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Wang R, Ye H, Ma L, Wei J, Wang Y, Zhang X, Wang L. Effect of Sacubitril/Valsartan on Reducing the Risk of Arrhythmia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Cardiovasc Med 2022; 9:890481. [PMID: 35859597 PMCID: PMC9289747 DOI: 10.3389/fcvm.2022.890481] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
Background and Objective Relevant data of PARADIGM-HF reveals sacubitril/valsartan (SV) therapy led to a greater reduction in the risks of arrhythmia, and sudden cardiac death than angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor inhibitor (ARB) therapy in HFrEF, however, inconsistent results were reported in subsequent studies. Here, we conduct a meta-analysis of related randomized controlled trials (RCTs) to evaluate the protective effect of SV on reducing the risk of arrhythmias. Methods and Results RCTs focused on the difference in therapeutic outcomes between SV and ACEI/ARB were searched from PUBMED, EMBASE, ClinicalTrials.gov, and Cochrane Library. The results were extracted from each individual study, expressed as binary risk, 95% confidence interval (CI) and relative risk (RR). Sixteen RCTs including 22, 563 patients met the study criteria. Compared with ACEI/ARB therapy, SV therapy did significantly reduce in the risks of severe arrhythmias among patients with heart failure with reduced ejection fraction (HFrEF) (RR 0.83, 95% CI 0.73–0.95, p = 0.006), ventricular tachycardia (VT) among patients with HFrEF (RR 0.69, 95% CI 0.51–0.92, p = 0.01), cardiac arrest among patients with heart failure (HF) (RR 0.52, 95% CI 0.37–0.73, p = 0.0002), cardiac arrest among patients with HFrEF (RR 0.49, 95% CI 0.32–0.76, p = 0.001), cardiac arrest or ventricular fibrillation (VF) among patients with HF (RR 0.63, 95% CI 0.48–0.83, p = 0.001), and cardiac arrest or VF among patients with HFrEF (RR 0.65, 95% CI 0.47–0.89, p = 0.008), but reduced the risks of arrhythmias (RR 0.87, 95% CI 0.74–1.01, p = 0.07), atrial arrhythmias (RR 0.98, 95% CI 0.83–1.16, p = 0.85), and atrial fibrillation (RR 0.98, 95% CI 0.82–1.17, p = 0.82) among all patients with no significant between-group difference. The merged result was robust after sensitivity analysis, and there was no publication bias. Conclusion Our meta-analysis provides evidence that, compared with ACEI/ARB, SV can additionally reduce the risks of most arrhythmias, just the significant differences are revealed in reducing the risks of VT, severe arrhythmias, and cardiac arrest in patients with HFrEF. Besides, the positive effect of SV on VF according to statistical result of combining VF with cardiac arrest in patients with HFrEF is credibility.
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Affiliation(s)
- Ruxin Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Haowen Ye
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Li Ma
- Department of Functional Examination, Gansu Provincial Maternal and Child Health Hospital, Lanzhou, China
| | - Jinjing Wei
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ying Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaofang Zhang
- Clinical Experimental Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Xiaofang Zhang,
| | - Lihong Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Lihong Wang,
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Butler J, Talha KM, Aktas MK, Zareba W, Goldenberg I. Role of Implantable Cardioverter Defibrillator in Heart Failure With Contemporary Medical Therapy. Circ Heart Fail 2022; 15:e009634. [PMID: 35726617 DOI: 10.1161/circheartfailure.122.009634] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Implantable cardioverter defibrillator therapy is indicated in a subset of patients with heart failure with reduced ejection as primary prevention for sudden cardiac death. The advent of novel medical therapies including mineralocorticoid receptor antagonists, angiotensin receptor blocker/neprilysin inhibitors, and sodium-glucose transporter 2 inhibitor in the past 2 decades has revolutionized heart failure with reduced ejection management. Current guideline-directed medical therapy has reduced all-cause mortality and sudden cardiac death and confers a considerable improvement in left ventricular ejection fraction over a short period of time. However, there is limited evidence at present to suggest whether implantable cardioverter defibrillator therapy continues to have the same benefit in sudden cardiac death prevention at current left ventricular ejection fraction cutoff indications for patients on contemporary guideline-directed medical therapy for heart failure with reduced ejection. In this review, the authors propose in lieu of current evidence that it is reasonable to reevaluate indications for implantable cardioverter defibrillator therapy in patients on contemporary guideline-directed medical therapy for heart failure with reduced ejection.
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Affiliation(s)
- Javed Butler
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (J.B.).,Department of Medicine, University of Mississippi Medical Center, Jackson (J.B., K.M.T.)
| | - Khawaja M Talha
- Department of Medicine, University of Mississippi Medical Center, Jackson (J.B., K.M.T.)
| | - Mehmet K Aktas
- Department of Medicine, Cardiology Division, University of Rochester Medical Center, NY (M.K.A, W.Z., I.G.)
| | - Wojciech Zareba
- Department of Medicine, Cardiology Division, University of Rochester Medical Center, NY (M.K.A, W.Z., I.G.)
| | - Ilan Goldenberg
- Department of Medicine, Cardiology Division, University of Rochester Medical Center, NY (M.K.A, W.Z., I.G.)
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Combined therapy with dapagliflozin and entresto offers an additional benefit on improving the heart function in rat after ischemia-reperfusion injury. Biomed J 2022; 46:100546. [PMID: 35718305 DOI: 10.1016/j.bj.2022.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/29/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study tested whether combined dapagliflozin and entresto treatment would be superior to either one alone for preserving the left-ventricular ejection-fraction (LVEF) in rat after ischemia-reperfusion (IR) injury. METHODS AND RESULTS In vitro flow-cytometric result showed that the intracellular and mitochondrial reactive oxygen species and mitochondrial permeability transition pore, and protein levels of oxidative-stress/DNA-damaged markers [NADPH-oxidase-1 (NOX-1)/NOX-2/oxidized-protein/γ-H2A-histone-family member X (γ-H2AX)] were significantly higher in hydrogen peroxide (H2O2) (300μM)-treated H9C2 cells as compared with the controls that were significantly reversed in sacubitril/valsartan and dapagliflozin therapy in the same H2O2-treated condition, whereas the protein expressions of antioxidants [Sirtuin-1 (SIRT1)/SIRT3/superoxide dismutase/catalase/glutathione peroxidase) exhibited an opposite pattern among the groups (all p<0.001). Adult-male-Sprague-Dawley rat (n=40) were equally categorized into group 1 (sham-operated control), group 2 (IR), group 3 (IR+dapagliflozin/20mg/kg/orally at 3h and post-days 1/2/3 after IR), group 4 (IR+entresto/100mg/kg/orally at 3h and post-days 1/2/3 after IR) and group 5 (IR+dapagliflozin+entresto) and the hearts were harvested by day 3 after IR. The 3rd day's LVEF was highest in group 1, lowest in group 2 and significantly higher in group 5 than in groups 3/4, but it was similar between the latter two groups (p<0.001). The protein expressions of oxidative-stress (NOX-1/NOX-2/oxidized protein), fibrotic (transforming-growth factor-ß/phosphorylated-Smad3), apoptotic [mitochondrial-Bax/cleaved-caspase-3/cleaved-poly (ADP-ribose) polymerase], mitochondria/DNA damaged (cytosolic-cytochrome-C/γ-H2AX), pressure-overload/heart-failure [brain natriuretic peptide (BNP)/ß-myosin heavy chain] and autophagic (ratio of meiotic cyclins CLB3-II/CLB3-I) biomarkers, and the upstream (high-mobility group box 1/Toll-like receptor-4/MyD88/phosphorylated-nuclear factor-κB and downstream [interleukin (IL)-1ß/IL-6/tumor necrosis factor-α] inflammatory signalings revealed an antithetical features of LVEF among the groups (all p<0.0001). The cellular levels of inflammatory (myeloperoxidase+/CD68+), pressure-overload/heart-failure (BNP+) and DNA-damage (γ-H2AX+) biomarkers as well as infarct area demonstrated an opposite pattern of LVEF among the groups (all p<0.0001). CONCLUSION Incorporated entresto-dapagliflozin treatment was superior to either one alone on protecting the heart against IR injury.
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54
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Kharoubi M, Bodez D, Bézard M, Zaroui A, Galat A, Guendouz S, Gendre T, Hittinger L, Attias D, Mohty D, Bergoend E, Itti E, Lebras F, Hamon D, Poullot E, Molinier-Frenkel V, Lellouche N, Deux JF, Funalot B, Fannen P, Oghina S, Arrouasse R, Lecorvoisier P, Souvannanorath S, Amiot A, Teiger E, Bougouin W, Damy T. Describing mode of death in three major cardiac amyloidosis subtypes to improve management and survival. Amyloid 2022; 29:79-91. [PMID: 35114877 DOI: 10.1080/13506129.2021.2013193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The three main cardiac amyloidosis (CA) types have different progression and prognosis. Little is known about the mode of death (MOD) which is commonly attributed to cardiovascular causes in CA. Improving MOD's knowledge could allow to adapt patient care. OBJECTIVE This retrospective study describes the MOD that occurred during long-term follow-up in CA patients in light-chain (AL), transthyretin hereditary (ATTRv) or wild-type (ATTRwt). MATERIAL AND METHODS Patients referred to and cared for, at the French referral centre for CA, Henri Mondor Hospital, Créteil between 2010 and 2016 were included. Clinical information surrounding patient deaths were investigated and centrally evaluated by two blinded clinical committees which classified MOD as cardiovascular, non-cardiovascular or unknown and sub-classified it depending on its subtype. RESULTS From the 566 patients included, 187 had AL, 206 ATTRv and 173 ATTRwt. During the 864 patient-year follow-up, 160 (28%) deaths occurred, with median survival time of 17.3 months (interquartile range 5.1-35.4). The most frequent MOD was cardiovascular (64%) of which worsening heart failure occurred most frequently and for which, 69% were of AL subtype, 79% ATTRv and 76% ATTRwt. Sudden death also occurred more frequently in AL subtype accounting for 29% of AL deaths. Non-cardiovascular MOD occurred in 26% of patients overall. Among these, infection was the most common non-cardiovascular MOD in any type of CA (80%). CONCLUSIONS Mortality is high during natural course of CA and differs between subtypes. The main MOD were worsening heart failure, sudden death and infection, opening room to optimise management.
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Affiliation(s)
- Mounira Kharoubi
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Diane Bodez
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France.,Centre Cardiologique du Nord, Saint Denis, France
| | - Mélanie Bézard
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Amira Zaroui
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Arnault Galat
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Soulef Guendouz
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Thierry Gendre
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Neurology, Henri Mondor University Hospital, Creteil, France
| | - Luc Hittinger
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - David Attias
- Centre Cardiologique du Nord, Saint Denis, France
| | - Dania Mohty
- Department of Cardiology, Dupuytren University Hospital, Limoges, France.,AL Amyloidosis Referral Center, Dupuytren University Hospital, Limoges, France
| | - Eric Bergoend
- AP-HP, Department of Cardiac Surgery, Henri Mondor University Hospital, Creteil, France
| | - Emmanuel Itti
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Nuclear Medicine, Henri Mondor University Hospital, Creteil, France
| | - Fabien Lebras
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Lymphoid Malignancy Unit, Henri Mondor University Hospital, Creteil, France
| | - David Hamon
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Elsa Poullot
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Biology-Pathology, Henri Mondor Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
| | - Valérie Molinier-Frenkel
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Biology-Pathology, Henri Mondor Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.,AP-HP, Department of Immunobiology, Henri Mondor University Hospital, Créteil, France
| | - Nicolas Lellouche
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Jean-François Deux
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Radiology, Henri Mondor University Hospital, Créteil, France
| | - Benoit Funalot
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Genetic, Henri Mondor Teaching Hospital, Créteil, France
| | - Pascale Fannen
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Genetic, Henri Mondor Teaching Hospital, Créteil, France
| | - Silvia Oghina
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Raphael Arrouasse
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,Inserm, Clinical Investigations Center 1430, AP-HP, DMU Saphire, Henri Mondor University Hospital, Creteil, France
| | - Philippe Lecorvoisier
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,Inserm, Clinical Investigations Center 1430, AP-HP, DMU Saphire, Henri Mondor University Hospital, Creteil, France
| | - Sarah Souvannanorath
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Referral Center for Neuromuscular Disease Department, Henri Mondor University Hospital, Créteil, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor University Hospital, AP-HP, EA7375, University Paris-Est Creteil, Creteil, France
| | - Emmanuel Teiger
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Wulfran Bougouin
- AP-HP, Centre de Recherche Cardiovasculaire de Paris (PARCC), INSERM U970, Centre d'Expertise Mort Subite (CEMS), Paris Descartes University, Paris, France.,Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Thibaud Damy
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France.,Inserm, Clinical Investigations Center 1430, AP-HP, DMU Saphire, Henri Mondor University Hospital, Creteil, France
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McMurray JJV, Docherty KF. Insights into foundational therapies for heart failure with reduced ejection fraction. Clin Cardiol 2022; 45 Suppl 1:S26-S30. [PMID: 35789017 PMCID: PMC9254667 DOI: 10.1002/clc.23847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 12/11/2022] Open
Abstract
In this review, we discuss what is meant by "foundational" therapy for patients with heart failure and reduced ejection fraction (HFrEF) and the evidence supporting the use of the five agents that comprise this group of drugs i.e., sacubitril/valsartan, a beta-blocker, an aldosterone or mineralocorticoid receptor antagonist (MRA) and a sodium-glucose cotransporter 2 (SGLT2) inhibitor. We review the conventional approach to sequencing these therapies in HFrEF and proposed new rapid sequencing strategies. We review a recent modelling study suggesting the optimal sequence of treatment includes a sodium-glucose cotransporter 2 inhibition and an MRA as the first two therapies. Finally, we review the important opportunity offered by hospitalization for worsening heart failure to initiate and optimize foundational therapies in patients at high risk of early adverse outcomes.
