Skeletal Muscle Mass in Elderly Heart Failure Patients; Comparison between Systolic and Diastolic Heart Failure and Corresponding Significance in Exercise Capacity

김광일,박시영,유현정,정수현,정수현,임수,김기웅,장학철,김철호 대한노인병학회 2011 Annals of geriatric medicine and research Vol.15 No.4

Background: Exercise intolerance is a common symptom of heart failure and has a detrimental impact on the quality of life. Skeletal muscle atrophy has been considered an important contributor to exercise intolerance; however, most studies have been conducted in patients with advanced systolic heart failure. Methods: We studied 39 ambulatory heart failure patients(age, 77.9±6.5; male, 17[43.6%]) and 39 age and gender-matched, community-dwelling, elderly subjects. Clinical, laboratory, and echocardiographic evaluations were performed. Dual-energy X- ray absorptiometry was performed to assess the body composition. Exercise capacity was measured by a six-minute walk test. Comprehensive geriatric assessments were also performed to evaluate comorbidity, medication, physical function, cog- nitive function, and nutritional status. Results: Skeletal muscle mass of heart failure patients showed no differences when compared with that of age- and gen- der-matched control subjects in any part of the body or in the whole body. Although diastolic heart failure patients showed lower levels of skeletal muscle mass than systolic heart failure patients, no significant difference was identified in either systolic or diastolic heart failure patients compared with respective age- and gender-matched control groups. The six-minute walk distances showed no difference between the groups(257.2±117.8m in the diastolic heart failure group versus 302.7± 109.4m in the systolic heart failure group, p=0.226). Conclusion: Although skeletal muscle mass has been known to be an independent factor associated with exercise capa- city in advanced heart failure patients, skeletal muscle mass was not decreased in ambulatory, elderly heart failure patients when comparing age- and gender-matched control subjects.

심부전의 한약 임상연구에 활용된 한약재에 대한 기구축 DB(K-HERB NETWORK)를 활용한 네트워크 분석

박수빈,김예지,배기상,김철현,윤인애,임정태,추홍민,Subin Park,Ye-ji Kim,Gi-Sang Bae,Cheol-Hyun Kim,Inae Youn,Jungtae Leem,Hongmin Chu 대한한방내과학회 2023 大韓韓方內科學會誌 Vol.44 No.3

Objectives: Heart failure is a chronic disease with increasing prevalence rates despite advancements in medical technology. Korean medicine utilizes herbal prescriptions to treat heart failure, but little is known about the specific herbal medicines comprising the network of herbal prescriptions for heart failure. This study proposes a novel methodology that can efficiently develop prescriptions and facilitate experimental research on heart failure by utilizing existing databases. Methods: Herbal medicine prescriptions for heart failure were identified through a PubMed search and compiled into a Google Sheet database. NetMiner 4 was used for network analysis, and the individual networks were classified according to the herbal medicine classification system to identify trends. K-HERB NETWORK was utilized to derive related prescriptions. Results: Network analysis of heart failure prescriptions and herbal medicines using NetMiner 4 produced 16 individual networks. Uhwangcheongsim-won (牛黃淸心元), Gamiondam-tang (加味溫膽湯), Bangpungtongseong-san (防風通聖散), and Bunsimgi-eum (分心氣飮) were identified as prescriptions with high similarity in the entire network. A total of 16 individual networks utilized K-HERB NETWORK to present prescriptions that were most similar to existing prescriptions. The results provide 1) an indication of existing prescriptions with potential for use to treat heart failure and 2) a basis for developing new prescriptions for heart failure treatment. Conclusion: The proposed methodology presents an efficient approach to developing new heart failure prescriptions and facilitating experimental research. This study highlights the potential of network pharmacology methodology and its possible applications in other diseases. Further studies on network pharmacology methodology are recommended.

