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The relationship between current American College of Cardiology/American Heart Association (ACC/AHA) performance measures for patients hospitalized with heart failure and relevant clinical outcomes are examined. The results have indicated that the heart failure measures, besides the prescription of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge, have little relationship to patient mortality and combined mortality/rehospitalization in the first 60 to 90 days after discharge.

Cardiac resynchronization treatment (CRT) is a well established treatment for patients with moderate to advanced heart failure on optimal medical therapy. CRT is related with a survival benefit in advanced heart failure both with and without defibrillator, thus eight landmark trials in CRT are reviewed.

A cohort study is conducted to evaluate the relationship between systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. The results suggest that systolic hypertension is common in patients hospitalized for heart failure and systolic blood pressure is an independent predictor of morbidity and mortality in patients with heart failure with either reduced or relatively preserved systolic function.

Heterogeneity of heart failure (HF) phenotypes indicates contributions from underlying common polymorphisms. We considered polymorphisms in the [[beta].sub.1]-adrenergic receptor ([[beta].sub.1]AR), a [beta]-blocker target, as candidate pharmacogenomic loci. Transfected cells, genotyped human nonfailing and failing ventricles, and a clinical trial were used to ascertain phenotype and mechanism. In nonfailing and failing isolated ventricles, [[beta].sub.1]-Arg-389 had respective 2.8 [+ or -] 0.3- and 4.3 [+ or -] 2.1-fold greater agonist-promoted contractility vs. [[beta].sub.1]-Gly-389, defining enhanced physiologic coupling under relevant conditions of endogenous expression and HF. The [beta]-blocker bucindolol was an inverse agonist in failing Arg, but not Gly, ventricles, without partial agonist activity at either receptor; carvedilol was a genotype-independent neutral antagonist. In transfected cells, bucindolol antagonized agonist-stimulated cAMP, with a greater absolute decrease observed for Arg-389 (435 [+ or -] 80 vs. 115 [+ or -] 23 fmol per well). Potential pathophysiologic correlates were assessed in a placebo-controlled trial of bucindolol in 1,040 HF patients. No outcome was associated with genotype in the placebo group, indicating little impact on the natural course of HF. However, the Arg-389 homozygotes treated with bucindolol had an age-, sex-, and race-adjusted 38% reduction in mortality (P = 0.03) and 34% reduction in mortality or hospitalization (P = 0.004) vs. placebo. In contrast, Gly-389 carriers had no clinical response to bucindolol compared with placebo. Those with Arg-389 and high baseline norepinephrine levels trended toward improved survival, but no advantage with this allele and exaggerated sympatholysis was identified. We conclude that [[beta].sub.1]AR-389 variation alters signaling in multiple models and affects the [beta]-blocker therapeutic response in HF and, thus, might be used to individualize treatment of the syndrome. adenylyl cyclase | G protein-coupled receptor | genetics | myocardium | signaling

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2005.06.024 Byline: Luis A. Pires (a)(b), William T. Abraham (c), James B. Young (d), Katrina M. Johnson (a)(b) Abstract: Based on current patient selection criteria, a significant proportion of recipients of cardiac resynchronization therapy (CRT) do not respond to treatment. The purpose of this analysis is to identify predictors and characterize the timing of response to CRT in patients with advanced heart failure. Author Affiliation: (a) The Heart Rhythm Center, Division of Cardiology, St John Hospital and Medical Center, Detroit, MI (b) Wayne State University School of Medicine, Detroit, MI (c) Ohio State University, Columbus, OH (d) Cleveland Clinic Foundation, Cleveland, OH Article History: Received 5 May 2005; Accepted 14 June 2005

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2005.03.002 Byline: Cecilia Linde (a), Michael Gold (b), William T. Abraham (c), Jean-Claude Daubert (d) Abstract: Cardiac resynchronization therapy (CRT) improves symptoms, reduces heart failure (HF)-related hospitalizations, and reverses left ventricular remodeling in some patients with moderate to severe HF and ventricular dyssynchrony defined by a prolonged QRS duration. The effects of CRT on HF outcomes in patients with asymptomatic left ventricular dysfunction (ALVD) or mild HF remain to be determined. Author Affiliation: (a) Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (b) Division of Cardiology, Medical University of South Carolina, Charleston, SC (c) Division of Cardiovascular Medicine and the Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio (d) Departement de Cardiologie, CHU, Rennes, France Article History: Received 18 November 2004; Accepted 1 March 2005 Article Note: (footnote) Supported by Medtronic Bakken Research Center BV, Maastricht, NL, Europe, and Medtronic Inc, Minneapolis, Minn.