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Affiliation(s)
- John J. V. McMurray
- British Heart Foundation Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - Kieran F. Docherty
- British Heart Foundation Glasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
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Ursaru AM, Petris AO, Costache II, Nicolae A, Crisan A, Tesloianu ND. Implantable Cardioverter Defibrillator in Primary and Secondary Prevention of SCD-What We Still Don't Know. J Cardiovasc Dev Dis 2022; 9:120. [PMID: 35448096 PMCID: PMC9028370 DOI: 10.3390/jcdd9040120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 12/07/2022] Open
Abstract
Implantable cardioverter defibrillators (ICDs) are the cornerstone of primary and secondary prevention of sudden cardiac death (SCD) all around the globe. In almost 40 years of technological advances and multiple clinical trials, there has been a continuous increase in the implantation rate. The purpose of this review is to highlight the grey areas related to actual ICD recommendations, focusing specifically on the primary prevention of SCD. We will discuss the still-existing controversies strongly reflected in the differences between the international guidelines regarding ICD indication class in non-ischemic cardiomyopathy, and also address the question of early implantation after myocardial infarction in the absence of clear protocols for patients at high risk of life-threatening arrhythmias. Correlating the insufficient data in the literature for 40-day waiting times with the increased risk of SCD in the first month after myocardial infarction, we review the pros and cons of early ICD implantation.
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Affiliation(s)
- Andreea Maria Ursaru
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
| | - Antoniu Octavian Petris
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
- Department of Cardiology, “Grigore. T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Irina Iuliana Costache
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
- Department of Cardiology, “Grigore. T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Ana Nicolae
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
| | - Adrian Crisan
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
| | - Nicolae Dan Tesloianu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, 700111 Iasi, Romania; (A.M.U.); (I.I.C.); (A.N.); (A.C.); (N.D.T.)
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Kashiwagi Y, Nagoshi T, Ogawa K, Kawai M, Yoshimura M. Heart Failure Treatments Such As Angiotensin Receptor/Neprilysin Inhibitor Improve Heart Failure Status and Glucose Metabolism. Cureus 2022; 14:e22762. [PMID: 35371876 PMCID: PMC8971101 DOI: 10.7759/cureus.22762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/05/2022] Open
Abstract
A recent study suggested that angiotensin receptor/neprilysin inhibitor (ARNI; sacubitril/valsartan) can improve functional capacity and cardiac reverse remodeling in patients with heart failure with reduced ejection fraction (HFrEF). Another study suggested that ARNI reduced glycated hemoglobin (HbA1c) in patients with diabetes and HFrEF; however, the details of its efficacy are unknown. We herein report a case of HFrEF with abnormal glucose metabolism in which ARNI was initiated. On the 7th day of admission (before the initiation of ARNI), blood tests showed an abnormal glucose metabolism as follows: fasting blood glucose 134 mg/dL; and fasting blood insulin 11.4 µU/mL (homeostasis model assessment of insulin resistance (HOMA-IR) index 3.77; homeostasis model assessment of β-cell function (HOMA-β), 57.8%). On the 23rd day after the initiation of ARNI, even though the patient was not using hypoglycemic drugs, his fasting blood glucose markedly decreased to 70 mg/dL without hypoglycemic symptoms, and his fasting blood insulin decreased to 5.4 µU/mL (HOMA-IR decreased to 0.93, HOMA-β increased to 277.7%). These results imply that ARNI has the potential to improve insulin resistance and the islet beta-cell function in patients with heart failure, in addition to the original effect of improving the hemodynamics, although the effect of improving the glucose metabolism is also considered to have been influenced by the improvement of the heart failure status and other drugs that the patient was taking.
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58
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Four aces of heart failure therapy: systematic review of established and emerging therapies for heart failure with reduced ejection fraction. CARDIOLOGY PLUS 2022. [DOI: 10.1097/cp9.0000000000000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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59
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Varshney AS, Singh JP, Vaduganathan M. A Heart Team approach to contemporary device decision-making in heart failure. Eur J Heart Fail 2022; 24:562-564. [PMID: 35118780 PMCID: PMC8986628 DOI: 10.1002/ejhf.2445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Anubodh S. Varshney
- Center for Advanced Heart Disease, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Jagmeet P. Singh
- Cardiac Arrhythmia Service, Division of Cardiology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Muthiah Vaduganathan
- Center for Advanced Heart Disease, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Ellermann C, Dimanski D, Wolfes J, Rath B, Leitz P, Willy K, Wegner FK, Eckardt L, Frommeyer G. Electrophysiologic effects of sacubitril in different arrhythmia models. Eur J Pharmacol 2022; 917:174747. [PMID: 35026194 DOI: 10.1016/j.ejphar.2022.174747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous studies report conflicting data regarding anti- or proarrhythmic effects of sacubitril. Aim of this study was to assess the impact of acute sacubitril treatment in different arrhythmia models. METHODS Sacubitril was administered (3, 5, 10 μM) in 12 isolated rabbit hearts. Further 12 hearts were treated with erythromycin to simulate long-QT-syndrome-2 (LQT2). Other 12 hearts were perfused with veratridine to mimic long-QT-syndrome-3 (LQT3). Both LQT-groups were treated with sacubitril (5 μM) additionally. Ventricular vulnerability was assessed by a pacing protocol. AV-blocked bradycardic hearts were perfused with a hypokalemic solution to trigger torsade de pointes (TdP). In further 13 hearts, AF was induced by a combination of acetylcholine and isoproterenol and sacubitril (5 μM) was added afterwards. RESULTS With sacubitril, action potential duration (APD) was abbreviated whereas spatial dispersion of repolarisation (SDR) remained stable. In both LQT groups, APD and SDR were increased. Infusion of sacubitril reduced APD (- 21 ms, p < 0.01) and SDR (- 8 ms) in the LQT2-group and did not alter APD (+2 ms) but reduced SDR (-19 ms, p < 0.01) in the LQT3-group. Ventricular vulnerability was not altered by sacubitril. No TdP were observed with sacubitril or under baseline conditions in any group. Sacubitril significantly suppressed TdP in the LQT2-group (3 vs. 43 episodes, p < 0.05) but not in the LQT3-group (10 vs. 16 episodes, p = ns). Sacubitril reduced inducibility of AF (9 vs. 31 episodes). CONCLUSION Sacubitril abbreviated APD. In addition, sacubitril exhibits potential antiarrhythmic effects in LQT2 and may be beneficial in LQT3 and AF.
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Affiliation(s)
- Christian Ellermann
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Darian Dimanski
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Julian Wolfes
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Benjamin Rath
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Patrick Leitz
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Kevin Willy
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Felix K Wegner
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II (Electrophysiology), University Hospital, Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Wang Q, Zhuo C, Xia Q, Jiang J, Wu B, Zhou D, Shu Z, Zhao J, Chen M, Chen H, Sun Z, Zhang B, Han J, Zheng L. Sacubitril/Valsartan Can Reduce Atrial Fibrillation Recurrence After Catheter Ablation in Patients with Persistent Atrial Fibrillation. Cardiovasc Drugs Ther 2022; 37:549-560. [PMID: 35138505 DOI: 10.1007/s10557-022-07315-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE This study compared the effectiveness of sacubitril/valsartan (SV) vs. valsartan (V) for treating persistent atrial fibrillation (AF) after radio-frequency catheter ablation (RFCA). METHODS Patients with persistent AF who received RFCA were randomly assigned to the SV or V treatment group with the intervention lasting for 12 months. The primary outcome included any atrial arrhythmia episode lasting ≥ 30 s after a 3-month blanking period. The secondary outcome included any atrial arrhythmia episode lasting ≥ 24 h or requiring cardioversion after a 3-month blanking period. The H2FPEF score was used to assess the possibility of patients suffering from heart failure with preserved ejection fraction. RESULTS A total of 143 patients with persistent AF who received RFCA were randomized for the study, with 5 patients failing to follow-up. Among them, 29 (42%) out of 69 patients receiving V and 15 (21.7%) out of 69 patients receiving SV reached the primary endpoint (P < 0.001). A total of 26 (37.7%) out of 69 patients receiving V and 7 (10.1%) out of 69 patients receiving SV reached the secondary endpoint (P < 0.001). A decrease in the H2FPEF score after a 1-year follow-up seemed to be related to the recurrence of AF (OR, 0.065; 95% CI: 0.018-0.238, P < 0.001). CONCLUSIONS SV can decrease AF recurrence after catheter ablation in patients with persistent AF at the 1-year follow-up. The mechanism for this process may be related to the reduction in the H2FPEF score in patients with preserved ejection fraction heart failure.
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Affiliation(s)
- Qiqi Wang
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People's Republic of China
| | - Chengui Zhuo
- Department of Cardiology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, 318000, People's Republic of China
| | - Qi Xia
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jiajia Jiang
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People's Republic of China
| | - Bifeng Wu
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People's Republic of China
| | - Dongchen Zhou
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People's Republic of China
| | - Zheyue Shu
- Department of Hepatobiliary Surgery, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jianqiang Zhao
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People's Republic of China
| | - Miao Chen
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People's Republic of China
| | - Heng Chen
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People's Republic of China
| | - Zewei Sun
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People's Republic of China
| | - Biqi Zhang
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jie Han
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People's Republic of China
| | - Liangrong Zheng
- Department of Cardiology and Atrial Fibrillation Center, The First Affiliated HospitalCollege of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, People's Republic of China.
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Kolesnik E, Scherr D, Rohrer U, Benedikt M, Manninger M, Sourij H, von Lewinski D. SGLT2 Inhibitors and Their Antiarrhythmic Properties. Int J Mol Sci 2022; 23:1678. [PMID: 35163599 PMCID: PMC8835896 DOI: 10.3390/ijms23031678] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are gaining ground as standard therapy for heart failure with a class-I recommendation in the recently updated heart failure guidelines from the European Society of Cardiology. Different gliflozins have shown impressive beneficial effects in patients with and without diabetes mellitus type 2, especially in reducing the rates for hospitalization for heart failure, yet little is known on their antiarrhythmic properties. Atrial and ventricular arrhythmias were reported by clinical outcome trials with SGLT2 inhibitors as adverse events, and SGLT2 inhibitors seemed to reduce the rate of arrhythmias compared to placebo treatment in those trials. Mechanistical links are mainly unrevealed, since hardly any experiments investigated their impact on arrhythmias. Prospective trials are currently ongoing, but no results have been published so far. Arrhythmias are common in the heart failure population, therefore the understanding of possible interactions with SGLT2 inhibitors is crucial. This review summarizes evidence from clinical data as well as the sparse experimental data of SGLT2 inhibitors and their effects on arrhythmias.
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Affiliation(s)
- Ewald Kolesnik
- Department of Cardiology, University Heart Centre Graz, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Daniel Scherr
- Department of Cardiology, University Heart Centre Graz, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Ursula Rohrer
- Department of Cardiology, University Heart Centre Graz, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Martin Benedikt
- Department of Cardiology, University Heart Centre Graz, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Martin Manninger
- Department of Cardiology, University Heart Centre Graz, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Harald Sourij
- Department of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Dirk von Lewinski
- Department of Cardiology, University Heart Centre Graz, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
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Docherty KF, McMurray JJV. Foundational drugs for HFrEF: the growing evidence for a rapid sequencing strategy. THE BRITISH JOURNAL OF CARDIOLOGY 2022; 29:2. [PMID: 35747316 PMCID: PMC9198897 DOI: 10.5837/bjc.2022.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In randomised, placebo- or active-controlled trials in patients with heart failure with reduced ejection fraction (HFrEF), each of the combination of a neprilysin inhibitor and an angiotensin-receptor blocker (i.e. sacubitril/valsartan), a beta blocker, a mineralocorticoidreceptor antagonist and a sodium-glucose co-transporter 2 (SGLT2) inhibitor have been shown to reduce morbidity and mortality, firmly establishing the role of these five agents, prescribed as four pills, as foundational therapy for HFrEF. Traditionally, the guideline-advocated strategy for the initiation of these therapies was based on the historical order in which the landmark clinical trials were performed, and the requirement to uptitrate each individual drug to the target dose (or maximally tolerated dose below this) prior to initiation of another therapy. This process could take six months or more to complete, during which time patients would not be taking one or more of these life-saving drugs. Recently an alternative, evidence-based, rapid three-step sequencing strategy has been proposed with the aim of establishing HFrEF patients on low-doses of all four foundational treatments within four weeks. This strategy is based on the premise that the benefits of each of these therapies are independent and additive to the others, the benefits are apparent at low doses early following initiation, and a specific ordering of therapies may increase likelihood of tolerance of others. This article will outline this novel rapid-sequencing strategy and provide an evidence-based framework to support its adoption into clinical practice.
