Frontiers in Heart Failure: Clinical Issues

Volume 1

by

Panagiotis Georgoulias

DOI: 10.2174/97816810837591160101
eISBN: 978-1-68108-375-9, 2016
ISBN: 978-1-68108-376-6
ISSN: 2468-8045 (Print)
ISSN: 2468-8053 (Online)



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Indexed in: EBSCO.

Ischemic cardiomyopathy is considered as the main cause of heart failure in industrialized countries. The condition can occur at any a...[view complete introduction]

Table of Contents

Foreword 1

- Pp. i-ii (2)

George N. Sfakianakis

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Foreword 2

- Pp. iii-iv (2)

Javed Butler

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Preface

- Pp. v-vi (2)

Panagiotis A. Georgoulias

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List of Contributors

- Pp. vii-viii (2)

Panagiotis A. Georgoulias

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Definition, Epidemiology, Economic Cost and Health Policies

- Pp. 3-25 (23)

Gregory Giamouzis, John Skoularigis and Filippos Triposkiadis

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Basics of Cardiac Physiology

- Pp. 26-39 (14)

Isaac Aidonidis, Rodopi Stamatiou, Sotirios Zarogiannis, Chrissi Hatzoglou, Konstantinos Gourgoulianis and Paschalis-Adam Molyvdas

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Aetiology and Pathophysiology: Cellular and Molecular Alterations of Heart Failure

- Pp. 40-71 (32)

Filippos Triposkiadis, Gregory Giamouzis and John Skoularigis

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Gene Polymorphisms, Mutations and Epigenetics in Heart Failure

- Pp. 72-121 (50)

Daphne Koumbi, Constantina Sambani, George P. Patrinos and Panagoula Kollia

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Clinical Manifestations, Co-existing Diseases, Patients’ Investigation and Prognostication

- Pp. 122-172 (51)

John Skoularigis, Andreas Xanthopoulos, Gregory Giamouzis and Filippos Triposkiadis

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Laboratory Variables and Biochemical Markers

- Pp. 173-212 (40)

Christos A. Zivlas and Dennis V. Cokkinos

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Echocardiography in the Management of Patients with Heart Failure

- Pp. 213-231 (19)

Elias Tsougkos

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Medical Therapy of Heart Failure

- Pp. 232-249 (18)

Spyridon Katsanos and John T. Parissis

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Interventional Therapy and Device Therapy

- Pp. 250-308 (59)

Polychronis Antonitsis, Chrysovalantou Nikolaidou and Antonios Ziakas

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Novel Therapies for Heart Failure: The Gene and Cell Methods

- Pp. 309-351 (43)

Eleni Papanikolaou and Nicholas P. Anagnou

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Subject Index

- Pp. 352-361 (10)

Panagiotis A. Georgoulias

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Foreword

Foreword 1:

When Dr. Georgoulias asked me to write this foreward, I was honored and thrilled to have the opportunity to introduce this outstanding work on the “Frontiers in Heart Failure – Molecular Imaging”.

This book represents the collaborative effort of numerous talented physicians and scientists throughout Greece with expertise in heart failure to present this complex topic. This challenging task has been accomplished via a multidisciplinary approach in this well organized e-book that discusses all aspects of the disease. Heart failure is a very prevalent disease with high mortality and significant social and economic impact on societies. As such it is imperative to understand this silent epidemic, which affects all organs and systems of the body. We live in the era of personalized medicine where the potential exists to identify and in theory prevent factors that lead to heart failure as well as to slow the progression of disease.