A study is conducted to develop a practical user-friendly bedside tool for risk stratification for patients hospitalized with acute decompensated heart failure (ADHF). The results suggest that ADHF patients at low, intermediate and high-risk for in-hospital mortality can be identified using vital sign and laboratory data obtained on hospital admission.

A pacemaker that provides cardiac resynchronization can improve the quality of life and exercise capacity of patients with advanced heart failure, according to a study of 369 patients. The pacemaker also included a cardioverter defibrillator, which is a device that detects abnormal heart rhythms and shocks the heart back into a normal rhythm. Unfortunately, the device did not prolong life or reduce hospitalization rates.

A test that measures blood levels of B-type natriuretic peptide can be used in conjunction with other tests to determine whether patients who have difficulty breathing have congestive heart failure. The heart secretes this peptide when it is under stress or is damaged.

A pacemaker may be beneficial for some patients with heart failure, according to a study of 453 patients with moderate to severe heart failure. The pacemaker used in this study coordinates the contraction of the right and left ventricles, which are the part of the heart that pumps blood to the lungs and body.

Beta blockers appear to turn on genes that can reverse the adverse changes in the structure and function of heart cells in patients with dilated cardiomyopathy. This would explain why beta blockers are beneficial in these patients. Cardiomyopathy is the general term for heart disease that is not caused by coronary artery disease.

Patients hospitalized with worsening symptoms of congestive heart failure may benefit from the drug nesiritide. Sold under the trade name Natrecor, this drug mimics the action of a natural protein in the body brain natriuretic peptide. Researchers randomly assigned 127 patients hospitalized with worsening symptoms of congestive heart failure to take intravenous nesiritide or a placebo for up to seven days. Over 60% of those who received nesiritide experienced an improvement in symptoms compared to 14% of those receiving a placebo.

Research has shed much light on the cause of heart failure. As the heart begins to fail, it cannot pump as much blood as before. There are cells inside arteries that can detect low blood flow through the artery. These cells trigger several mechanisms to maintain adequate blood flow to other organs. However, these mechanisms may have a negative side, causing fluid to accumulate in various tissues, as well as other effects. For this reason, doctors often use ACE inhibitors and beta blockers in addition to diuretics to treat heart failure.

Sixteen women were studied to investigate the renal and systemic hemodynamic changes in the midluteal and midfollicular phases of the menstrual cycle. The decrease in mean arterial pressure, which was caused by the primary vasolidation during the midluteal phase of the menstrual cycle, was found to be similar to the increase in cardiac output experienced during early pregnancy. Both the peripheral vasodilation during the luteal phase of the menstrual cycle and the early part of pregnancy were related to the rise in renal plasma flow and renal vascular resistance.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2010.02.034 Byline: William T. Abraham (a), Daniel Gras (b), Cheuk Man Yu (c), Lisa Guzzo (d), Manish S. Gupta (e) Abstract: The aim of the study was to describe the rationale, design, and end points of a randomized, double-blind, controlled trial evaluating frequent systematic optimization of atrioventricular (AV) and interventricular (VV) delays in patients receiving cardiac resynchronization therapy (CRT). Author Affiliation: (a) The Ohio State University, Columbus, OH (b) Nouvelles Cliniques Nantaises, Nantes, France (c) Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, P.R. China (d) St Jude Medical, Brussels, Belgium (e) St Jude Medical, Sylmar, CA Article History: Received 19 April 2009; Accepted 24 February 2010 Article Note: (footnote) RCT Reg #NCT00418314.