Recommendations for the Use of Mechanical Circulatory Support: Device Strategies and Patient Selection

European Journal of Heart FailureVolume 2, Issue S1 p. 102-102 AbstractsFree Access Cytokines and cytokine receptors are predictive for increased mortality in chronic heart failure M. Rauchhaus, M. Rauchhaus Clinical Cardiology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorW. Doehner, W. Doehner Clinical Cardiology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorV. Koloczek, V. Koloczek Clinical Cardiology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorM. Kemp, M. Kemp Clinical Cardiology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorH.-D Volk, H.-D Volk Medical Immunology, Charite, Berlin, United KingdomSearch for more papers by this authorA.J.S. Coats, A.J.S. Coats Clinical Cardiology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorS.D. Anker, S.D. Anker Clinical Cardiology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this author M. Rauchhaus, M. Rauchhaus Clinical Cardiology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorW. Doehner, W. Doehner Clinical Cardiology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorV. Koloczek, V. Koloczek Clinical Cardiology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorM. Kemp, M. Kemp Clinical Cardiology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorH.-D Volk, H.-D Volk Medical Immunology, Charite, Berlin, United KingdomSearch for more papers by this authorA.J.S. Coats, A.J.S. Coats Clinical Cardiology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorS.D. Anker, S.D. Anker Clinical Cardiology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this author First published: 19 May 2004 https://doi.org/10.1016/S1388-9842(00)80365-7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume2, IssueS1June 2000Pages 102-102 RelatedInformation

Pediatric Allergy and ImmunologyVolume 4, Issue S4 p. 13-18 Modulation of human eosinophil chemotaxis and adhesion by anti-allergic drugs in vitro R. Sehmi, R. Sehmi Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorG. M. Walsh, G. M. Walsh Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorA. Hartnell, A. Hartnell Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorJ. Barkans, J. Barkans Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorJ. North, J. North Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorA. B. Kay, A. B. Kay Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorR. Moqbel, Corresponding Author R. Moqbel Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United Kingdom*Department of Allergy and Clinical Immunology, National Heart and Lung Institute, Dovehouse St., London SW3 6LY, United KingdomSearch for more papers by this author R. Sehmi, R. Sehmi Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorG. M. Walsh, G. M. Walsh Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorA. Hartnell, A. Hartnell Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorJ. Barkans, J. Barkans Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorJ. North, J. North Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorA. B. Kay, A. B. Kay Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United KingdomSearch for more papers by this authorR. Moqbel, Corresponding Author R. Moqbel Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United Kingdom*Department of Allergy and Clinical Immunology, National Heart and Lung Institute, Dovehouse St., London SW3 6LY, United KingdomSearch for more papers by this author First published: December 1993 https://doi.org/10.1111/j.1399-3038.1993.tb00333.xCitations: 20AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume4, IssueS4December 1993Pages 13-18 RelatedInformation

Discussions in Cardiothoracic Treatment and Care: Mechanical Circulatory Support Left Ventricular Assist Device Therapy for Patients With Advanced Heart Failure

Recurrent orthostatic syncope due to left atrial and left ventricular collapse after a continuous-flow left ventricular assist device implantation

What is the truth behind pump thrombosis in the HeartMate II device? A National Heart, Lung, and Blood Institute perspective based on data from the Interagency Registry for Mechanically Assisted Circulatory Support

Heart failure has become one of the fastest growing cardiovascular diagnoses, with estimates as high as 500 000 new cases per year.1,2 This growth is in part a result of the reductions in death from acute coronary syndromes, increased use of implantable cardioverter defibrillators, and improved survival with most cardiovascular interventions, which have led to this continued increase in the number of patients who develop progressive heart failure (HF). The estimated number of people in the United States with the diagnosis of HF may exceed 7 million, based on the estimated average prevalence of 2.6%,3,4 and a census of >300 million population (Figure 1).5,6 HF is clearly age related,1,–,4 with prevalence as low as 0.5% in those 65 years of age.2 This is an important demographic, because it is estimated that the number of people >65 years of age will double in the next 20 to 30 years.4,–,7 HF is not a homogeneous condition. Based primarily on data from recent hospital registries8,9 and other studies,10 nearly half of all patients have HF with preserved systolic function, and the other half have varying degrees of severity of HF with reduced systolic function. Although the prevalence of HF is higher in males at <70 years of age, overall HF is equally common in men and women. Unfortunately, the average survival of patients with either preserved or reduced systolic function is only 40% at 5 years after diagnosis,10,11 and may be as high as 80% when it reaches a refractory stage.12 One study of 3500 patients in Minnesota suggested that there is …

