Browsing by Author "Neumann, Till"

Background: To assess heart failure therapies in diabetic patients with preserved as compared to impaired systolic ventricular function. Methods: 3304 patients with heart failure from 9 different studies were included (mean age 63 +/- 14 years); out of these, 711 subjects had preserved left ventricular ejection fraction (>= 50%) and 994 patients in the whole cohort suffered from diabetes. Results: The majority (>90%) of heart failure patients with reduced ejection fraction (SHF) and diabetes were treated with an ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) or with beta-blockers. By contrast, patients with diabetes and preserved ejection fraction (HFNEF) were less likely to receive these substance classes (p < 0.001) and had a worse blood pressure control (p < 0.001). In comparison to patients without diabetes, the probability to receive these therapies was increased in diabetic HFNEF patients (p < 0.001), but not in diabetic SHF patients. Aldosterone receptor blockers were given more often to diabetic patients with reduced ejection fraction (p < 0.001), and the presence and severity of diabetes decreased the probability to receive this substance class, irrespective of renal function. Conclusions: Diabetic patients with HFNEF received less heart failure medication and showed a poorer control of blood pressure as compared to diabetic patients with SHF. SHF patients with diabetes were less likely to receive aldosterone receptor blocker therapy, irrespective of renal function.

Background: HIV infection is a global public health issue that is frequently associated with cardiac involvement. However, myocardial dysfunction and heart failure are often clinically occult or attributed incorrectly to other non-cardiac disease processes even a heightened awareness and knowledge for these cardiac diseases in HIV-infected patients may lead to earlier detection and a reduction in morbidity and mortality The present study evaluates the frequency and clinical course of Myocardial dysfunction and heart failure in a HIV-infected population. Methods: The HIV-HEART (HIV-infection and HEART disease) study is a prospective, long-term cohort study The study is designed and powered to define prevalence and natural history of chronic heart failure. Following a pilot-study of 105 HIV-infected subjects the HIV-HEART trial will contain 802 HIV-infected males and females with and without antiretroviral therapy in an urban population. HIV-HEART is performed by using non-invasive techniques for the quantification of exercise intolerance and ventricular dysfunction, including concentration of B-type natriretic peptide (BNP), transthoracal echocardiography and endurance testing. Patients with BNP >100 pg/ml achieve a magnetic resonance tomography of the heart for characterization of myocardial dysfunction and type of cardiomyopathy. To determine incidence and natural history of myocardial dysfunction and heart failure, a 2 year follow-up started in September 2006. Conclusions: The HIV-HEART study will define the significance of myocardial dysfunction and heart failure in a HIV-infected urban population and classify appropriate methods for identifying high-risk patients, the basis for risk stratification and therapy.

Background: An increased life span and the amount of cardiovascular risk factors necessitate a closer look on cardiac diseases in the population of human immunodeficiency virus (HIV) – infected subjects. Therefore, we launched a cardiology driven study analyzing HIV-associated diseases supported by the federal ministry of research. Methods: The HIV-HEART (HIV-infection and HEART disease) study is a prospective and multicenter cohort study performed in an urban area. The study comprehends standardized non-invasive cardiology tests of cardiac diseases, such as laboratory parameter, electrocardiogram, echocardiography and an endurance testing by a six-minute walk test. Results: In a 20 month recruiting period 802 HIV-infected patients (age: 44,2 ± 10,3 years; male: 83,4%) were included into the HIV-HEART Study. Duration of HIV-infection since initial diagnosis was 7,6 ± 5,8 years. Virus load was in 65,6% less than 50 copies/ml and CD4 - cell count (508,8 ± 300,6 cells/􀀁l) was more than 500 cells/􀀁l in 42,6%. A reduced CD4 – cell count between 200 and 499 cells/􀀁l or less than 200 cells/􀀁l was present in 45% and 12, 4%, respectively. Of all participants, 85,2% received antiretroviral therapy, most of these patients NRTIs (96,8%), followed by PIs (48,5%), and NNRTIs (45,7%). Conclusions: The characteristics of the HIV-HEART Study cohort are comparable to other national or international cohort registers on HIV-infected persons, performed in industrialized countries. Therefore, the HIV-HEART Study will be able to yield reliable data on the performance of HIV-associated diseases. (Clinical Trials NCT01119729).