The layout of this e-book follows a logical progression and thus gives the reader a comprehensive approach to the study of heart failure. The first several chapters discuss epidemiology, cardiac physiology and pathophysiology, genetics, clinical manifestations, laboratory variables and biochemical markers. The book goes on to address management of heart failure patients including the role of echocardiography, medical therapy, interventional and device therapy, as well as novel treatments for heart failure such as gene and cell therapy approaches. The second portion of the book is dedicated to imaging modalities for heart failure other than echocardiography. Computed tomography is first discussed as a fundamental method to delineate structural anatomy as well as to provide support for invasive techniques used in heart failure. Magnetic resonance imaging is then discussed as an imaging modality which can accurately establish the diagnosis of heart failure and which can also be used for quantification of ventricular function as well as tissue characterization. The bulk of the second portion of the book is a journey through the various imaging capabilities of Nuclear Medicine, which provide both functional and anatomic information. Myocardial Perfusion (SPECT) Imaging and Gated-SPECT are first highlighted, as they are particularly useful in the heart failure patient population, two thirds of which has ischemic heart disease as the underlying cause. The importance of identifying myocardium at risk, (ischemic yet viable), is emphasized in these chapters, as is the ability of these agents to assess myocardial viability and follow-up of left ventricular function after revascularization. Subsequent chapters discuss PET perfusion imaging, hybrid imaging, and assessment of viability with both SPECT and PET applications. More advanced topics such as cardiac neurotransmission SPECT and PET imaging, radiolabelled fatty acid metabolism imaging, and molecular imaging of: apoptosis, atheromatous plaques, and gene and stem cell therapies complete this section of the book. The final portion of this book discusses important related topics including: artifacts and pitfalls in cardiac molecular imaging, radiation safety, and technical advances such as the rapidly evolving role of PET/MRI and as yet only experimental SPECT/MRI in heart failure management.

I would like to thank my colleague Efrosyni Sfakianaki MD, Assistant Professor in Radiology/NM at UM for her cooperation in reviewing this great e-book.

In conclusion, I am very excited about this e-book, not only because of its superbly organized, well- illustrated and presented content, but also because as an e-book it can be carried and propagated throughout the community much more easily than a hard copy book. The editor and chapter authors have succeeded admirably in the endeavor to produce what promises to be an outstanding resource for the examination and therapy of the patients with Heart Failure both now and in the future.

Dr. George N. Sfakianakis
Department of Radiology
University of Miami, Miller School of Medicine
Miami
FL
USA

Foreword 2:

Heart failure represents a global healthcare challenge. The severity of the problem is well established in the industrialized countries, where heart failure incidence, prevalence, morbidity and mortality have affected a large population with significant medical and economic demands of the society. Ischemic cardiomyopathy constitutes the most common cause of heart failure in western societies, whereas other causes, such as valvular cardiomyopathy and Chagas disease, may play a more important role in the rest parts of the world. However, as the developing nations also became more urbanized, an increase of heart failure rate has been observed, particularly cases with ischemic aetiology.

We have witnessed major advances in our diagnostic and therapeutic options for heart failure during the last decades. In particular, molecular imaging methods have broadened our understanding of the failing heart at the molecular and cellular level. The continual upsurge in research is promising but this increase in the available literature makes it difficult to stay informed with selected topics in the field. Therefore, it is my pleasure to write a foreword for this e-Book, entitled “Frontiers in Heart Failure – Molecular Imaging”, (Editor Professor P. Georgoulias, Bentham Science Publishers). Experts providing crucial and updated information concerning all aspects of heart failure management wrote the chapters in this excellent book.

The e-Book is divided into two sections. The first section includes an update on the pathophysiological and clinical characteristics of the heart failure syndrome, and the therapeutic strategies that can be implemented for these patients. It would be useful not only for cardiologists, but also for any health professionals interested in state-of-the-art heart failure management. Additionally, novel therapies are presented, such as gene and cell therapies. The role of molecular imaging for the evaluation and follow-up of heart failure patients is approached in the second section. It allows the reader to understand better the wide range of molecular imaging methods, including myocardial perfusion imaging, viability assessment, cardiac remodelling evaluation, cardiac neurotransmission imaging, atheromatous plaques imaging and free fatty acids studies. The most advanced imaging modalities in heart failure are also presented, such as single photon emission tomography, positron emission tomography, computed tomography, magnetic resonance imaging and hybrid imaging systems. Finally, important relevant technical factors and advances are comprehensively addressed in the last part of the e-Book.

Based on its strong clinical orientation, I believe that most clinicians will find “Frontiers in Heart Failure – Molecular Imaging” of immediate practical interest. I consider this e-Book an excellent contribution for anyone involved in health failure patients’ care or research.

