Background and objective: Major risk factors for congestive heart failure (CHF) are myocardial infarction, hypertension, diabetes, atrial fibrillation, smoking, left ventricular hypertrophy (LVH) and obesity. However, since these risk factors only explain part of the risk of CHF, we investigated whether persistent organic pollutants (POPs) might also play a role. Methods: In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, left ventricular ejection fraction, (EF), E/A-ratio and isovolumic relaxation time (IVRT), were determined by echocardiography and serum samples of 21 POPs were analyzed in serum measured by high-resolution chromatography coupled to high-resolution mass spectrometry (HRGC/HRMS) in 998 subjects all aged 70 years. Results: In this cross-sectional analysis, high levels of several of the polychlorinated biphenyls (PCB congeners 99, 118, 105, 138, 153, and 180) and octachlorodibenzo-p-dioxin (OCDD) were significantly related to a decreased EF. Some POPs were also related to a decreased E/A-ratio (PCBs 206 and 209). All the results were adjusted for gender, hypertension, diabetes, smoking, LVH and BMI, and subjects with myocardial infarction or atrial fibrillation were excluded from the analysis. Conclusions: Circulating levels of POPs were related to impairments in both left ventricular systolic and diastolic function independently of major congestive heart failure risk factors, suggesting a possible role of POPs in heart failure.

Bakgrund: Risken för hjärtsvikt ökar med stigande ålder. Upplevelser av att leva med hjärtsvikt varierar vilket kan påverka det dagliga livet och leda till individuella vårdbehov. Patienter med hjärtsvikt ska vid behov erbjudas vård i hemmet och den är idag mer avancerad än tidigare. Syfte: Syftet med studien var att belysa patienters upplevelser av att få vård i hemmet för sin hjärtsvikt. Metod: En induktiv intervjustudie med semistrukturerade frågor har använts. Genom ett strategiskt urval framkom sex informanter. Intervjumaterialet analyserades med kvalitativ manifest innehållsanalys. Resultat: Vården i hemmet utformades individuellt och informanterna upplevde att de fick all vård de var i behov av. Olika yrkeskategorier samverkade och möjliggjorde vården i hemmet. En relation till vårdpersonalen var viktig och hembesöken medförde ett socialt sällskap. Det innebar en trygghet att vara med och planera sin vård och kontinuitet i vården var viktig. Möjligheten att ta kontakt med vårdpersonal var viktig vid olika vårdbehov samt att få vara kvar i hemmet för vård. Känslorna inför framtiden och vården i hemmet varierade. Slutsats: Samverkan mellan olika yrkeskategorier möjliggör vård i hemmet för patienter med hjärtsvikt. För patienten skapas möjlighet att vara i sin hemmiljö, även vid progression av hjärtsvikten. Vården i hemmet påverkar upplevelsen av trygghet och skapar förutsättningar för en god hälsa. / Background: The risk of heart failure increases with age, and experiences of living with heart failure varies. This condition can affect the daily life and lead to individual care needs. If necessary, patients with heart failure should be offered attendence at home. The home health care is more advanced now than before. Aim: The aim of the study was to illuminate the experiences of heart failure patients whom received care at home. Method: An inductive interview study with semi-structured questions were used. Six informants emerged from a strategic sampling. During the study of the interview material, a qualitative content analysis was used. Results: The results showed that attendance at home was designed individually, and the informants received the care they needed. Interaction between different professions made this possible. The relationship between the resident and the caregiver was important, and it also led to social company. It meant security to be involved in the creating of the care plan, and the continuity of care was important. The possibility to contact the caregiver at different care needs, and to stay at home were important. Feelings about the future and the home health care varied. Conclusion: Home health care for patients with heart failure is enabled by collaboration between different professions. Even during the progression of heart failure, the patient may still be given the opportunity to stay at home. The attendence at home affects the perception of being safe and enables conditions for good health.

