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Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Pathophysiology of Heart Failure01:17

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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Heart Failure Drugs: Inotropic Agents01:26

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Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
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Heart Failure Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

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β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
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Pathophysiology of Cardiac Performance01:29

Pathophysiology of Cardiac Performance

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Typical heart performance is influenced by heart rate, rhythm, myocardial contraction, and metabolism or blood flow. The cardiac muscle exhibits distinct electrophysiological features, including pacemaker activity and calcium channel control, which play a vital role in the heart's response to various drugs. The autonomic nervous system, comprising the sympathetic and parasympathetic branches, regulates heart rate. Sympathetic activation increases heart rate, while parasympathetic activation...
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Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

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Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
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Related Experiment Video

Updated: Jun 25, 2025

Evaluation of Cardiac Contractility Modulation Therapy in 2D Human Stem Cell-Derived Cardiomyocytes
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Evaluation of Cardiac Contractility Modulation Therapy in 2D Human Stem Cell-Derived Cardiomyocytes

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HF Etiology and cardiac contractility modulation therapy.

Karapet Davtyan1, Ivan Chugunov1, Arpi Topchyan2

  • 1National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia.

BMC Cardiovascular Disorders
|May 29, 2024
PubMed
Summary

Cardiac contractility modulation (CCM) therapy improved heart function in patients with heart failure with reduced ejection fraction (HFrEF). Non-ischemic HFrEF patients showed greater left ventricular ejection fraction (LVEF) improvement than ischemic patients, with similar survival rates.

Keywords:
Device-based therapyHeart failureHeart failure etiologyOptimizer

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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction

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Area of Science:

  • Cardiology
  • Heart Failure Research
  • Medical Device Technology

Background:

  • Heart failure with reduced ejection fraction (HFrEF) remains a significant clinical challenge, necessitating advanced therapeutic strategies.
  • Cardiac contractility modulation (CCM) therapy offers a potential treatment option for patients with HFrEF refractory to optimal medical therapy.

Purpose of the Study:

  • To evaluate the safety and efficacy of CCM therapy in HFrEF patients, stratified by the etiology of heart failure (HF).
  • To compare treatment outcomes between patients with ischemic (ICM) and non-ischemic (NICM) HFrEF undergoing CCM therapy.

Main Methods:

  • A retrospective analysis of 166 patients with drug-resistant HFrEF who received CCM device implantation between 2013 and 2019.
  • HF etiology was determined via coronary angiography or cardiac MRI. Outcomes including left ventricular ejection fraction (LVEF), 6-minute walking test (6MWT), and NYHA class were assessed at baseline and 12 months post-implantation.

Main Results:

  • No significant difference in mortality was observed between the ICM (61.5%) and NICM (38.5%) groups.
  • Patients with NICM demonstrated a significantly greater improvement in LVEF (7.7% vs. 2.0%, p < 0.001) and LV reverse remodeling compared to ICM patients at 12 months.
  • Improvements in 6MWT and NYHA class were not significantly different between the groups, though factors like atrial fibrillation and COPD were associated with poorer NYHA class improvement.

Conclusions:

  • CCM therapy is a viable option for drug-resistant HFrEF, with no significant difference in survival based on HF etiology.
  • Patients with non-ischemic HFrEF experience superior improvements in LVEF and LV reverse remodeling following CCM implantation compared to those with ischemic HFrEF.