This finding warrants additional investigation, including replication, in other
studies of HF. (Circ Cardiovasc Genet. 2010;3:248-255.)”
“Purpose of review
Heart transplantation remains the treatment of choice for patients with advanced heart failure. We review the current definition of optimal therapy, prediction of prognosis and revisit contraindications for transplant.
Recent findings
Clinical trials of eplerenone and ivabradine were associated with improved prognosis, whereas others (nesiritide) were disappointing. Advances in cardiac resynchronization therapy and ventricular assist devices (VAD) have resulted in an expansion of their indications. Advances in catheter ablation for ventricular tachycardia have made this an uncommon indication for heart transplantation. Surgical ventricular reconstruction and mitral valve intervention have not resulted in survival benefit. click here Bypass surgery was
associated with a lower mortality from cardiovascular causes. Prognostic risk scores have been developed in heart failure patients; however, GPCR Compound Library cell assay ongoing refinements are needed. Selected patients with diabetes, HIV and pretransplant malignancy, now have favourable outcomes after heart transplantation. VAD as bridge to candidacy is an option in heart failure patients with ‘fixed’ pulmonary hypertension. Alternate listing strategies have also been studied to provide high-risk patients with an opportunity for heart transplantation.
Summary
Heart failure patients
should be on current optimal medical and device therapy with a poor prognosis before consideration for heart transplantation. An individualized approach to heart transplantation assessment is recommended.”
“Background-Although genetic factors contribute to the onset of heart failure (HF), no large-scale genome-wide investigation of HF risk has been published to date. We have investigated the association of 2 478 304 single-nucleotide polymorphisms with incident HF by meta-analyzing data from 4 community-based prospective cohorts: the Atherosclerosis Risk in Communities Study, the Cardiovascular Health Study, the VX-680 Framingham Heart Study, and the Rotterdam Study.
Methods and Results-Eligible participants for these analyses were of European or African ancestry and free of clinical HF at baseline. Each study independently conducted genome-wide scans and imputed data to the approximate to 2.5 million single-nucleotide polymorphisms in HapMap. Within each study, Cox proportional hazards regression models provided age-and sex-adjusted estimates of the association between each variant and time to incident HF. Fixed-effect meta-analyses combined results for each single-nucleotide polymorphism from the 4 cohorts to produce an overall association estimate and P value. A genome-wide significance P value threshold was set a priori at 5.0 x 10(-7). During a mean follow-up of 11.5 years, 2526 incident HF events (12%) occurred in 20 926 European-ancestry participants.