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Association of β-Blocker Therapy at Discharge with Clinical Outcomes after Acute Coronary Syndrome in Patients without Heart Failure. Cardiovasc Ther 2020; 2020:4351469. [PMID: 32405323 PMCID: PMC7196986 DOI: 10.1155/2020/4351469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/26/2020] [Accepted: 04/06/2020] [Indexed: 11/18/2022] Open
Abstract
Aim To evaluate the clinical impact of β-blocker in patients with adequate left ventricular ejection function (LVEF) who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Methods A total of 10,724 consecutive patients who underwent PCI throughout 2013 were prospectively enrolled in the study. Among these, we analyzed 5,631 ACS patients who were discharged with LVEF ≥ 40%. Patients were then compared according to the β-blocker prescription at discharge. Results During a 2-year follow-up, no significant association was observed of β-blocker use with all-cause mortality (with β-blockers 47/5,043 (0.9%) vs. without β-blocker use 8/588 (1.4%); hazard ratio (HR) 0.762, 95% confidence interval 0.36 to 1.64; P = 0.485), cardiac death, myocardial infarction (MI), or major adverse cardiovascular and cerebrovascular events. Subgroup analysis demonstrated that the β-blocker use at discharge reduced the 2-year mortality in patients with unstable angina (UA) (HR 0.42, 95% CI 0.19 to 0.94, P = 0.034). Landmark analysis at 1 year showed that patients with UA who were discharged with β-blockers had lower mortality (HR 0.17, 95% CI 0.04-0.65, P = 0.010) and cardiac death (HR 0.12, 95% CI 0.01-0.99, P = 0.049) than those discharged without β-blockers. However, the benefit was lost beyond 1 year. No differences in outcomes were recorded in the AMI or overall population. Conclusions We present that β-blocker significantly lowers the rate of all-cause death up to 1 year, in UA patients who have undergone PCI and have adequate LVEF. Its role in patients with AMI also deserves further exploration.
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52
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Kim MN, Park SM. Heart failure with preserved ejection fraction: insights from recent clinical researches. Korean J Intern Med 2020; 35:514-534. [PMID: 32392659 PMCID: PMC7214356 DOI: 10.3904/kjim.2020.104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/23/2020] [Indexed: 02/07/2023] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for nearly half of the cases of HF and its incidence might be increasing with the aging society. Patients with HFpEF present with significant symptoms, including exercise intolerance, impaired quality of life, and have a poor prognosis as well as frequent hospitalization and increased mortality compared with HF with reduced ejection fraction. The concept of HFpEF is still evolving and may be a virtual complex rather than a real systemic disorder. Thus, beyond solely targeting cardiac abnormalities management strategies need to be extended, such as left ventricular diastolic dysfunction. In this review, we examine new diagnostic algorithms, pathophysiology, current management status, and ongoing trials based on heterogeneous pathophysiology and etiology in HFpEF.
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Affiliation(s)
- Mi-Na Kim
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Korea University Anam Hospital, Seoul, Korea
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53
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Sinagra G, Corrà U, Contini M, Magrì D, Paolillo S, Perrone Filardi P, Sciomer S, Badagliacca R, Agostoni P. Choosing among β-blockers in heart failure patients according to β-receptors' location and functions in the cardiopulmonary system. Pharmacol Res 2020; 156:104785. [PMID: 32224252 DOI: 10.1016/j.phrs.2020.104785] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/05/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023]
Abstract
Several large clinical trials showed a favorable effect of β-blocker treatment in patients with chronic heart failure (HF) as regards overall mortality, cardiovascular mortality, and hospitalizations. Indeed, the use of β-blockers is strongly recommended by current international guidelines, and it remains a cornerstone in the pharmacological treatment of HF. Although different types of β-blockers are currently approved for HF therapy, possible criteria to choose the best β-blocking agent according to HF patients' characteristics and to β-receptors' location and functions in the cardiopulmonary system are still lacking. In such a context, a growing body of literature shows remarkable differences between β-blocker types (β1-selective blockers versus β1-β2 blockers) with respect to alveolar-capillary gas diffusion and chemoreceptor response in HF patients, both factors able to impact on quality of life and, most likely, on prognosis. This review suggests an original algorithm for choosing among the currently available β-blocking agents based on the knowledge of cardiopulmonary pathophysiology. Particularly, starting from lung physiology and from some experimental models, it focuses on the mechanisms underlying lung mechanics, chemoreceptors, and alveolar-capillary unit impairment in HF. This paper also remarks the significant benefit deriving from the correct use of the different β-blockers in HF patients through a brief overview of the most important clinical trials.
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Affiliation(s)
- Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, Veruno Institute, Veruno, Italy
| | | | - Damiano Magrì
- Department of Clinical and Molecular Medicine, "Sapienza" Università Degli Studi Di Roma, Roma, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | | | - Susanna Sciomer
- Dipartimento Di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza" Università Degli Studi Di Roma, Roma, Italy
| | - Roberto Badagliacca
- Dipartimento Di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza" Università Degli Studi Di Roma, Roma, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy.
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54
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Bajaj NS, Gupta K, Gharpure N, Pate M, Chopra L, Kalra R, Prabhu SD. Effect of immunomodulation on cardiac remodelling and outcomes in heart failure: a quantitative synthesis of the literature. ESC Heart Fail 2020; 7:1319-1330. [PMID: 32198851 PMCID: PMC7261557 DOI: 10.1002/ehf2.12681] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/09/2020] [Accepted: 02/22/2020] [Indexed: 11/13/2022] Open
Abstract
Aims Immunomodulation in heart failure (HF) has been studied in several randomized controlled trials (RCTs) with variable effects on cardiac structure, function, and outcomes. We sought to determine the effect of immunomodulation on left ventricular ejection fraction (LVEF), LV end‐diastolic dimension (LVEDD), and all‐cause mortality in patients with HF with reduced ejection fraction (HFrEF) through meta‐analyses and trial sequential analyses (TSAs) of RCTs. Methods and results PubMed, Embase®, Cochrane CENTRAL, and http://ClinicalTrials.gov were systematically reviewed to identify RCTs that studied the effects of immunomodulation in patients with HFrEF. The primary endpoint in this analysis was change in LVEF. Secondary outcomes were changes in LVEDD and all‐cause mortality. TSA was used to quantify the statistical reliability of data in the cumulative meta‐analyses. Nineteen RCTs with 1341 HFrEF subjects were eligible for analyses. The aetiology of HF, specific immunomodulation strategy, and treatment duration were variable across trials. Immunomodulation led to a greater improvement in LVEF [mean difference: +5.7% 95% confidence interval (CI): 3.0–8.5%, P < 0.001] and reduction in LVEDD (mean difference: −3.7 mm, 95% CI: −7.0 to −0.4 mm, P = 0.028) than no immunomodulation in meta‐analyses and TSAs. We observed a non‐significant decrease in all‐cause mortality among those on immumomodulation (risk ratio: 0.7, 95% CI: 0.4–1.3, P = 0.234), but the Z‐curve for cumulative treatment effect of immunomodulation in the TSA did not cross the boundary of futility. Conclusions Immunomodulation led to improved cardiac structure and function in patients with HFrEF. While these benefits did not translate into a significant improvement in mortality, our analysis suggests that larger studies of targeted immunomodulation are needed to understand the true benefits.
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Affiliation(s)
- Navkaranbir S Bajaj
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1900 University Boulevard, 311 THT, Birmingham, AL, 35294-0006, USA.,Cardiology Service, Birmingham Veterans Affair Medical Center, Birmingham, AL, USA.,Division of Molecular Imaging and Therapeutics, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kartik Gupta
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1900 University Boulevard, 311 THT, Birmingham, AL, 35294-0006, USA
| | - Nitin Gharpure
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1900 University Boulevard, 311 THT, Birmingham, AL, 35294-0006, USA
| | - Mike Pate
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1900 University Boulevard, 311 THT, Birmingham, AL, 35294-0006, USA
| | - Lakshay Chopra
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1900 University Boulevard, 311 THT, Birmingham, AL, 35294-0006, USA
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Sumanth D Prabhu
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1900 University Boulevard, 311 THT, Birmingham, AL, 35294-0006, USA.,Cardiology Service, Birmingham Veterans Affair Medical Center, Birmingham, AL, USA
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Sokos GG, Raina A. Understanding the early mortality benefit observed in the PARADIGM-HF trial: considerations for the management of heart failure with sacubitril/valsartan. Vasc Health Risk Manag 2020; 16:41-51. [PMID: 32021227 PMCID: PMC6972579 DOI: 10.2147/vhrm.s197291] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 08/02/2019] [Indexed: 12/11/2022] Open
Abstract
This review aims to elucidate the optimal dosing of angiotensin receptor-neprilysin inhibitor (ARNI) therapy in the heart failure (HF) treatment paradigm through examination of the trial population characteristics and the mortality benefit observed in the Prospective Comparison of ARNI with angiotensin-converting enzyme inhibitor (ACEI) to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF; NCT01035255) trial. Considerations regarding the initiation and titration of sacubitril/valsartan, a first-in-class ARNI, will also be addressed. The approval of sacubitril/valsartan heralded the first novel pharmacological class in over a decade for the treatment of heart failure with reduced ejection fraction (HFrEF). The PARADIGM-HF trial showed that treatment with valsartan/valsartan reduced the risk of first occurrence of either cardiovascular death or HF-related hospitalization (composite primary endpoint) by 20% compared with enalapril in patients with HFrEF. The incremental benefits of treatment with valsartan/valsartan over enalapril demonstrated in the PARADIGM-HF trial led to strong recommendations for its use over ACEIs or angiotensin receptor blockers to further reduce morbidity and mortality in the 2016 and 2017 American College of Cardiology/American Heart Association/Heart Failure Society of America updates to the guidelines for the management of HF. Although the optimal timing for the initiation of valsartan/valsartan has yet to be determined, its early use is likely to have a positive impact on patient outcomes.
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Affiliation(s)
- George G Sokos
- Department of Medicine, Division of Cardiology, West Virginia School of Medicine, Morgantown, WV, USA
| | - Amresh Raina
- Pulmonary Hypertension Program, Section of Heart Failure/Transplant/MCS & Pulmonary Hypertension, Allegheny General Hospital, AGH McGinnis Cardiovascular Institute, Pittsburgh, PA, USA
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Prins KW, Thenappan T, Weir EK, Kalra R, Pritzker M, Archer SL. Repurposing Medications for Treatment of Pulmonary Arterial Hypertension: What's Old Is New Again. J Am Heart Assoc 2020; 8:e011343. [PMID: 30590974 PMCID: PMC6405714 DOI: 10.1161/jaha.118.011343] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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)
- Kurt W Prins
- 1 Cardiovascular Division University of Minnesota Medical School Minneapolis MN
| | - Thenappan Thenappan
- 1 Cardiovascular Division University of Minnesota Medical School Minneapolis MN
| | - E Kenneth Weir
- 1 Cardiovascular Division University of Minnesota Medical School Minneapolis MN
| | - Rajat Kalra
- 1 Cardiovascular Division University of Minnesota Medical School Minneapolis MN
| | - Marc Pritzker
- 1 Cardiovascular Division University of Minnesota Medical School Minneapolis MN
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Abi Khalil C, Sulaiman K, Asaad N, AlHabib KF, Alsheikh-Ali A, Jameesh M, Al-Jarallah M, Bulbanat B, AlMahmeed W, Ridha M, Bazargani N, Amin H, Al-Motarreb A, AlFaleh H, Panduranga P, Mahfoud Z, Al Suwaidi J. Beta-Blockers and Cardiovascular Outcomes in Acute Heart Failure with a History of Coronary Artery Disease and an Ejection Fraction ≥ 40. Curr Vasc Pharmacol 2020; 18:644-651. [PMID: 31889498 DOI: 10.2174/1570161118666191231114203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/20/2022]
Abstract
The prognostic impact of beta-blockers (BB) in coronary artery disease (CAD) is controversial, especially in the post-reperfusion era. We studied in-hospital cardiovascular events in patients hospitalized for acute HF, a previous history of CAD and a left ventricular ejection fraction (LVEF) ≥40%, in relation to BB on admission; and 1-year outcome in relation to BB on discharge, in the GULF aCute heArt failuRe (GULF-CARE) registry. From a total of 5005 patients included in the GULF-CARE registry, 303 patients with a previous history of CAD and a LVEF ≥40% on BB were propensity-matched to 303 patients without BB on admission. In-hospital mortality (OR= 0.82; 95% CI [0.35-1.94]), stroke and cardiogenic shock were not reduced by BB. On discharge, 306 patients on BB, including the ones newly diagnosed with myocardial infarction as a precipitating cause of HF, were propensity-scored matched with 306 patients without BB. Mortality (OR= 0.86; 95%CI [0.51-1.45], hospitalization for HF or PCI/CABG at 1 year were also not reduced by BB at discharge. In summary, our data show that BB have a neutral effect on in-hospital and 1-year outcomes in acute heart failure patients with a previous history of CAD and a LVEF ≥40%.
