Tuesday, January 24, 2006
This week's article:
'Statin' drug may be helpful in heart failure
Jan 20 (Reuters Health) - Treatment with Lipitor (atorvastatin), one of the popular cholesterol-lowering "statin" drugs, can help the heart pump better in patients with heart failure, according to a new report.
By contrast, findings from a much smaller study showed that aside from lowering cholesterol levels, Lipitor did not benefit patients with heart failure. Both reports are published in the Journal of the American College of Cardiology.
"Although the reasons for these discrepant findings are not known, the most logical explanation is that the (group in the second study) had relatively mild heart failure" and thus there was less chance for Lipitor to show a benefit, Dr. Douglas L. Mann and Dr. Kumudha Ramasubbu, from Baylor College of Medicine in Houston, note in a related editorial.
Still, the second study is important because it shows that cholesterol lowering can be achieved in these patients without any obvious side effects using high-dose statin therapy, the editorialists point out.
In the first study, Dr. Srikanth Sola, from Emory University in Atlanta, and colleagues assessed the outcomes of 108 heart failure patients who were randomly assigned to receive Lipitor (20 milligrams per day) or inactive "placebo" for 12 months.
A significant improvement in the heart's pumping ability was noted in the Lipitor group during the study period, whereas a drop was observed in the placebo group. In addition, use of the drug appeared to reduce inflammation.
In the second study, Dr. Barry E. Bleske, from the University of Michigan at Ann Arbor, and colleagues assessed the outcomes of 15 patients with heart failure who were treated with Lipitor (80 milligrams per day) or placebo for 12-weeks and then crossed over to the other treatment for another 12 weeks.
With the exception of a significant drop in LDL ("bad") cholesterol levels, Lipitor therapy produced no beneficial, or harmful, effects in this patient group.
At present, statins can be recommended to heart failure patients with known heart disease and elevated levels of LDL cholesterol, Mann and Ramasubbu note. The broader question of whether these drugs should be given to all patients with heart failure remains unanswered, but several ongoing trials are addressing this topic, they add.
SOURCE: Journal of the American College of Cardiology, January 17, 2006.
Wednesday, January 18, 2006
I just realized I hadn't ever mentioned the results of the MUGA scan. I saw my cardiologist last week to discuss them. The MUGA gives an exact number, instead of the range that an echo gives. My EF is, therefore, 21%.
And while I'm relatively asymptomatic compared to most people with EFs that low, he finds it frustrating that despite all the meds and my reasonable weight and all that, we haven't managed to improve that to at least 30%. So he's referred me to an electrophysiologist with Johns Hopkins, to be evaluated for going back in and implanting that third lead on the pacemaker. As I mentioned when I started this blog, the EP who did it couldn't get the third lead in; the vein at the back of my heart was too "tortuous." Anyway, that was nearly 3 years ago; since then, surgeons have become more experienced at laparascopic implantation, and also there's a possibility that the doctors at Johns Hopkins might just be better than the ones back in Austin... anyway, he's gonna look at me and see if it might be possible now to do that.
If he judges that it's not, then we have to decide whether it's worth it to do a limited thoracotomy, cracking open a couple ribs to get at the heart - much less invasive and quicker recovery than cracking the sternum for open-heart, but a lot more trouble than laparascopic surgery, and it would actually require a couple of nights in the hospital and a couple of weeks of recovery time. And not playing a large saxophone that hangs from around my neck for a couple of months. So I'd have to think about that. Maybe wait until the summer, after the 4th of July concerts are over!
And while I'm relatively asymptomatic compared to most people with EFs that low, he finds it frustrating that despite all the meds and my reasonable weight and all that, we haven't managed to improve that to at least 30%. So he's referred me to an electrophysiologist with Johns Hopkins, to be evaluated for going back in and implanting that third lead on the pacemaker. As I mentioned when I started this blog, the EP who did it couldn't get the third lead in; the vein at the back of my heart was too "tortuous." Anyway, that was nearly 3 years ago; since then, surgeons have become more experienced at laparascopic implantation, and also there's a possibility that the doctors at Johns Hopkins might just be better than the ones back in Austin... anyway, he's gonna look at me and see if it might be possible now to do that.
If he judges that it's not, then we have to decide whether it's worth it to do a limited thoracotomy, cracking open a couple ribs to get at the heart - much less invasive and quicker recovery than cracking the sternum for open-heart, but a lot more trouble than laparascopic surgery, and it would actually require a couple of nights in the hospital and a couple of weeks of recovery time. And not playing a large saxophone that hangs from around my neck for a couple of months. So I'd have to think about that. Maybe wait until the summer, after the 4th of July concerts are over!