심부전의 치료에서 안지오텐신 수용체 차단제의 역할

전은석 대한순환기학회 2002 Korean Circulation Journal Vol.32 No.12

Right Ventricular Assist Device with Extracorporeal Membrane Oxygenation for Bridging of Right Ventricular Heart Failure to Lung Transplantation: A Single-Center Case Series

( Jae Guk Lee ),( Sang-bum Hong ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Background Right ventricular heart failure is a critical complication of respiratory failure patients, especially those who have transitioned to lung transplantation using V-V extracorporeal membrane oxygenation (V-V ECMO). In these patients, both cardiac and respiratory functions are supported using venous-arteries (V-A ECMO) or venous-arterio-venous extracorporeal membrane oxygenation (V-AV ECMO). However, these configurations increase the risk of device-related complications such as thromboembolism, bleeding, and limb ischemia, and may prevent early rehabilitation. Instead of V-A / V-AV ECMO with these limitations, Oxy-RVAD (right ventricular assist device with an oxygenator) ECMO can be considered for patients with right ventricular heart failure with V-V ECMO. The use of Oxy-RVAD ECMO to bridge right ventricular heart failure to lung transplantation was evaluated. Method The case series is a retrospective case series studied at a University Hospital between 2018 and 2020. Patients were a group of patients who underwent Oxy-RVAD ECMO due to right ventricular heart failure while V-V ECMO as bridging to lung transplantation (BTT) was performed due to severe respiratory failure. Result Eight patients underwent Oxy-RVAD ECMO due to right ventricular heart failure during bridging V-V ECMO to lung transplantation. Excluding one patient, seven patients were bridged successfully to lung transplantation. One patient who did not receive lung transplantation died from aggravation of interstitial lung disease. There was no major ECMO-related complication during the Oxy-RVAD ECMO period in each patient. In patients who were successfully bridged, the average duration of V-V ECMO was 10 days and Oxy-RVAD ECMO was 12 days. Among the patients who underwent lung transplantation, the 30-days survival rate was 100% (7/7 patients) and the 180-days survival rate was 85% (6/7 patients). Conclusion This study suggests that Oxy-RVAD ECMO may be a viable option for the bridging of right ventricular heart failure to lung transplantation.

급성 신부전, 심부전이 동반된 갑상선기능저하증 1예

김재하,홍상모,박용수,이창범,이재곤,최은영,김병식 대한노인병학회 2013 Annals of geriatric medicine and research Vol.17 No.4

Here we report a 65-year-old male patient initially presented with dyspnea and chest discomfort. This patient was finally diagnosed with severe hypothyroidism accompanied by heart failure, pericardial effusion and acute renal failure. We suspected that heart failure, pericardial effusion and acute kidney injury were induced by severe hypothyroidism. Thus, we began thyroid hormone replacement therapy. After the therapy, the patient’s dyspnea and chest discomfort were improved. Hypothyroidism has many complications, such as myxedema, dyslipidemia, and depression. In contrast, heart failure, pericardial effusion, and acute kidney injury are very rare complications of hypothyroidism. Only a few cases of heart failure or renal failure combined with hypothyroidism have been reported. Our case suggests that severe hypothyroidism can lead to multiorgan failure, such as heart failure as well as renal failure. Moreover, congestive heart failure induced by severe hypothyroidism can be reversed by thyroid hormone replacement therapy.

만성 심부전환자의 혈액에서 측정한 Tumor necrosis factor-α 및 Interleukin-6의 임상적 의의

김명구,김성구,박상호,한대희,강진환,변정득,심규혁,최병조,방덕원,온영근,현민수,권영주 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