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Affiliation(s)
| | | | - Nidal Asaad
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Alawi Alsheikh-Ali
- College of Medicine Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | | | | | - Bassam Bulbanat
- Department of Medicine, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Wael AlMahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Mustafa Ridha
- Department of Cardiology, Adan Hospital, Kuwait City, Kuwait
| | - Nooshin Bazargani
- Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Ahmed Al-Motarreb
- Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Husam AlFaleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | | | - Ziyad Mahfoud
- Biostatistics, Epidemiology and BioMathematical Research Core, Doha, Qatar
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58
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Lin L, Chu H, Hodges JS. On evidence cycles in network meta-analysis. STATISTICS AND ITS INTERFACE 2020; 13:425-436. [PMID: 32742550 PMCID: PMC7394478 DOI: 10.4310/sii.2020.v13.n4.a1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
As an extension of pairwise meta-analysis of two treatments, network meta-analysis has recently attracted many researchers in evidence-based medicine because it simultaneously synthesizes both direct and indirect evidence from multiple treatments and thus facilitates better decision making. The Bayesian hierarchical model is a popular method to implement network meta-analysis, and it is generally considered more powerful than conventional pairwise meta-analysis, leading to more precise effect estimates with narrower credible intervals. However, the improvement of effect estimates produced by Bayesian network meta-analysis has never been studied theoretically. This article shows that such improvement depends highly on evidence cycles in the treatment network. When all treatment comparisons are assumed to have different heterogeneity variances, a network meta-analysis produces posterior distributions identical to separate pairwise meta-analyses for treatment comparisons that are not contained in any evidence cycles. However, this equivalence does not hold under the commonly-used assumption of a common heterogeneity variance for all comparisons. Simulations and a case study are used to illustrate the equivalence of the Bayesian network and pairwise meta-analyses in certain networks.
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Affiliation(s)
- Lifeng Lin
- Department of Statistics, Florida State University, Tallahassee, FL, USA
| | - Haitao Chu
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - James S Hodges
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
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Safi S, Sethi NJ, Nielsen EE, Feinberg J, Gluud C, Jakobsen JC. Beta-blockers for suspected or diagnosed acute myocardial infarction. Cochrane Database Syst Rev 2019; 12:CD012484. [PMID: 31845756 PMCID: PMC6915833 DOI: 10.1002/14651858.cd012484.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiovascular disease is the number one cause of death globally. According to the World Health Organization, 7.4 million people died from ischaemic heart diseases in 2012, constituting 15% of all deaths. Acute myocardial infarction is caused by blockage of the blood supplied to the heart muscle. Beta-blockers are often used in patients with acute myocardial infarction. Previous meta-analyses on the topic have shown conflicting results ranging from harms, neutral effects, to benefits. No previous systematic review using Cochrane methodology has assessed the effects of beta-blockers for acute myocardial infarction. OBJECTIVES To assess the benefits and harms of beta-blockers compared with placebo or no intervention in people with suspected or diagnosed acute myocardial infarction. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index Expanded and BIOSIS Citation Index in June 2019. We also searched the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Turning Research into Practice, Google Scholar, SciSearch, and the reference lists of included trials and previous reviews in August 2019. SELECTION CRITERIA We included all randomised clinical trials assessing the effects of beta-blockers versus placebo or no intervention in people with suspected or diagnosed acute myocardial infarction. Trials were included irrespective of trial design, setting, blinding, publication status, publication year, language, and reporting of our outcomes. DATA COLLECTION AND ANALYSIS We followed the Cochrane methodological recommendations. Four review authors independently extracted data. Our primary outcomes were all-cause mortality, serious adverse events according to the International Conference on Harmonization - Good Clinical Practice (ICH-GCP), and major adverse cardiovascular events (composite of cardiovascular mortality and non-fatal myocardial infarction during follow-up). Our secondary outcomes were quality of life, angina, cardiovascular mortality, and myocardial infarction during follow-up. Our primary time point of interest was less than three months after randomisation. We also assessed the outcomes at maximum follow-up beyond three months. Due to risk of multiplicity, we calculated a 97.5% confidence interval (CI) for the primary outcomes and a 98% CI for the secondary outcomes. We assessed the risks of systematic errors through seven bias domains in accordance to the instructions given in the Cochrane Handbook. The quality of the body of evidence was assessed by GRADE. MAIN RESULTS We included 63 trials randomising a total of 85,550 participants (mean age 57.4 years). Only one trial was at low risk of bias. The remaining trials were at high risk of bias. The quality of the evidence according to GRADE ranged from very low to high. Fifty-six trials commenced beta-blockers during the acute phase of acute myocardial infarction and seven trials during the subacute phase. At our primary time point 'less than three months follow-up', meta-analysis showed that beta-blockers versus placebo or no intervention probably reduce the risk of a reinfarction during follow-up (risk ratio (RR) 0.82, 98% confidence interval (CI) 0.73 to 0.91; 67,562 participants; 18 trials; moderate-quality evidence) with an absolute risk reduction of 0.5% and a number needed to treat for an additional beneficial outcome (NNTB) of 196 participants. However, we found little or no effect of beta-blockers when assessing all-cause mortality (RR 0.94, 97.5% CI 0.90 to 1.00; 80,452 participants; 46 trials/47 comparisons; high-quality evidence) with an absolute risk reduction of 0.4% and cardiovascular mortality (RR 0.99, 95% CI 0.91 to 1.08; 45,852 participants; 1 trial; moderate-quality evidence) with an absolute risk reduction of 0.4%. Regarding angina, it is uncertain whether beta-blockers have a beneficial or harmful effect (RR 0.70, 98% CI 0.25 to 1.84; 98 participants; 3 trials; very low-quality evidence) with an absolute risk reduction of 7.1%. None of the trials specifically assessed nor reported serious adverse events according to ICH-GCP. Only two trials specifically assessed major adverse cardiovascular events, however, no major adverse cardiovascular events occurred in either trial. At maximum follow-up beyond three months, meta-analyses showed that beta-blockers versus placebo or no intervention probably reduce the risk of all-cause mortality (RR 0.93, 97.5% CI 0.86 to 0.99; 25,210 participants; 21 trials/22 comparisons; moderate-quality evidence) with an absolute risk reduction of 1.1% and a NNTB of 91 participants, and cardiovascular mortality (RR 0.90, 98% CI 0.83 to 0.98; 22,457 participants; 14 trials/15 comparisons; moderate-quality evidence) with an absolute risk reduction of 1.2% and a NNTB of 83 participants. However, it is uncertain whether beta-blockers have a beneficial or harmful effect when assessing major adverse cardiovascular events (RR 0.81, 97.5% CI 0.40 to 1.66; 475 participants; 4 trials; very low-quality evidence) with an absolute risk reduction of 1.7%; reinfarction (RR 0.89, 98% CI 0.75 to 1.08; 6825 participants; 14 trials; low-quality evidence) with an absolute risk reduction of 0.9%; and angina (RR 0.64, 98% CI 0.18 to 2.0; 844 participants; 2 trials; very low-quality evidence). None of the trials specifically assessed nor reported serious adverse events according to ICH-GCP. None of the trials assessed quality of life. We identified two ongoing randomised clinical trials investigating the effect of early administration of beta-blockers after percutaneous coronary intervention or thrombolysis to patients with an acute myocardial infarction and one ongoing trial investigating the effect of long-term beta-blocker therapy. AUTHORS' CONCLUSIONS Our present review indicates that beta-blockers for suspected or diagnosed acute myocardial infarction probably reduce the short-term risk of a reinfarction and the long-term risk of all-cause mortality and cardiovascular mortality. Nevertheless, it is most likely that beta-blockers have little or no effect on the short-term risk of all-cause mortality and cardiovascular mortality. Regarding all remaining outcomes (serious adverse events according to ICH-GCP, major adverse cardiovascular events (composite of cardiovascular mortality and non-fatal myocardial infarction during follow-up), the long-term risk of a reinfarction during follow-up, quality of life, and angina), further information is needed to confirm or reject the clinical effects of beta-blockers on these outcomes for people with or suspected of acute myocardial infarction.
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Affiliation(s)
- Sanam Safi
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Naqash J Sethi
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Emil Eik Nielsen
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
- Cardiology SectionDepartment of Internal MedicineSmedelundsgade 60HolbækDanmarkDenmark4300
| | - Joshua Feinberg
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Christian Gluud
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
- Holbaek HospitalDepartment of CardiologyHolbaekDenmark4300
- University of Southern DenmarkDepartment of Regional Health Research, the Faculty of Health SciencesHolbaekDenmark
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Biondi Zoccai G, Frati G, Romagnoli E, Sciarretta S, Abbate A. Final results of the ISCHEMIA trial: distinguishing mass media coverage from clinical interpretation. Minerva Cardioangiol 2019; 68:9-14. [PMID: 31820619 DOI: 10.23736/s0026-4725.19.05106-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy -
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS NEUROMED, Pozzilli, Isernia, Italy
| | - Enrico Romagnoli
- Institute of Cardiology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Sebastiano Sciarretta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS NEUROMED, Pozzilli, Isernia, Italy
| | - Antonio Abbate
- Pauley Heart Center and Wright Center for Clinical and Translation Research, Virginia Commonwealth University, Richmond, VA, USA
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Martínez-Milla J, Raposeiras-Roubín S, Pascual-Figal DA, Ibáñez B. Papel de los bloqueadores beta en la enfermedad cardiovascular en 2019. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2019.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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D-dimer level and long-term outcome in patients with end-stage heart failure secondary to idiopathic dilated cardiomyopathy. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2019; 16:621-629. [PMID: 31555330 PMCID: PMC6748897 DOI: 10.11909/j.issn.1671-5411.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Previous studies had demonstrated hemostatic abnormalities in patients with heart failure (HF) and several studies have shown that abnormal coagulation indices, represented by elevated D-dimer, had prognostic significance in patients with compatible or acute decompensated HF. However, the impact of D-dimer on the outcome in patients with end-stage HF remains unclear. Methods A total of 244 consecutive patients with end-stage HF due to idiopathic dilated cardiomyopathy (DCM) were prospectively enrolled from February 2011 to September 2014. D-dimer levels were measured and its prognostic value was assessed. Primary endpoint was all-cause mortality during the follow-up period. Secondary endpoints were stroke, bleeding, occurrence of sustained ventricular tachycardia or ventricular fibrillation, and major adverse cardiovascular events (MACE). Results D-dimer was significantly elevated in the non-survivors (median: 0.8 vs. 1.1 mg/L, P < 0.001). Traditional markers including B-type natriuretic peptide, troponin I, left ventricular ejection fraction, and left ventricular end-diastolic dimension provided limited prognostic value; but the addition of D-dimer refined the risk stratification. The optimal cut-off value of D-dimer to predict all-cause mortality was 0.84 mg/L by receiver operator characteristic analysis. Elevated D-dimer level was independently associated with increased risk of long-term all-cause mortality (HR = 2.315, 95% CI: 1.570–3.414, P < 0.001) and MACE (HR = 1.256, 95% CI: 1.058–1.490, P = 0.009), and the predictive value was independent of age, sex, atrial fibrillation and anticoagulation status. Conclusions Elevated D-dimer level was independently associated with poor long-term outcome in patients with end-stage HF secondary to idiopathic DCM, and the predictive value was superior to that of traditional prognostic markers.
