Marco Triggiani

Effects of n-3 Polyunsaturated Fatty Acids on Left Ventricular Function and Functional Capacity in Patients With Dilated Cardiomyopathy

Methods Patients with chronic HF due to NICM and minimal symptoms while receiving evidence-based therapy were enrolled. LV function and functional capacity were assessed prospectively by echocardiography, cardiopulmonary exercise test, and New York Heart Association functional class at baseline and at 12 months after randomization to eithe r2go f n-3PUFAs or placebo. Results At 12 months after randomization, the n-3 PUFAs group and the placebo group differed significantly (p 0.001) in regard to: 1) LV ejection fraction (increased by 10.4% and decreased by 5.0%, respectively); 2) peak VO2 (increased by 6.2% and decreased by 4.5%, respectively); 3) exercise duration (increased by 7.5% and decreased by 4.8%, respectively); and 4) mean New York Heart Association functional class (decreased from 1.88 0.33 to 1.61 0.49 and increased from 1.83 0.38 to 2.14 0.65, respectively). The hospitalization rates for HF were 6% in the n-3 PUFAs and 30% in the placebo group (p 0.0002). Conclusions In patients with NICM and minimal symptoms in response to evidence-based medical therapy, n-3 PUFAs treatment increases LV systolic function and functional capacity and may reduce hospitalizations for HF. Given these promising results, larger studies are in order to confirm our findings. (J Am Coll Cardiol 2011;57:870‐9)

Effects of n-3 polyunsaturated fatty acids on left ventricular function and functional capacity in patients with dilated cardiomyopathy.

OBJECTIVES This study was designed to test the effects of n-3 polyunsaturated fatty acids (PUFAs) on left ventricular (LV) systolic function in chronic heart failure (HF) due to nonischemic dilated cardiomyopathy (NICM). BACKGROUND One hundred thirty-three patients with NICM and minimal symptoms on standard therapy were randomized to 2 g of n-3 PUFAs or placebo. LV function and functional capacity were assessed prospectively by echocardiography and cardiopulmonary exercise testing at baseline and at 12 months after randomization. METHODS Patients with chronic HF due to NICM and minimal symptoms while receiving evidence-based therapy were enrolled. LV function and functional capacity were assessed prospectively by echocardiography, cardiopulmonary exercise test, and New York Heart Association functional class at baseline and at 12 months after randomization to either 2 g of n-3 PUFAs or placebo. RESULTS At 12 months after randomization, the n-3 PUFAs group and the placebo group differed significantly (p <0.001) in regard to: 1) LV ejection fraction (increased by 10.4% and decreased by 5.0%, respectively); 2) peak VO(2) (increased by 6.2% and decreased by 4.5%, respectively); 3) exercise duration (increased by 7.5% and decreased by 4.8%, respectively); and 4) mean New York Heart Association functional class (decreased from 1.88 ± 0.33 to 1.61 ± 0.49 and increased from 1.83 ± 0.38 to 2.14 ± 0.65, respectively). The hospitalization rates for HF were 6% in the n-3 PUFAs and 30% in the placebo group (p = 0.0002). CONCLUSIONS In patients with NICM and minimal symptoms in response to evidence-based medical therapy, n-3 PUFAs treatment increases LV systolic function and functional capacity and may reduce hospitalizations for HF. Given these promising results, larger studies are in order to confirm our findings.

n-3 Polyunsaturated Fatty Acids in the Prevention of Atrial Fibrillation Recurrences After Electrical Cardioversion A Prospective, Randomized Study

Background— n-3 polyunsaturated fatty acids (n-3 PUFAs) exert antiarrhythmic effects and reduce sudden cardiac death. However, their role in the prevention of atrial fibrillation remains controversial. We aimed to determine the effect of n-3 PUFAs in addition to amiodarone and a renin-angiotensin-aldosterone system inhibitor on the maintenance of sinus rhythm after direct current cardioversion in patients with persistent atrial fibrillation. Methods and Results— We conducted a randomized, double-blind, placebo-controlled, parallel-arm trial in patients with persistent atrial fibrillation, with at least 1 relapse after cardioversion, and treated with amiodarone and a renin-angiotensin-aldosterone system inhibitor. Participants were assigned to placebo or n-3 PUFAs 2 g/d and then underwent direct current cardioversion 4 weeks later. The primary end point was the probability of maintenance of sinus rhythm at 1 year after cardioversion. Of 254 screened patients, 199 were found to be eligible and randomized. At the 1-year follow up, the probability of maintenance of sinus rhythm was significantly higher in the n-3 PUFAs–treated patients compared with the placebo group (hazard ratio, 0.62 [95% confidence interval, 0.52 to 0.72] and 0.36 [95% confidence interval, 0.26 to 0.46], respectively; P=0.0001). Conclusions— In patients with persistent atrial fibrillation on amiodarone and a renin-angiotensin-aldosterone system inhibitor, the addition of n-3 PUFAs 2 g/d improves the probability of the maintenance of sinus rhythm after direct current cardioversion. Our data suggest that n-3 PUFAs may exert beneficial effects in the prevention of atrial fibrillation recurrence. Further studies are needed to confirm and expand our findings. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01198275.

Spectrum of epidemiological and clinical findings in patients with heart failure with preserved ejection fraction stratified by study design: A systematic review

Heart failure with preserved ejection fraction (HFpEF) represents a major global and economic burden, but its epidemiological, clinical, and outcome data have varied according to study design.