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Affiliation(s)
- Kieran F Docherty
- Cardiology Specialist Registrar and Clinical Lecturer Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA
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Greenberg B. Medical Management of Patients With Heart Failure and Reduced Ejection Fraction. Korean Circ J 2022; 52:173-197. [PMID: 35257531 PMCID: PMC8907986 DOI: 10.4070/kcj.2021.0401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022] Open
Abstract
The options for treating heart failure with reduced ejection fraction (HFrEF) have expanded considerably over the past decade. While neurohormonal modulation using angiotensin converting enzyme inhibitors and angiotensin receptor blockers, beta blockers and mineralocorticoid receptor antagonists remain the cornerstone of therapy, additional novel approaches including angiotensin receptor neprilysin inhibitors, sodium glucose cotransporter 2 inhibitors, ivrabradine, vericiguat and omecamtiv mecarbil have been shown to improve outcomes in patients with HFrEF. This reviews summarizes currently available approaches as well as promising additional strategies that may be used in the future. Treatment options for patients with heart failure (HF) with reduced ejection fraction (HFrEF) have expanded considerably over the past few decades. Whereas neurohormonal modulation remains central to the management of patients with HFrEF, other pathways have been targeted with drugs that have novel mechanisms of action. The angiotensin receptor-neprilysin inhibitors (ARNIs) which enhance levels of compensatory molecules such as the natriuretic peptides while simultaneously providing angiotensin receptor blockade have emerged as the preferred strategy for inhibiting the renin angiotensin system. Sodium glucose cotransporter 2 (SGLT2) inhibitors which were developed as hypoglycemic agents have been shown to improve outcomes in patients with HF regardless of their diabetic status. These agents along with beta blockers and mineralocorticoid receptor antagonists are the core medical therapies for patients with HFrEF. Additional approaches using ivabradine to slow heart rate in patients with sinus rhythm, the hydralazine/isosorbide dinitrate combination to unload the heart, digoxin to provide inotropic support and vericiguat to augment cyclic guanosine monophosphate production have been shown in well-designed trials to have beneficial effects in the HFrEF population and are used as adjuncts to the core therapies in selected patients. This review provides an overview of the medical management of patients with HFrEF with focus on the major developments that have taken place in the field. It offers prospective of how these drugs should be employed in clinical practice and also a glimpse into some strategies that may prove to be useful in the future.
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Elsokkari I, Tsuji Y, Sapp JL, Nattel S. Recent insights into mechanisms and clinical approaches to electrical storm. Can J Cardiol 2021; 38:439-453. [PMID: 34979281 DOI: 10.1016/j.cjca.2021.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 12/14/2022] Open
Abstract
Electrical storm, characterized by repetitive ventricular tachycardia/fibrillation (VT/VF) over a short period, is becoming commoner with widespread use of implantable cardioverter-defibrillator (ICD) therapy. Electrical storm, sometimes called "arrhythmic storm" or "VT-storm", is usually a medical emergency requiring hospitalization and expert management, and significantly affects short- and long-term outcomes. This syndrome typically occurs in patients with underlying structural heart disease (ischemic or non-ischemic cardiomyopathy) or inherited channelopathies. Triggers for electrical storm should be sought but are often unidentifiable. Initial management is dictated by the hemodynamic status, while subsequent management typically involves ICD interrogation and reprogramming to reduce recurrent shocks, identification/management of triggers like electrolyte abnormalities, myocardial ischemia, or decompensated heart failure, and antiarrhythmic-drug therapy or catheter ablation. Sympathetic nervous system activation is central to the initiation and maintenance of arrhythmic storm, so autonomic modulation is a cornerstone of management. Sympathetic inhibition can be achieved with medications (particularly beta-adrenoreceptor blockers), deep sedation, or cardiac sympathetic denervation. More definitive management targets the underlying ventricular arrhythmia substrate to terminate and prevent recurrent arrhythmia. Arrhythmia targeting can be achieved with antiarrhythmic medications, catheter ablation or more novel therapies such as stereotactic radiation therapy that targets the arrhythmic substrate. Mechanistic studies point to adrenergic activation and other direct consequences of ICD-shocks in promoting further arrhythmogenesis and hypocontractility. Here, we review the pathophysiologic mechanisms, clinical features, prognosis, and therapeutic options for electrical storm. We also outline a clinical approach to this challenging and complex condition, along with its mechanistic basis.
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Affiliation(s)
- Ihab Elsokkari
- University of Sydney, Nepean Blue Mountains local health district, Australia
| | - Yukiomi Tsuji
- Department of Physiology of Visceral Function, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - John L Sapp
- Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
| | - Stanley Nattel
- Departments of Medicine and Research Center, Montreal Heart Institute and Université de Montréal and Pharmacology and Therapeutics McGill University, Montreal, Quebec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany; IHU LIYRC Institute, Bordeaux, France.
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Curtain JP, Jackson A, Shen L, Jhund PS, Docherty KF, Petrie MC, Castagno D, Desai AS, Rohde LE, Lefkowitz MP, Rouleau JL, Zile MR, Solomon SD, Swedberg K, Packer M, McMurray JJV. Effect of sacubitril/valsartan on investigator-reported ventricular arrhythmias in PARADIGM-HF. Eur J Heart Fail 2021; 24:551-561. [PMID: 34969175 PMCID: PMC9542658 DOI: 10.1002/ejhf.2419] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
Aims Sudden death is a leading cause of mortality in heart failure with reduced ejection fraction (HFrEF). In PARADIGM‐HF, sacubitril/valsartan reduced the incidence of sudden death. The purpose of this post hoc study was to analyse the effect of sacubitril/valsartan, compared to enalapril, on the incidence of ventricular arrhythmias. Methods and results Adverse event reports related to ventricular arrhythmias were examined in PARADIGM‐HF. The effect of randomized treatment on two arrhythmia outcomes was analysed: ventricular arrhythmias and the composite of a ventricular arrhythmia, implantable cardioverter defibrillator (ICD) shock or resuscitated cardiac arrest. The risk of death related to a ventricular arrhythmia was examined in time‐updated models. The interaction between heart failure aetiology, or baseline ICD/cardiac resynchronization therapy‐defibrillator (CRT‐D) use, and the effect of sacubitril/valsartan was analysed. Of the 8399 participants, 333 (4.0%) reported a ventricular arrhythmia and 372 (4.4%) the composite arrhythmia outcome. Ventricular arrhythmias were associated with higher mortality. Compared with enalapril, sacubitril/valsartan reduced the risk of a ventricular arrhythmia (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.62–0.95; p = 0.015) and the composite arrhythmia outcome (HR 0.79, 95% CI 0.65–0.97; p = 0.025). The treatment effect was maintained after adjustment and accounting for the competing risk of death. Baseline ICD/CRT‐D use did not modify the effect of sacubitril/valsartan, but aetiology did: HR in patients with an ischaemic aetiology 0.93 (95% CI 0.71–1.21) versus 0.53 (95% CI 0.37–0.78) in those without an ischaemic aetiology (p for interaction = 0.020). Conclusions Sacubitril/valsartan reduced the incidence of investigator‐reported ventricular arrhythmias in patients with HFrEF. This effect may have been greater in patients with a non‐ischaemic aetiology.
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Affiliation(s)
- James P Curtain
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Alice Jackson
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Li Shen
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Division of Health Sciences, Hangzhou Normal University, Hangzhou, 311121, China
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Kieran F Docherty
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mark C Petrie
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Davide Castagno
- Division of Cardiology, Città della Salute e della Scienza Hospital, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Akshay S Desai
- Division of Cardiovascular, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Luis E Rohde
- Division of Cardiovascular, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Hospital de Clínicas de Porto Alegre and UFRGS Medical School, Porto Alegre, Brazil
| | | | - Jean-Lucien Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Canada
| | - Michael R Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA
| | - Scott D Solomon
- Division of Cardiovascular, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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Silva-Cardoso J, Fonseca C, Franco F, Morais J, Ferreira J, Brito D. Optimization of heart failure with reduced ejection fraction prognosis-modifying drugs: A 2021 heart failure expert consensus paper. Rev Port Cardiol 2021; 40:975-983. [PMID: 34922707 DOI: 10.1016/j.repce.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/27/2021] [Indexed: 10/19/2022] Open
Abstract
Heart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients' functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members' clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks.
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Affiliation(s)
- José Silva-Cardoso
- Department of Medicine, Faculdade de Medicina, Universidade do Porto, Oporto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, Oporto, Portugal; CINTESIS, Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Oporto, Portugal.
| | - Cândida Fonseca
- Heart Failure Clinic, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Fátima Franco
- Serviço de Cardiologia, Unidade de Tratamento de Insuficiência Cardíaca Avançada (UTICA), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Morais
- Cardiology Division, Centro Hospitalar de Leiria, Leiria, Portugal; CiTechCare, Center for Innovative Care and Health, Instituto Politécnico de Leiria, Leiria, Portugal
| | - Jorge Ferreira
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Dulce Brito
- Heart and Vessels Department, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal; CCUL, Cardiovascular Center, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
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Fernandes ADF, Fernandes GC, Ternes CMP, Cardoso R, Chaparro SV, Goldberger JJ. Sacubitril/valsartan versus angiotensin inhibitors and arrhythmia endpoints in heart failure with reduced ejection fraction. Heart Rhythm O2 2021; 2:724-732. [PMID: 34988523 PMCID: PMC8710618 DOI: 10.1016/j.hroo.2021.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Angiotensin receptor–neprilysin inhibitor (ARNI) therapy has been associated with improved survival for patients with symptomatic heart failure and reduced ejection fraction (HFrEF). Objectives We performed a meta-analysis of arrhythmia endpoints from studies comparing ARNI with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) for patients with HFrEF to assess for incremental benefit. Methods We searched PubMed, Embase, and ClinicalTrials.gov. Baseline study characteristics were collected and outcomes were sustained ventricular arrhythmias, atrial arrhythmias, appropriate implantable cardioverter-defibrillator (ICD) therapy, sudden cardiac death (SCD), and biventricular (BiV) pacing rate. Results We included 9 studies, 4 randomized trials, and 5 observational studies (5589 patients on ARNI vs 5615 on ACEIs/ARBs). Follow-up ranged from 2 to 51 months. The mean age was 65.4 ± 9.8 years, with 77.3% male patients and a mean ejection fraction of 29.0% ± 7.6%. Ischemic cardiomyopathy was present in 62% of patients. In the ARNI group, there were less SCD (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.63–0.96; P = .02), ventricular arrhythmias (OR 0.45, 95% CI 0.25–0.79; P = .005), and appropriate ICD therapy (OR 0.39, 95% CI 0.21–0.74; P = .004). Higher rates of BiV pacing were seen (mean difference 3.13, 95% CI 2.58–3.68; P < .00001) when compared with ACEIs/ARBs. No difference in atrial arrhythmias was seen. Conclusion ARNI therapy provides incremental benefit with respect to ventricular tachyarrhythmias/SCD, which may, in part, explain improved outcomes in patients with HFrEF compared to ACEIs/ARBs. There was increased BiV pacing and decreased ICD therapy in the ARNI group.
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Affiliation(s)
- Amanda D F Fernandes
- Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Gilson C Fernandes
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Caique M P Ternes
- Cardiac Arrhythmia Service, SOS Cardio Hospital, Florianopolis, Brazil
| | - Rhanderson Cardoso
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sandra V Chaparro
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida
| | - Jeffrey J Goldberger
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
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Obrova J, Sovova E, Kocianova E, Taborsky M. Sudden cardiac death - a known unknown? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:258-266. [PMID: 34782798 DOI: 10.5507/bp.2021.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
Sudden cardiac death (SCD) is a major medical, economic and social problem. The estimated annual number of SCDs is approximately 4 million cases worldwide. Approximately 50% of SCDs are unexpected first manifestations of cardiac disease. The survival rate after out-of-hospital cardiac arrest is low even in countries with the most advanced health care systems. It all emphasizes the importance of prevention, in which implantable cardioverter-defibrillators play a dominant role. However, our ability to recognize high-risk patients remains insufficient. Moreover, a declining rate of shockable rhythm as the initial recording has been reported in the last decades. Despite numerous SCD studies and undisputed progress, there are still many unanswered questions.