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Choi KH, Lee GY, Choi JO, Jeon ES, Lee HY, Lee SE, Kim JJ, Chae SC, Baek SH, Kang SM, Choi DJ, Yoo BS, Kim KH, Cho MC, Park HY, Oh BH. The mortality benefit of carvedilol versus bisoprolol in patients with heart failure with reduced ejection fraction. Korean J Intern Med 2019; 34:1030-1039. [PMID: 30317846 PMCID: PMC6718755 DOI: 10.3904/kjim.2018.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/02/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/AIMS It is unknown whether different β-blockers (BBs) have variable effects on long-term survival of patients with heart failure with reduced ejection fraction (HFrEF). This study compares the effects of two BBs, carvedilol and bisoprolol, on survival in patients with HFrEF. METHODS The Korean Acute Heart Failure (KorAHF) registry is a prospective multicenter cohort that includes 5,625 patients who were hospitalized for acute heart failure (AHF). We selected 3,016 patients with HFrEF and divided this study population into two groups: BB at discharge (n = 1,707) or no BB at discharge (n = 1,309). Among patients with BB at discharge, subgroups were formed based on carvedilol prescription (n = 831), or bisoprolol prescription (n = 553). Propensity score matching analysis was performed. RESULTS Among patients who were prescribed a BB at discharge, 60.5% received carvedilol and 32.7% received bisoprolol. There was a significant reduction in allcause mortality in those patients with HFrEF prescribed a BB at discharge compared to those who were not (BB vs. no BB, 26.1% vs. 40.8%; hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.52 to 0.67; p < 0.001). However, there was no significant difference in the rate of all-cause mortality between those receiving different types of BB (carvedilol vs. bisoprolol, 27.5% vs. 23.5%; HR, 1.21; 95% CI, 0.99 to 1.47; p = 0.07). Similar results were observed after propensity score matching analysis (508 pairs, 26.2% vs. 23.8%; HR, 1.10; 95% CI, 0.86 to 1.40; p = 0.47). CONCLUSION In the treatment of AHF with reduced EF after hospitalization, mortality benefits of carvedilol and bisoprolol were comparable.
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Affiliation(s)
- Ki Hong Choi
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga Yeon Lee
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Seok Jeon
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Eun Lee
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joong Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Hong Baek
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok-Min Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung-Su Yoo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kye Hun Kim
- Heart Research Center of Chonnam National University, Gwangju, Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | | | - Byung-Hee Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Martínez-Milla J, Raposeiras-Roubín S, Pascual-Figal DA, Ibáñez B. Role of Beta-blockers in Cardiovascular Disease in 2019. ACTA ACUST UNITED AC 2019; 72:844-852. [PMID: 31402328 DOI: 10.1016/j.rec.2019.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/24/2019] [Indexed: 11/17/2022]
Abstract
Beta-blockers are the cornerstone of treatment for various cardiovascular conditions. Although their effects have classically been considered to be driven by their antagonistic and competitive action on beta-adrenergic receptors, nowadays it is known that their effect goes beyond that of mere competition with catecholamines on these receptors. Beta-blockers were discovered as antianginal drugs in the 1960s and are currently widely used in heart failure, arrhythmias, and ischemic heart disease. In this article, we review the evidence for the beneficial effects of beta-blockers in these conditions, as well as the current recommendations in clinical practice guidelines for their use. Surprisingly, despite having been prescribed for more than 4 decades, new, previously unnoticed mechanisms of action on cellular compartments are still being discovered, which continues to open up new horizons for their use. All in all, beta-blockers are one of the most fascinating drug groups in our therapeutic armamentarium.
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Affiliation(s)
- Juan Martínez-Milla
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | | | - Domingo A Pascual-Figal
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Universidad de Murcia, El Palmar, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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AlHabeeb W, Al-Ayoubi F, AlGhalayini K, Al Ghofaili F, Al Hebaishi Y, Al-Jazairi A, Al-Mallah MH, AlMasood A, Al Qaseer M, Al-Saif S, Chaudhary A, Elasfar A, Tash A, Arafa M, Hassan W. Saudi Heart Association (SHA) guidelines for the management of heart failure. J Saudi Heart Assoc 2019; 31:204-253. [PMID: 31371908 PMCID: PMC6660461 DOI: 10.1016/j.jsha.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/31/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is the leading cause of morbidity and mortality worldwide and negatively impacts quality of life, healthcare costs, and longevity. Although data on HF in the Arab population are scarce, recently developed regional registries are a step forward to evaluating the quality of current patient care and providing an overview of the clinical picture. Despite the burden of HF in Saudi Arabia, there are currently no standardized protocols or guidelines for the management of patients with acute or chronic heart failure. Therefore, the Heart Failure Expert Committee, comprising 13 local specialists representing both public and private sectors, has developed guidelines to address the needs and challenges for the diagnosis and treatment of HF in Saudi Arabia. The ultimate aim of these guidelines is to assist healthcare professionals in delivering optimal care and standardized clinical practice across Saudi Arabia.
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Affiliation(s)
- Waleed AlHabeeb
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
- Corresponding author at: Cardiac Sciences Department, King Saud University, P.O. Box 7805, Riyadh 11472, Saudi Arabia.
| | - Fakhr Al-Ayoubi
- King Fahad Cardiac Center, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
| | - Kamal AlGhalayini
- King Abdulaziz University Hospital, Jeddah, Saudi ArabiaSaudi Arabia
| | - Fahad Al Ghofaili
- King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi ArabiaSaudi Arabia
| | | | - Abdulrazaq Al-Jazairi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaSaudi Arabia
| | - Mouaz H. Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi ArabiaSaudi Arabia
| | - Ali AlMasood
- Riyadh Care Hospital, Riyadh, Saudi ArabiaSaudi Arabia
| | - Maryam Al Qaseer
- King Fahad Specialist Hospital, Dammam, Saudi ArabiaSaudi Arabia
| | - Shukri Al-Saif
- Saud Al-Babtain Cardiac Center, Dammam, Saudi ArabiaSaudi Arabia
| | - Ammar Chaudhary
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi ArabiaSaudi Arabia
| | - Abdelfatah Elasfar
- Madina Cardiac Center, AlMadina AlMonaoarah, Saudi ArabiaSaudi Arabia
- Cardiology Department, Tanta University, EgyptEgypt
| | - Adel Tash
- Ministry of Health, Riyadh, Saudi ArabiaSaudi Arabia
| | - Mohamed Arafa
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi ArabiaSaudi Arabia
| | - Walid Hassan
- International Medical Center, Jeddah, Saudi ArabiaSaudi Arabia
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Cao W, Ma L. Curative effect of β-blocker on various ejection fractions of patients with atrial fibrillation. Exp Ther Med 2019; 18:1149-1154. [PMID: 31363367 PMCID: PMC6614719 DOI: 10.3892/etm.2019.7703] [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: 05/10/2019] [Accepted: 06/20/2019] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to retrospectively determine the effects of metoprolol on patients presenting with persistent atrial fibrillation (AF), but either with or without a reduced ejection fraction (EF). All patients meeting the inclusion criteria were treated for 2 years with metoprolol. Blood pressure, heart rate and echocardiography parameters were measured and analysed in patients before and after treatment. The patients were divided into 2 cohorts as follows: Those presenting with a low EF (<50%) and those with normal EF values (≥50%). In total, 151 patients enrolled were 136; however, of these 15 were lost to mortality during the follow-up period, thus leaving a total of 136 patients. In total, 42 patients presented EF values <50%, while the remaining 94 presented with normal EF values. Treatment with metoprolol controlled blood pressure (both diastolic and systolic) and heart rate in patients with both low and normal EF values. EF values in the low EF group significantly increased following treatment. In addition, the echocardiography data revealed a statistically significant decrease in left atrial and ventricular diameters in the low EF group. On the whole, the findings of this study demonstrate that patients with AF and low EF values who were treated with metoprolol presented with improved cardiac function parameters. However, metoprolol should be contraindicated for patients with high EF values (i.e., absence of heart failure) as it seemed to increase their risk of heart failure based on the N-terminal pro b-type natriuretic peptide (NT-pro BNP) results.
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Affiliation(s)
- Wei Cao
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, P.R. China
| | - Likun Ma
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, P.R. China
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Joseph P, Swedberg K, Leong DP, Yusuf S. The Evolution of β-Blockers in Coronary Artery Disease and Heart Failure (Part 1/5). J Am Coll Cardiol 2019; 74:672-682. [DOI: 10.1016/j.jacc.2019.04.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 01/09/2023]
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Qintar M, Hirai T, Arnold SV, Sheehy J, Sapontis J, Jones P, Tang Y, Lombardi W, Karmpaliotis D, Moses J, Patterson C, Nicholson WJ, Cohen DJ, Spertus JA, Grantham JA, Salisbury AC. De-escalation of antianginal medications after successful chronic total occlusion percutaneous coronary intervention: Frequency and relationship with health status. Am Heart J 2019; 214:1-8. [PMID: 31152872 DOI: 10.1016/j.ahj.2019.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can markedly reduce angina symptom burden, but many patients often remain on multiple antianginal medications (AAMs) after the procedure. It is unclear when, or if, AAMs can be de-escalated to prevent adverse effects or limit polypharmacy. We examined the association of de-escalation of AAMs after CTO PCI with long-term health status. METHODS In a 12-center registry of consecutive CTO PCI patients, health status was assessed at 6 months after successful CTO PCI with the Seattle Angina Questionnaire and the Rose Dyspnea Scale. Among patients with technical CTO PCI success, we examined the association of AAM de-escalation with 6-month health status using multivariable models adjusting for revascularization completeness and predicted risk of post-PCI angina (using a validated risk model). We also examined predictors and variability of AAMs de-escalation. RESULTS Of 669 patients with technical success of CTO PCI, AAMs were de-escalated in 276 (35.9%) patients at 1 month. Patients with AAM de-escalation reported similar angina and dyspnea rates at 6 months compared with those whose AAMs were reduced (any angina: 22.5% vs 20%, P = .43; any dyspnea: 51.8% vs 50.1%, P = .40). In a multivariable model adjusting for complete revascularization and predicted risk of post-PCI angina, de-escalation of AAMs at 1 month was not associated with an increased risk of angina, dyspnea, or worse health status at 6 months. CONCLUSIONS Among patients with successful CTO PCI, de-escalation of AAMs occurred in about one-third of patients at 1 month and was not associated with worse long-term health status.
