Heart failure

Irregular heartbeat is riskier for women

An irregular heartbeat, also known as atrial fibrillation, appears to be a stronger risk factor for heart disease and death in women than in men, according to research published in The BMJ.

Atrial fibrillation (AF) is associated with a higher risk of stroke and death generally, with an estimated 33.5 million people affected globally in 2010, and an age-adjusted mortality rate of 1.7 per 100,000 people.

The prevalence is increasing in both developed and developing countries.

Evidence is now emerging that women and men experience risk factors, such as diabetes and smoking, differently for cardiovascular disease (CVD).

This could have significant implications for estimating the AF burden, targeting treatment to manage it and for future research into gender differences.

An international team of researchers set out to estimate the association between AF and CVD and death in women and men and to compare the genders.

In a meta-analysis of 30 studies published between January 1966 and March 2015, they analyzed data for over 4 million participants.

12% higher risk of mortality for women with AF
All the studies had a minimum of 50 participants with AF and 50 without, which reported sex-specific associations between AF and all-cause mortality, cardiovascular mortality, stroke, cardiac events – including cardiac death and non-fatal myocardial infarction – and heart failure.

They took into consideration the differences in study design and quality in order to minimize bias.

AF was linked to a 12% higher relative risk of all-cause mortality in women and a much stronger risk of stroke, cardiovascular mortality, cardiac events and heart failure. The reason for the gender differences is not known.

With respect to clinical care, the results support the development of a specific risk score for AF in women and more aggressive treatment of risk factors in women, as recently recommended by the American Heart Association (AHA).

In relation to public health policy, the researchers say estimation of the global and regional burden of AF should be independent of sex, while “allocation of public health resources for prevention and treatment of AF should also consider the differential effects of AF by sex.”

Finally, they say future research should aim to determine the underlying causes of the observed sex differences.

Source: BBC news

Experimental heart failure drug shows promise, study says

A new study reports one of the biggest potential advances against heart failure in more than a decade — a first-of-a-kind, experimental drug that lowered the chances of death or hospitalization by about 20 percent.

Experimental heart failure drug shows promise, study says

Doctors say the Novartis drug — which doesn’t have a name yet — seems like one of those rare, breakthrough therapies that could quickly change care for more than half of the 6 million Americans and 24 million people worldwide with heart failure.

“This is a new day” for patients, said Dr. Clyde Yancy, cardiology chief at Northwestern University in Chicago and a former American Heart Association president.

“It’s been at least a decade since we’ve had a breakthrough of this magnitude,” said Yancy, who had no role in the study.

It involved nearly 8,500 people in 47 countries and was the largest experiment ever done in heart failure. It was paid for, designed and partly run by Novartis, based in Basel, Switzerland. Independent monitors stopped the study in April, seven months earlier than planned, when it was clear the drug was better than an older one that is standard now.

During the 27-month study, the Novartis drug cut the chances of dying of heart-related causes by 20 percent and for any reason by 16 percent, compared to the older drug. It also reduced the risk of being hospitalized for heart failure by 21 percent.

“We are really excited,” said one study leader, Dr. Milton Packer of UT Southwestern Medical Center in Dallas. The benefit “exceeded our original expectations.”

Results were disclosed Saturday at a European Society of Cardiology conference in Barcelona and published online by the New England Journal of Medicine.

Novartis will seek approval for the drug — for now called LCZ696 — by the end of this year in the United States and early next year in Europe

Heart failure is the top reason older people are hospitalized, and a leading cause of death. It develops when the heart muscle weakens over time and can no longer pump effectively, often because of damage from a heart attack. Fluid can back up into the lungs and leave people gasping for breath.

The people in this study were already taking three to five medicines to control the condition. One medicine often used is an ACE inhibitor, and the study tested one of these — enalapril, sold as Vasotec and in generic form — against the Novartis drug.

The new drug is a twice-a-day pill combination of two medicines that block the effects of substances that harm the heart while also preserving ones that help protect it. One of the medicines also dilates blood vessels and allows the heart to pump more effectively.

In the study, 26.5 percent on the older drug, enalapril, died of heart-related causes or were hospitalized for heart failure versus less than 22 percent of those on the Novartis drug. Quality of life also was better with the experimental drug.