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Affiliation(s)
- Jana Obrova
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Eliska Sovova
- Department of Exercise Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Eva Kocianova
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Pascual-Figal D, Bayés-Genis A, Beltrán-Troncoso P, Caravaca-Pérez P, Conde-Martel A, Crespo-Leiro MG, Delgado JF, Díez J, Formiga F, Manito N. Sacubitril-Valsartan, Clinical Benefits and Related Mechanisms of Action in Heart Failure With Reduced Ejection Fraction. A Review. Front Cardiovasc Med 2021; 8:754499. [PMID: 34859070 PMCID: PMC8631913 DOI: 10.3389/fcvm.2021.754499] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/06/2021] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is a clinical syndrome characterized by the presence of dyspnea or limited exertion due to impaired cardiac ventricular filling and/or blood ejection. Because of its high prevalence, it is a major health and economic burden worldwide. Several mechanisms are involved in the pathophysiology of HF. First, the renin-angiotensin-aldosterone system (RAAS) is over-activated, causing vasoconstriction, hypertension, elevated aldosterone levels and sympathetic tone, and eventually cardiac remodeling. Second, an endogenous compensatory mechanism, the natriuretic peptide (NP) system is also activated, albeit insufficiently to counteract the RAAS effects. Since NPs are degraded by the enzyme neprilysin, it was hypothesized that its inhibition could be an important therapeutic target in HF. Sacubitril/valsartan is the first of the class of dual neprilysin and angiotensin receptor inhibitors (ARNI). In patients with HFrEF, treatment with sacubitril/valsartan has demonstrated to significantly reduce mortality and the rates of hospitalization and rehospitalization for HF when compared to enalapril. This communication reviews in detail the demonstrated benefits of sacubitril/valsartan in the treatment of patients with HFrEF, including reduction of mortality and disease progression as well as improvement in cardiac remodeling and quality of life. The hemodynamic and organic effects arising from its dual mechanism of action, including the impact of neprilysin inhibition at the renal level, especially relevant in patients with type 2 diabetes mellitus, are also reviewed. Finally, the evidence on the demonstrated safety and tolerability profile of sacubitril/valsartan in the different subpopulations studied has been compiled. The review of this evidence, together with the recommendations of the latest clinical guidelines, position sacubitril/valsartan as a fundamental pillar in the treatment of patients with HFrEF.
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Affiliation(s)
- Domingo Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Antoni Bayés-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Autonomous University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain
| | | | - Pedro Caravaca-Pérez
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain
- Cardiology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | | | - Maria G. Crespo-Leiro
- Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- Institute of Biomedical Research (INIBIC), A Coruña, Spain
| | - Juan F. Delgado
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain
- Cardiology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Javier Díez
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain
- Cardiovascular Diseases Programme, Centre of Applied Medical Research, University of Navarra, Pamplona, Spain
- Departments of Nephrology, Cardiology, and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Nicolás Manito
- Heart Failure and Heart Transplantation Unit, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Abumayyaleh M, Pilsinger C, El-Battrawy I, Kummer M, Kuschyk J, Borggrefe M, Mügge A, Aweimer A, Akin I. Clinical Outcomes in Patients with Ischemic versus Non-Ischemic Cardiomyopathy after Angiotensin-Neprilysin Inhibition Therapy. J Clin Med 2021; 10:jcm10214989. [PMID: 34768510 PMCID: PMC8584412 DOI: 10.3390/jcm10214989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022] Open
Abstract
Background: The angiotensin receptor-neprilysin inhibitor (ARNI) decreases cardiovascular mortality in patients with chronic heart failure with a reduced ejection fraction (HFrEF). Data regarding the impact of ARNI on the outcome in HFrEF patients according to heart failure etiology are limited. Methods and results: One hundred twenty-one consecutive patients with HFrEF from the years 2016 to 2017 were included at the Medical Centre Mannheim Heidelberg University and treated with ARNI according to the current guidelines. Left ventricular ejection fraction (LVEF) was numerically improved during the treatment with ARNI in both patient groups, that with ischemic cardiomyopathy (n = 61) (ICMP), and that with non-ischemic cardiomyopathy (n = 60) (NICMP); p = 0.25. Consistent with this data, the NT-proBNP decreased in both groups, more commonly in the NICMP patient group. In addition, the glomerular filtration rate (GFR) and creatinine changed before and after the treatment with ARNI in both groups. In a one-year follow-up, the rate of ventricular tachyarrhythmias (ventricular tachycardia and ventricular fibrillation) tended to be higher in the ICMP group compared with the NICMP group (ICMP 38.71% vs. NICMP 17.24%; p = 0.07). The rate of one-year all-cause mortality was similar in both groups (ICMP 6.5% vs. NICMP 6.6%; log-rank = 0.9947). Conclusions: This study shows that, although the treatment with ARNI improves the LVEF in ICMP and NICMP patients, the risk of ventricular tachyarrhythmias remains higher in ICMP patients in comparison with NICMP patients. Renal function is improved in the NICMP group after the treatment. Long-term mortality is similar over a one-year follow-up.
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Affiliation(s)
- Mohammad Abumayyaleh
- First Department of Medicine, University Medical Center Mannheim, University Heidelberg, 68167 Mannheim, Germany; (M.A.); (C.P.); (M.K.); (J.K.); (M.B.); (I.A.)
- DZHK (German Centre for Cardiovascular Research) Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
| | - Christina Pilsinger
- First Department of Medicine, University Medical Center Mannheim, University Heidelberg, 68167 Mannheim, Germany; (M.A.); (C.P.); (M.K.); (J.K.); (M.B.); (I.A.)
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Center Mannheim, University Heidelberg, 68167 Mannheim, Germany; (M.A.); (C.P.); (M.K.); (J.K.); (M.B.); (I.A.)
- DZHK (German Centre for Cardiovascular Research) Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
- Correspondence: ; Tel.: +49-621-383-1447; Fax: +49-621-383-1474
| | - Marvin Kummer
- First Department of Medicine, University Medical Center Mannheim, University Heidelberg, 68167 Mannheim, Germany; (M.A.); (C.P.); (M.K.); (J.K.); (M.B.); (I.A.)
- DZHK (German Centre for Cardiovascular Research) Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
| | - Jürgen Kuschyk
- First Department of Medicine, University Medical Center Mannheim, University Heidelberg, 68167 Mannheim, Germany; (M.A.); (C.P.); (M.K.); (J.K.); (M.B.); (I.A.)
| | - Martin Borggrefe
- First Department of Medicine, University Medical Center Mannheim, University Heidelberg, 68167 Mannheim, Germany; (M.A.); (C.P.); (M.K.); (J.K.); (M.B.); (I.A.)
- DZHK (German Centre for Cardiovascular Research) Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (A.M.); (A.A.)
| | - Assem Aweimer
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, 44789 Bochum, Germany; (A.M.); (A.A.)
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim, University Heidelberg, 68167 Mannheim, Germany; (M.A.); (C.P.); (M.K.); (J.K.); (M.B.); (I.A.)
- DZHK (German Centre for Cardiovascular Research) Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
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72
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Abid L, Kammoun I, Ben Halima M, Charfeddine S, Ben Slima H, Drissa M, Mzoughi K, Mbarek D, Riahi L, Antit S, Ben Halima A, Ouechtati W, Allouche E, Mechri M, Yousfi C, Khorchani A, Abid O, Sammoud K, Ezzaouia K, Gtif I, Ouali S, Triki F, Hamdi S, Boudiche S, Chebbi M, Hentati M, Farah A, Triki H, Ghardallou H, Raddaoui H, Zayed S, Azaiez F, Omri F, Zouari A, Ben Ali Z, Najjar A, Thabet H, Chaker M, Mohamed S, Chouaieb M, Ben Jemaa A, Tangour H, Kammoun Y, Bouhlel M, Azaiez S, Letaief R, Maskhi S, Amri A, Naanaa H, Othmani R, Chahbani I, Zargouni H, Abid S, Ayari M, Ben Ameur I, Gasmi A, Ben Halima N, Haouala H, Boughzela E, Zakhama L, Ben Youssef S, Nasraoui W, Boujnah MR, Barakett N, Kraiem S, Drissa H, Ben Khalfallah A, Gamra H, Kachboura S, Bezdah L, Baccar H, Milouchi S, Sdiri W, Ben Omrane S, Abdesselem S, Kanoun A, Hezbri K, Zannad F, Mebazaa A, Kammoun S, Mourali MS, Addad F. Design and Rationale of the National Tunisian Registry of Heart Failure (NATURE-HF): Protocol for a Multicenter Registry Study. JMIR Res Protoc 2021; 10:e12262. [PMID: 34704958 PMCID: PMC8581756 DOI: 10.2196/12262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/04/2019] [Accepted: 03/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). OBJECTIVE The aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. METHODS A total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. RESULTS At the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. CONCLUSIONS The NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. TRIAL REGISTRATION ClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12262.
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Affiliation(s)
- Leila Abid
- Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Tunis, Tunisia
| | - Ikram Kammoun
- Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Tunis, Tunisia.,Hôpital Abderrahmen Mami-Ariana, Ariana, Tunisia
| | - Manel Ben Halima
- Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Tunis, Tunisia.,Hôpital La Rabta 2, Tunis, Tunisia
| | - Salma Charfeddine
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | - Meriem Drissa
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Khadija Mzoughi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Dorra Mbarek
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Leila Riahi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Saoussen Antit
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Afef Ben Halima
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Wejdene Ouechtati
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Emna Allouche
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Mehdi Mechri
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Chedi Yousfi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Ali Khorchani
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Omar Abid
- Centre Hospitalier de Chambéry, Chambéry, France
| | - Kais Sammoud
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Khaled Ezzaouia
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Imen Gtif
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Sana Ouali
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Feten Triki
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Sonia Hamdi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Selim Boudiche
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Marwa Chebbi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Mouna Hentati
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Amani Farah
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Habib Triki
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Houda Ghardallou
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Haythem Raddaoui
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Seifeddine Azaiez
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | - Aymen Amri
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | - Iheb Chahbani
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | - Syrine Abid
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | - Ali Gasmi
- Hospital Lariboisière, Paris, France
| | | | | | | | - Lilia Zakhama
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | - Wided Nasraoui
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | - Sondes Kraiem
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | | | | | | | | | | | | | | | | | - Alifa Kanoun
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | | | - Samir Kammoun
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | - Faouzi Addad
- Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Tunis, Tunisia
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Subramanyan R. Avalanches in cardiology. Ann Pediatr Cardiol 2021; 14:401-407. [PMID: 34667416 PMCID: PMC8457267 DOI: 10.4103/apc.apc_235_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/05/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022] Open
Abstract
Sudden cardiac death (SCD) accounts for 15%–60% of mortality in patients with heart disease. Generally, this has been attributed to ventricular tachyarrhythmia. However, ventricular tachyarrhythmia has been documented or strongly suspected on clinical grounds in a relatively small proportion of SCD patients (8%–50%). Attempted prophylaxis of SCD by implantation of cardioverter-defibrillator is associated with variable success in different subsets of high-risk cardiac patients (30%–70%). A significant number of SCD, therefore, appear to be due to catastrophic circulatory failure. Multiple interdependent compensatory mechanisms help to maintain circulation in advanced cardiac disease. Rapid, unexpected, and massive breakdown of the compensated state can be precipitated by small and often imperceptible triggers. The initial critical but stable state followed by rapid circulatory failure and death has been considered to be analogous to snow avalanches. It is typically described in patients with left ventricular (LV) dysfunction (ischemic or nonischemic). It is now recognized that SCD can also happen in conditions where the right ventricle (RV) takes the brunt of the hemodynamic load. Advanced pulmonary arterial hypertension and operated patients of tetralogy of Fallot with pulmonary regurgitation are of particular interest to pediatric cardiologists. A large amount of data is available on LV changes and mechanics, while relatively little information is available on the mechanisms of RV adaptation to increased load and RV failure. Whether the triggers and the decompensatory processes are similar for the two ventricles is a moot point. This article highlights the currently available knowledge on the pathophysiology of SCD in RV overload states, with special reference to RV adaptive and decompensatory mechanisms, and therapeutic measures that can potentially interrupt the vicious downward course (cardiac avalanches).