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Sant'Anna RT, Eibel B, Markoski MM, Rodrigues CG, de Salles FB, Giusti II, Nesralla IA, Nardi NB, Kalil RAK. Gene therapy for refractory angina and cell therapy for heart failure: experience of a Brazilian research group. Gene Ther 2019; 27:40-50. [PMID: 31278371 DOI: 10.1038/s41434-019-0087-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 12/11/2022]
Abstract
Cell therapy has shown impressive effects in experimental cardiomyopathy models. To a lesser extent, gene therapy has also been studied. In both cases, translation to clinical therapy has been disappointing. This paper is intended to describe the experience and achievements of a multicenter working group located in Porto Alegre, southern Brazil, in experimental and translational research projects for cell-based and gene therapy methods in the treatment of dilated and ischemic cardiomyopathies. The results of preclinical and clinical studies showed that bone marrow mononuclear stem cells indeed have an effect in improving myocardial perfusion and contractile function, but the overall results are poorly translated to the clinical level. Gene therapy studies with direct myocardial injections of naked VEGF 165 plasmid showed improvement in myocardial perfusion and function in animal models. A randomized clinical trial found that this method is safe and improved myocardial perfusion, but the benefits disappeared after 1 year. An animal experiment associating VEGF 165 with angiopoietin was undertaken in mini pigs to extend the durability of that therapy. In conclusion, our efforts to better understand the mechanisms and functions of gene and cell-based therapies in cardiology resulted in significant findings and propose a future look at cell-free therapeutic approaches.
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Affiliation(s)
- Roberto Tofani Sant'Anna
- Instituto de Cardiologia do Rio Grande do Sul, Av Princesa Isabel 395, 90620-001, Porto Alegre, RS, Brazil
| | - Bruna Eibel
- Instituto de Cardiologia do Rio Grande do Sul, Av Princesa Isabel 395, 90620-001, Porto Alegre, RS, Brazil
| | - Melissa Medeiros Markoski
- Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite 245, 90050-170, Porto Alegre, RS, Brazil
| | - Clarissa Garcia Rodrigues
- Global Research and Innovation Network - GRINN, Rua Doutor João Colin 1285, Sala 03, 89204-001, Joinville, SC, Brazil
| | - Felipe Borsu de Salles
- Instituto de Cardiologia do Rio Grande do Sul, Av Princesa Isabel 395, 90620-001, Porto Alegre, RS, Brazil
| | - Imarilde Inês Giusti
- Instituto de Cardiologia do Rio Grande do Sul, Av Princesa Isabel 395, 90620-001, Porto Alegre, RS, Brazil
| | - Ivo Abrahão Nesralla
- Instituto de Cardiologia do Rio Grande do Sul, Av Princesa Isabel 395, 90620-001, Porto Alegre, RS, Brazil
| | - Nance Beyer Nardi
- Instituto de Cardiologia do Rio Grande do Sul, Av Princesa Isabel 395, 90620-001, Porto Alegre, RS, Brazil.,Universidade Luterana do Brasil, Av Farroupilha, 8001, 92425-900, Canoas, RS, Brazil
| | - Renato Abdala Karam Kalil
- Instituto de Cardiologia do Rio Grande do Sul, Av Princesa Isabel 395, 90620-001, Porto Alegre, RS, Brazil.
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Valentim Gonçalves A, Pereira-da-Silva T, Galrinho A, Rio P, Moura Branco L, Soares R, Feliciano J, Ilhão Moreira R, Cruz Ferreira R. Antiarrhythmic Effect of Sacubitril-Valsartan: Cause or Consequence of Clinical Improvement? J Clin Med 2019; 8:jcm8060869. [PMID: 31216679 PMCID: PMC6616876 DOI: 10.3390/jcm8060869] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/01/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022] Open
Abstract
Sacubitril/Valsartan (LCZ696) reduced sudden cardiac death in the PARADIGM-HF trial. However, the mechanism by which LCZ696 reduces ventricular arrhythmias remains unclear. The aim of this study was to compare electrocardiographic (ECG) parameters and mechanical dispersion index, assessed by left ventricular (LV) global longitudinal strain (GLS), before and after LCZ696 therapy. We prospectively evaluated chronic Heart Failure (HF) patients with LV ejection fraction ≤40%, despite optimal medical and device therapy, in which LCZ696 therapy was started, while no additional HF treatment was expected to change. ECG and transthoracic echocardiographic data were gathered in the week before starting LCZ696 and at six months of therapy. A semiautomated analysis of LV GLS was performed and mechanical dispersion index was defined as the standard deviation from 16 time intervals corresponding to each LV segment. Of the 42 patients, 35 completed the six month follow-up, since two patients died and five discontinued treatment for adverse events. QTc interval (451.9 vs. 426.0 ms, p < 0.001), QRS duration (125.1 vs. 120.8 ms, p = 0.033) and mechanical dispersion index (88.4 vs. 78.1 ms, p = 0.036) were significantly reduced at six months. LCZ696 therapy is associated with a reduction in QTc interval, QRS duration and mechanical dispersion index as assessed by LV GLS.
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Affiliation(s)
- António Valentim Gonçalves
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Tiago Pereira-da-Silva
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Ana Galrinho
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Pedro Rio
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Luísa Moura Branco
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Rui Soares
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Joana Feliciano
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Rita Ilhão Moreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
| | - Rui Cruz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, 1169-024 Lisbon, Portugal.
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Whang W, Holmes DR, Miller MA, Langan MN, Choudry S, Sofi A, Koruth JS, Dukkipati SR, Reddy VY. Does Left Atrial Appendage Closure Reduce Mortality? A Vital Status Analysis of the Randomized PROTECT AF and PREVAIL Clinical Trials. J Atr Fibrillation 2019; 11:2119. [PMID: 31139291 DOI: 10.4022/jafib.2119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/25/2017] [Accepted: 10/05/2018] [Indexed: 11/10/2022]
Abstract
Compared with warfarin, left atrial appendage closure (LAAC) reduced mortality in an analysis of the PROTECTAF and PREVAIL trials. However, these data were limited by patient drop-out.We sought to estimatethe mortality benefit with LAACusing updated vital status information.In PROTECT AF and PREVAIL, 227 of 1114 randomized subjects failed to complete 5-year follow-up. Centers were manually queried for updated vital status on 76 subjects (33%).During median follow-up 5.0 years (interquartile range 3.8, 5.1), 112 of 732 LAAC subjects (15.3%) and 79 of 382 controls (20.7%) died. The hazard ratio for all-cause mortality with LAAC compared with warfarin was 0.70 (95% CI 0.53-0.94, p=0.017).Subgroup analyses suggested that subjects <75 years and those with higher CHA2DS2-VASc score, history of transient ischemic attack or stroke, and permanent AF derived particular benefit, although interaction terms were not significant.The number needed to treat(NNT) with LAAC to prevent one death over 5 years was 16 (95% CI 10-82). Despite competing mortality risks in this elderly cohort, updated vital status data from PROTECT AF and PREVAIL revealed that LAAC was associated with 30% improved survival compared with warfarin, with an NNT of 16.
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Affiliation(s)
- William Whang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Marc A Miller
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Aamir Sofi
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jacob S Koruth
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Chimenti I, Pagano F, Sciarretta S, Marullo AGM, Greco E, Tonelli E, Peruzzi M, Cavarretta E, Biondi-Zoccai G, Frati G. Cardiac Recovery During Long-Term LVAD: Is There an Interaction Between Beta-Blockers and Cardiac Progenitor Cells? J Am Coll Cardiol 2019; 69:1880-1881. [PMID: 28385324 DOI: 10.1016/j.jacc.2016.11.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 02/05/2023]
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Andersson C, Hansen PW, Steffensen IE, Andreasen C, Weeke PE, Køber L, Gislason GH, Torp-Pedersen C. Mortality associated with cardiovascular drugs in patients with chronic obstructive pulmonary disease and right-sided heart failure - A danish nationwide registry-based study. Eur J Intern Med 2019; 63:56-61. [PMID: 30833208 DOI: 10.1016/j.ejim.2019.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/03/2019] [Accepted: 02/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The optimal medical treatment in patients with chronic obstructive pulmonary disease (COPD) and right-sided heart failure (RHF) is unknown. We aimed to estimate the risks of all-cause mortality associated with the current clinical use of various cardiovascular drugs in this patient-group. METHODS We followed all patients with registered COPD and RHF (defined as a diagnosis of pulmonary hypertension plus use of loop-diuretics) for the risk of all-cause mortality (Jan 1, 1995 to Dec 31, 2015) using the Danish nationwide administrative registries. The association between mortality and claimed prescriptions for cardiovascular drugs was assessed by multivariable Cox regression models. RESULTS 5991 patients (mean age 74 ± standard deviation 10 years, 51% women) were included. Of these, 1440 (24%) used beta-blockers, 2149 (36%) renin-angiotensin system inhibitors [RASi], 1340 (22%) oral anticoagulants, 1376 (23%) calcium channel blockers, 1194 (20%) statins, 1824 (30%) spironolactone, and 2099 (35%) low-dose aspirin. During an average follow-up of 2.2 years (±standard deviation 2.8, min-max 0-19.6 years), 5071 (85%) died, corresponding to a mortality rate of 38 per 100 person-years (95% confidence interval 37-39). Compared to no use, beta-blockers were associated with adjusted hazards ratio 0.90 (95% confidence interval 0.84-0.98), RASi 0.92 (0.86-0.98), calcium channel blockers 0.86 (0.80-0.92), spironolactone 1.17 (1.10-1.24), statins 0.85 (0.78-0.92), oral anticoagulants 0.87 (0.79-0.95), and aspirin 0.99 (0.93-1.05). Propensity-score matched analyses and inverse-probability-weighted models yielded similar results. CONCLUSION Several cardiovascular drugs may be associated with lowered mortality in COPD and RHF. Given the grave prognosis, randomized clinical trials are warranted to test this hypothesis.
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Affiliation(s)
- Charlotte Andersson
- Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
| | - Peter Wæde Hansen
- Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen, Denmark
| | - Ida E Steffensen
- Department of Internal Medicine, Division of Pulmonology, Herlev Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Charlotte Andreasen
- Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Peter E Weeke
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Department of Internal Medicine, Division of Pulmonology, Herlev Gentofte Hospital, University of Copenhagen, Herlev, Denmark; The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; The Institute of Health Science and Technology, Aalborg University, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Loiacono F, Fragasso G, Calori G, Alberti L, Marinosci G, Salerno A, Margonato A. Validation of a new score for outcome prediction in patients with heart failure with reduced ejection fraction. Minerva Cardioangiol 2019; 67:191-199. [DOI: 10.23736/s0026-4725.19.04823-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Mechanisms of Improved Mortality Following Ablation: Does Ablation Restore Beta-Blocker Benefit in Atrial Fibrillation/Heart Failure? Cardiol Clin 2019; 37:177-183. [PMID: 30926019 DOI: 10.1016/j.ccl.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Observational trials have shown that atrial fibrillation ablation favorably impacts long-term outcomes in systolic heart failure. These outcomes have been confirmed by randomized prospective trials highlighting the favorable impact of ablation on left ventricular function and remodeling, risk of heart failure hospitalization, and mortality. Ablation along with established heart failure medications is new and supported conceptually by the value of restoring sinus rhythm, avoiding long-term antiarrhythmic drugs, and minimizing drug-drug interactions. Observational data suggest a potential long-term benefit of beta-blockers with ablation that becomes augmented as follow-up is extended from 1 to 5 years.