With the recent advent of gene therapy, anti-apoptotic therapy has been receiving spotlight as a potential modality to inhibit the deterioration of pump function in the failing heart. We hypothesized that anti-apoptotic therapy using survivin gene delivery will 1) salvage H9c2 cells exposed to doxorubicin toxicity, and 2) ameliorate the progressive decline in left ventricular function in a rat model of doxorubicin-induced cardiomyopathy. The in vitro data suggested that survivin successfully prevented cell death under doxorubicin stress by both direct and indirect/paracrine mechanisms. Doxorubicin-treated animals developed progressive left ventricular dysfunction as evident by echocardiography and invasive pressure-volume loop analysis, which was prevented by ultrasound-mediated survivin plasmid delivery, but not empty plasmid delivery. Post-mortem analysis of myocardial tissue indicated a lowered apoptotic index in survivin-treated hearts, with evidence of decrease in interstitial fibrosis. In conclusion, survivin gene therapy was shown to ameliorate doxorubicin-induced cardiomyopathy, by decreasing apoptosis and preventing adverse remodeling.

With the recent advent of gene therapy, anti-apoptotic therapy has been receiving spotlight as a potential modality to inhibit the deterioration of pump function in the failing heart. We hypothesized that anti-apoptotic therapy using survivin gene delivery will 1) salvage H9c2 cells exposed to doxorubicin toxicity, and 2) ameliorate the progressive decline in left ventricular function in a rat model of doxorubicin-induced cardiomyopathy. The in vitro data suggested that survivin successfully prevented cell death under doxorubicin stress by both direct and indirect/paracrine mechanisms. Doxorubicin-treated animals developed progressive left ventricular dysfunction as evident by echocardiography and invasive pressure-volume loop analysis, which was prevented by ultrasound-mediated survivin plasmid delivery, but not empty plasmid delivery. Post-mortem analysis of myocardial tissue indicated a lowered apoptotic index in survivin-treated hearts, with evidence of decrease in interstitial fibrosis. In conclusion, survivin gene therapy was shown to ameliorate doxorubicin-induced cardiomyopathy, by decreasing apoptosis and preventing adverse remodeling.

Bakgrund: Hjärtsvikt är den vanligaste orsaken till sjukhusinläggning hos äldre personer. Upp till 50 % av dessa patienter är felnärda. Detta kan delvis orsakas av de gastrointestinala symtom som sjukdomen ger såsom tidig mättnadskänsla, aptitlöshet och illamående. Syfte: Att ur patienters perspektiv belysa problematik med mat och kostråd vid kronisk hjärtsvikt. Metod: En litteraturstudie där tio kvalitativa eller kvantitativa vetenskapliga artiklar ingår. Resultat: Personer med hjärtsvikt förstod inte alltid att de hade en kronisk sjukdom och att detta skulle påverka deras matintag för resten av livet. Att följa en saltfattigkost kunde ge svårigheter i det dagliga livet. Maten kunde väcka både positiva och negativa känslor. De kunde känna sig begränsade i sociala situationer t ex. vid högtider eller restaurangbesök, då maten de blev bjudna på oftast innehöll för mycket salt. De flesta patienterna utvecklade strategier för att lättare följa kostråden. Diskussion: Patienter och anhöriga har ett stort informationsbehov om sjukdomen och dess påverkan i det dagliga livet. De kan behöva stöd och uppmuntran från omgivningen för att genomföra livsstilsförändringarna. Det är viktigt att förstår sambandet mellan saltrik mat och ökade symtom. Personcentrerad vård kan minska vårdtiden och förbättra eller bevara patienternas vardagliga resurser jämfört med traditionell vård samt minska återinläggningarna. / Background: Heart failure is the leading cause of hospitalization of older people. Up to 50% of these patients are malnourished. This may be partly caused by the gastrointestinal symptoms caused by the disease, as early satiety, loss of appetite and nausea. Aim: From patient’s perspective highlight problems with food and dietary advice in chronic heart failure. Method: A literature review where ten qualitative or quantitative scientific papers were included.  Results: People with heart failure did not always understand that they had a chronic illness and that this would affect their food intake for the rest of their lives. To follow a low salt diet could cause difficulties in the daily life. The food could give both positive and negative emotions. They could feel limited at social occasions, feasts or when visiting restaurants, when the food they were invited to often included too much salt. Many patients developed strategies to follow the dietary recommendations more easily. Discussion: Patients and their relatives have a great need for information about the disease and the impact in daily life. They may need support and encouragement from the environment to implement lifestyle changes. It is important to understand the relationship between salty food and increased symtoms. Person-centred care could reduce the length of stay and maintain or improve the patient´s daily resources and reduce re-admission.