Background and objectives: Many conditions are responsible for the pathophysiology and progressive mechanisms of congestive heart failure. More recently, it has also become evidence that another class of biologycally activated molecules generically reffered to as cytokine these are also over expressed in congestive heart failure. Therefore, the purpose of this study was to measure concentrations of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) in mild to severe symptoms of heart failure and compare their values with those found in normal control and analysed correlation relationship between cytokine level, clinical findings and hemodynamic indicies. Subjects and Methodology: Levels of TNF-α and IL-6 were measured on pulmonary artery during cardiac catheterization in heart failure patients(n=32) and normal subjects(n=8) as well as physical examination and echocardiogram. Cytokines assay were performed on plasma using commercially available ELISA(Enazyme-Linked Immunosorbent Assay) kits. Results: Although the levels of TNF-α and IL-6 tend to increase in congestive heart failure group, the cytokines level was not made significantly statistical difference between congestive heart failure group and controls. When analyzing the correlation between the levels of PCWP(pulmonary capillary wedge pressure) and cytokines(TNF-α, IL-6), respectively, there were statistically significant correlation coefficient 0.32,(p<0.05), 0.39(p<0.01). The cytokine IL-6 and pressure of pulmonary artery were significant correlation.(correlation coefficient 0.36, p<0.02) More significantly, there was correlated with TNF-α and IL-6.(correlation coefficient 0.57, p<0.001) Conclusions: There was tended toward high concentration of TNF-α & IL-6 in congestive heart failure and significant difference for PCWP between TNF-α & IL-6, thus may be correlated with development and progression in congestive heart failure.

Clinical Characteristics and Outcome of Acute Heart Failure in Korea: Results from the Korean Acute Heart Failure Registry (KorAHF)

이상언,이해영,조현재,최원석,김호곤,최진오,전은석,김민석,김재중,황경국,채성철,백상홍,강석민,최동주,유병수,김계훈,박현영,조명찬,오병희 대한심장학회 2017 Korean Circulation Journal Vol.47 No.3

Background and Objectives: The burden of heart failure has increased in Korea. This registry aims to evaluate demographics, clinical characteristics, management, and long-term outcomes in patients hospitalized for acute heart failure (AHF). Subjects and Methods: We prospectively enrolled a total of 5625 consecutive subjects hospitalized for AHF in one of 10 tertiary university hospitals from March 2011 to February 2014. Descriptive statistics were used to determine the baseline characteristics of the study population and to compare them with those from other registries. Results: The mean age was 68.5±14.5 years, 53.2% were male, and 52.2% had de novo heart failure. The mean systolic and diastolic blood pressures were 131.2±30.3 mmHg and 78.6±18.8 mmHg at admission, respectively. The left ventricular ejection fraction was ≤40% in 60.5% of patients. Ischemia was the most frequent etiology (37.6%) and aggravating factor (26.3%). Angiotensin converting enzyme inhibitors/ angiotensin receptor blockers, beta-blockers, and aldosterone antagonists were prescribed in 68.8%, 52.2%, and 46.6% of the patients at discharge, respectively. Compared with the previous registry performed in Korea a decade ago, extracorporeal membrane oxygenation (ECMO) and heart transplantation have been performed more frequently (ECMO 0.8% vs. 2.8%, heart transplantation 0.3% vs. 1.2%), and in-hospital mortality decreased from 7.6% to 4.8%. However, the total cost of hospital care increased by 40%, and one-year follow-up mortality remained high. Conclusion: While the quality of acute clinical care and AHF-related outcomes have improved over the last decade, the long-term prognosis of heart failure is still poor in Korea. Therefore, additional research is needed to improve long-term outcomes and implement cost-effective care.

Role of the PRC2-Six1-miR-25 signaling axis in heart failure

Oh, Jae Gyun,Jang, Seung Pil,Yoo, Jimeen,Lee, Min-Ah,Lee, Seung Hee,Lim, Taejoong,Jeong, Eden,Kho, Changwon,Kook, Hyun,Hajjar, Roger J.,Park, Woo Jin,Jeong, Dongtak Elsevier 2019 Journal of molecular and cellular cardiology Vol.129 No.-