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76
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Influence of remote ischemic conditioning on radial artery occlusion. Heart Vessels 2019; 34:771-776. [PMID: 30834949 DOI: 10.1007/s00380-018-1310-6] [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] [Received: 10/09/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
This study aimed to explore the influence of remote ischemic conditioning (RIC) on radial artery occlusion (RAO) and distinguish the risk factors for RAO. A total of 640 consecutive patients who prospectively underwent transradial artery coronary angiography (TRACA) (322 patients received RIC before TRACA) were enrolled. RIC was not performed in 318 patients. RAO was estimated using Doppler ultrasonography after the procedure. Patients were divided into two groups according to the protocol of RIC: RIC and non-RIC. The rate of RAO was significantly lower in the RIC group than in the non-RIC group. Patients were divided into two groups according to the patency of radial artery: radial artery patency (RAP) and RAO. The radial artery diameter was significantly narrower in the RAO group (2.31 ± 0.53) than in the RAP group (2.59 ± 0.47). The rate of applying β-blocker was significantly higher in the RAP group (69%) than in the RAO group (41%). The rate of applying trimetazidine was significantly higher in the RAP group (49.1%) than in the RAO group (17.6%). The multiple logistic regression analysis using radial artery diameter, RIC, β-blocker, and trimetazidine treatments revealed that small radial artery diameter, lack of β-blockers, and RIC were independent predictors of RAO. RIC might help in improving the rate of RAO. The multiple logistic regression analysis showed that the lack of β-blockers, RIC, and small radial artery diameter were independent predictors of RAO.
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Proietti R, Russo V, AlTurki A. Anti-arrhythmic therapy in patients with non-ischemic cardiomyopathy. Pharmacol Res 2019; 143:27-32. [PMID: 30844534 DOI: 10.1016/j.phrs.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/02/2019] [Accepted: 03/03/2019] [Indexed: 01/29/2023]
Abstract
Implantable cardiac defibrillators (ICD) are the foundation of therapy for the prevention of sudden cardiac death. While ICDs prevent SCD, they do not prevent the occurrence of ventricular arrhythmias which are usually symptomatic. Though catheter ablation has been successful in substrate modification of ventricular tachycardia in patients with ischemic cardiomyopathy, there is much less evidence to support its use in non-ischemic cardiomyopathy. Therefore, anti-arrhythmic drugs (AADs) are an essential adjunctive therapy for secondary prevention of ventricular arrhythmias in patients with non-ischemic cardiomyopathy. In patients with hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM), the prevalence of ventricular arrhythmias correlates with the volume of scar as characterized by late gadolinium enhancement. Beta-blockers forms the cornerstone of treatment to prevent ventricular arrhythmias in both HCM and DCM. Disopyramide is an important therapeutic option in HCM as it provides both negative inotropy which reduces obstruction as well as lass I anti-arrhythmic action. In DCM sotalol, through is combined beta-blocking and class III AD effects, significantly reduces the burden of ventricular arrhythmias. Though amiodarone is efficacious in the prevention of ventricular arrhythmias in both HCM and DCM, its use is limited by its side-effects profile. Evidence for AAD therapy for arrhythmogenic right ventricular dysplasia (ARVD) is limited by its low prevalence and lack of studies. ICDs have been shown to reduce SCD regardless of whether patients are receiving AAD therapy.
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Affiliation(s)
- Riccardo Proietti
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Vincenzo Russo
- Chair of Cardiology, University of Campania, Ospedale Monaldi, Naples, Italy
| | - Ahmed AlTurki
- Division of Cardiology, McGill University Health Center, Montreal, Canada.
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Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. J Clin Sleep Med 2019; 15:301-334. [PMID: 30736888 DOI: 10.5664/jcsm.7638] [Citation(s) in RCA: 330] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/14/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The purpose of this systematic review is to provide supporting evidence for the clinical practice guideline for the treatment of obstructive sleep apnea (OSA) in adults using positive airway pressure (PAP). METHODS The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of PAP with no treatment as well as studies that compared different PAP modalities. Meta-analyses were performed to determine the clinical significance of using PAP in several modalities (ie, continuous PAP, auto-adjusting PAP, and bilevel PAP), to treat OSA in adults. In addition, meta-analyses were performed to determine the clinical significance of using an in-laboratory versus ambulatory strategy for the initiation of PAP, educational and behavioral interventions, telemonitoring, humidification, different mask interfaces, and flexible or modified pressure profile PAP in conjunction with PAP to treat OSA in adults. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations. RESULTS The literature search resulted in 336 studies that met inclusion criteria; 184 studies provided data suitable for meta-analyses. The data demonstrated that PAP compared to no treatment results in a clinically significant reduction in disease severity, sleepiness, blood pressure, and motor vehicle accidents, and improvement in sleep-related quality of life in adults with OSA. In addition, the initiation of PAP in the home demonstrated equivalent effects on patient outcomes when compared to an in-laboratory titration approach. The data also demonstrated that the use of auto-adjusting or bilevel PAP did not result in clinically significant differences in patient outcomes compared with standard continuous PAP. Furthermore, data demonstrated a clinically significant improvement in PAP adherence with the use of educational, behavioral, troubleshooting, and telemonitoring interventions. Systematic reviews for specific PAP delivery method were also performed and suggested that nasal interfaces compared to oronasal interfaces have improved adherence and slightly greater reductions in OSA severity, heated humidification compared to no humidification reduces some continuous PAP-related side effects, and pressure profile PAP did not result in clinically significant differences in patient outcomes compared with standard continuous PAP.
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Affiliation(s)
| | - Indu A Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - R Joh Kimoff
- McGill University Health Centre, Montreal, Quebec, Canada
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Shu Q, Wu L, Zhang R, Zhang Q, Huang J, Meng Y. Age-dependent changes in cardiac performance, motor function, QoL, and mental status in metoprolol-treated chronic heart failure patients. Sci Rep 2019; 9:453. [PMID: 30679746 PMCID: PMC6345765 DOI: 10.1038/s41598-018-37520-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/06/2018] [Indexed: 01/11/2023] Open
Abstract
No previous study reports the effect of age on cardiac performance, motor function and quality of life (QoL) in Chinese chronic heart failure (CHF) patients. This single-center, prospective study enrolled CHF patients with resting heart rate (RHR) > 80 bpm, who were treated with metoprolol and were followed up at 1, 3, 6, and 12 months. Changes in cardiac, motor, and QoL parameters between patients aged ≥60 years and those aged <60 years were compared at all time points. P < 0.05 was considered significant. A total of 154 patients were enrolled (median age: 66.39 years; 116 aged ≥60 years, 38 aged <60 years; 95% New York Heart Association class III-IV). RHR decreased significantly in both patient groups (P < 0.0001 for both groups). Patients aged ≥60 years had a significant improvement in both ejection fraction (EF) at 6 and 12 months and in cardiac index (CI) at 3, 6, and 12 months. However, no major difference was observed in motor function in both groups. Significantly higher SF-8 scores showed greater improvement in QoL in the <60 age group at 12 months (P = 0.0008). Metoprolol demonstrated improvement in cardiac performance, motor function, QoL, and anxiety with increase in depression and burnout in both genders; however, the findings were independent of age.
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Affiliation(s)
- Qiuhong Shu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Liyong Wu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Ran Zhang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Qian Zhang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Jingjing Huang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Yong Meng
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China.
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Mittal R, Jhaveri VM, Kay SIS, Greer A, Sutherland KJ, McMurry HS, Lin N, Mittal J, Malhotra AK, Patel AP. Recent Advances in Understanding the Pathogenesis of Cardiovascular Diseases and Development of Treatment Modalities. Cardiovasc Hematol Disord Drug Targets 2019; 19:19-32. [PMID: 29737266 DOI: 10.2174/1871529x18666180508111353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/15/2017] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
Cardiovascular Diseases (CVDs) are a leading cause of morbidity and mortality worldwide. The underlying pathology for cardiovascular disease is largely atherosclerotic in nature and the steps include fatty streak formation, plaque progression and plaque rupture. While there is optimal drug therapy available for patients with CVD, there are also underlying drug delivery obstacles that must be addressed. Challenges in drug delivery warrant further studies for the development of novel and more efficacious medical therapies. An extensive understanding of the molecular mechanisms of disease in combination with current challenges in drug delivery serves as a platform for the development of novel drug therapeutic targets for CVD. The objective of this article is to review the pathogenesis of atherosclerosis, first-line medical treatment for CVD, and key obstacles in an efficient drug delivery.
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Affiliation(s)
- Rahul Mittal
- Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, Florida FL, United States
| | - Vasanti M Jhaveri
- Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, Florida FL, United States
| | - Sae-In Samantha Kay
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida FL, United States
| | - Aubrey Greer
- Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, Florida FL, United States
| | - Kyle J Sutherland
- Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, Florida FL, United States
| | - Hannah S McMurry
- Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, Florida FL, United States
| | - Nicole Lin
- Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, Florida FL, United States
| | - Jeenu Mittal
- Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, Florida FL, United States
| | - Arul K Malhotra
- Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, Florida FL, United States
| | - Amit P Patel
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida FL, United States
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Zhang Q, Shu Q, Wu L, Zhang R, Meng Y. Dose-independent influence of metoprolol on cardiac and motor functions, QoL, and mental status in Chinese patients with CHF. Ther Clin Risk Manag 2018; 15:23-31. [PMID: 30588002 PMCID: PMC6302828 DOI: 10.2147/tcrm.s188123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective The objective of the study was to evaluate the dose-related influence of metoprolol on cardiac performance, motor function, quality of life (QoL), and mental status in Chinese patients with chronic heart failure (CHF). Patients and methods This was a prospectively designed single-center study which enrolled CHF patients with resting heart rate (HR) >80 bpm belonging to the New York Heart Association (NYHA) III/IV functional classification. Patients were initiated with 12.5 mg of metoprolol, and every second week, the dose was escalated until the target HR level (60–70 bpm) was achieved during the follow-up at 1st, 3rd, 6th, and 12th months. Patients were divided into two groups depending on the doses administered: 47.5 mg (n=37) and 118.75 mg (n=74), respectively, for comparison in terms of change in cardiac function, motor function, QoL, and mental status. Results Among the 111 patients with CHF, no significant difference was shown between the two doses administered. Irrespective of the dose, the cardiac performance, motor function, QoL, and anxiety improved and there was an increase in depression, whereas the effect on burnout, calculated as Copenhagen Burnout Inventory (CBI), equally was insignificant throughout the 1-year follow-up period in both the CHF patient groups. Conclusion Lower dose of metoprolol (47.5 mg) is as effective as higher dose (118.75 mg) in Chinese population with CHF to improve the cardiac function, motor function, QoL, and mental status.
