The Canadian journal of cardiology
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Diastolic heart failure (DHF) is an important entity, the significance of which is increasingly recognized. This report examines the available evidence regarding the role, significance, and mechanisms of DHF. Epidemiologic studies have documented the rising burden of DHF, and experimental data are revealing the unique mechanisms distinguishing it from systolic heart failure. ⋯ Exacerbating factors include volume and sodium indiscretion, arrhythmias, ischemia, and comorbidities. Strategies to ameliorate or to obviate these precipitating factors are most effective in preventing DHF and its exacerbations. Meanwhile, prevention of DHF through appropriate and aggressive risk factor identification and management must remain the cornerstone of clinical intervention.
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Acute heart failure (AHF) affects nearly every Canadian with heart failure (HF) at least once. Despite several attempts, no medical therapies have been shown to improve the natural history of AHF. In addition, the place of diagnosis of AHF is increasingly made in the outpatient setting. ⋯ This report reviews the recent literature regarding the presentation, diagnosis, management, and prognosis of AHF. Areas of future research priority are indicated and guidelines for improving treatment are provided. AHF is an important clinical area that has not been as intensively studied as chronic HF; it presents both important needs and exciting opportunities for research and innovation.
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Abnormal diastolic function portends a poor prognosis regardless of any associated systolic dysfunction. There is controversy regarding the precision with which diagnosis of diastolic dysfunction can be made non-invasively. Clinical studies show that non-invasive evaluation of the severity of diastolic function predicts the risk of cardiac death and heart failure whereas invasive monitoring of intracardiac pressures is not proven to be better than clinical judgement in guiding patient management. ⋯ A better understanding of the physiology of diastole highlights the relevance of the cardiac substrate in the genesis of diastolic dysfunction. The availability of newer diagnostic tools such as tissue Doppler imaging has informed the need to assess all components of diastolic function within the context of predisposing or consequential morphological substrates. A new prognosis-centred paradigm implies that diastolic function need only be stratified into "normal", "mildly abnormal" (compensated dysfunction), or "severely abnormal" (uncompensated diastolic dysfunction) categories.
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Comparative Study
Prevalence and treatment patterns of lower extremity peripheral arterial disease among patients at risk in ambulatory health settings.
Lower extremity peripheral arterial disease (PAD) is underdiagnosed and undertreated in Canada, although data are limited. We sought to measure PAD prevalence and treatment patterns in ambulatory settings. ⋯ About 1 in 20 ambulatory persons > 50 years of age screened had PAD. All cases of PAD that we found were previously undiagnosed, and there was a large treatment gap for those without concomitant CVD.
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Cardiac resynchronization therapy (CRT) is an established treatment of severe systolic heart failure with intraventricular conduction delay. The influence on mortality of the left ventricular (LV) pacing site and the type of bundle-branch block during CRT is unclear. ⋯ LV lead position and nonspecific conduction delay are predictors of mortality in patients during cardiac resynchronization therapy.