic dysfunction, the heart muscle becomes thicker and stiffer. As a result, when blood enters the heart, the heart muscle can’t stretch enough to accept all the blood. The blood backs up into the lungs, causing breathing difficulty. Blood also backs up into the rest of the body, causing fatigue and swelling — particularly of the legs and feet.

We don’t know what causes age-related heart failure in humans, and because of that, we don’t know how to prevent or reverse it. A similar condition occurs in mice, and we may now have figured out how to treat it.

A group of my colleagues at Harvard Medical School conducted the research in mice that you read about. They were led by Dr. Richard Lee, co-editor-in-chief of the Harvard Heart Letter, and professor Amy Wagers.

Dr. Lee and Dr. Wager’s team joined the blood circulation of an old mouse to that of a young mouse. Suddenly, the arteries and veins of the two animals shared the same blood. After four weeks of a shared circulation, the thickened, stiff heart muscle of the old mouse became dramatically less thick and stiff. The experiment was repeated on many pairs of old and young mice, with the same results.

This indicated that some substance was present in the blood of the young mice that rejuvenated the heart muscle of the old mice. Most likely, that substance had been in the blood of the old mice when they were younger, but the substance had decreased as the mice aged.

The team then identified a substance, called GDF11, which was present at high levels in the blood of young mice but not old mice. They treated old mice with enough GDF11 to raise their blood levels of GDF11 to the same levels as it was present in young mice. Again, the thickened, stiff heart muscle of the old mice became thinner and more flexible.

This discovery in mice may one day lead to effective treatments to prevent or reverse this common type of heart failure in humans. Although it will take many more years of research to determine if this discovery will help us, recent advances in aging research gives me hope that it will.

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Friday, June 28, 2013

Simple Breath Test Might Diagnose Heart Failure

Title: Simple Breath Test Might Diagnose Heart Failure
Category: Health News
Created: 3/25/2013 4:36:00 PM
Last Editorial Review: 3/26/2013 12:00:00 AM

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Wednesday, June 19, 2013

Simple Breath Test Might Diagnose Heart Failure

Noninvasive method found accurate in small, early studyResults surprise, disappoint scientists.

By Alan Mozes

HealthDay Reporter

MONDAY, March 25 (HealthDay News) -- An experimental breath test, designed to quickly identify patients suffering from heart failure simply by analyzing the contents of a single exhaled breath, has demonstrated promise in early trials, a team of researchers says.

The investigators stressed that their evaluation is based on a small group of participating patients, and that more extensive research will have to be done to confirm their initial success.

But by subjecting a patient's breath to a rigorous but fast analysis of the hundreds of so-called volatile organic compounds contained therein, the study team said it has so far been able to correctly diagnose heart failure among newly hospitalized patients with a 100 percent accuracy.

"Every individual has a breath print that differentiates them from other people, depending on what's going on in their body," explained study lead author Dr. Raed Dweik, a staff physician in the department of pulmonary, allergy and critical care medicine with the Respiratory Institute at Cleveland Clinic. "And that print can tell us a lot about a person, what they've been exposed to and what disease they have," he added.

"That's what makes the new field of breath testing so promising, because it is non-intrusive, so there is no risk involved," Dweik said. "And you can do it anywhere, in a clinic, in a hospital, anywhere."

The findings were published March 25 in the Journal of the American College of Cardiology.

The study authors pointed out that the most common reason American patients are admitted to a hospital is when there is a suspicion of heart failure -- a tough-to-treat condition in which the heart's pumping action grows gradually weaker over time.

Currently, a diagnosis of heart failure comes from a variety of factors, according to the U.S. National Heart, Lung, and Blood Institute. These include medical history and symptoms, and a physical exam in which a doctor will listen to a patient's heart and lung sounds, and check ankles, feet, legs and abdomen for signs of fluid buildup. Blood tests and an electrocardiogram can help confirm that heart failure exists.

In the new study, to gauge how well the noninvasive breath test could identify heart failure, the team collected exhaled breath samples from 41 patients who had been admitted as in-patients to the Cleveland Clinic.