No description available.

Heart failure is a common disease which is difficult to diagnose. To aid physicians in diagnosing heart failure, a decision support system has been proposed. Parameters useful to the system are suggested. Some of these, such as age and gender, should be provided by the physician, and some should be derived from electro- and phonocardiographic signals. Various methods of signal processing, such as wavelet theory and principal components analysis, are described. Heart failure should be diagnosed based on the parameters, and so various forms of decision support systems, such as neural networks and support vector machines, are described. The methods of signal processing and classification are discussed and suggestions on how to develop the system are made.

Chronic kidney disease (CKD) and its cardiac complications represent a large and growing problem in Canada. The progression of CKD is driven by the activation of several final common pathways of injury, including fibrosis and oxidative stress. If left unchecked, these inter-connected processes lead to progressive damage and subsequent organ dysfunction. Current clinical therapies, consisting of aggressive blood pressure control and blockade of the renin-angiotensin system, fail to arrest this progressive injury in a significant number of patients. Early outgrowth cells (EOCs) represent a novel bone marrow-derived cell population that have been recently described to have tissue protective activity. In this work, we examined the effects of intravascular EOC infusion in two independent models of CKD, demonstrating potent anti-fibrotic renoprotective effects in the subtotally nephrectomized (SNX) rat, a well-established model of non-diabetic progressive CKD, and anti-fibrotic and anti-oxidant effects in the db/db mouse, a commonly used model of type 2 diabetic nephropathy. In the SNX rat, which is characterized by impaired cardiac relaxation reminiscent of a common and high risk clinical CKD phenotype, EOC infusion was also associated with improved cardiac structure and function. In both cases, infused EOCs were not retained in significant numbers within the diseased kidney or heart, but rather localized to distant organs such as the liver, spleen, and bone marrow. We further demonstrated that EOCs release soluble factors with anti-oxidant and anti-fibrotic activity in vitro, and that a cell-free preparation of EOC-derived factors can mimic the reno- and cardiac protective effects of the cells themselves when infused into the SNX rat. Taken together, our results demonstrate the therapeutic potential of an EOC-based strategy for the treatment of CKD and its cardiac complications, and provide the preclinical rationale for the design of clinical trials of EOC-based therapies for this devastating disease.

Chronic kidney disease (CKD) and its cardiac complications represent a large and growing problem in Canada. The progression of CKD is driven by the activation of several final common pathways of injury, including fibrosis and oxidative stress. If left unchecked, these inter-connected processes lead to progressive damage and subsequent organ dysfunction. Current clinical therapies, consisting of aggressive blood pressure control and blockade of the renin-angiotensin system, fail to arrest this progressive injury in a significant number of patients. Early outgrowth cells (EOCs) represent a novel bone marrow-derived cell population that have been recently described to have tissue protective activity. In this work, we examined the effects of intravascular EOC infusion in two independent models of CKD, demonstrating potent anti-fibrotic renoprotective effects in the subtotally nephrectomized (SNX) rat, a well-established model of non-diabetic progressive CKD, and anti-fibrotic and anti-oxidant effects in the db/db mouse, a commonly used model of type 2 diabetic nephropathy. In the SNX rat, which is characterized by impaired cardiac relaxation reminiscent of a common and high risk clinical CKD phenotype, EOC infusion was also associated with improved cardiac structure and function. In both cases, infused EOCs were not retained in significant numbers within the diseased kidney or heart, but rather localized to distant organs such as the liver, spleen, and bone marrow. We further demonstrated that EOCs release soluble factors with anti-oxidant and anti-fibrotic activity in vitro, and that a cell-free preparation of EOC-derived factors can mimic the reno- and cardiac protective effects of the cells themselves when infused into the SNX rat. Taken together, our results demonstrate the therapeutic potential of an EOC-based strategy for the treatment of CKD and its cardiac complications, and provide the preclinical rationale for the design of clinical trials of EOC-based therapies for this devastating disease.

No description available.