| 1. |
- Baba, Akiyasu, et al.
(författare)
-
Autoantibodies in atrial fibrillation: actor, biomaker or bystander?
- 2008
-
Ingår i: Autoimmunity. - : Informa UK Limited. - 1607-842X .- 0891-6934. ; 41:6, s. 470-2
-
Forskningsöversikt (refereegranskat)abstract
- Atrial fibrillation (AF) is one of the most common arrhythmias in patients with congestive heart failure, although the underlying mechanism has still to be determined. There is increasing evidence to suggest that autoimmunity may play an important role in the pathogenesis of AF. To date, at least three types of autoantibody have been found in AF: the anti-myosin heavy chain autoantibody, the anti-M2 muscarinic receptor autoantibody and the anti-heat shock protein autoantibody. The question is: are these autoantibodies actors, biomakers or merely bystanders? How much knowledge do we have?
|
|
| 2. |
|
|
| 3. |
- Fu, Michael, 1963
(författare)
-
Autoimmunity and idiopathic dilated cardiomyopathy: where we stand?
- 2008
-
Ingår i: Autoimmunity. - : Informa UK Limited. - 1607-842X .- 0891-6934. ; 41:6, s. 415-8
-
Forskningsöversikt (refereegranskat)abstract
- Idiopathic dilated cardiomyopathy (DCM) with its heterogeneous phenotype and genotype remains one of the leading causes of severe heart failure particularly in the younger. Even in the elderly, it appears around 15% of heart failure is due to DCM. Despite great improvements in heart failure therapy, prognoses remains poor. One of the most important reasons is that the present heart failure management is aimed mostly at restoration of neurohormonal balance, rather than targeting primary causes of the disease. As a matter of fact, a substantial subgroup of DCM and chronic heart failure is accompanied by autoimmune mechanism, in particular a wide spectrum of autoantibodies. For almost two decades, the autoimmune hypothesis has been considered a "fairy tale". Today, we have better understanding of autoimmune mechanism in DCM. This focused issue is aimed to summarize what has happened in the last two decades in the context of basic understanding of underlying mechanisms and clinical relevance.
|
|
| 4. |
- Fu, Michael, 1963
(författare)
-
Beta-blocker therapy in heart failure in the elderly.
- 2008
-
Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 125:2, s. 149-53
-
Forskningsöversikt (refereegranskat)abstract
- Chronic heart failure (CHF) is a common and disabling condition with morbidity and mortality that increase dramatically with advancing age. There is some evidence available about beta-blocker therapy in the elderly. The Study of the Effects of Nebivolol Intervention on Outcomes and Rehospitalisation in Seniors with Heart Failure (SENIORS) and retrospective subgroup (elderly) analyses of landmark clinical trials in stable systolic heart failure have provided data supporting the use of beta-blocker as baseline therapy in heart failure in the elderly. However, beta-blocker is still less frequently used in elderly compared to younger patients. There are many reasons, one of which is that available data on elderly patients are not as convincing as those pertaining to their younger counterparts. There is uncertainty or disagreement about whether beta-blockers are equally beneficial and well tolerated in elderly heart failure patients as in younger ones. In other words, the level of evidence regarding beta-blocker therapy in the elderly is not regarded as high as that in younger patients. Indeed, the senior heart failure population, which in fact comprises the majority of all heart failure patients, is in general less well studied, both experimentally and clinically, than younger populations. Both clinical studies and experience indicate good tolerability in the use of beta-blocker in the elderly. Although beta-blockers are well tolerated by the elderly, target doses (based on previous clinical trials) may be difficult to achieve. The question is whether we should use the same target dose in the elderly as that in younger patients. Theoretically, the most effective dose is the highest dose tolerated, which may differ across different age groups. Is it time to abandon the "target dose" for the "highest dose tolerated"? The time has come to carry out active research to achieve better documentation of evidence based heart failure management in the elderly for the benefit of a large number of elderly patients with heart failure. We need clinical trial data that show definite improvement in outcomes as well as a clear-cut, favourable benefit-risk analysis involving beta-blockers in typical older heart failure patients irrespective of comorbidity and polypharmacy. Until the above is available, it may be wiser to adhere to beta-blocker therapy, which at present is better documented than other heart failure therapies in the elderly.
|
|
| 5. |
- Fu, Michael, 1963
(författare)
-
Do immune system changes have a role in hypertension?
- 1995
-
Ingår i: Journal of hypertension. - 0263-6352. ; 13:11, s. 1259-65
-
Forskningsöversikt (refereegranskat)abstract
- There is growing evidence to indicate that there is a strong association between changes in the immune system and the development of hypertension in both animal models and humans. Alterations in immune function in hypertension are generally accompanied by an increase in the level and secretion of immunoglobulin, a decrease in the number and function of T-lymphocytes, genetic predisposition, auto-antibodies against nuclear structure, smooth muscle cells, native thymus tissue and G-protein-coupled cardiovascular receptors. Although there is evidence from a variety of observations to suggest that an abnormal immune system is involved in the pathogenesis of hypertension, the immunological mechanism and the specific role of changes in the immune system in the development of hypertension have not been elucidated.
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Kang, Yu, et al.
(författare)
-
Tolerability and effectiveness of beta-blockers in patients with cardiac amyloidosis: A systematic review and meta-analysis
- 2024
-
Ingår i: International Journal of Cardiology. - 0167-5273 .- 1874-1754. ; 402
-
Forskningsöversikt (refereegranskat)abstract
- Objective: This systematic review aimed to assess the tolerability of patients with cardiac amyloidosis (CA) to beta-blockers (BBs) and evaluate its association with adverse outcomes. Methods: We performed a comprehensive search from January 1, 2000 to October 20, 2023. Studies examining BB use and tolerance or the relationship between BB use and outcomes in patients with CA were included. Pooled adjusted hazard ratios (aHRs) for all-cause mortality were calculated using random- and fixed-effects models. Results: Eight observational studies involving 4002 patients with CA (87.5% with transthyretin CA [ATTR-CA] and 12.5% with immunoglobulin light chain CA [AL-CA]) were assessed. BBs were used by 52.5% of the patients. However, 26.3% of the patients discontinued BBs because of hypotension, bradycardia, or fatigue. Regarding the association between BB use and all-cause death, four studies were identified that included 2874 patients with ATTR-CA and 16 patients with AL-CA. The meta-analysis revealed no apparent relationship between BB use and all-cause mortality (pooled aHR = 0.78, 95% confidence interval (CI) = 0.40–1.51). Two studies on patients with ATTR-CA found no impact of BB use on all-cause mortality in the subgroup with left ventricular ejection fraction (LVEF) > 40%, but conflicting results exist for those with LVEF ≤40% (pooled aHR = 0.78, 95% CI = 0.40–1.54). Conclusion: The limited number of observational studies that predominantly enrolled patients with ATTR-CA showed that BBs were used in almost half of the patients with CA, with varying tolerability. However, no significant association was observed between BB use and all-cause mortality.
|
|