Dr. Javed Butler
Heart Institute
Stony Brook University
New York
USA


Preface

During the last decades, heart failure has become a main reason for health care utilization by patients living in western countries. It represents one of the leading causes of morbidity and mortality due to cardiovascular disorders, particularly in the elderly. Undoubtedly, heart failure can be regarded as a contemporary epidemic since the prevalence of the syndrome has steadily risen. Despite its clinical importance, various aspects of the pathophysiology of the failing heart seem to be inadequately understood. A better understanding of this complex syndrome, at the molecular and cellular level, is expected to have significant consequences for the patients at the clinical setting. Therefore, more accurate investigation of the disorder and effective management of heart failure patients remain primary objectives in the field of cardiovascular research.

This e-Book aims to present cutting edge heart failure diagnostic methods and therapies related to the major fields of interest of the authors, along with findings obtained through their research work. After providing clinically oriented information in the first part, the second part of the e-Book focuses on molecular imaging techniques. The first chapter by G Giamouzis et al. includes current definitions, epidemiology, cost and health care policies in the field of heart failure management. In the second chapter, I Aidonidis et al. present fundamental cardiac cellular and subcellular physiology concepts that could permit a better assessment of myocardial pathophysiology. The third chapter by F Triposkiadis et al. is devoted to molecular and cellular alteration in heart failure, while recent advances regarding the genetic basis of the syndrome are reported by D Koumbi et al. in the next chapter. J Skoularigis et al. focus on clinical manifestations, patients’ investigation, co-existing diseases and prognosis estimation. Laboratory variables and biomarkers represent useful tools for clinicians when treating patients with heart failure clinical findings. This chapter by CA Zivlas and DV Cokkinos reviews well established and novel laboratory tests that may support clinical decision making. By assessing cardiac structure and function, echocardiography offers diagnostic and prognostic information. E Tsougos summarizes the role of echocardiography based on current applications and future developments. Three chapters are devoted to heart failure therapies. S Katsanos and JT Parissis present up-to-date medical therapy of the syndrome, while P Antonitsis et al. review available interventional and device therapies. The novel gene and cellular therapeutic strategies are discussed by E Papanikolaou and NP Anagnou in the last chapter of the first section of the e-Book.

The second section of the e-Book starts with computed tomography (CT) and magnetic resonance imaging (MRI) in heart failure that are reviewed by IA Chryssogonidis et al. and MA Mademli and NL Kelekis in the first two chapters, respectively. Radiopharmaceuticals and techniques used for myocardial perfusion single photon emission computed tomography (SPECT) imaging are presented in the next chapter by PA Georgoulias et al. Electrocardiographically gated SPECT (G-SPECT) combines assessment of myocardial perfusion and left ventricular function within a single study. Applications of G-SPECT for functional evaluation and remodelling investigation in the failing heart are discussed by S Tsiouris et al. Positron emission tomography (PET) perfusion imaging is reviewed by S Chatziioannou et al. based on its advantages, such as high diagnostic accuracy, short study time and lower radiation doses compared to SPECT. Hybrid imaging systems (SPECT/CT, PET/CT, PET/MRI) are reported in the chapter by DJ Apostolopoulos as the integration of structural and functional or metabolic information, achieved by multimodality imaging, offer valuable insights in heart failure syndrome. The presence of myocardial viability has been considered a significant determinant of patients’ outcome. Two chapters are devoted to myocardial viability assessment; E Moralidis presents SPECT and PET techniques for these purposes, whereas VI Valotassiou and JV Malamitsi provide a comparison of radioisotopic and non-radioisotopic methods for viability identification. Furthermore, cardiac neurotransmission imaging in heart failure is reviewed by D Agostini et al., based on SPECT techniques, and SI Koukouraki according to PET imaging. Cardiac metabolism is essential for myocardial contractility and maintenance of cardiomyocyte integrity. HJ Verberne presents various SPECT and PET tracers for the assessment of myocardial free fatty acids imaging. Moreover, A Doumas and I Iakovou focus on current and future applications of molecular imaging in heart failure regarding cell apoptosis and atheromatous plaques formation. Molecular imaging of the novel gene and cell therapies is presented by A Katsikis and M Koutelou. In the last three chapters of the e-Book, potential artifacts and pitfalls are reported by I Tsougos and PA Georgoulias, radiation protection considerations are reviewed by C Kappas and K Theodorou, and various technical advances in the field of cardiac molecular imaging are provided by GK Loudos.