Effects of supplementation with polyunsaturated fatty acids in patients with heart failure

Despite the clinical and prognostic improvement obtained with the current medical treatment, heart failure (HF) continues to have high morbidity and mortality and its prevalence is increasing in most regions of the world. Thus, there is a need for novel adjunctive therapies that act independently of current neurohormonally and haemodynamically oriented drugs. Nutritional approaches are particularly attractive because they could work additively with established therapies without negative hemodynamic effects. There is growing evidence that omega-3 polyunsaturated fatty acids (n-3 PUFAs) supplementation positively impacts established pathophysiological mechanisms in HF and thus has a potential role for preventing and treating HF. The results of the GISSI-HF trial have indicated that, in patients with chronic HF on evidence-based therapy, long term treatment with PUFAs reduced mortality and hospitalizations for cardiovascular reasons, irrespective of etiology and left ventricular (LV) ejection fraction (EF). The purpose of this review is to summarize the evidence emerged from studies conducted so far on the effect of n-3 PUFAs in HF.

Preventing antiblastic drug-related cardiomyopathy: Old and new therapeutic strategies

Because of the recent advances in chemotherapeutic protocols, cancer survival has improved significantly, although cardiovascular disease has become a major cause of morbidity and mortality among cancer survivors: in addition to the well-known cardiotoxicity (CTX) from anthracyclines, biologic drugs that target molecules that are active in cancer biology also interfere with cardiovascular homeostasis. Pharmacological and non-pharmacological strategies to protect the cardiovascular structure and function are the best approaches to reducing the prevalence of cardiomyopathy linked to anticancer drugs. Extensive efforts have been devoted to identifying and testing strategies to achieve this end, but little consensus has been reached on a common and shared operability. Timing, dose and mode of chemotherapy administration play a crucial role in the development of acute or late myocardial dysfunction. Primary prevention initiatives cover a wide area that ranges from conventional heart failure drugs, such as &bgr;-blockers and renin-angiotensin-aldosterone system antagonists to nutritional supplementation and physical training. Additional studies on the pathophysiology and cellular mechanisms of anticancer-drug-related CTX will enable the introduction of novel therapies. We present various typologies of prevention strategies, describing the approaches that have already been used and those that could be effective on the basis of a better understanding of pharmacokinetic and pharmacodynamic CTX mechanisms.

USE OF N-3 POLYUNSATURATED FATTY ACIDS TO MAINTAIN SINUS RHYTHM AFTER CONVERSION FROM PERSISTENT ATRIAL FIBRILLATION. A PROSPECTIVE RANDOMIZED STUDY

Background: The risk of atrial fibrillation recurrences (AFR) after cardioversion(CV) is one of the most important problems in the treatment of this arrhythmia. Literature data showed that amiodarone is the most effective antiarrhythmic drug in sinus rhythm maintenance.Several studies have recently demonstrated that also non-antiarrhythmic drugs as RAS inhibitors (RASi) and n-3 PUFAs can prevent atrial remodeling and reduce AF occurrence or recurrences. At present only few evidences suggested the beneficial effect of n-3PUFAS in AF. This study has evaluated the role of n-3 PUFAs in addition to amiodarone and RASi on maintaining sinus rhythm (SR) after conversion from persistent AF.

Pre‐discharge and early post‐discharge troponin elevation among patients hospitalized for heart failure with reduced ejection fraction: findings from the ASTRONAUT trial

Troponin levels are commonly elevated among patients hospitalized for heart failure (HF), but the prevalence and prognostic significance of early post‐discharge troponin elevation are unclear. This study sought to describe the frequency and prognostic value of pre‐discharge and post‐discharge troponin elevation, including persistent troponin elevation from the inpatient to outpatient settings.

PROGNOSTIC ROLE OF ATRIAL FIBRILLATION AND HEART RATE CONTROL IN CHRONIC HEART FAILURE PATIENTS

methods: we performed a retrospective analysis of pts with reduced Left Ventricular Ejection Fraction (LVEF<45%) and stable clinical condition (neither events nor therapeutic changes in the previous 3 months) followed in our HF clinic. Demographic, clinical, echocardiographic and laboratory parameters were recorded. We considered as composite endpoint the occurrence of cardiovascular (CV) death and HF or CV hospitalization at 1 year follow-up. We analyzed clinical characteristics and events in sinus rhythm (SR) pts and in AF pts, stratified according to median baseline HR value (70 bpm).

Heart failure and cardiorenal syndrome: a case report

Cardio-Renal Syndrome (CRS) is a renal dysfunction occurring in a large percentage of pts hospitalised for congestive heart failure (CHF). It is characterised by an excessive fluid retention inside the body, resistance to conventional medical therapy, worsening renal function (WRF) and higher mortality. The prevalence of CRS is likely increased because of the improved survival of HF patients. WRF occurs frequently among hospitalised HFF and is associated with a significantly worse outcome. Clinical features at admission can be used to identify patients at high risk for developing WRF. The clinical case presented concerns a 70-year-old diabetic man with post-ischemic cardiomyopathy and chronic kidney failure, admitted to our division for acute heart failure. During hospitalisation he showed a progressive WRF and resistance to diuretic treatment. After Ultrafiltration treatment there was a progressive clinical improvement. Many treatments have been investigated in order to improve renal function, but none has been demonstrated to improve clinical outcome. Currently Ultrafiltration is reserved to patients with volume overload when traditional medical therapies fail and/or patients become resistant to diuretics.