Letters7 December 2004Angiotensin-Converting Enzyme Inhibitors and Diuretics: Optimal Combination TherapyBarry R. Davis, MD, PhD, Curt D. Furberg, MD, PhD, Jackson T. Wright Jr., MD, PhD, Jeffrey A. Cutler, MD, MPH, and Paul Whelton, MD, MScBarry R. Davis, MD, PhDFrom The University of Texas School of Public Health at Houston, Houston, TX 77030; Wake Forest University School of Medicine, Winston-Salem, NC 27157; Case Western Reserve University, Cleveland, OH 44106; National Heart, Lung, and Blood Institute, Bethesda, MD 20892; and Tulane University Health Sciences Center, New Orleans, LA 70112.Search for more papers by this author, Curt D. Furberg, MD, PhDFrom The University of Texas School of Public Health at Houston, Houston, TX 77030; Wake Forest University School of Medicine, Winston-Salem, NC 27157; Case Western Reserve University, Cleveland, OH 44106; National Heart, Lung, and Blood Institute, Bethesda, MD 20892; and Tulane University Health Sciences Center, New Orleans, LA 70112.Search for more papers by this author, Jackson T. Wright Jr., MD, PhDFrom The University of Texas School of Public Health at Houston, Houston, TX 77030; Wake Forest University School of Medicine, Winston-Salem, NC 27157; Case Western Reserve University, Cleveland, OH 44106; National Heart, Lung, and Blood Institute, Bethesda, MD 20892; and Tulane University Health Sciences Center, New Orleans, LA 70112.Search for more papers by this author, Jeffrey A. Cutler, MD, MPHFrom The University of Texas School of Public Health at Houston, Houston, TX 77030; Wake Forest University School of Medicine, Winston-Salem, NC 27157; Case Western Reserve University, Cleveland, OH 44106; National Heart, Lung, and Blood Institute, Bethesda, MD 20892; and Tulane University Health Sciences Center, New Orleans, LA 70112.Search for more papers by this author, and Paul Whelton, MD, MScFrom The University of Texas School of Public Health at Houston, Houston, TX 77030; Wake Forest University School of Medicine, Winston-Salem, NC 27157; Case Western Reserve University, Cleveland, OH 44106; National Heart, Lung, and Blood Institute, Bethesda, MD 20892; and Tulane University Health Sciences Center, New Orleans, LA 70112.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-11-200412070-00029 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank Dr. Krantz for his thoughtful letter. The proposed strategy of using a diuretic and an ACE inhibitor simultaneously is supported by the effects of combined treatment in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) (1). However, that study could also be (and was) interpreted as showing that it's the blood pressure that matters, especially for stroke, and blood pressure reduction is much more effective with a diuretic in the regimen. Although the use of ACE inhibitors could in theory offset the metabolic effects (higher glucose and lower potassium levels) of thiazides, other potassium-sparing regimens may ...Reference1. Chapman N, Huxley R, Anderson C, Bousser MG, Chalmers J, Colman S, et al. Effects of a perindopril-based blood pressure-lowering regimen on the risk of recurrent stroke according to stroke subtype and medical history: the PROGRESS Trial. Stroke. 2004;35:116-21. [PMID: 14671247] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From The University of Texas School of Public Health at Houston, Houston, TX 77030; Wake Forest University School of Medicine, Winston-Salem, NC 27157; Case Western Reserve University, Cleveland, OH 44106; National Heart, Lung, and Blood Institute, Bethesda, MD 20892; and Tulane University Health Sciences Center, New Orleans, LA 70112. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoALLHAT: Setting the Record Straight Barry R. Davis , Curt D. Furberg , Jackson T. Wright Jr. , Jeffrey A. Cutler , Paul Whelton , and Angiotensin-Converting Enzyme Inhibitors and Diuretics: Optimal Combination Therapy Mori J. Krantz and Philip S. Mehler Metrics 7 December 2004Volume 141, Issue 11Page: 893KeywordsACE inhibitorsBlood pressureDiureticsDrugsEnzyme replacement therapyGlucoseHeart failurePotassiumRandomized trialsStroke ePublished: 7 December 2004 Issue Published: 7 December 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Change in Health-Related Quality of Life from before to 2 Years after Surgery: Findings from the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support (SUSTAIN-IT) Study

