Vasodilator Therapy of Cardiac Failure

Cohn, Jay N.; Franciosa, Joseph A.

doi:10.1056/nejm197707072970105

Cited by 418 publications

(13 citation statements)

References 27 publications

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“… 3 These observations have formed the hemodynamic basis for the use of vasodilator therapies in HF for the past 4 decades. 20 However, it remains unclear how aggressively patients with HF should be treated with vasoactive therapies, or how best to titrate medication adjustments in practice. 21 …”

Section: Discussionmentioning

confidence: 99%

A Randomized Pilot Study of Aortic Waveform Guided Therapy in Chronic Heart Failure

Borlaug

Olson

Mohamed

et al. 2014

JAHA

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BackgroundMedication treatment decisions in heart failure (HF) are currently informed by measurements of brachial artery pressure, but ventricular afterload is more accurately represented by central aortic pressure, which differs from brachial pressure. We sought to determine whether aggressive titration of vasoactive medicines beyond goal‐directed heart failure medical therapy (GDMT) based upon aortic pressure improves exercise capacity and cardiovascular structure‐function.Methods and ResultsSubjects with chronic HF (n=50) underwent cardiopulmonary exercise testing, echocardiography, and arterial tonometry to measure aortic pressure and augmentation index, and were then randomized to aortic pressure‐guided treatment (active, n=23) or conventional therapy (control, n=27). Subjects returned for 6 monthly visits wherein GDMT was first optimized. Additional vasoactive therapies were then sequentially added with the goal to reduce aortic augmentation index to 0% (active) or if brachial pressure remained elevated (control). Subjects randomized to active treatment experienced greater improvement in peak oxygen consumption compared with controls (1.37±3.76 versus −0.65±2.21 mL min−1 kg−1, P=0.025) though reductions in aortic augmentation index were similar (−7±9% versus −5±6%, P=0.46). Forward stroke volume increased while arterial elastance and left ventricular volumes decreased in all participants, with no between‐group difference. Subjects randomized to active treatment were more likely to receive additional vasoactive therapies including nitrates, aldosterone antagonists and hydralazine, with no increased risk of hypotension or worsening renal function.ConclusionsMaximization of goal‐directed medical therapy in heart failure patients may enhance afterload reduction and lead to reverse remodeling, while additional medicine titration based upon aortic pressure data improves exercise capacity in patients with heart failure.

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Section: Discussionmentioning

confidence: 99%

A Randomized Pilot Study of Aortic Waveform Guided Therapy in Chronic Heart Failure

Borlaug

Olson

Mohamed

et al. 2014

JAHA

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“…As to nitroglycerin, Koch et al [40] found that nitroglycerin can produce a sharp fall in the cardiac filling pressures and the pulmonary arterial pressures. Moreover, the vasodilatory effects of nitroglycerin also have the potential to be used in cardiovascular therapeutics [41].…”

Section: Discussionmentioning

confidence: 99%

A physarum-inspired prize-collecting steiner tree approach to identify subnetworks for drug repositioning

et al. 2016

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BackgroundDrug repositioning can reduce the time, costs and risks of drug development by identifying new therapeutic effects for known drugs. It is challenging to reposition drugs as pharmacological data is large and complex. Subnetwork identification has already been used to simplify the visualization and interpretation of biological data, but it has not been applied to drug repositioning so far. In this paper, we fill this gap by proposing a new Physarum-inspired Prize-Collecting Steiner Tree algorithm to identify subnetworks for drug repositioning.ResultsDrug Similarity Networks (DSN) are generated using the chemical, therapeutic, protein, and phenotype features of drugs. In DSNs, vertex prizes and edge costs represent the similarities and dissimilarities between drugs respectively, and terminals represent drugs in the cardiovascular class, as defined in the Anatomical Therapeutic Chemical classification system. A new Physarum-inspired Prize-Collecting Steiner Tree algorithm is proposed in this paper to identify subnetworks. We apply both the proposed algorithm and the widely-used GW algorithm to identify subnetworks in our 18 generated DSNs. In these DSNs, our proposed algorithm identifies subnetworks with an average Rand Index of 81.1%, while the GW algorithm can only identify subnetworks with an average Rand Index of 64.1%. We select 9 subnetworks with high Rand Index to find drug repositioning opportunities. 10 frequently occurring drugs in these subnetworks are identified as candidates to be repositioned for cardiovascular diseases.ConclusionsWe find evidence to support previous discoveries that nitroglycerin, theophylline and acarbose may be able to be repositioned for cardiovascular diseases. Moreover, we identify seven previously unknown drug candidates that also may interact with the biological cardiovascular system. These discoveries show our proposed Prize-Collecting Steiner Tree approach as a promising strategy for drug repositioning.Electronic supplementary materialThe online version of this article (doi:10.1186/s12918-016-0371-3) contains supplementary material, which is available to authorized users.

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“…[1213] In one of our patient who was a known case of CAD, we preferred to infuse NTG during aortic cross clamping as it may be useful in these patients to reduce PCWP and improve myocardial contractility by moving them to more favorable position on the frank–Starling curve. [14]…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of descending thoracic aortobifemoral bypass for aortoiliac occlusive disease: Our experience

et al. 2014

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Background:Complete obstruction of the abdominal aorta at the renal artery level is a difficult surgical problem. Aortic clamping and declamping can lead to profound haemodynamic changes, myocardial infarction, ventricular failure or even death may result. These complications are important challenges in anesthetic management of these patients.Methods:Between August, 2010 and April, 2012, descending thoracic aorta to femoral artery bypass grafting was used to revascularize lower limbs in 11 patients in our institute. The anesthetic management of these patients is described here. Epidural catheter placement was done in T 5-6 or T 6-7 space for post operative pain relief. Induction was done by, Inj. Glycopyrolate 0.2 mg, Inj. Fentanyl 5 μg/kg., Inj. Pentothal sodium 5 mg/kg, Inj. Rocuronium 0.9 mg/kg, IPPV done. Left sided double lumen tube was inserted, Maintenance of Anesthesia was done by O2 + N2 O (30:70). Increments of Vecuronium and Fentanyl were given Monitoring of Heart rate, arterial pressure, central venous pressure were continuously displayed. The available pharmacological agents were used when there is deviation of more than 15% from base line.Results:In our study, inspite of measures taken to control rise in blood pressure during aortic cross clamping, a rise of 90 mm of Hg in one patient and 60-80 mm of Hg in four patients was observed, which was managed by sodium nitropruside infusion. At the end of surgery seven patients were extubated on the operation table. In remaining four patients DLT was replaced by single lumen endotracheal tube and were shifted to ICU on IPPV. They weaned off gradually in 3-5 hours. In our series blood loss was 400 ml to 1000 ml. There was no mortality in the first 24 hours. Postoperative bleeding was reported in one case which was re-explored and stood well.Conclusion:The anesthetic technique during aortic surgery is directed at minimizing the hemodynamic effects of cross clamping in order to maintain the myocardial oxygen supply demand ratio.

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Vasodilator Therapy of Cardiac Failure

Cited by 418 publications

References 27 publications

A Randomized Pilot Study of Aortic Waveform Guided Therapy in Chronic Heart Failure

A Randomized Pilot Study of Aortic Waveform Guided Therapy in Chronic Heart Failure

A physarum-inspired prize-collecting steiner tree approach to identify subnetworks for drug repositioning

Anesthetic management of descending thoracic aortobifemoral bypass for aortoiliac occlusive disease: Our experience

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