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Affiliation(s)
- Qian Zhang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, People's Republic of China,
| | - Qiuhong Shu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, People's Republic of China,
| | - Liyong Wu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, People's Republic of China,
| | - Ran Zhang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, People's Republic of China,
| | - Yong Meng
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, People's Republic of China,
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El Moheb M, Nicolas J, Khamis AM, Iskandarani G, Akl EA, Refaat M. Implantable cardiac defibrillators for people with non-ischaemic cardiomyopathy. Cochrane Database Syst Rev 2018; 12:CD012738. [PMID: 30537022 PMCID: PMC6517305 DOI: 10.1002/14651858.cd012738.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is evidence that implantable cardioverter-defibrillator (ICD) for primary prevention in people with an ischaemic cardiomyopathy improves survival rate. The evidence supporting this intervention in people with non-ischaemic cardiomyopathy is not as definitive, with the recently published DANISH trial finding no improvement in survival rate. A systematic review of all eligible studies was needed to evaluate the benefits and harms of using ICDs for primary prevention in people with non-ischaemic cardiomyopathy. OBJECTIVES To evaluate the benefits and harms of using compared to not using ICD for primary prevention in people with non-ischaemic cardiomyopathy receiving optimal medical therapy. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and the Web of Science Core Collection on 10 October 2018. For ongoing or unpublished clinical trials, we searched the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and the ISRCTN registry. To identify economic evaluation studies, we conducted a separate search to 31 March 2015 of the NHS Economic Evaluation Database, and from March 2015 to October 2018 on MEDLINE and Embase. SELECTION CRITERIA We included randomised controlled trials involving adults with chronic non-ischaemic cardiomyopathy due to a left ventricular systolic dysfunction with an ejection fraction of 35% or less (New York Heart Association (NYHA) type I-IV). Participants in the intervention arm should have received ICD in addition to optimal medical therapy, while those in the control arm received optimal medical therapy alone. We included studies with cardiac resynchronisation therapy when it was appropriately balanced in the experimental and control groups. DATA COLLECTION AND ANALYSIS The primary outcomes were all-cause mortality, cardiovascular mortality, sudden cardiac death, and adverse events associated with the intervention. The secondary outcomes were non-cardiovascular death, health-related quality of life, hospitalisation for heart failure, first ICD-related hospitalisation, and cost. We abstracted the log (hazard ratio) and its variance from trial reports for time-to-event survival data. We extracted the raw data necessary to calculate the risk ratio. We summarised data on quality of life and cost-effectiveness narratively. We assessed the certainty of evidence for all outcomes using GRADE. MAIN RESULTS We identified six eligible randomised trials with a total of 3128 participants. The use of ICD plus optimal medical therapy versus optimal medical therapy alone decreases the risk of all-cause mortality (hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.66 to 0.92; participants = 3128; studies = 6; high-certainty evidence). An average of 24 patients need to be treated with ICD to prevent one additional death from any cause (number needed to treat for an additional beneficial outcome (NNTB) = 24). Individuals younger than 65 derive more benefit than individuals older than 65 (HR 0.51, 95% CI 0.29 to 0.91; participants = 348; studies = 1) (NNTB = 10). When added to medical therapy, ICDs probably decrease cardiovascular mortality compared to not adding them (risk ratio (RR) 0.75, 95% CI 0.46 to 1.21; participants = 1781; studies = 4; moderate-certainty evidence) (possibility of both plausible benefit and no effect). Implantable cardioverter-defibrillator was also found to decrease sudden cardiac deaths (HR 0.45, 95% CI 0.29 to 0.70; participants = 1677; studies = 3; high-certainty evidence). An average of 25 patients need to be treated with an ICD to prevent one additional sudden cardiac death (NNTB = 25). We found that ICDs probably increase adverse events (possibility of both plausible harm and benefit), but likely have little or no effect on non-cardiovascular mortality (RR 1.17, 95% CI 0.81 to 1.68; participants = 1781; studies = 4; moderate-certainty evidence) (possibility of both plausible benefit and no effect). Finally, using ICD therapy probably has little or no effect on quality of life, however shocks from the device cause a deterioration in quality of life. No study reported the outcome of first ICD-related hospitalisations. AUTHORS' CONCLUSIONS The use of ICD in addition to medical therapy in people with non-ischaemic cardiomyopathy decreases all-cause mortality and sudden cardiac deaths and probably decreases mortality from cardiovascular causes compared to medical therapy alone. Their use probably increases the risk for adverse events. However, these devices come at a high cost, and shocks from ICDs cause a deterioration in quality of life.
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Affiliation(s)
- Mohamad El Moheb
- American University of Beirut Medical CenterFaculty of MedicineBeirutLebanon
| | - Johny Nicolas
- American University of Beirut Medical CenterFaculty of MedicineBeirutLebanon
| | - Assem M Khamis
- American University of Beirut Medical CenterClinical Research InstituteBeirutLebanon
| | - Ghida Iskandarani
- American University of Beirut Medical CenterFaculty of MedicineBeirutLebanon
| | - Elie A Akl
- American University of Beirut Medical CenterDepartment of Internal MedicineRiad El Solh StBeirutLebanon
| | - Marwan Refaat
- American University of Beirut Medical CenterDepartment of Internal MedicineRiad El Solh StBeirutLebanon
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ADLAN AHMEDM. Inflammation and Heart Rate–corrected QT Interval: Evidence for a Potentially Reversible Cause of Sudden Death in Patients with Rheumatoid Arthritis? J Rheumatol 2018; 45:1609-1610. [DOI: 10.3899/jrheum.180921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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84
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Paul TK, Mukherjee D. Silent myocardial infarction and risk of heart failure. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:S35. [PMID: 30613610 DOI: 10.21037/atm.2018.09.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Timir K Paul
- Division of Cardiology, East Tennessee State University, Johnson City, TN, USA
| | - Debabrata Mukherjee
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
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Cvetinovic N, Sekularac N, Von Haehling S, Tahirovic E, Inkrot S, Lainscak M, Apostolovic S, Putnikovic B, Waagstein F, Gelbrich G, Aleksic A, Loncar G, Düngen HD. The β-blocker uptitration in elderly with heart failure regarding biomarker levels: CIBIS-ELD substudy. Biomark Med 2018; 12:1261-1270. [PMID: 30450925 DOI: 10.2217/bmm-2018-0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM We investigated if the baseline value of mid-regional pro-atrial natriuretic peptide (NP), N-terminal pro-B-type NP and copeptin may be helpful in optimizing β-blocker uptitration in elderly patients with heart failure. PATIENTS & METHODS According to the biomarkers' levels, 457 patients were divided into three subgroups and compared with each other at baseline and 3 months after. RESULTS All mid-regional pro-atrial NP and N-terminal pro-B-type NP subgroups had significant amelioration of left ventricle ejection fraction and New York Heart Association (NYHA) class after 3 months of β-blocker uptitration (p < 0.001). More prominent improvement of left ventricle ejection fraction and New York Heart Association class was observed in subgroups with lower versus higher NPs levels. CONCLUSION NPs levels, unlike copeptin levels, might be useful tool for objective selection of elderly heart failure patients who could have the greatest benefit of forced uptitration.
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Affiliation(s)
- Natasa Cvetinovic
- Department of Cardiology, University Clinical Center Zvezdara, Belgrade, Serbia
| | - Nikola Sekularac
- Department of Cardiology, University Clinical Center Zvezdara, Belgrade, Serbia
| | - Stephan Von Haehling
- Innovative Clinical Trials, Department of Cardiology & Pneumology, University of Medicine Göttingen, Germany
| | - Elvis Tahirovic
- Department of Cardiology, Charite -Campus Virchow-Klinikum, Berlin, Germany
| | - Simona Inkrot
- Department of Cardiology, Charite -Campus Virchow-Klinikum, Berlin, Germany
| | - Mitja Lainscak
- Departments of Cardiology & Research & Education, General Hospital Celje, Celje, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Biljana Putnikovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Hospital Zemun, Belgrade, Serbia
| | - Finn Waagstein
- Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Goetz Gelbrich
- Coordination Centre for Clinical Trials Leipzig (KKSL), University of Leipzig, Leipzig, Germany
| | - Andja Aleksic
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Loncar
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Department, Cardiovascular Institute Dedinje, Belgrade, Serbia
| | - Hans-Dirk Düngen
- Department of Cardiology, Charite -Campus Virchow-Klinikum, Berlin, Germany
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86
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Loop MS, van Dyke MK, Chen L, Safford MM, Kilgore ML, Brown TM, Durant RW, Levitan EB. Low Utilization of Beta-Blockers Among Medicare Beneficiaries Hospitalized for Heart Failure With Reduced Ejection Fraction. J Card Fail 2018; 25:343-351. [PMID: 30339796 DOI: 10.1016/j.cardfail.2018.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 09/05/2018] [Accepted: 10/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The evidence-based beta-blockers carvedilol, bisoprolol, and metoprolol succinate reduce mortality and hospitalizations among patients with heart failure with reduced ejection fraction (HFrEF). Use of these medications is not well described in the general population of patients with HFrEF, especially among patients with potential contraindications. OBJECTIVES Our goal was to describe the patterns of prescription fills for carvedilol, bisoprolol, and metoprolol succinate among Medicare beneficiaries hospitalized for HFrEF, as well as to estimate the associations between specific contraindications for beta-blocker therapy and those patterns. METHODS AND RESULTS With the use of the cohort of 15,205 Medicare beneficiaries hospitalized for HFrEF from 2007 to 2013 in the 5% Medicare random sample, we described prescription fills (30 days after discharge) and dosage patterns (1 year after discharge) for beta-blockers. By means of of Fine and Gray competing risk models, we estimated the associations between potential contraindications (hypotension, chronic obstructive pulmonary disease [COPD], asthma, and syncope) and prescription fill and dosing patterns while adjusting for demographics, comorbidities, and health care utilization. For beneficiaries who did not die or readmitted to the hospital, 38% of hospitalizations were followed by a prescription fill for an evidence-based beta-blocker within 30 days, 12% were followed by prescription fills for at least 50% of the recommended dose of an evidence-based beta-blocker within 1 year, and 9% were followed by a prescription fill for an up-titrated dose of an evidence-based beta-blocker within 1 year. The prevalence of the contraindications were 21% for hypotension, 48% for COPD, 15% for asthma, and 12% for syncope. Among beneficiaries who did not fill a prescription for an evidence-based beta-blocker within 30 days, 67% had at least 1 of these contraindications. Hypotension, COPD, and syncope were each associated with a ∼10% lower risk of filling a prescription for an evidence-based beta-blocker. CONCLUSIONS Prescription fill and up-titration rates for evidence-based beta-blockers are low among Medicare beneficiaries with HFrEF, but contraindications explain only a minor part of these low rates.
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Affiliation(s)
- Matthew Shane Loop
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina.