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Affiliation(s)
- Raghavan Subramanyan
- Department of Pediatric Cardiology, Frontier Lifeline Hospital, Chennai, Tamil Nadu, India
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Yeh JN, Yue Y, Chu YC, Huang CR, Yang CC, Chiang JY, Yip HK, Guo J. Entresto protected the cardiomyocytes and preserved heart function in cardiorenal syndrome rat fed with high-protein diet through regulating the oxidative stress and Mfn2-mediated mitochondrial functional integrity. Biomed Pharmacother 2021; 144:112244. [PMID: 34601193 DOI: 10.1016/j.biopha.2021.112244] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/15/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022] Open
Abstract
This study tested the hypothesis that Entresto (En) therapy protected the cardiomyocytes and heart function in cardiorenal syndrome (CRS) rats fed with high-protein diet (HPD) through regulating the oxidative-stress and Mfn2-mediated mitochondrial functional integrity. En (12.5 μM for the in-vitro study) protected the H9C2-cells against H2O2-induced cell apoptosis, whereas stepwise-increased H2O2 concentrations induced a significant increase in protein expressions of Mfn2/phosphorylated (p)-DRP1/mitochondrial-Bax in H9C2-cells. En downregulated H2O2-induced mitochondrial fission/upregulated mitochondrial fusion and deletion of Mfn2 gene (i.e., shMfn2) to significantly reduce H2O2-induced ROS production. En significantly suppressed and shMfn2 further significantly suppressed both H2O2-reduced mitochondrial-membrane potential and H2O2-induced ROS production/cell apoptosis/mitochondrial damage/mitochondrial-Bax released from mitochondria in H9C2 cells. En significantly reduced protein expressions of Mfn2 and p-DRP1. Additionally, En significantly suppressed and shMfn2 further significantly suppressed the protein expressions of mitochondrial-damaged (DRP1)/oxidative-stress (NOX-1/NOX-2)/apoptosis (mitochondrial-Bax/caspase-3/PARP)/autophagic (LC3B-II/LC3B-I) biomarkers (all p < 0.01). Rats were categorized into group 1 [sham-control + high-protein-diet (HPD)], group 2 (CRS + HPD) and group 3 (CRS+ HPD + En/100 mg/kg/day). By day 63 after CRS induction, the LVEF was significantly lower in group 3 and more significantly lower in group 2 than in group 1, whereas the protein expressions of oxidative-stress (NOX-1/NOX-2/p22phox/oxidized protein)/apoptotic (mitochondrial-Bax/caspase-3/PARP), fibrotic (Smad-3/TGF-ß), autophagic (Beclin-1/Atg5/ratio of LC3B-II/LC3B-I) and mitochondrial-damaged (DRP1/cyclophilin-D/cytosolic-cytochrome-C) biomarkers exhibited an opposite pattern of LVEF among the groups. Downregulation of Mfn2 by En or shMfn2 in cardiomyocytes avoided H2O2 damage and En improved the cardiac function in HPD-feeding CRS rat via adjusting Mfn2-mediated mitochondrial functional integrity.
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Affiliation(s)
- Jui-Ning Yeh
- Department of Cardiology, The First Affiliated Hospital, Jinan University, 613W. Huangpu Avenue, Guangzhou 510630, China
| | - Ya Yue
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yi-Ching Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist., Kaohsiung City 83301, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital Kaohsiung, Taiwan
| | - Chi-Ruei Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist., Kaohsiung City 83301, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital Kaohsiung, Taiwan
| | - Chih-Chao Yang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosung Dist., Kaohsiung City 83301, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital Kaohsiung, Taiwan; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital Kaohsiung, Taiwan; Department of Nursing, Asia University Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Xiamen Chang Gung Hospital, Xiamen, Fujian, China.
| | - Jun Guo
- Department of Cardiology, The First Affiliated Hospital, Jinan University, 613W. Huangpu Avenue, Guangzhou 510630, China.
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75
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Angiotensin receptor-neprilysin inhibitors: Comprehensive review and implications in hypertension treatment. Hypertens Res 2021; 44:1239-1250. [PMID: 34290389 DOI: 10.1038/s41440-021-00706-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
Angiotensin receptor-neprilysin inhibitors (ARNIs) are a new class of cardiovascular agents characterized by their dual action on the major regulators of the cardiovascular system, including the renin-angiotensin system (RAS) and the natriuretic peptide (NP) system. The apparent clinical benefit of one ARNI, sacubitril/valsartan, as shown in clinical trials, has positioned the drug class as a first-line therapy in patients with heart failure, particularly with reduced ejection fraction. Accumulating evidence also suggests that sacubitril/valsartan is superior to conventional RAS blockers in lowering blood pressure in patients with hypertension. To decide whether to apply an ARNI to treat hypertension clinically, it is important to understand the potential properties of the drug in modulating multiple factors inside and outside the cardiovascular system beyond its effect on reducing peripheral blood pressure. In this context, ARNIs are distinct from preexisting antihypertensive medications in terms of the multiple actions of NPs in various organs and the pharmacological potential of neprilysin inhibitors to modulate multiple cardiac and noncardiac peptides. In particular, analysis of the clinical trials of sacubitril/valsartan implies that ARNIs can provide additional clinical benefits independent of their original purpose, including alleviation of glycemic control and renal impairment in patients with heart failure. Understanding the potential mechanisms of action of ARNIs will help interpret the relevance of their additional benefits beyond lowering blood pressure in hypertension. This review summarizes the comprehensive clinical evidence and relevance of ARNIs by specifically focusing on the potential properties of this new drug class in treating patients with hypertension.
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Karabulut U, Keskin K, Karabulut D, Yiğit E, Yiğit Z. Effect of Sacubitril/Valsartan Combined with Dapagliflozin on Long-Term Cardiac Mortality in Heart Failure with Reduced Ejection Fraction. Angiology 2021; 73:350-356. [PMID: 34560822 DOI: 10.1177/00033197211047329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan and sodium-glucose cotransporter-2 (SGLT-2) inhibitor dapagliflozin have been shown to reduce rehospitalization and cardiac mortality in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to compare the long-term cardiac and all-cause mortality of ARNI and dapagliflozin combination therapy against ARNI monotherapy in patients with HFrEF. This retrospective study involved 244 patients with HF with New York Heart Association (NYHA) class II-IV symptoms and ejection fraction ≤40%. The patients were divided into 2 groups: ARNI monotherapy and ARNI+dapagliflozin. Median follow-up was 2.5 (.16-3.72) years. One hundred and seventy-five (71.7%) patients were male, and the mean age was 65.9 (SD, 10.2) years. Long-term cardiac mortality rates were significantly lower in the ARNI+dapagliflozin group (7.4%) than in the ARNI monotherapy group (19.5%) (P = .01). Dapagliflozin [Hazard Ratio (HR) [95% Confidence Interval (CI)] = .29 [.10-.77]; P = .014] and left ventricular ejection fraction (LVEF) [HR (95% CI) = .89 (.85-.93); P < .001] were found to be independent predictors of cardiac mortality. Our study showed a significant reduction in cardiac mortality with ARNI and dapagliflozin combination therapy compared with ARNI monotherapy.
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Affiliation(s)
- Umut Karabulut
- Department of Cardiology, 64296Acıbadem International Hospital, Istanbul, Turkey
| | - Kudret Keskin
- Department of Cardiology, İstanbul Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Dilay Karabulut
- Department of Cardiology İstanbul, İstanbul Bakırköy Dr.Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Ece Yiğit
- Department of Internal Medicine, 218502İstanbul Pendik Medipol University Hospital, İstanbul, Turkey
| | - Zerrin Yiğit
- Department of Cardiology, İstanbul University, Cerrahpaşa Cardiology Institute, İstanbul, Turkey
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Li W, Yuan W, Zhang D, Cai S, Luo J, Zeng K. LCZ696 Possesses a Protective Effect Against Homocysteine (Hcy)-Induced Impairment of Blood-Brain Barrier (BBB) Integrity by Increasing Occludin, Mediated by the Inhibition of Egr-1. Neurotox Res 2021; 39:1981-1990. [PMID: 34542838 DOI: 10.1007/s12640-021-00414-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/24/2021] [Accepted: 09/03/2021] [Indexed: 12/14/2022]
Abstract
Homocysteine (Hcy) is a non-essential amino acid produced from methionine. It has been reported that high concentrations of Hcy are related to the pathogenesis of neurodegenerative diseases and induce the disruption of the blood-brain barrier (BBB) by triggering oxidative stress and inflammation. LCZ696 is a novel antihypertensive agent that has been recently reported to possess promising anti-inflammatory properties. However, whether it has a protective effect on the BBB disruption is still unknown. For the first time, in this study, we aim to investigate whether LCZ696 exerts anti-inflammatory effects on Hcy-induced injury in brain endothelial cells and explore its neuroprotective properties. In in vivo experiments, we found that treatment with LCZ696 ameliorated oxidative stress by reducing malondialdehyde (MDA) and increasing glutathione (GSH). Furthermore, LCZ696 downregulated the excessive release of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) at mRNA and protein levels. Importantly, it reversed the disruption of the BBB induced by Hcy stimulation. In the in vitro human brain microvascular endothelial cell (HBMVEC) experiments, compared to the control, the permeability of the endothelial monolayer was significantly enlarged, the expression level of occludin declined, and Egr-1 upregulated by the introduction of Hcy, and these were all reversed by the treatment with LCZ696. Lastly, we found that the protective effects of LCZ696 against Hcy-induced reduction of occludin and hyper-permeability of the endothelial monolayer were greatly abolished by the overexpression of Egr-1. Taken together, we found that LCZ696 protected against Hcy-induced impairment of BBB integrity by increasing the expression of occludin, all mediated by the inhibition of Egr-1.
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Affiliation(s)
- Wenfeng Li
- Department of Cardiology, The First Affiliated Hospital of Ji'nan University, Guangzhou, 510630, Guangdong, China.,Department of Cardiology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| | - Wenjin Yuan
- Department of Cardiology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| | - Dandan Zhang
- Department of Cardiology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| | - Shuchun Cai
- Department of Cardiology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| | - Jun Luo
- Department of Cardiology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| | - Kanghua Zeng
- Department of Cardiology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China.
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Silva-Cardoso J, Fonseca C, Franco F, Morais J, Ferreira J, Brito D. Optimization of heart failure with reduced ejection fraction prognosis-modifying drugs: A 2021 heart failure expert consensus paper. Rev Port Cardiol 2021; 40:S0870-2551(21)00355-3. [PMID: 34462172 DOI: 10.1016/j.repc.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 12/22/2022] Open
Abstract
Heart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients' functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members' clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks.
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Affiliation(s)
- José Silva-Cardoso
- Department of Medicine, Faculdade de Medicina, Universidade do Porto, Oporto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, Oporto, Portugal; CINTESIS, Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Oporto, Portugal.
| | - Cândida Fonseca
- Heart Failure Clinic, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Fátima Franco
- Serviço de Cardiologia, Unidade de Tratamento de Insuficiência Cardíaca Avançada (UTICA), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Morais
- Cardiology Division, Centro Hospitalar de Leiria, Leiria, Portugal; CiTechCare, Center for Innovative Care and Health, Instituto Politécnico de Leiria, Leiria, Portugal
| | - Jorge Ferreira
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Dulce Brito
- Heart and Vessels Department, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal; CCUL, Cardiovascular Center, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
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Yeh JN, Sung PH, Chiang JY, Sheu JJ, Huang CR, Chu YC, Chua S, Yip HK. Early treatment with combination of SS31 and entresto effectively preserved the heart function in doxorubicin-induced dilated cardiomyopathic rat. Biomed Pharmacother 2021; 141:111886. [PMID: 34426177 DOI: 10.1016/j.biopha.2021.111886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/17/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND This study tested the hypothesis that early administration of SS31 and entresto (En) was superior to either one alone on preserving the heart function in setting of dilated cardiomyopathy (DCM) induced by doxorubicin (Dox) [accumulated dosage of 12.5 mg/kg/administered by intraperitoneal (IP) at 4 separated time points within 20 days] in rat. METHODS AND RESULTS Adult-male SD rats (n = 40) were equally categorized into groups 1 (sham-control), 2 (DCM), 3 (DCM + SS31/0.7 mg/kg/day/IP, since day-14 after DCM induction to day-60), 4 [DCM + En (30 mg/kg/day/orally since day-14 after DCM induction to day-60)] and 5 (DCM + combined SS31-En), and animals were euthanized by day 60. By day 60, left-ventricular ejection-fraction (LVEF) was highest in group 1, lowest in group 2 and significantly higher in group 5 than in groups 3 and 4 (all p < 0.0001), but it showed no difference between groups 3/4. The microscopic study showed that the fibrosis area/cardiomyocyte size and DNA-damaged (γ-H2AX+)/inflammatory (CD14+//CD68+) markers, and flow analysis of inflammatory (Ly6G+/MPO+/CD11b/c+) and early/late apoptosis (AN-V+/PI-//AN-V+/PI+) cells exhibited an opposite pattern of LVEF among the five groups (all p < 0.0001). The protein expressions of inflammatory upstream (TLR2/TLR4/MyD88/Mal/ TRAF6/IKK-α/IKK-ß) and downstream (p-NF-κb/TNF-α/IL-1ß/MMP-9), oxidative-stress/mitochondrial-damaged (NOX-1/NOX-2/cytosolic cytochrome-C/cyclophilin-D/DRP1) and autophagic/apoptotic (ratio of LC3B-II/LC3B-I and mitochondrial-Bax/caspase3/9) signaling pathways also exhibited an opposite pattern of LVEF among the five groups (all p < 0.0001). CONCLUSION Combined SS31-En therapy was superior to either one alone on protecting the heart structural and functional integrities against Dox-induced DCM damage.
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Affiliation(s)
- Jui-Ning Yeh
- Department of Cardiology, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiunn-Jye Sheu
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chi-Ruei Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yi-Ching Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Sarah Chua
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Nursing, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Xiamen Chang Gung Hospital, Xiamen, Fujian, China.