Of those, 25 had been admitted with a primary diagnosis of "acute decompensated heart failure" while another 16 patients had shown no signs of heart failure but did have other cardiovascular issues. A single breath sample was obtained from each of the patients within 24 hours of admission, as well as from an additional 36 patients with acute decompensated heart failure as an independent point of comparison.


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Tuesday, May 14, 2013

Certain Diabetes Medications May Lower Heart Failure Risk

Study found people taking newer drugs were 44 percent less likely to be hospitalized with the conditionStudy found people taking newer drugs were 44

By Maureen Salamon

HealthDay Reporter

SUNDAY, March 10 (HealthDay News) -- A newer class of diabetes drugs may offer an extra benefit: A new study suggests these medications lower the odds of suffering heart failure.

Researchers from Henry Ford Hospital in Detroit found that patients taking so-called GLP-1 drugs -- including brand-name medications such as Byetta, Januvia and Victoza -- were more than 40 percent less likely to be hospitalized for heart failure than patients prescribed other blood sugar-lowering medications. GLP-1 diabetes drugs have been in use for only the last several years and are considered second-line treatments after well-established medications such as metformin, physicians said.

"I don't think we can say this will magically prevent all heart failure deaths, but the strength of the association warrants more investigation," said study author and cardiologist Dr. David Lanfear. "Heart failure is a very common disease . . . but something about diabetics make them definitely at increased risk for developing heart failure."

The study is to be presented Sunday at the American College of Cardiology's annual meeting in San Francisco. Evidence presented at medical meetings has not been peer-reviewed and is considered preliminary.

According to the U.S. National Institutes of Health, about 6 million Americans suffer from heart failure, which occurs when the heart can't efficiently pump blood through the body. Diabetics, who now number 25 million in the United States, are between two and four times more likely than those without the condition to die of heart disease, which includes heart attacks, heart failure and other cardiac problems.

In the retrospective study, Lanfear and his colleagues examined data from more than 4,400 patients taking diabetes medications between 2000 and 2012. About 1,500 were taking GLP-1 medications and nearly 3,000 were not.

Over an average nine-month follow-up period, patients taking GLP-1 medications were 41 percent less likely than others to be hospitalized with heart failure. Additionally, these patients were 44 percent less likely to be hospitalized for any reason, and 80 percent less likely to die of any cause.

But neither Lanfear nor a doctor not involved with the research could point to reasons why this newer class of diabetes drugs seems to dampen the risk of heart failure.

"We don't know the mechanism yet. It's under active investigation," Lanfear said. "There are clues, but they would be a guess."

Lanfear noted that of the total 20,000 patients at Henry Ford Hospital identified as taking diabetes drugs during the study period, only about 1,500 were taking GLP-1 medications, or about 7 percent.

"We were surprised a little bit by the strength of the association [between the GLP-1 drugs and lower heart failure], but the results still need to be confirmed by other studies," he said. "We can't take this as an endorsement of these drugs."

Calling the study promising, Dr. David Friedman, chief of heart failure services at North Shore-LIJ's Plainview Hospital in Plainview, N.Y., said future research should be prospective instead of analyzing past data.

"Heart failure is a huge problem among diabetics. Every year, there are about a half-million new heart failure patients, and a tremendous portion are those who've survived heart attacks and a fair number have diabetes," Friedman said.

"With diabetes and obesity issues constantly on the radar now, and with the onset of more heart failure cases, we need to find more novel approaches," he added. "If we can improve outcomes in this way, we'll have more hope for these patients."


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Thursday, April 25, 2013

Heart Failure Drug May Only Help Heart's Function, Not Symptoms

Spironolactone didn't boost treadmill test

By Amy Norton

HealthDay Reporter

TUESDAY, Feb. 26 (HealthDay News) -- A drug often used to treat chronic heart failure may not ease symptoms in people with one form of the disease, a new study suggests.

The medication, called spironolactone (Aldactone), failed to improve symptoms or quality of life among 422 patients with diastolic heart failure -- a form of the disease that affects about half of all people with heart failure.

The drug did, however, benefit the structure and function of patients' hearts. And experts said it's too early to know what to make of the results, which appear in the Feb. 27 issue of the Journal of the American Medical Association.