| | | | - Ligong Chen
- Department of Epidemiology, University of Alabama, Birmingham, Alabama
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medical College, New York, New York
| | - Meredith L Kilgore
- Department of Health Care Organization and Policy, University of Alabama, Birmingham, Alabama
| | - Todd M Brown
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Alabama
| | - Raegan W Durant
- Division of Preventive Medicine, University of Alabama, Birmingham, Alabama
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama, Birmingham, Alabama
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Alkhatib NS, Ramos K, Slack M, Erstad B, Gharaibeh M, Klimecki W, Karnes JH, Sweitzer NK, Abraham I. Ex ante economic evaluation of genetic testing for the ARG389 beta1-adrenergic receptor polymorphism to support bucindolol treatment decisions in Stage III/IV heart failure. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2018. [DOI: 10.1080/23808993.2018.1526079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Nimer S. Alkhatib
- Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Kenneth Ramos
- Center for Applied Genetics and Genomic Medicine, University of Arizona, Tucson, AZ, USA
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Marion Slack
- Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Brian Erstad
- Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Mahdi Gharaibeh
- Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Walter Klimecki
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Jason H Karnes
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Nancy K. Sweitzer
- College of Medicine, University of Arizona, Tucson, AZ, USA
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, AZ, USA
- Center for Applied Genetics and Genomic Medicine, University of Arizona, Tucson, AZ, USA
- College of Medicine, University of Arizona, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
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D'Ascenzo F, Celentani D, Brustio A, Grosso A, Raposeiras-Roubín S, Abu-Assi E, Henriques JPS, Saucedo J, González-Juanatey JR, Wilton SB, Kikkert WJ, Nuñez-Gil I, Ariza-Sole A, Song X, Alexopoulos D, Liebetrau C, Kawaji T, Huczek Z, Nie SP, Fujii T, Correia L, Kawashiri MA, García-Acuña JM, Southern D, Alfonso E, Terol B, Garay A, Zhang D, Chen Y, Xanthopoulou I, Osman N, Möllmann H, Shiomi H, Kowara M, Filipiak K, Wang X, Yan Y, Fan JY, Ikari Y, Nakahayshi T, Sakata K, Yamagishi M, Kalpak O, Kedev S, Moretti C, D'Amico M, Gaita F. Association of Beta-Blockers with Survival on Patients Presenting with ACS Treated with PCI: A Propensity Score Analysis from the BleeMACS Registry. Am J Cardiovasc Drugs 2018; 18:299-309. [PMID: 29691803 DOI: 10.1007/s40256-018-0273-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE The aim was to evaluate prognostic value of beta-blocker (BB) administration in acute coronary syndromes (ACS) patients in the percutaneous coronary intervention (PCI) era. METHODS AND RESULTS The BleeMACS project is a multicenter, observational, retrospective registry enrolling patients with ACS worldwide in 15 hospitals. Patients discharged with BB therapy were compared to those discharged without a BB before and after propensity score with matching. The primary endpoint was all-cause mortality at 1 year. Secondary endpoints included in-hospital reinfarction, in-hospital heart failure, 1-year myocardial infarction, 1-year bleeding and 1-year composite of death and recurrent myocardial infarction. After matching, 2935 patients for each group were enrolled. The primary endpoint of 1-year death was significantly lower in the group on BB therapy (4.5 vs 7%, p < 0.05), while only a trend was noted for recurrent acute myocardial infarction (4.5 vs 4.9%, p = 0.54). These results were consistent for patients older than 80 years of age, for ST-elevation myocardial infarction (STEMI) patients, and for those discharged with complete versus incomplete revascularization, but not for non-STEMI/unstable angina patients. CONCLUSIONS BB therapy was related to 1-year lower risk of all-cause mortality, independently from completeness of revascularization, admission diagnosis, age and ejection fraction. Randomized controlled trials for patients treated with PCI for ACS should be performed.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy.
| | - Dario Celentani
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Brustio
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Alberto Grosso
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | | | | | | | | | | | | | | | | | | | - Xiantao Song
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | - Shao-Ping Nie
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | | | | | - Masa-Aki Kawashiri
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | | | | | | | | | | | - Dongfeng Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yalei Chen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Neriman Osman
- Kerckhoff Heart and Thorax Center, Frankfurt, Germany
| | | | | | | | | | - Xiao Wang
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yan Yan
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Jing-Yao Fan
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yuji Ikari
- Tokai University School of Medicine, Tokyo, Japan
| | - Takuya Nakahayshi
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenji Sakata
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Masakazu Yamagishi
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | | | - Sasko Kedev
- University Clinic of Cardiology, Skopje, Macedonia
| | - Claudio Moretti
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy
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Thaper A, Kulik A. Rationale for administering beta-blocker therapy to patients undergoing coronary artery bypass surgery: a systematic review. Expert Opin Drug Saf 2018; 17:805-813. [PMID: 30037300 DOI: 10.1080/14740338.2018.1504019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/20/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Secondary preventative therapies are essential for patients undergoing coronary artery bypass graft (CABG) surgery to optimize perioperative and long-term outcomes. Beta-blockers are commonly used to treat patients with coronary artery disease and congestive heart failure (CHF), but their role for CABG patients remains unclear. The goal of this systematic review was to evaluate the rationale for administering beta-blockers to the CABG population and to assess their efficacy before and after coronary surgical revascularization. AREAS COVERED A systematic literature review was performed to retrieve relevant articles from the PubMed database published between 1985 and 2017. EXPERT OPINION Outside of the surgical field, strong evidence supports the use of beta-blockers for patients with a history of previous myocardial infarction (MI) or CHF. For the CABG population, studies have suggested that perioperative beta-blocker therapy is beneficial, with an associated reduction in mortality, particularly among those with a history of previous MI or CHF. Beta-blocker administration has also clearly been shown to lower the rate of new-onset postoperative atrial fibrillation after CABG. Among the different types of beta-blockers, perioperative carvedilol appears to be the most beneficial. In the absence of contraindications, nearly all CABG patients are candidates for perioperative beta-blocker therapy.
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Affiliation(s)
- Arushi Thaper
- a Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, and Charles E. Schmidt College of Medicine , Florida Atlantic University , Boca Raton , FL , USA
| | - Alexander Kulik
- a Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, and Charles E. Schmidt College of Medicine , Florida Atlantic University , Boca Raton , FL , USA
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Al-Gobari M, Al-Aqeel S, Gueyffier F, Burnand B. Effectiveness of drug interventions to prevent sudden cardiac death in patients with heart failure and reduced ejection fraction: an overview of systematic reviews. BMJ Open 2018; 8:e021108. [PMID: 30056380 PMCID: PMC6067373 DOI: 10.1136/bmjopen-2017-021108] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To summarise and synthesise the current evidence regarding the effectiveness of drug interventions to prevent sudden cardiac death (SCD) and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). DESIGN Overview of systematic reviews. DATA SOURCES MEDLINE, Embase, ISI Web of Science and Cochrane Library from inception to May 2017; manual search of references of included studies for potentially relevant reviews. ELIGIBILITY CRITERIA FOR STUDY SELECTION We reviewed the effectiveness of drug interventions for SCD and all-cause mortality prevention in patients with HFrEF. We included overviews, systematic reviews and meta-analyses of randomised controlled trials of beta-blockers, angiotensin-converting enzyme inhibitors (ACE-i), angiotensin receptor blockers (ARBs), antialdosterones or mineralocorticoid-receptor antagonists, amiodarone, other antiarrhythmic drugs, combined ARB/neprilysin inhibitors, statins and fish oil supplementation. REVIEW METHODS Two independent reviewers extracted data and assessed the methodological quality of the reviews and the quality of evidence for the primary studies for each drug intervention, using Assessing the Methodological Quality of Systematic Reviews (AMSTAR) and Grading of Recommendations, Assessment, Development and Evaluation(GRADE), respectively. RESULTS We identified 41 reviews. Beta-blockers, antialdosterones and combined ARB/neprilysin inhibitors appeared effective to prevent SCD and all-cause mortality. ACE-i significantly reduced all-cause mortality but not SCD events. ARBs and statins were ineffective where antiarrhythmic drugs and omega-3 fatty acids had unclear evidence of effectiveness for prevention of SCD and all-cause mortality. CONCLUSIONS This comprehensive overview of systematic reviews confirms that beta-blockers, antialdosterone agents and combined ARB/neprilysin inhibitors are effective on SCD prevention but not ACE-i or ARBs. In patients with high risk of SCD, an alternative therapeutic strategy should be explored in future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2017: CRD42017067442.
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Affiliation(s)
- Muaamar Al-Gobari
- Institute of Social and Preventive Medicine (IUMSP), Cochrane Switzerland, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sinaa Al-Aqeel
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - François Gueyffier
- Laboratoire de Biologie et Biométrie Evolutive-Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Bernard Burnand
- Institute of Social and Preventive Medicine (IUMSP), Cochrane Switzerland, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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91
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Katsi V, Georgiopoulos G, Laina A, Koutli E, Parissis J, Tsioufis C, Nihoyannopoulos P, Tousoulis D. Left ventricular ejection fraction as therapeutic target: is it the ideal marker? Heart Fail Rev 2018; 22:641-655. [PMID: 28601914 DOI: 10.1007/s10741-017-9624-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) consists the fastest growing clinical cardiac disease. HF patients are categorized on the basis of underlying left ventricular ejection fraction (LVEF) into HF with preserved EF (HFpEF), reduced LVEF (HFrEF), and mid-range LVEF (HFmrEF). While LVEF is the most commonly used surrogate marker of left ventricular (LV) systolic function, the implementation of two-dimensional echocardiography in estimating this parameter imposes certain caveats on current HF classification. Most importantly, LVEF could fluctuate in repeated measurements or even recover after treatment, thus blunting the borders between proposed categories of HF and enabling upward classification of patients. Under this prism, we sought to summarize possible procedures to improve systolic function in patients with HFrEF either naturally or by the means of pharmacologic and non-pharmacologic treatment and devices. Therefore, we reviewed established pharmacotherapy, including beta-blockers, inhibitors of renin-angiotensin-aldosterone axis, statins, and digoxin as well as novel treatments like sacubitril-valsartan, ranolazine, and ivabradine. In addition, we assessed evidence in favor of cardiac resynchronization therapy and exercise training programs. Finally, innovative therapeutic strategies, including stem cells, xanthine oxidase inhibitors, antibiotic regimens, and omega-3 polyunsaturated fatty acids, were also taken into consideration. We concluded that LVEF is subject to changes in HF after intervention and besides the aforementioned HFrEF, HFpEF, and HFmrEF categories, a new entity of HF patients with recovered LVEF should be acknowledged. An improved global and refined LV function assessment by sophisticated imaging modalities and circulating biomarkers is expected to render HF classification more accurate and indicate patients with viable-yet dysfunctional-myocardium and favorable characteristics as the ideal candidates for LVEF recovery by individualized HF therapy.
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Affiliation(s)
- V Katsi
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - G Georgiopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece.
| | - A Laina
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - E Koutli
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - J Parissis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - C Tsioufis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - P Nihoyannopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - D Tousoulis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
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You SC, An MH, Yoon D, Ban GY, Yang PS, Yu HT, Park RW, Joung B. Rate control and clinical outcomes in patients with atrial fibrillation and obstructive lung disease. Heart Rhythm 2018; 15:1825-1832. [PMID: 30509364 DOI: 10.1016/j.hrthm.2018.06.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rate-control medications are considered first-line treatment for patients with atrial fibrillation (AF). However, obstructive lung disease (OLD), a condition prevalent in those with AF, often makes it difficult to use those medications because of the lack of studies on new-onset AF in patients with OLD. OBJECTIVE The purpose of this study was to investigate clinical outcomes after administration of each class of rate-control medication in patients with concomitant AF and OLD (AF-OLD). METHODS This study used the entire database provided by the National Health Insurance Service from 2002 to 2015. Risk of all-cause mortality was compared between use of calcium channel blocker (CCB) and use of other drug classes in AF-OLD patients using Cox regression analyses after propensity score matching. RESULTS Among the 13,111 patients, the number of AF-OLD patients treated with a CCB, cardioselective β-blocker (BB), nonselective BB, and digoxin was 2482, 2379, 2255, and 5995, respectively. The risk of mortality was lower with use of selective BB (hazard ratio [HR] 0.84; 95% confidence interval [CI] 0.75-0.94; P = .002) and nonselective BB (HR 0.85; 95% CI 0.77-0.95; P = .003) compared to use of CCBs. Digoxin use was related with worse survival, with marginal statistical significance (HR 1.09; 95% CI 1.00-1.18; P = .053). CONCLUSION Among patients with AF-OLD, rate-control treatment using selective and nonselective BB was associated with a significant reduction in mortality compared with CCB use. Further prospective randomized trials are required to confirm these findings.
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Affiliation(s)
- Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Korea
| | - Min Ho An
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Korea
| | - Dukyong Yoon
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Korea
| | - Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University Hospital, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Korea
| | - Pil-Sung Yang
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Tae Yu
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Korea; Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon-si, Gyeonggi-do, Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea.