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Yuheng J, Yanyan L, Song Z, Yafang Z, Xiaowei M, Jiayan Z. The effects of sacubitril/valsartan on heart failure with preserved ejection fraction: a meta-analysis. Acta Cardiol 2021; 77:471-479. [PMID: 34380373 DOI: 10.1080/00015385.2021.1963101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Compared with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, Sacubitril/Valsartan has been reported to have superior results. However, the effects of sacubitril/valsartan on heart failure with preserved ejection fraction (HFpEF) are still in dispute. OBJECTIVES This study aims to evaluate the effects of sacubitril/valsartan on the treatment of HFpEF patients. METHODS PubMed, Embase, Web of Science, Cochrane Library, and Clinicaltrials.gov were used to search for randomised controlled trials of sacubitril/valsartan in HFpEF patients from inception to 7 December 2020. RESULTS Four studies, with a total of 7739 participants, met the inclusion criteria. The present meta-analysis results showed that compared with the control group, sacubitril/valsartan reduced the hospitalisation rate of HF in HFpEF patients [Risk Ratio(RR): 0.85; 95% confidence interval (CI): 0.79-0.93; p = 0.0002). Regarding all-cause mortality, cardiovascular mortality, and the improvement in NYHA class, sacubitril/valsartan did not show apparent advantages. Although sacubitril/valsartan was linked to increasing the risk of symptomatic hypotension (RR: 1.44; 95% CI: 1.25-1.66; p﹤0.00001), there was no evidence supporting the incidence of renal function worsening and hyperkalemia. CONCLUSION Our study shows that compared with valsartan or individualised medical therapy (IMT), there were not different between the two groups except for the hospitalisation rate which was favoured by Sacubitril/Valsartan treatment group for HFpEF patients.
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Affiliation(s)
- Jiao Yuheng
- Department of Cardiovascular Diseases, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Li Yanyan
- Department of Cardiovascular Diseases, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Zhang Song
- Department of Cardiovascular Diseases, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Zha Yafang
- Department of Cardiovascular Diseases, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Meng Xiaowei
- Department of Cardiovascular Diseases, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Zhang Jiayan
- Department of Cardiovascular Diseases, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
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Marschall A, Del Castillo Carnevali H, Fernández Pascual C, Lorente Rubio A, Morales Gallardo MJ, Dejuán Bitriá C, Delgado Calva FA, Duarte Torres J, Biscotti Rodil B, Rodriguez Torres D, Álvarez Antón S, Martí Sánchez D. Incidence and Predictors of Progression in Asymptomatic Patients With Stable Heart Failure. Am J Cardiol 2021; 152:88-93. [PMID: 34147209 DOI: 10.1016/j.amjcard.2021.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 11/15/2022]
Abstract
Data from previous heart failure (HF) trials suggest that patients with mild symptoms (NYHA II) actually have a poor clinical outcome. However, these studies did not assess clinical stability and rarely included patients in NYHA I. We sought to determine the incidence of short-term clinical progression in supposedly stable HF patients in NYHA I. In addition, we aimed to investigate the predictive value of widely available electrocardiographic and echocardiographic parameters for short-term disease progression. This is a retrospective study including 153 consecutive patients with HF with reduced and mid-range ejection fraction (HFrEF: LVEF<40%; HFmrEF: LVEF 40-49%) in NYHA I with no history of decompensation within the previous 6 months. All patients underwent comprehensive baseline echocardiographic and electrocardiographic assessment. The primary endpoint was the composite of cardiovascular death, hospitalization and need for intensification of HF treatment within a 12 month follow-up period. The cumulative incidence of HF progression was 17.8%, with a median time to event of 193 days. Death and hospitalization due to HF accounted for three-quarters of the events. QRS duration ≥120ms and mitral regurgitation grade >1 showed to be significant predictors of HF progression (HR: 8.92, p<0.001; and HR: 4.10, p<0.001, respectively). Patients without these risk factors had a low incidence of clinical events (3.8%). In conclusion, almost one in five supposedly stable HF patients in NYHA I experience clinical progression in short-term follow-up. Simple electrocardiographic and echocardiographic predictors may be useful for risk stratification and could help to improve individual HF patient management and outcomes.
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82
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Ghys LF, Martens P, Heggermont WA, Gabriel L, Heyse A, Troisfontaines P, Maris M. The in- and out-of-hospital management of HF patients: results from a nationwide Belgian survey. Acta Cardiol 2021; 76:632-641. [PMID: 32507048 DOI: 10.1080/00015385.2020.1765105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND We conducted a nationwide survey to describe the in-and out-of-hospital flow (diagnosis, treatment and follow-up) of patients with heart failure with reduced ejection fraction (HFrEF). METHOD A survey was developed with five dedicated HF cardiologists. The data are all self-reported by cardiologists. RESULTS The response rate was 84%. Presence of a dedicated HF cardiologist or HF nurse was indicated by 49% and 46% of the hospitals respectively. Devices (p < .05), angiotensin receptor neprilysin inhibitors, and rehabilitation are considered more standard of care therapy by dedicated compared to non-dedicated HF cardiologists. Most cardiologists indicated that target dosages of HF drugs can be reached in 25‒75% of patients. Achieving >75% of the target dose seems easier for angiotensin converting enzyme inhibitor/angiotensin receptor blockers (ACEI/ARB) (22%) and mineralocorticoid receptor antagonists (25%), compared to β-blockers (10%) and angiotensin receptor neprilysin inhibitors (7%). 62%, 49% and 4% of the cardiologists indicated to use subtypes of angiotensin converting enzyme inhibitors, angiotensin receptor blockers and β-blockers respectively not validated in the HF population. In the acute setting, dedicated HF cardiologists (23%) are less influenced by blood parameters for decongestion compared to non-dedicated HF cardiologists (39%). They tend to change patients more to guideline-recommended drugs (60% vs 47%). Six minutes walk test and ergospirometry are significantly more used by dedicated compared to non-dedicated HF cardiologists for HF drug change (17% and 29% vs 2% and 4%). CONCLUSION This survey showed that a minority of hospitals have HF care. Those that do, report a higher implementation of guideline-recommended diagnosis, treatment and follow-up of HF patients. Competent authorities could use this survey as a tool to improve HF care.
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Affiliation(s)
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Belgium
| | - Ward A. Heggermont
- Department of Cardiology, OLV Hospital Aalst, Aalst, Belgium
- Cardiovascular Research Center Maastricht, Maastricht, The Netherlands
| | - Laurence Gabriel
- Department of Cardiology, CHU Université Catholique de Louvain, Dinant, Belgium
| | - Alex Heyse
- Department of Cardiology, AZ Glorieux, Ronse, Belgium
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Effect of SAcubitril/Valsartan on left vEntricular ejection fraction and on the potential indication for Implantable Cardioverter Defibrillator in primary prevention: the SAVE-ICD study. Eur J Clin Pharmacol 2021; 77:1835-1842. [PMID: 34279677 DOI: 10.1007/s00228-021-03189-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 07/08/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Sacubitril/valsartan has been associated with a positive reverse left ventricular remodelling in patients with heart failure with reduced ejection fraction (HFrEF). These patients may also benefit from an ICD implant. We aimed to assess EF improvement after 6 months of treatment with sacubitril/valsartan, evaluating when ICD as primary prevention was no longer indicated. METHODS Multicentre, observational, prospective study enrolling all consecutive patients with HFrEF and EF ≤ 35% with an ICD as primary prevention and starting treatment with sacubitril/valsartan (NCT03935087). Resynchronization therapy and patients experiencing appropriate ICD therapies before sacubitril/valsartan were excluded. RESULTS Two-hundred-and-thirty patients were enrolled (73.9% males, mean age 64.3 ± 12.1 years) After 6 months of treatment, a reduction in left ventricular end-diastolic and end-systolic volumes was noted and LVEF increased from 28.3 ± 5.6% to 32.2 ± 6.5% (p < 0.001). At 6 months, a non-ischemic aetiology of cardiomyopathy and a final dose of sacubitril/valsartan > 24/26 mg twice daily were associated with a higher probability of an absolute increase of > 5% in LVEF. A total of 5.3% of primary prevention patients still had an arrhythmic event in the first 6 months after treatment with sacubitril/valsartan started. CONCLUSIONS Sacubitril/valsartan improves systolic function in HFrEF, mainly due to reverse left ventricular remodelling. Improvement in EF after 6 months of treatment could help prevent ICD implantation in nearly one out of four patients, with important clinical and economic implications. However, the risk of sudden cardiac death in this recovered HFrEF population has not been thoroughly studied, and the present data should be interpreted only as hypothesis-generating.
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Felker GM, Butler J, Ibrahim NE, Piña IL, Maisel A, Bapat D, Camacho A, Ward JH, Williamson KM, Solomon SD, Januzzi JL. Implantable Cardioverter-Defibrillator Eligibility After Initiation of Sacubitril/Valsartan in Chronic Heart Failure: Insights From PROVE-HF. Circulation 2021; 144:180-182. [PMID: 34251893 PMCID: PMC8270225 DOI: 10.1161/circulationaha.121.054034] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- G Michael Felker
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, NC (G.M.F.)
| | - Javed Butler
- University of Mississippi Medical Center, Jackson (J.B.)
| | | | | | | | - Devavrat Bapat
- Massachusetts General Hospital, Boston (N.E.I., J.L.J., D.B., A.C.)
| | | | | | | | | | - James L Januzzi
- Massachusetts General Hospital, Boston (N.E.I., J.L.J., D.B., A.C.)
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Sacubitril/Valsartan in the Management of Heart Failure Patients with Cardiac Implantable Electronic Devices. Am J Cardiovasc Drugs 2021; 21:383-393. [PMID: 33118151 DOI: 10.1007/s40256-020-00448-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 12/11/2022]
Abstract
For heart failure patients with cardiac implantable electronic devices (CIEDs), especially those who remain symptomatic after implantation, the best management strategy is still unclear. Although there are several concerns regarding the clinical utilization of sacubitril/valsartan, it has improved the prognosis of patients with heart failure compared with the use of renin-angiotensin system inhibitors in recent years. Recent real-world observational studies and post hoc analyses demonstrated that sacubitril/valsartan might have effects in patients with CIEDs. Given its potential underlying mechanisms, sacubitril/valsartan could improve outcomes of mortality and sudden cardiac death incidence, as well as clinical and echocardiographic evaluations. The possible antiarrhythmic effect of sacubitril/valsartan is still debated. Moreover, given that hypotension is the critical limitation of uptitration, the rise in systolic blood pressure attributed to cardiac resynchronization therapy might support the use of sacubitril/valsartan, with improved tolerance. The clinical utility of sacubitril/valsartan in heart failure patients with CIEDs requires further investigation to determine the actual effects, optimal target populations, and underlying mechanisms.
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86
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Solomon SD, Rohde LE. Reply: Presumed Sudden Cardiac Deaths in the PARADIGM-HF Trial. JACC-HEART FAILURE 2021; 9:165-166. [PMID: 33509380 DOI: 10.1016/j.jchf.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
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Chalikias G, Kikas P, Thomaidis A, Rigopoulos P, Pistola A, Lantzouraki A, Zisimopoulos A, Tziakas D. Effect of Sacubitril/Valsartan on circulating catecholamine levels during a 6-month follow-up in heart failure patients. Timeo Danaos et dona ferentes? Acta Cardiol 2021; 76:396-401. [PMID: 32223369 DOI: 10.1080/00015385.2020.1746094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We assessed the effect of Sacubitril/Valsartan on circulating catecholamine levels in patients with HF in an observational cohort study. We included 108 consecutive HF patients attending our HF Outpatients Clinic who were eligible to Sacubitril/Valsartan according to the PARADIGM-HF inclusion and exclusion criteria. We furthermore included 58 stable HF patients under optimal medical therapy as a control group. Norepinephrine and epinephrine were measured with immunoradiometric assays at baseline, at 3- and at 6-month time follow-up. Compared to baseline levels there was no change at three months in epinephrine (p = 0.177) or norepinephrine (p = 0.815) concentrations. At 6 months norepinephrine remained unchanged (p = 0.359). However, at 6 months we observed a significant increase in epinephrine levels compared to baseline [66 pg/mL (37-93) vs 38 pg/mL (18-74), p < 0.001]. In the control group no change was observed in epinephrine levels compared to baseline (p = 0.838). This study is the first to report on the effect of the new drug Sacubitril/Valsartan on circulating catecholamine levels in HF patients. Our data show a significant increase in epinephrine levels during a 6 month follow up in stable HF patients.