<P><B>Abstract</B></P> <P>The reduced expression of cardiac sarco-endoplasmic reticulum Ca<SUP>2+</SUP> ATPase (SERCA2a) is a hallmark of heart failure. We previously showed that miR-25 is a crucial transcriptional regulator of SERCA2a in the heart. However, the precise mechanism of cardiac miR-25 regulation is largely unknown. Literatures suggested that miR-25 is regulated by the transcriptional co-factor, sine oculis homeobox homolog 1 (Six1), which in turn is epigenetically regulated by polycomb repressive complex 2 (PRC 2) in cardiac progenitor cells. Therefore, we aimed to investigate whether Six1 and PRC2 are indeed involved in the regulation of the miR-25 level in the setting of heart failure. Six1 was up-regulated in the failing hearts of humans and mice. Overexpression of Six1 led to adverse cardiac remodeling, whereas knock-down of Six1 attenuated pressure overload-induced cardiac dysfunction. The adverse effects of Six1 were ameliorated by knock-down of miR-25. The epigenetic repression on the <I>Six1</I> promoter by PRC2 was significantly reduced in failing hearts. Epigenetic repression of Six1 is relieved through a reduction of PRC2 activity in heart failure. Six1 up-regulates miR-25, which is followed by reduction of cardiac SERCA2a expression. Collectively, these data showed that the PRC2-Six1-miR-25 signaling axis is involved in heart failure. Our finding introduces new insight into potential treatments of heart failure.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Six1 is up-regulated in failing hearts. </LI> <LI> Overexpression of Six1 leads to cardiac abnormalities in vitro and in vivo. </LI> <LI> In cardiac stress conditions, Six1 directly binds to the <I>MCM7</I> promoter, inducing an elevation of miR-25, which in turn reduces SERCA2a. </LI> <LI> In failing hearts, Six1 is epigenetically regulated through the PRC2 complex across species. </LI> </UL> </P>

Pediatric Mechanical Circulatory Support

Ivan Wilmot,Angela Lorts,David Morales 대한흉부외과학회 2013 Journal of Chest Surgery (J Chest Surg) Vol.46 No.6

Mechanical circulatory support (MCS) in the pediatric heart failure population has a limited history especially for infants,and neonates. It has been increasingly recognized that there is a rapidly expanding population of children diagnosed and living with heart failure. This expanding population has resulted in increasing numbers of children with medically resistant end-stage heart failure. The traditional therapy for these children has been heart transplantation. However, children with heart failure unlike adults do not have symptoms until they present with end-stage heart failure and therefore, cannot safely wait for transplantation. Many of these children were bridged to heart transplantation utilizing extracorporeal membranous oxygenation as a bridge to transplant which has yielded poor results. As such, industry, clinicians, and the government have refocused interest in developing increasing numbers of MCS options for children living with heart failure as a bridge to transplantation and as a chronic therapy. In this review,we discuss MCS options for short and long-term support that are currently available for infants and children with end-stage heart failure.

Factors Affecting Adherence to Self-care Behaviors among Outpatients with Heart Failure in Korea

옥종선,최희정 한국성인간호학회 2015 성인간호학회지 Vol.27 No.2

Purpose: To evaluate heart failure knowledge and adherence to self-care behaviors, and to identify factors affecting adherence to self-care behaviors among Korean patients with heart failure. Methods: Correlational research using the European Heart Failure Self-care Behavior Scale, the Duke Activity Status Index, the Dutch Heart Failure Knowledge Scale, the New York Heart Association Functional Classification, and the Medical Outcomes Study Social Support Survey was conducted. A total of 280 outpatients with heart failure responded to the five questionnaires. Results: The mean scores for self-care adherence and heart failure knowledge were 31.98 ± 6.81 and 8.78 ± 2.53, respectively, indicating lower adherence and knowledge than those previously reported. Subjects with lower functional status, more social supports, and greater knowledge of heart failure are more likely to adhere to prescribed regimens. Conclusion: Nurses should focus on patient education and support to improve their adherence to self-care behaviors.