A short article from New Scientist, 14 January 2006:
There's a couple paragraphs more, but that's the gist of it. What I get from this is that it's ONLY a defibrillator, not a pacemaker; it wouldn't be used for anyone who needs a pacemaker as well as an ICD, and doesn't therefore apply to anyone who is getting bi-ventricular pacing out of their device.
Plus, I'd have to say I haven't heard of any noticeable number of people getting unnecessary shocks; I've met many people with the ICD/pacemaker devices, and most have *never* had their ICD shock them. Let alone unnecessarily. So I'm not convinces that this was as big a problem as the developer of the new device is making out. However, others' experience may vary. Certainly, for people who need only an ICD, smaller and easier would be better. I wonder, though, whether it eats up more battery power monitoring more of the heart? Would that mean more frequent, if less invasive, surgery?
Implantable defibrillators have saved countless lives by applying electric shicks to jump-start failing hearts. But these devices have one serious flaw: they often go off when they are not needed, giving unsuspecting and perfectly healthy recipients the fright of their lives. [BunRab's 2 cents worth: if they were perfectly healthy, they wouldn't have implanted defibrillators, would they now.] "People often don't realise just what unpleasant and flawed devices standard defibrillators are," says Andrew Grace... For this reason, he has been working with Cameron Health of an Clemente, CA, to develop a defibrillator that may spell an end to unnecessary shocks by more thoroughly assessing electrical activity in the heart.
Standard defibrillators are connected to the heart via wires, and judge how well the organ iz functioning by monitoring the small area of tissue that is usually the origin of rhythm disturbances. However, electrical anaomalies in this area are not always morrored elsewhere in the heart, and are therefore not always significant. But defibrillators still kick in and give the heart an unnecessary shock.
The new device scans the whole heart in the same way as an ECG, and will only provide a shock if it picks up a major, organ-wide irregularity. Like an ECG it uses sensor electrodes and magnets to pick up the electric fields generated by electrical activity in the heart muscle.
As well as avoiding false alarms, the device is less invaive than standard defibrillators as it is not attached to the heart itself but fits on the chest just under skin. This makes fitting it simpler and safer.
There's a couple paragraphs more, but that's the gist of it. What I get from this is that it's ONLY a defibrillator, not a pacemaker; it wouldn't be used for anyone who needs a pacemaker as well as an ICD, and doesn't therefore apply to anyone who is getting bi-ventricular pacing out of their device.
Plus, I'd have to say I haven't heard of any noticeable number of people getting unnecessary shocks; I've met many people with the ICD/pacemaker devices, and most have *never* had their ICD shock them. Let alone unnecessarily. So I'm not convinces that this was as big a problem as the developer of the new device is making out. However, others' experience may vary. Certainly, for people who need only an ICD, smaller and easier would be better. I wonder, though, whether it eats up more battery power monitoring more of the heart? Would that mean more frequent, if less invasive, surgery?
Friday, January 06, 2006
This week's news article:
Resistance training OK for heart failure patients
Dec 27 (Reuters Health) - Contrary to qualms about deleterious effects on the heart, people with chronic heart failure can safely undertake a resistance training program, Australian researchers report. In fact, such training appears to have a beneficial effect on how strongly the heart is able to pump blood.
Resistance training has been shown to improve the functional ability of people with chronic heart failure to perform activities of daily living, and to improve their overall quality of life. However, there have been concerns that it may accelerate the remodeling process that affects the main pumping chamber of the heart -- the left ventricle -- when chronic heart failure sets in.
To investigate, Dr. Itamar Levinger, from Victoria University of Technology in Melbourne, and colleagues used ultrasound to assess the structure and function of the left ventricles of eight men with heart failure who participated in an 8-week resistance training program and seven similar men who did not.
The investigators' findings appear in the International Journal of Cardiology. The resistance training did not appear to have a significant effect on left ventricle measurements, the report indicates.
Yet, the patients who undertook the resistance training showed significant increases in the amount of blood the heart was able to pump with each beat, compared with the non-training group.
"Since resistance training improves functional ability and quality of life of patients with chronic heart failure without causing a reduction in left ventricular contractile function or structure it is recommended to add this training regime to the regular exercise rehabilitation programs of these patients," Levinger's team concludes.
SOURCE: International Journal of Cardiology, November 2, 2005.
Publish Date: December 27, 2005