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Affiliation(s)
- George Chalikias
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Petros Kikas
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Adina Thomaidis
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagiotis Rigopoulos
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anastasia Pistola
- Nuclear Medicine Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Asimina Lantzouraki
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasios Zisimopoulos
- Nuclear Medicine Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Tziakas
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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88
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Packer M, McMurray JJ. Rapid evidence-based sequencing of foundational drugs for heart failure and a reduced ejection fraction. Eur J Heart Fail 2021; 23:882-894. [PMID: 33704874 PMCID: PMC8360176 DOI: 10.1002/ejhf.2149] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/18/2021] [Accepted: 03/09/2021] [Indexed: 12/11/2022] Open
Abstract
Foundational therapy for heart failure and a reduced ejection fraction consists of a combination of an angiotensin receptor-neprilysin inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and a sodium-glucose co-transporter 2 (SGLT2) inhibitor. However, the conventional approach to the implementation is based on a historically-driven sequence that is not strongly evidence-based, typically requires ≥6 months, and frequently leads to major gaps in treatment. We propose a rapid sequencing strategy that is based on four principles. First, since drugs act rapidly to reduce morbidity and mortality, patients should be started on all four foundational treatments within 2-4 weeks. Second, since the efficacy of each foundational therapy is independent of treatment with the other drugs, priority can be determined by considerations of relative efficacy, safety and ease-of-use. Third, low starting doses of foundational drugs have substantial therapeutic benefits, and achievement of low doses of all four classes of drugs should take precedence over up-titration to target doses. Fourth, since drugs can influence the tolerability of other foundational agents, sequencing can be based on whether agents started earlier can enhance the safety of agents started simultaneously or later in the sequence. We propose an accelerated three-step approach, which consists of the simultaneous initiation of a beta-blocker and an SGLT2 inhibitor, followed 1-2 weeks later by the initiation of sacubitril/valsartan, and 1-2 weeks later by a mineralocorticoid receptor antagonist. The latter two steps can be re-ordered or compressed depending on patient circumstances. Rapid sequencing is a novel evidence-based strategy that has the potential to dramatically improve the implementation of treatments that reduce the morbidity and mortality of patients with heart failure and a reduced ejection fraction.
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Affiliation(s)
- Milton Packer
- Baylor University Medical CenterDallasTXUSA
- Imperial CollegeLondonUK
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
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89
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Tsai YN, Cheng WH, Chang YT, Hsiao YW, Chang TY, Hsieh YC, Lin YJ, Lo LW, Chao TF, Kuo MJ, Higa S, Chang SL, Chen SA. Mechanism of angiotensin receptor-neprilysin inhibitor in suppression of ventricular arrhythmia. J Cardiol 2021; 78:275-284. [PMID: 34059408 DOI: 10.1016/j.jjcc.2021.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The mechanisms underlying angiotensin receptor-neprilysin inhibitor (ARNi) suppression of ventricular arrhythmia (VA) are unclear. This study aimed to investigate the mechanism of ARNi-related suppression of VA in a heart failure (HF) model. METHODS New Zealand white rabbits (n = 6 per group) were assigned to normal, HF [4 weeks of left ascending artery (LAD) ligation], angiotensin receptor blocker (ARB, valsartan at 27 mg/kg/day for 3 weeks after 1 week of LAD ligation), and ARNi (sacubitril at 34 mg/kg/day and valsartan at 27 mg/kg/day for 3 weeks after 1 week of LAD ligation) groups. Experiments involving echocardiogram, optical mapping, histological of trichrome stain and immunostain, and flow cytometry were performed. RESULTS HF group had larger left ventricular (LV) internal dimensions in diastole and systole, and lower LV ejection fraction and fractional shortening than normal, ARB, and ARNi groups. HF group had a prolonged action potential duration (APD) and decreased conduction velocity (CV), which was mitigated in ARB and ARNi groups. HF group had a prolonged QRS duration, QT and QTc intervals, which was reversed in ARB and ARNi groups. HF group had a steeper maximum slope of APD restitutions, which was attenuated in normal, ARB, and ARNi groups. HF group had increased number of phase singularities (PSs) and VA inducibility than normal, ARB, and ARNi groups. A higher content of fibrosis was found in HF group than that in normal, ARB, and ARNi groups. Compared to ARB group, ARNi had a lower context of fibrosis. HF group had more peripheral blood CD4+ and CD8+ cells count than normal, ARB, and ARNi group. CONCLUSIONS In a rabbit model of ischemic HF, ventricular arrhythmogenesis could be suppressed by ARNi treatment. This appears to be mediated by reversing changes in the APD, CV, maximum slope of the APDR, PSs, fibrosis, and inflammation.
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Affiliation(s)
- Yung-Nan Tsai
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Han Cheng
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yao-Ting Chang
- Division of Cardiology, Tzu-Chi General Hospital, Taipei, Taiwan
| | - Ya-Wen Hsiao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Cheng Hsieh
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yenn-Jiang Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Wei Lo
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tze-Fan Chao
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Jen Kuo
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Satoshi Higa
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan
| | - Shih-Lin Chang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Shih-Ann Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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90
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Ameri P, Bertero E, Maack C, Teerlink JR, Rosano G, Metra M. Medical treatment of heart failure with reduced ejection fraction: the dawn of a new era of personalized treatment? EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2021; 7:539-546. [PMID: 34037742 DOI: 10.1093/ehjcvp/pvab033] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/21/2021] [Indexed: 12/19/2022]
Abstract
Recent trials have shown the efficacy of new drugs for the medical therapy of heart failure and reduced ejection fraction (HFrEF). Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduced hospitalizations for HF, HF events, and cardiovascular death in patients with HFrEF or hospitalized for HF. Iron repletion with ferric carboxymaltose (FCM) improved symptoms, functional capacity, and quality of life in chronic HFrEF patients, and decreased the risk of subsequent HF hospitalizations in subjects with acutely decompensated HF. New-generation potassium binders may allow initiation and up-titration of renin-angiotensin-aldosterone system inhibitors (RASi). Lastly, the guanylate cyclase stimulator vericiguat and the myosin activator omecamtiv mecarbil reduced the primary endpoint in two major controlled trials. These results open novel pathways for the treatment of HFrEF. This review discusses new opportunities of an individualized approach to HFrEF pharmacotherapy, where new compounds expand a spectrum of drugs that target primarily neuroendocrine activation. SGLT2i can be safely applied once daily at a fixed dose to the vast majority of patients with HFrEF, including those with moderate renal dysfunction and/or systolic blood pressure as low as 95-100 mmHg. Additional medications are suitable for more specific phenotypes, with ivabradine providing benefit in patients with sinus rhythm and heart rates ≥70 beats per minute, FCM in the presence of iron deficiency, and potassium-lowering agents to implement RASi when hyperkalaemia occurs. Vericiguat and omecamtiv mecarbil also have potential for tailored approaches towards the hemodynamic status. Thus, a new era is starting for a more personalized medical treatment of HFrEF.
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Affiliation(s)
- Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy-IRCCS Italian Cardiology Network.,Department of Internal Medicine, University of Genova, Genova, Italy
| | - Edoardo Bertero
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Christoph Maack
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Roma, Italy
| | - Marco Metra
- Cardiology Unit, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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91
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Fong MC, Feng AN, Yin WH, Tsao TP, Chang HY. Defibrillation therapies following sodium-glucose cotransporter 2 inhibitor treatment: A report of two cases. HeartRhythm Case Rep 2021; 7:338-342. [PMID: 34026528 PMCID: PMC8134786 DOI: 10.1016/j.hrcr.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Man-Cai Fong
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - An-Ning Feng
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tien-Ping Tsao
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Yu Chang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Address reprint requests and correspondence: Dr Hung-Yu Chang, Heart Center, Cheng Hsin General Hospital, No.45 Cheng-Hsin Street, 112 Beitou, Taipei, Taiwan.
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92
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Packer M. What causes sudden death in patients with chronic heart failure and a reduced ejection fraction? Eur Heart J 2021; 41:1757-1763. [PMID: 31390006 PMCID: PMC7205466 DOI: 10.1093/eurheartj/ehz553] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/14/2019] [Accepted: 07/19/2019] [Indexed: 01/10/2023] Open
Abstract
Sudden death characterizes the mode of demise in 30–50% of patients with chronic heart failure and a reduced ejection fraction. Occasionally, these events have an identifiable pathophysiological trigger, e.g. myocardial infarction, catecholamine surges, or electrolyte imbalances, but in most circumstances, there is no acute precipitating mechanism. Instead, adverse left ventricular remodelling and fibrosis creates an exceptionally fragile and highly vulnerable substrate, which can be characterized using the model developed in theoretical physics of ‘self-organizing criticality’. This framework has been applied to describe the genesis of avalanches, nodes of traffic congestion unrelated to an accident, the abrupt system-wide failure of electrical grids, and the initiation of cancer and neurodegenerative diseases. Self-organizing criticality within the ventricular myocardium relies on complex adaptations to progressive stress and stretch, which evolve inevitably to an abrupt end (termed ‘cascading failure’), even though the rate of deterioration of the underlying disease process has not changed. The result is acute circulatory collapse (i.e. sudden death) in the absence of an identifiable triggering event. Cascading failure in a severely remodelled or fibrotic heart can become manifest electrically as a first-time ventricular tachyarrhythmia that is responsive to the shock delivered by an implantable cardioverter-defibrillator (ICD). Alternatively, it may present as an acute mechanical failure, which is manifest as (i) asystole, bradyarrhythmia, or electromechanical dissociation; or (ii) incessant ventricular fibrillation that persists despite repetitive ICD discharges; in both instances, the sudden deaths cannot be prevented by an ICD. This conceptual framework explains why anti-remodelling and antifibrotic interventions (i.e. neurohormonal antagonists and cardiac resynchronization) reduce the risk of sudden death in patients with heart failure in the absence of an ICD and provide incremental benefits in those with an ICD. The adoption of anti-remodelling and antifibrotic treatments may explain why the incidence of sudden death in clinical trials of heart failure has declined dramatically over the past 10–15 years, independent of the use of ICDs. ![]()
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, 621 N. Hall Street, Dallas, TX 75226, USA.,Imperial College, London, UK
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93
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Marzlin KM. Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death Guideline Update. AACN Adv Crit Care 2021; 31:221-227. [PMID: 32526005 DOI: 10.4037/aacnacc2020586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Karen M Marzlin
- Karen M. Marzlin is Advanced Practice Registered Nurse, Aultman Hospital; Adjunct Faculty, Malone University; and Owner/Author/Educator/Consultant, Key Choice/Cardiovascular Nursing Education Associates, 4565 Venus Rd, Uniontown, OH 44685
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94
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Miró Ò, Rossello X, Platz E, Masip J, Gualandro DM, Peacock WF, Price S, Cullen L, DiSomma S, de Oliveira MT, McMurray JJ, Martín-Sánchez FJ, Maisel AS, Vrints C, Cowie MR, Bueno H, Mebazaa A, Mueller C. Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 9:375-398. [PMID: 33191763 DOI: 10.1177/2048872620930889] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS This study aimed to systematically identify and summarise all risk scores evaluated in the emergency department setting to stratify acute heart failure patients. METHODS AND RESULTS A systematic review of PubMed and Web of Science was conducted including all multicentre studies reporting the use of risk predictive models in emergency department acute heart failure patients. Exclusion criteria were: (a) non-original articles; (b) prognostic models without predictive purposes; and (c) risk models without consecutive patient inclusion or exclusively tested in patients admitted to a hospital ward. We identified 28 studies reporting findings on 19 scores: 13 were originally derived in the emergency department (eight exclusively using acute heart failure patients), and six in emergency department and hospitalised patients. The outcome most frequently predicted was 30-day mortality. The performance of the scores tended to be higher for outcomes occurring closer to the index acute heart failure event. The eight scores developed using acute heart failure patients only in the emergency department contained between 4-13 predictors (age, oxygen saturation and creatinine/urea included in six scores). Five scores (Emergency Heart Failure Mortality Risk Grade, Emergency Heart Failure Mortality Risk Grade 30 Day mortality ST depression, Epidemiology of Acute Heart Failure in Emergency department 3 Day, Acute Heart Failure Risk Score, and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) have been externally validated in the same country, and two (Emergency Heart Failure Mortality Risk Grade and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) further internationally validated. The c-statistic for Emergency Heart Failure Mortality Risk Grade to predict seven-day mortality was between 0.74-0.81 and for Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure to predict 30-day mortality was 0.80-0.84. CONCLUSIONS There are several scales for risk stratification of emergency department acute heart failure patients. Two of them are accurate, have been adequately validated and may be useful in clinical decision-making in the emergency department i.e. about whether to admit or discharge.
