The Ibadan Acute and Chronic Heart Failure Project
Heart FailureContemporary studies from South Africa and Nigeria have built on historical reports to demonstrate that the etiology and indeed case profile of acute HF (i.e. more women and younger individuals affected in the prime of their life) is different from high-income countries. As such, HF is now responsible for 7-10% of medical admissions in the region. These are entirely based on studies on acute HF and few on chronic HF. The nexus between endemic infections such as tuberculosis (TB) and HIV/AIDS and other non-communicable or non-infectious risk factors and HF in Africa is scarcely documented. This study will assess the long-term outcomes, risk factors, clinical phenotypes, and genomics of HF in Ibadan, Nigeria, estimate catastrophic healthcare cost associated with CHF and how it affects evidence-based care; understand cultural and social conceptions of HF in the city and by extension in Nigeria. Data from each subject shall be obtained using a uniform and standardized case report forms (CRF). A detailed clinical documentation on cases of HF will be undertaken. All variables will be summarized using appropriate descriptive statistics. Means and proportions will be estimated with two-tailed 95% confidence intervals. Specified patients' outcomes will also be summarized using proportions. Factors associated wit patient outcomes will be investigated using multivariable logistic regression models. Crude and adjusted Odds Ratio (OR) with 95% confidence intervals (CI) will be estimated. The primary event outcome of the study will be mortality by cause. Secondary event outcomes will include non-fatal major events (both resulting in and not resulting in admission).
Purinergic Signaling and the Postmenopausal Heart
Diastolic Heart FailureHeart Failure With Preserved Ejection FractionThere is an increased risk of diastolic heart failure in post menopausal women. Estrogen plays a positive role in regulating molecular pathways in heart remodeling. Such pathways may work through purinergic signaling and its downstream effects on the heart's mitochondrial metabolism and angiogenic response to stress. Loss of estrogen functionality in post menopausal women may account for the increased risk of diastolic heart failure. The investigators will explore said pathways using cardiac tissue obtained from patients undergoing cardiac surgery.
Mechanisms of Excess Risk in Aortic Stenosis
Aortic StenosisNon-Sustained VT1 moreAortic stenosis (AS) is caused by narrowing of one of the main heart valves. Replacing the valve is the only treatment to prevent the heart from failing or death. The timing of replacement is currently often too late - half of patients are left with permanent scarring and a quarter die within 3.5 years. Studies are underway to see if earlier replacement makes a difference. But for those with scarring of the heart, there is currently no tailored treatment. I want to change this by understanding why and how patients with scar are dying and what the investigators can do to prevent this. In this study, the investigators will use a heart scan (MRI) to detect scarring before valve replacement. After replacement, patients will receive a tiny monitor (paper clip size), which the investigators inject underneath the skin. This monitor continuously checks the heartbeat and can detect increased body fluid due to heart failure. The investigators will monitor patients for an average of 3 years to see if scarring is linked to abnormal heart rhythms and heart failure. Once the investigators know how and why, the investigators can target patients with available medications and design studies using specialised treatments, eg defibrillator implantation, to protect patients with scar from dying.
Psychosocial Syndemics of Heart Failure
Heart FailureHeart failure (HF) is a common and debilitating chronic disease with a poor prognosis. Many patients with HFhave psychiatric problems such as depression and other medical disorders such as lung or kidney disease.This study will examine the effects that these psychiatric and medical disorders have on HF outcomes.
Cardiac Amyloidosis in HFpEF
Heart Failure With Preserved Ejection FractionAmyloidosis CardiacHeart failure with preserved ejection fraction (HFpEF) accounts for half of heart failure cases with heterogenous cause and variable presentations. The diagnosis of HFpEF required clinical signs and symptoms of HF, normal left ventricular ejection fraction (LVEF) and evidence of diastolic dysfunction. No treatment has been shown in recent major clinical trials having benefits in these patients. One major reason of the poor response to medical treatment is the heterogeneity of HFpEF, which contains many different underline causes. To identify the underlying causes of HFpEF may improve the diagnosis and treatment in these patients. Age-related amyloid deposition has first been reported in 1876 and the following autopsy studies showed the prevalence of senile cardiac amyloid is up to 25%. Recently, it has been recognized that the deposits in senile cardiac amyloid are derived from wild-type transthyretin (TTR). Transthyretin amyloidosis cardiac amyloidosis (ATTR CA) is caused by myocardial deposition of misfolded transthyretin protein. There are 2 types of ATTR classified by genetic mutation including wild-type ATTR (ATTRwt) and familial cardiac amyloid caused by TTR mutation (ATTRm). Multimodality techniques have been developed to assist in the diagnosis of the diagnosis of TTR. Among them, 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scintigraphy is a non-invasive test and it can diagnose TTR from other cause diverse form of cardiac amyloidosis and cardiomyopathy. In the study of Gonzalez-Lopez et al, in 120 HFpEF patients, 16 (13.3%) had positive 99mTc-DPD scan. Four patients with positive 99mTc-DPD scan received endomyocardial biopsy and confirmed cardiac amyloid deposition. ATTRwt could be an important cause of HFpEF and it was often under diagnosed. A recent study in Spain reported that 13% of patents over age of 60 years with HFpEF and left ventricular wall thickness of 12mm or more had ATTRwt. However, the prevalence of ATTRwt among patients with HFpEF is not well-established in Taiwan and Asia. The aim of this study is to determine the prevalence, clinical characteristics, risk factors and outcomes of ATTRwt related HFpEF patients in Taiwan.
The Psoriasis Echo Study
PsoriasisCardiovascular Diseases24 moreIn a prospective cohort study (n = 1.000), the investigators aim to investigate the correlation between cardiac biomarkers and advanced echocardiography and determine whether these are prognostic markers of heart disease in patients suffering from psoriasis.
A Multicenter Registry to Study the Characteristics and Outcomes of Jordanian Heart Failure Patients....
Heart FailureChronic Heart Failure1 moreHeart Failure research registry is a collection of computerized information about individuals with heart failure. The database in this registry is obtained from several Jordanian medical centers which will represent an extremely valuable resource for epidemiological research on heart failure patients.
Inspiratory Muscle Training in Acute Decompensated Heart Failure
Acute Decompensated Heart FailureHospitalized patients with acute decompensated heart failure (ADHF) present a high prevalence of inspiratory muscle weakness on admission and discharge. Inspiratory muscle training has been reported as a beneficial approach in chronic heart failure. However, the effects of inspiratory muscle training in hospitalized patients with ADHF have been not known. The aim of this study is to investigate the safety, feasibility, and effects of inspiratory muscle training in hospitalized patients with ADHF.
RAndomized Controlled Trial of a Multiple INtervention proGram to Decrease Heart Failure Rehospitalization...
Heart DecompensationThe prevalence of heart failure (HF) is constantly increasing in France due to the aging of the population, better management of etiological factors and improved treatments (drug / interventional). On the other hand, re-hospitalizations for heart failure continue to increase, exceeding reception capacities and constitute a real challenge for current public health systems. The PRADO system provides administrative support (through a health insurance advisor) in the management of patient appointments with their doctors as well as home visits by a nurse trained in heart failure. Other interventional medical and educational interventions performed during an out-of-hospital consultation guided by a computer platform would help to optimize the care and continuity of care.
Levosimendan In Ambulatory Heart Failure Patients
Heart Failure New York Heart Association Class IIIHeart Failure New York Heart Association Class IV3 moreThe objective of the study is to determine the efficacy of repeated infusions of levosimendan in the group of outpatients with advanced systolic heart failure (HF).