“We now have a way of stabilizing and managing their disease which is better than what we could offer them before,” Packer said.

The new drug also seemed safe — reassuring because safety concerns doomed a couple of other promising-looking treatments over the last decade. There were more cases of too-low blood pressure and non-serious swelling beneath the skin with the Novartis drug, but more kidney problems, excess potassium in the blood and cough with the older drug. More people on the older treatment dropped out of the study than those on the new one.

About 32 people would need to be treated with the new drug to prevent one death from heart-related causes.

“That’s a favorable number,” said Dr. Joseph G. Rogers, a Duke University cardiologist with no role in the study. He said the benefits were big enough that “I would switch people over” as soon as the drug is available.

The drug “may well represent a new threshold of hope” for patients, Dr. Mariell Jessup, heart failure chief at the University of Pennsylvania, wrote in a commentary in the journal. It may help “a wide spectrum of patients, even those who are currently receiving the best possible therapy.”

Source: fox news

SRL Diagnostics introduces ST2 biomarker to predict heart failure

breakthrough-technique-to-predict-heart-failure

SRL Diagnostics on Monday announced the launch of new lab test ST2 to help predict risks of coronary heart disease by finding a specific biomarker in the bloodstream.

SRL claims to be the first diagnostic lab in India to have launched this key medical test, available across India at all Fortis Labs, SRL Diagnostics Labs and its collection centres.

Dr B R Das, president – research & innovation, SRL Diagnostics, said, “Unlike many other cardiac biomarkers, ST2 is faster thus helping physicians make informed decisions on an appropriate course of action to take and, if needed, to quickly adjust treatment. It can reduce 30-day rehospitalisation rates by 17.3 per cent and also reduce 30-day mortality rates by 17.6 per cent.”

Recent evidence has reported the incidence of cardiovascular disease (CVD) to be 40 to 50 per cent higher in Asian Indians than individuals of other ethnic origins. In addition, some 30 to 40 per cent of cardiovascular deaths occur between 35 and 64 years of age. The prevalence of heart failure in India due to coronary heart disease, hypertension, obesity, diabetes and rheumatic heart disease ranges from 1.3 million to 4.6 million, with an annual incidence of 4,91,600–1.8 million, according to a statement by SRL.

“ST2 is ELISA based test which is a US FDA approved technology and was included in 2013 ACC/AHA Guidelines for The Management of Heart Failure. It has been extensively evaluated with more than 100 peer-reviewed articles and scientific posters studying more than 35,000 patients. So far, SRL Diagnostics has collected 100 samples for predicting the heart failure,” Dr Das added.

The American College of Cardiology Foundation / American Heart Association Task Force jointly released its expanded clinical practice guideline for the management of patients with heart failure and has identified ST2 “not only predictive of hospitalization and death in patients with HF [heart failure] but also additive to natriuretic peptide levels in its prognostic value.

Source: India medical Times

Traffic pollution may alter structure of the heart; promote heart failure

Traffic air pollution has been linked to poor health in the past – with wheezing, coughing, and watery eyes just the tip of the iceberg. Later studies have also established a relationship between pollution and a host of heart problems, including left ventricular hypertrophy and heart failure, among others. However, a new study, from the University of Washington’s Medical Center in Seattle, has now found that air pollution emitted from traffic sources also changes the structure of the heart’s right ventricle – further increasing the risk of heart failure for residents’ of pollution-dense areas.

“Although the link between traffic-related air pollution and left ventricular hypertrophy, heart failure, and cardiovascular death is established, the effects of traffic-related air pollution on the right ventricle have not been well studied,” said the study’s lead author Peter Leary, MD, MS, of the UW Medical Center in a press release. “Using exposure to nitrogen dioxide as a surrogate for exposure to traffic-related air pollution, we were able to demonstrate for the first time that higher levels of exposure were associated with greater right ventricular mass and larger right ventricular end-diastolic volume. Greater right ventricular mass is also associated with increased risk for heart failure and cardiovascular death.”

The study observed the health patterns of 3,896 individuals who participated in the Multi-Ethnic Study of Atherosclerosis, each of whom had no prior history of cardiac disruption or disease. All of the test subjects had previously undertaken magnetic resonance imaging (MRI) scans, with authors observing their levels of exposure to pollutant nitrogen oxide in the year leading up to the scan.