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Affiliation(s)
- Òscar Miró
- Emergency Department, University of Barcelona, Spain
| | - Xavier Rossello
- Cardiology Department, Hospital Universitari Son Espases, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.,Grupo de Fisiopatologia y Terapeutica Cardiovascular, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, USA
| | - Josep Masip
- Intensive Care Department, University of Barcelona, Spain.,Cardiology Department, Hospital Sanitas CIMA, Spain
| | - Danielle M Gualandro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland.,Heart Institute (INCOR), University of Sao Paulo Medical School, Brazil
| | - W Frank Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, USA
| | - Susanna Price
- Royal Brompton and Harefield NHS Foundation Trust, Imperial College, UK
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Australia
| | - Salvatore DiSomma
- Royal Brompton and Harefield NHS Foundation Trust, Imperial College, UK
| | | | - John Jv McMurray
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Australia
| | - Francisco J Martín-Sánchez
- Department of Emergency Medicine, Hospital Clínico San Carlos, Spain.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Spain
| | - Alan S Maisel
- Coronary Care Unit and Heart Failure Program, Veteran Affairs (VA) San Diego, USA
| | | | - Martin R Cowie
- Royal Brompton and Harefield NHS Foundation Trust, Imperial College, UK
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.,Department of Cardiology and Cardiovascular Research Area, Universidad Complutense de Madrid, Spain
| | - Alexandre Mebazaa
- University Paris Diderot, France.,APHP Hôpitaux Universitaires Saint Louis Lariboisière, France
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland
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95
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Das BB, Moskowitz WB, Butler J. Current and Future Drug and Device Therapies for Pediatric Heart Failure Patients: Potential Lessons from Adult Trials. CHILDREN-BASEL 2021; 8:children8050322. [PMID: 33922085 PMCID: PMC8143500 DOI: 10.3390/children8050322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/11/2022]
Abstract
This review discusses the potential drug and device therapies for pediatric heart failure (HF) due to reduced systolic function. It is important to realize that most drugs that are used in pediatric HF are extrapolated from adult cardiology practices or consensus guidelines based on expert opinion rather than on evidence from controlled clinical trials. It is difficult to conclude whether the drugs that are well established in adult HF trials are also beneficial for children because of tremendous heterogeneity in the mechanism of HF in children and variations in the pharmacokinetics and pharmacodynamics of drugs from birth to adolescence. The lessons learned from adult trials can guide pediatric cardiologists to design clinical trials of the newer drugs that are in the pipeline to study their efficacy and safety in children with HF. This paper's focus is that the reader should specifically think through the pathophysiological mechanism of HF and the mode of action of drugs for the selection of appropriate pharmacotherapy. We review the drug and device trials in adults with HF to highlight the knowledge gap that exists in the pediatric HF population.
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Affiliation(s)
- Bibhuti B. Das
- Heart Center, Department of Pediatrics, Mississippi Children’s Hospital, University of Mississippi Medical Center, Jackson, MS 39212, USA;
- Correspondence: ; Tel.: +601-984-5250; Fax: +601-984-5283
| | - William B. Moskowitz
- Heart Center, Department of Pediatrics, Mississippi Children’s Hospital, University of Mississippi Medical Center, Jackson, MS 39212, USA;
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39212, USA;
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96
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Gori M, Januzzi JL, D'Elia E, Lorini FL, Senni M. Rationale for and Practical Use of Sacubitril/Valsartan in the Patient's Journey with Heart Failure and Reduced Ejection Fraction. Card Fail Rev 2021; 7:e06. [PMID: 33889425 PMCID: PMC8054374 DOI: 10.15420/cfr.2020.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/11/2020] [Indexed: 11/04/2022] Open
Abstract
Sacubitril with valsartan (sacubitril/valsartan) is a relatively novel compound that has become a milestone in the treatment of patients with chronic heart failure (HF) with reduced ejection fraction (HFrEF) in the last decade. Contemporary data suggest that sacubitril/valsartan is associated with improved outcomes compared with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, and has a greater beneficial effect on myocardial reverse remodelling. Additionally, two recent trials have shown that sacubitril/valsartan is well-tolerated even in the acute HF setting, thus enabling a continuum of use in the patient's journey with HFrEF. This article summarises available data on the effectiveness and tolerability of sacubitril/valsartan in patients with HFrEF, and provides the clinician with practical insights to facilitate the use of this drug in every setting, with an emphasis on acute HF, hypotension, electrolyte imbalance and renal insufficiency.
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Affiliation(s)
- Mauro Gori
- Cardiovascular Department, Papa Giovanni XXIII Hospital Bergamo, Italy
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital Boston, MA, US
| | - Emilia D'Elia
- Cardiovascular Department, Papa Giovanni XXIII Hospital Bergamo, Italy
| | | | - Michele Senni
- Cardiovascular Department, Papa Giovanni XXIII Hospital Bergamo, Italy
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97
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Salamanca-Bautista P, Álvarez-García J, Aramburu-Bodas Ó, Ferrero-Gregori A, Arias-Jiménez JL, Delgado JF, Formiga F, Vázquez R, Manzano L, Puig T, Llàcer P, Vives-Borras M, Cinca J, Montero-Pérez-Barquero M. Modes of death in heart failure according to age, sex and left ventricular ejection fraction. Intern Emerg Med 2021; 16:643-652. [PMID: 32813117 DOI: 10.1007/s11739-020-02468-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
Modes of death in patients with heart failure (HF) have been well characterized in randomized studies, but data from real-life are scarce, especially in the elderly, women and in HF with mid-range or preserved left ventricular ejection fraction (LVEF). Our purpose was to examine modes of death in HF patients according to age, sex and LVEF. We analysed the mode of death of HF patients from two prospective multicentre contemporary Spanish registries conducted by cardiologists (REDINSCOR, n = 2150) and by internists (RICA, n = 1396). Mode of death was pre-specified. Out of 3546 patients, 485 (13.7%) died during the 9-month follow-up. Cardiovascular (CV) causes were the most frequent, regardless of the age, sex and LVEF. More than half of patients died due to worsening HF in both groups of patients, followed by other non-CV causes in those attended by internists, and sudden cardiac death in those cared by cardiologists. Stroke was more common among elderly patients, women and HF with preserved LVEF. Non-CV causes, particularly infectious diseases, accounted for a remarkable proportion of deaths, especially in the elderly and in HF patients with preserved LVEF. Functional class, age and anaemia had a strong influence on both CV and non-CV death. CV death due to refractory HF was the most prevalent among our population, irrespective of age, sex or LVEF. However, a significant proportion of HF patients died from non-CV causes, particularly elderly with mid-range and preserved LVEF. These patients could benefit significantly from a multidisciplinary follow-up.
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Affiliation(s)
- Prado Salamanca-Bautista
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Av. Dr. Fedriani s/n, 41009, Seville, Spain.
| | - Jesús Álvarez-García
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Óscar Aramburu-Bodas
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Av. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Andreu Ferrero-Gregori
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - José Luis Arias-Jiménez
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Av. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Juan F Delgado
- Cardiology Department, Fundación de Investigación i+12, Hospital Universitario Doce de Octubre, CIBERCV, Facultad de Medicina UCM, Madrid, Spain
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Rafael Vázquez
- Cardiology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Luis Manzano
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, University of Alcalá, IRYCIS, Madrid, Spain
| | - Teresa Puig
- Epidemiology and Public Health Department, Hospital de la Santa Creu I Sant Pau, II-B SantPau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pau Llàcer
- Internal Medicine Department, Hospital de Manises, Valencia, Spain
| | - Miquel Vives-Borras
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain
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98
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Książczyk M, Lelonek M. Angiotensin receptor/neprilysin inhibitor-a breakthrough in chronic heart failure therapy: summary of subanalysis on PARADIGM-HF trial findings. Heart Fail Rev 2021; 25:393-402. [PMID: 31713710 PMCID: PMC7181555 DOI: 10.1007/s10741-019-09879-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
It is over 4 years since the Prospective Comparison of angiotensin receptor/neprilysin inhibitor (ARNI) with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial was published in New England Journal of Medicine. The PARADIGM-HF trial was the one that contributed to the official approval to use ARNI simultaneously with cardiac resynchronisation therapy (CRT) or implantable cardioverter-defibrillator (ICD) in patients who receive optimal medical treatment and still presented NYHA II-IV class symptoms according to the 2016 European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure. The aim of this article is to summarise current knowledge on the activity of ARNI in a selected group of patients with heart failure with reduced ejection fraction (HFrEF) based on a recent PARADIGM-HF subanalysis in the field of renal function in patients with and without chronic kidney disease, glycaemia control in patients with diabetes, ventricular arrhythmias and sudden cardiac death and health-related quality of life. This article includes also recently announced findings on the TRANSITION study which revealed that HFrEF therapy with ARNI might be safely initiated after an acute decompensated heart failure episode, including patients with heart failure de novo and ACEI/ARB naïve, both hospitalised or shortly after discharge, in contrary to the PARADIGM-HF trial, where patients had to be administered a stable dose of an ACEI/ARB equivalent to enalapril 10 mg a day for at least 4 weeks before the screening.
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Affiliation(s)
- Marcin Książczyk
- Department of Noninvasive Cardiology, Medical University of Lodz, ul. Żeromskiego 113, 90-549, Lodz, Poland. .,Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Lodz, Poland.
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, ul. Żeromskiego 113, 90-549, Lodz, Poland
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99
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Abumayyaleh M, El-Battrawy I, Kummer M, Pilsinger C, Sattler K, Kuschyk J, Aweimer A, Mügge A, Borggrefe M, Akin I. Comparison of the prognosis and outcome of heart failure with reduced ejection fraction patients treated with sacubitril/valsartan according to age. Future Cardiol 2021; 17:1131-1142. [PMID: 33733830 DOI: 10.2217/fca-2020-0213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The treatment with sacubitril/valsartan in patients suffering from chronic heart failure with reduced ejection fraction increases left ventricular ejection fraction and decreases the risk of sudden cardiac death. We conducted a retrospective analysis regarding the impact of age differences on the treatment outcome of sacubitril/valsartan in patients with chronic heart failure with reduced ejection fraction. Patients were defined as adults if ≤65 years (n = 51) and older if >65 years of age (n = 76). The incidence of ventricular arrhythmias at 1-year follow-up was comparable in both groups (30.8 vs 26.5%; p = 0.71). The mortality rate in adult patients is significantly lower as compared with older patients (2 vs 14.5%; log-rank = 0.04). Older patients may suffer remarkably more side effects than adult patients (21.1 vs 11.8%; p = 0.03).
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Affiliation(s)
- Mohammad Abumayyaleh
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Marvin Kummer
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Christina Pilsinger
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Katherine Sattler
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jürgen Kuschyk
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Assem Aweimer
- Department of Cardiology & Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Andreas Mügge
- Department of Cardiology & Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
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100
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Nishino M, Yano M, Ukita K, Kawamura A, Nakamura H, Matsuhiro Y, Yasumoto K, Tsuda M, Okamoto N, Tanaka A, Matsunaga-Lee Y, Egami Y, Shutta R, Tanouchi J, Yamada T, Yasumura Y, Tamaki S, Hayashi T, Nakagawa A, Nakagawa Y, Suna S, Nakatani D, Hikoso S, Sakata Y. Impact of readmissions on octogenarians with heart failure with preserved ejection fraction: PURSUIT-HFpEF registry. ESC Heart Fail 2021; 8:2120-2132. [PMID: 33689231 PMCID: PMC8120360 DOI: 10.1002/ehf2.13293] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/12/2021] [Accepted: 02/19/2021] [Indexed: 11/30/2022] Open
Abstract
Aims Heart failure (HF) readmissions with preserved ejection fraction (HFpEF) are increasing in the elderly, which is a major socioeconomic problem. We investigated the clinical impact of HF readmissions (HFR) on octogenarians with HFpEF. Methods and results We enrolled consecutive octogenarians (≥80 years old) from June 2016 to February 2020 in PURSUIT‐HFpEF registry. We divided them into HFR group readmitted for HF during the follow‐up period and non‐HF readmission (non‐HFR) group. We evaluated the impact of HFR on all‐cause mortality, cardiac death, and quality of life (QOL). Additionally, we evaluated the factors at discharge correlated with HFR. HFR group comprised 116 patients (21.4%). Among all‐cause deaths, 40 patients suffered cardiac deaths (48.2%). The Kaplan–Meier analysis revealed a similar prognosis between HFR and non‐HFR groups as well as similar incidences of HF deaths. The QOL scores had significantly deteriorated by 1 year later in the HFR group (0.71 ± 0.19 vs. 0.59 ± 0.21, P < 0.001), while it was similar at 1 year in the non‐HFR group. In the multivariate analysis, diabetes mellitus (DM) (P = 0.019), N‐terminal pro‐B‐type natriuretic peptide (NT‐pro BNP) levels ≥ 1611 pg/mL (P < 0.001), and serum albumin level ≤ 3.7 g/dL (P = 0.011) were useful markers for HFR in octogenarians. Conclusions In octogenarians with HFpEF, HF readmission was not directly correlated with the prognosis but was well correlated with the QOL. Close follow‐up is essential to decrease HFR of octogenarians with HFpEF with DM, high NT‐pro BNP (≥1611 pg/mL) and low albumin (≤3.7 g/dL) levels at discharge.
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Affiliation(s)
- Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yutaka Matsuhiro
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Akihiro Tanaka
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yasuharu Matsunaga-Lee
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Ryu Shutta
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yoshio Yasumura
- Division of Cardiology, Amagasaki Chuo Hospital, Amagasaki, Japan
| | - Shunsuke Tamaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | | | - Akito Nakagawa
- Division of Cardiology, Amagasaki Chuo Hospital, Amagasaki, Japan.,Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Hospital, Kawanishi, Japan
| | - Shinichiro Suna
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Medical Innovation, Osaka University Hospital, Suita, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Medical Innovation, Osaka University Hospital, Suita, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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