"It would be premature to say this is not beneficial," said Dr. Sanjiv Shah, a cardiologist at Northwestern University Feinberg School of Medicine, in Chicago, who was not involved in the study.

Shah is involved in an ongoing study of spironolactone's effects in people with diastolic heart failure. And that trial is focusing on the big questions: Can the drug prevent or delay hospitalizations, or prolong people's lives?

Spironolactone is in a class of drugs called aldosterone receptor antagonists. They cause the kidneys to eliminate excess water and sodium from the body, so they can lower blood pressure and get rid of fluid build-up in some people with heart failure.

And studies have shown that spironolactone can extend the lives of some heart failure patients -- namely, those with a low "ejection fraction." That means the percentage of blood pushed out by the heart with each contraction is abnormally low.

The problem is that heart failure is "heterogeneous," according to Shah, who described it as a "syndrome" -- or a collection of signs and symptoms -- rather than a disease. So a treatment that works for some patients may not work as well for others.

In general, heart failure is a chronic condition where the heart does not pump blood efficiently enough to meet the body's needs. That causes symptoms such as fatigue, breathlessness and fluid build-up in the legs and feet.

In systolic heart failure, the heart's left ventricle (the main pumping chamber) cannot contract strongly enough, and many people with this form of heart failure have a reduced ejection fraction.

In the diastolic form, the left ventricle doesn't relax enough between contractions, which means it cannot fill up with as much blood as it should. But the heart's ejection fraction is actually normal.

Diastolic heart failure is trickier to diagnose, and doctors know less about how to best treat it, said Dr. John Cleland, a cardiologist at Hull York Medical School in Kingston-upon-Hull, England, who co-wrote an editorial published with the study.

He agreed that it's too soon to draw conclusions from the current findings, and that doctors will know more when Shah's study results are in.


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Thursday, April 18, 2013

Gene Therapy Shows Early Promise for Heart Failure

Testing in pigs shows it serves as platform for

By Amy Norton

HealthDay Reporter

THURSDAY, Feb. 21 (HealthDay News) -- When it comes to treating heart failure, the ultimate hope is to develop a therapy that repairs the damaged heart muscle.

Now, an early study hints at a way to do that by harnessing the body's natural capacity for repair.

Heart failure is a chronic, progressive condition where the heart cannot pump blood efficiently enough to meet the body's needs, which leads to problems like fatigue, breathlessness and swelling in the legs and feet. Most often, it arises after a heart attack leaves heart muscle damaged and scarred.

In the new study, researchers were able to use gene therapy to modestly improve symptoms in 17 patients with stage III heart failure -- where the disease is advanced enough that even routine daily tasks become difficult.

What is novel about the tactic, the researchers said, is that the gene therapy is designed to attract the body's own stem cells to the part of the heart muscle that's damaged. The hope is that the stem cells will then get some repair work done.

The findings, published Feb. 21 in the journal Circulation Research, are preliminary, and much more research needs to be done.

"This is a proof-of-concept study," explained lead researcher Dr. Marc Penn, a professor at Northeast Ohio Medical University in Rootstown, and director of research at Summa Cardiovascular Institute in Akron. But Penn and other heart failure experts said they were cautiously optimistic about the therapy's potential for at least some patients.

Stem cells are primitive cells that can develop into different types of body tissue. Adults have the cells in their bone marrow, and they give rise to blood cells. Researchers have also found that individual organs in the body, including the heart, have their own pools of stem cells.

Those stem cells may try to repair damaged tissue, but they are not all that successful, Penn said. So his team sought to give the stem cells a helping hand. They infused patients' heart muscle with three different doses of a drug that carried a gene for SDF-1, a natural protein in the body believed to recruit stem cells to sites of tissue damage.

Lab research has suggested that after a heart attack, SDF-1 activity in the heart goes up -- but only for a short time, Penn said. The goal of the experimental therapy is to enhance SDF-1 and draw more stem cells to where they are needed.

The initial results are promising, Penn said. The approach seemed safe, with no major side effects linked to the treatment. Two of the study patients died within a year, but the deaths were deemed not to be connected to the treatment.

Among the 15 patients who were alive one year later, there were improvements in their symptoms and walking ability.


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