Harold A. Kahn (1920-2009): a remembrance of a life devoted to public health.

33-Year-Old Woman With Postpartum Acute Shortness of Breath

Corticosteroids in ARDS: A Counterpoint

Systemic arterial hypertension affects 72 million US adults and an additional hundreds of millions of persons worldwide.1,2 Most of these are candidates for pharmacological treatment to reduce risk of cardiovascular disease (CVD) events, based primarily on a very large body of epidemiological and intervention research in humans. Because of this high prevalence and the cardiovascular consequences of untreated or inadequately treated hypertension, the selection of drugs for initial and continuing, long-term treatment has large public health and economic implications. Fortunately, such decisions and the expert recommendations that seek to guide them can call on evidence from 4 decades of randomized multicenter clinical trials evaluating effects of treatment on clinical CVD. We summarize that evidence in this article, in approximate chronological order, and we comment on the related treatment guidelines. We close with some of the major clinical questions yet to be resolved. Response by Messerli et al p 2705 Before the current era beginning in the early 1990s of emphasis on positive-control trials, which directly compare different drug regimens, there were 3 decades of trials that compared an active regimen with placebo or, in a few cases, “usual care.” For most of this period, the mainstay of treatment was generally a thiazide-type diuretic (hereinafter called thiazides) or, to a lesser extent, a β-adrenergic blocker (termed β-blockers). With few exceptions, these trials, especially those with high statistical power and thiazide-based regimens, showed benefit for CVD outcomes.3–8 This evidence, which provided a basis for recommending thiazides or β-blockers as first-step drugs in most editions of US guidelines through 1997,9 needs to continue to be given due weight in practice and practice guidelines. The largest and most consistent benefits from the earlier trials were for stroke and (where reported) heart failure. Benefits for coronary heart disease (CHD) were less clear, …

Expert Panel Report 3: Moving forward to improve asthma care

Mechanical circulatory support is used to augment circulatory flow in cardiogenic shock and end-stage heart failure. Support can last from hours for temporary mechanical circulatory support to years for durable mechanical circulatory support. The physiologic relationship of heart and kidney function and the epidemic of cardio-kidney-metabolic disease lead to frequent use of simultaneous mechanical circulatory support and extracorporeal KRT (dialysis). The need for dialysis can range from short periods of AKI in cardiogenic shock to long-term dialysis for individuals who receive left ventricular assist devices (LVADs) for destination therapy in advanced heart failure and progress to CKD G5 with replacement therapy. Changes in technology, clinical evidence, and organ transplantation have led to major changes in mechanical circulatory support use. With temporary mechanical circulatory support, devices and clinical situations vary widely, with intra-aortic balloon pumps, microaxial flow pumps, and venoarterial extracorporeal membrane oxygenation providing different levels of circulatory support. Considerations for dialysis, whether for AKI or CKD G5, are discussed. In durable mechanical circulatory support, LVADs are now used primarily for permanent therapy, and most LVAD recipients survive for more than 5 years, time in which kidney dysfunction can develop or progress. Outpatient dialysis with LVADs is performed for both AKI and for CKD G5, with in-center intermittent hemodialysis, peritoneal dialysis, or home hemodialysis. This article discusses considerations specific to dialysis in temporary and durable circulatory support, including the challenging aspects of volume management and complication risks. Concurrent mechanical circulatory support and dialysis present diverse clinical challenges in patients with complex medical needs. Meeting this challenge requires close cooperation and shared decision making incorporating cardiologists, nephrologists, other medical professionals, patients, and their caregivers.

Current and Future Challenges in Mechanical Circulatory Support