On average, the study found that a higher incidence of exposure to nitrogen oxide coincided with a five percent increase (around one gram) in right ventricular mass and a three percent increase (4.1 mL) in right ventricular end-diastolic volume. The researchers combed through a range of differentiating factors that could have skewed the data before confirming their findings, including variations in lung disease, socioeconomic standing, inflammation, and left ventricular mass and volume.

“The morphologic changes in the right ventricle of the heart that we found with increased exposure to nitrogen dioxide add to the body of evidence supporting a connection between traffic-related air pollution and cardiovascular disease,” said Leary. “The many adverse effects of air pollution on human health support continued efforts to reduce this burden.”

It should be noted, however, that while increased exposure to nitrogen oxide led to a notable change in the heart’s structure, the findings have not definitively been linked to traffic air pollution. However, the researchers are confident that these recent findings are aligned with previous studies on the matter, and serve to strengthen beliefs that traffic air pollution is detrimental to cardiovascular health.

The study was published in the American Journal of Respiratory and Critical Care Medicine.

Source: Tech Times

Carmat artificial heart patient in satisfactory condition

A patient with terminal heart failure is in “satisfactory condition” two months after becoming the first person to be fitted with Carmat’s artificial heart which is designed to beat for several years, his hospital said.

The 76-year-old man is eating normally, no longer needs constant respiratory assistance and is able to walk a little further every day thanks to physical therapy, the Georges Pompidou European Hospital in Paris said in a statement on Tuesday.

“The Carmat bioprosthesis continues to function satisfactorily, without any anti-clotting treatment since January 10,” said the hospital, where the implant surgery was performed on December 18 and where the patient is being treated.

It praised the patient’s “exemplary courage, sense of humour and family support” for playing a role in his recovery.

Heart-assistance devices have been used for decades as a temporary solution for patients awaiting transplants, but Carmat’s product is designed to replace the real heart over the long term, mimicking nature using biological materials and sensors.

It aims to extend life for thousands of patients who die each year while awaiting a donor, while reducing the side-effects that can be associated with transplants, such as blood clots and rejection.

Three more patients in France are due to be fitted with Carmat’s device. The people selected in this first series of clinical studies suffer from terminal heart failure – when the sick heart can no longer pump enough blood to sustain the body – and would otherwise have only a few days or weeks to live.

Success will be judged on whether the patients survive with the implant for at least a month. If deemed safe, the device will then be fitted into about 20 lower-risk patients.

A spokeswoman for Carmat declined to say when the other three patients in the first round of tests would be fitted with its artificial heart.

The company estimates around 100,000 patients in the United States and Europe could benefit from its artificial heart, a market worth more than 16 billion euros ($22 billion)

Chief Executive Marcello Conviti told Reuters in November that Carmat hoped to finish human trials of the heart by the end of 2014 and to obtain approval to market them in the European Union by early 2015.

Among its competitors for artificial heart implants are privately-held SynCardia Systems and Abiomed, both of the United States.

Source: Diabetes Support

US firm brings next generation pacemaker in India

St Jude Medical Inc, a global medical device company, today announced the launch of next generation pacemaker in India.

The NYSE-listed firm announced the first commercial implant of `Allure Quadra’, a cardiac resynchronisation therapy pacemaker (CRT-P), in the country.

The first-to-market quadripolar pacemaker system offers more pacing options for patients with heart failure (HF), a company release said here.

Quadripolar leads allow for increased implant efficiencies, which clinical data indicates can result in fewer surgical revisions. Broad clinical evidence on the advantages of the quadripolar technology has been documented in more than 100 publications worldwide, it said.

Explaining how this new technology works, Anil Saxena of Fortis Escorts Hospital, said: “Historically, pacing systems that treat heart failure included a lead with only one electrode in the heart. Later, these were replaced by leads with two electrodes.

“Nearly 40 per cent of patients do not effectively benefit from traditional pacing due to potential complications all of which require repeat surgeries.”

The new technology has four electrodes and 10 programmable pacing configurations, allowing electro-physiologists to manage their patients with greater flexibility and improved patient outcomes, Saxena said.

The worldwide prevalence of heart failure has been rising over the last few decades. More than 26 million people globally suffer from HF, with a prevalence rate in India estimated to range from 1.3 to 4.6 million people.