In conclusion, the purpose of this e-Book is to capture and explore improvements towards the diagnosis and therapy of heart failure by established and novel strategies and procedures, focusing on molecular imaging methods.

This e-Book represents significant work of chapters’ authors who deserve all appreciation. I would like to highlight the major contribution of G Angelidis and I Tsougos. Further, I wish to acknowledge the contribution of E Kapitsaki (SPEG Consulting Co., Athens, Greece) for the designing of the cover page of this e-Book. Finally, I would like to thank the excellent team of Bentham Science Publishers and especially Faryal Sami for the cooperation.

Panagiotis A Georgoulias
Nuclear Medicine Department
School of Medicine, University of Thessaly
Larissa, Greece

List of Contributors

Editor(s):
Panagiotis Georgoulias
Nuclear Medicine Department
School of Medicine, University of Thessaly
Larissa
Greece




Contributor(s):
Andreas Xanthopoulos
Department of Cardiology
University Hospital of Larissa, University of Thessaly
Larissa
Greece


Antonios Ziakas
1st Department of Cardiology
AHEPA University Hospital
Thessaloniki
Greece


Chrissi Hatzoglou
Department of Physiology, School of Medicine
Faculty of Health Sciences, University of Thessaly
Larissa
Greece


Christos A. Zivlas
Biomedical Research Foundation of the Academy of Athens
Athens
Greece


Chrysovalantou Nikolaidou
1st Department of Cardiology
AHEPA University Hospital
Thessaloniki
Greece


Constantina Sambani
Laboratory of Health Physics
Radiobiology & Cytogenetics, NCSR “Democritus”
Athens
Greece.


Daphne Koumbi
Laboratory of Health Physics
Radiobiology & Cytogenetics, NCSR “Democritus”
Athens
Greece.
/
Department of Genetics & Biotechnology, Faculty of Biology
National & Kapodistrian University of Athens
Athens
Greece


Dennis V. Cokkinos
Biomedical Research Foundation of the Academy of Athens
Athens
Greece


Eleni Papanikolaou
Laboratory of Cell and Gene Therapy
Biomedical Research Foundation of the Academy of Athens
Athens
Greece.
/
Laboratory of Biology
National & Kapodistrian University of Athens, Medical School
Athens
Greece


Elias Tsougkos
2nd Cardiology Clinic (Heart Failure and Preventive Cardiology Section)
Henry Dunant Hospital Center
Athens
Greece


Filippos Triposkiadis
Department of Cardiology
University Hospital of Larissa, University of Thessaly
Larissa
Greece


George Patrinos
Department of Pharmacy
University of Patras
Patras
Greece


Gregory Giamouzis
Department of Cardiology
University Hospital of Larissa, University of Thessaly
Larissa
Greece


Isaac Aidonidis
Department of Physiology, School of Medicine
Faculty of Health Sciences, University of Thessaly
Larissa
Greece


John Skoularigis
Department of Cardiology
University Hospital of Larissa, University of Thessaly
Larissa
Greece


John T. Parissis
Heart Failure Unit
Attikon University Hospital
Athens
Greece


Konstantinos Gourgoulianis
Department of Physiology, School of Medicine
Faculty of Health Sciences, University of Thessaly
Larissa
Greece


Nicholas P. Anagnou
Laboratory of Cell and Gene Therapy
Biomedical Research Foundation of the Academy of Athens
Athens
Greece.
/
Laboratory of Biology
National & Kapodistrian University of Athens, Medical School
Athens
Greece


Panagoula Kollia
Department of Genetics & Biotechnology, Faculty of Biology
National & Kapodistrian University of Athens
Athens
Greece


Paschalis-Adam Molyvdas
Department of Physiology, School of Medicine
Faculty of Health Sciences, University of Thessaly
Larissa
Greece


Polychronis Antonitsis
Cardiothoracic Department
AHEPA University Hospital
Thessaloniki
Greece


Rodopi Stamatiou
Department of Physiology, School of Medicine
Faculty of Health Sciences, University of Thessaly
Larissa
Greece


Sotirios Zarogiannis
Department of Physiology, School of Medicine
Faculty of Health Sciences, University of Thessaly
Larissa
Greece


Spyridon Katsanos
Heart Failure Unit
Attikon University Hospital
Athens
Greece




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