Herz
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In June 2012, the New Guidelines for the Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology were published. According to the EMPHASIS-HF trial, mineralocorticoid receptor antagonists are indicated in all stages of symptomatic chronic heart failure under treatment with β-blockers and ACE inhibitors. ⋯ In acute heart failure, the RELAX-AHF trial showed promising results with serelaxin. This manuscript summarizes the innovations of the new guidelines and the underlying clinical trials.
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Clinical registries have become increasingly more important tools for scientists as well as for medical admission boards worldwide during recent years due to the ability to investigate the safety and efficacy of a therapeutic method in the general population under real world conditions. The clinical benefit of current registry data seems to be particularly high in a treatment method, such as carotid artery stenting (CAS) where safety and efficacy, especially in daily clinical practice, could not be totally clarified by several randomized clinical trials (RCT). For this reason the new multidisciplinary, multicenter and prospective German Carotid Artery Registry (GeCAS) was founded in January 2011 for continuing quality control in CAS in clinical practice in Germany. ⋯ This generates an image of the current reality of CAS in Germany in addition to the nationwide obligatory documentation. Furthermore, data of the GeCAS registry is the basis for research work (e.g. publications and presentations), for generating new hypotheses and for technical development in CAS in Germany. Consequently, the existence of a multicenter and multidisciplinary CAS registry, such as the GeCAS registry, is considered necessary and medically useful.
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Controlled Clinical Trial
H-FABP, cardiovascular risk factors, and functional status in asymptomatic spinal cord injury patients.
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Paradoxical embolization through the patent foramen ovale (PFO) is the major cause of most cryptogenic stroke cases. However, the presence of PFO may simply be an incidental finding in these patients, and endothelial dysfunction may be the underlying reason of ischemic stroke. The aim of this study was to compare the endothelial function of cryptogenic stroke patients according to the presence of PFO. ⋯ Endothelial dysfunction seems to play a more important role than PFO in the underlying mechanism of cryptogenic stroke.
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Sleep apnea can influence cardiac function, by which the development of heart failure is facilitated. Vice versa, chronic heart failure increases the risk for sleep apnea. Consequently, in patients with symptomatic chronic heart failure, sleep apnea is a frequent comorbidity occuring in up to 75% of cases. ⋯ Therefore, a screening of all heart failure patients for sleep apnea is mandatory. Currently, large studies are underway which investigate whether the treatment of sleep apnea, esp. central sleep apnea, will beneficially influence the clinical course of heart failure (SERVE-HF, ADVENT-HF). A new therapeutic approach for central sleep apnea is the phrenic nerve stimulation.