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Hong J, Barry AR. Long-Term Beta-Blocker Therapy after Myocardial Infarction in the Reperfusion Era: A Systematic Review. Pharmacotherapy 2018; 38:546-554. [DOI: 10.1002/phar.2110] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jenny Hong
- Faculty of Pharmaceutical Sciences; University of British Columbia; Vancouver British Columbia Canada
| | - Arden R. Barry
- Faculty of Pharmaceutical Sciences; University of British Columbia; Vancouver British Columbia Canada
- Chilliwack General Hospital; Lower Mainland Pharmacy Services; Chilliwack British Columbia Canada
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Castaldo C, Chimenti I. Cardiac Progenitor Cells: The Matrix Has You. Stem Cells Transl Med 2018; 7:506-510. [PMID: 29688622 PMCID: PMC6052608 DOI: 10.1002/sctm.18-0023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/27/2018] [Indexed: 12/14/2022] Open
Abstract
Components of the cardiac extracellular matrix (ECM) are synthesized by residing cells and are continuously remodeled by them. Conversely, residing cells (including primitive cells) receive constant biochemical and mechanical signals from the ECM that modulate their biology. The pathological progression of heart failure affects all residing cells, inevitably causing profound changes in ECM composition and architecture that, in turn, impact on cell phenotypes. Any regenerative medicine approach must aim at sustaining microenvironment conditions that favor cardiogenic commitment of therapeutic cells and minimize pro‐fibrotic signals, while conversely boosting the capacity of therapeutic cells to counteract adverse remodeling of the ECM. In this Perspective article, we discuss multiple issues about the features of an optimal scaffold for supporting cardiac tissue engineering strategies with cardiac progenitor cells, and, conversely, about the possible antifibrotic mechanisms induced by cell therapy. Stem Cells Translational Medicine2018;7:506–510
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Affiliation(s)
- Clotilde Castaldo
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Isotta Chimenti
- Department of Medical Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Latina, Italy
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96
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A physician targeted intervention improves prescribing in chronic heart failure in general medical units. BMC Health Serv Res 2018; 18:206. [PMID: 29566753 PMCID: PMC5865296 DOI: 10.1186/s12913-018-3009-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/15/2018] [Indexed: 01/19/2023] Open
Abstract
Background Despite strong evidence for beta-blockers and angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in chronic heart failure (CHF), they have been under-utilised especially in general medical units. We aim to evaluate the effectiveness and feasibility of a physician-targeted quality improvement intervention with education and feedback on the prescription of beta-blockers and ACEI/ARB for CHF management in an inpatient setting. Methods We conducted an interrupted time series study between January 2009 and February 2012. A two-stage intervention was implemented. Between November 2009 and January 2011, a structured physician-oriented education program was undertaken. From February 2011, quarterly performance feedback was provided to each medical unit by a senior clinician. Medical notes of patients admitted with CHF under general medical units before and during the intervention were prospectively audited. Main outcomes were beta-blockers and ACEI/ARB prescription rates, and 180-day readmission rates for CHF. Results Four hundred and sixty-eight patients were included in this study. Structured education program was associated with a significant rise in beta-blockers prescription rates from a baseline of 60 to 92% (p = 0.003), but a non-sustained rise in ACEI/ARB prescription. Regular performance feedback resulted in a further sustained increase in ACEI/ARB prescription rates from 62 to 93% (p = 0.028) and a positive trend for beta-blockers with rates maintained at 89%. There was a reduction in 180-day readmission rates that correlated with the improvements in beta-blocker (p = 0.030) and ACEI/ARB (p = 0.035) prescription. Conclusion Implementation of a structured education program with regular performance feedback was durable and was associated with improvements in appropriate prescribing and an observed decrease in CHF-related readmissions.
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Savarese G, Orsini N, Hage C, Vedin O, Cosentino F, Rosano GMC, Dahlström U, Lund LH. Utilizing NT-proBNP for Eligibility and Enrichment in Trials in HFpEF, HFmrEF, and HFrEF. JACC-HEART FAILURE 2018; 6:246-256. [PMID: 29428439 DOI: 10.1016/j.jchf.2017.12.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiovascular (CV) versus non-CV events and between NT-proBNP and potential treatment effects in heart failure (HF) with preserved, mid-range, and reduced ejection fraction (HFpEF, HFmrEF, and HFrEF, respectively) and clinically relevant subgroups. BACKGROUND Optimizing patient eligibility criteria in HF trials requires biomarkers that enrich for CV but not for non-CV events and select patients most likely to respond to the tested intervention. METHODS In the Swedish HF registry population stratified by EF category, we used Kaplan-Meier curves to estimate unadjusted CV and non-CV risks (mortality or hospitalization); Poisson regressions to calculate crude event rates of CV and non-CV events according to NT-proBNP levels; and Cox regressions to calculate the adjusted hazard ratios for HF therapies according to NT-proBNP ≤ or > median. RESULTS In a cohort of 15,849 patients (23% HFpEF, 21% HFmrEF, 56% HFrEF), median NT-proBNP was 2,037, 2,192, and 3,141 pg/ml, respectively. With increasing NT-proBNP, CV event rates increased more steeply than non-CV rates (range 20 to 160 and 30 to 100 per 100 patient-years in HFpEF; 20 to 130 and 20 to 100 in HFmrEF; and 20 to 110 and 20 to 50 in HFrEF, respectively). The CV-to-non-CV ratio increased with increasing NT-proBNP in HFpEF and HFrEF, but only in the lower range in HFmrEF. The association between treatments (e.g., angiotensin-converting enzyme-inhibitor, angiotensin II receptor blockers, and beta-blockers) and outcomes was consistent in NT-proBNP ≤ and > median. CONCLUSIONS In HF trial design in different EF categories, NT-proBNP may be a useful tool for eligibility and enrichment for CV events, but its role in predicting a potential treatment response remains unclear.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Nicola Orsini
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Hage
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ola Vedin
- Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Francesco Cosentino
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Giuseppe M C Rosano
- Cardiovascular and Cell Sciences Research Institute, St. George's University, London, United Kingdom; Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana, Rome, Italy
| | - Ulf Dahlström
- Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
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98
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Machuki J, Zhang H, Harding S, Sun H. Molecular pathways of oestrogen receptors and β-adrenergic receptors in cardiac cells: Recognition of their similarities, interactions and therapeutic value. Acta Physiol (Oxf) 2018; 222. [PMID: 28994249 PMCID: PMC5813217 DOI: 10.1111/apha.12978] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/07/2017] [Accepted: 10/02/2017] [Indexed: 12/18/2022]
Abstract
Oestrogen receptors (ERs) and β-adrenergic receptors (βARs) play important roles in the cardiovascular system. Moreover, these receptors are expressed in cardiac myocytes and vascular tissues. Numerous experimental observations support the hypothesis that similarities and interactions exist between the signalling pathways of ERs (ERα, ERβ and GPR30) and βARs (β1 AR, β2 AR and β3 AR). The recently discovered oestrogen receptor GPR30 shares structural features with the βARs, and this forms the basis for the interactions and functional overlap. GPR30 possesses protein kinase A (PKA) phosphorylation sites and PDZ binding motifs and interacts with A-kinase anchoring protein 5 (AKAP5), all of which enable its interaction with the βAR pathways. The interactions between ERs and βARs occur downstream of the G-protein-coupled receptor, through the Gαs and Gαi proteins. This review presents an up-to-date description of ERs and βARs and demonstrates functional synergism and interactions among these receptors in cardiac cells. We explore their signalling cascades and the mechanisms that orchestrate their interactions and propose new perspectives on the signalling patterns for the GPR30 based on its structural resemblance to the βARs. In addition, we explore the relevance of these interactions to cell physiology, drugs (especially β-blockers and calcium channel blockers) and cardioprotection. Furthermore, a receptor-independent mechanism for oestrogen and its influence on the expression of βARs and calcium-handling proteins are discussed. Finally, we highlight promising therapeutic avenues that can be derived from the shared pathways, especially the phosphatidylinositol-3-OH kinase (PI3K/Akt) pathway.
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Affiliation(s)
- J.O. Machuki
- Department of Physiology; Xuzhou Medical University; Xuzhou China
| | - H.Y. Zhang
- Department of Physiology; Xuzhou Medical University; Xuzhou China
| | - S.E. Harding
- National Heart and Lung Institute; Imperial College; London UK
| | - H. Sun
- Department of Physiology; Xuzhou Medical University; Xuzhou China
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99
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Liappas G, González-Mateo G, Aguirre AR, Abensur H, Albar-Vizcaino P, Parra EG, Sandoval P, Ramírez LG, Del Peso G, Acedo JM, Bajo MA, Selgas R, Sánchez Tomero JA, López-Cabrera M, Aguilera A. Nebivolol, a β1-adrenergic blocker, protects from peritoneal membrane damage induced during peritoneal dialysis. Oncotarget 2017; 7:30133-46. [PMID: 27102153 PMCID: PMC5058669 DOI: 10.18632/oncotarget.8780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 03/31/2016] [Indexed: 01/26/2023] Open
Abstract
Peritoneal dialysis (PD) is a form of renal replacement treatment, which employs the peritoneal membrane (PM) to eliminate toxins that cannot be removed by the kidney. The procedure itself, however, contributes to the loss of the PM ultrafiltration capacity (UFC), leading consequently to the technique malfunction. β-blockers have been considered deleterious for PM due to their association with loss of UFC and induction of fibrosis. Herein we analyzed the effects of Nebivolol, a new generation of β1-blocker, on PM alterations induced by PD fluids (PDF). In vitro: We found that mesothelial cells (MCs) express β1-adrenergic receptor. MCs were treated with TGF-β to induce mesothelial-to-mesenchymal transition (MMT) and co-treated with Nebivolol. Nebivolol reversed the TGF-β effects, decreasing extracellular matrix synthesis, and improved the fibrinolytic capacity, decreasing plasminogen activator inhibitor-1 (PAI-1) and increasing tissue-type plasminogen activator (tPA) supernatant levels. Moreover, Nebivolol partially inhibited MMT and decreased vascular endothelial growth factor (VEGF) and IL-6 levels in supernatants. In vivo: Twenty-one C57BL/6 mice were divided into 3 groups. Control group carried a catheter without PDF infusion. Study group received intraperitoneally PDF and oral Nebivolol during 30 days. PDF group received PDF alone. Nebivolol maintained the UFC and reduced PM thickness, MMT and angiogenesis promoted by PDF. It also improved the fibrinolytic capacity in PD effluents decreasing PAI-1 and IL-8 and increased tPA levels. Conclusion: Nebivolol protects PM from PDF-induced damage, promoting anti-fibrotic, anti-angiogenic, anti-inflammatory and pro-fibrinolytic effects.
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Affiliation(s)
- Georgios Liappas
- Immunology and Cellular Biology Department, Molecular Biology Centre Severo Ochoa, Madrid, Spain
| | - Guadalupe González-Mateo
- Immunology and Cellular Biology Department, Molecular Biology Centre Severo Ochoa, Madrid, Spain
| | - Anna Rita Aguirre
- Nephrology Department, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil
| | - Hugo Abensur
- Nephrology Department, University of Sao Paulo, School of Medicine, Sao Paulo, Brazil
| | - Patricia Albar-Vizcaino
- Molecular Biology Unit and Nephrology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Emilio González Parra
- Nephrology Department, Fundación Jiménez-Díaz, Instituto de Investigación Sanitaria, Madrid, Spain
| | - Pilar Sandoval
- Immunology and Cellular Biology Department, Molecular Biology Centre Severo Ochoa, Madrid, Spain
| | - Laura García Ramírez
- Molecular Biology Unit and Nephrology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Gloria Del Peso
- Nephrology Department, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | - María A Bajo
- Nephrology Department, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Rafael Selgas
- Nephrology Department, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - José A Sánchez Tomero
- Molecular Biology Unit and Nephrology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
| | - Manuel López-Cabrera
- Immunology and Cellular Biology Department, Molecular Biology Centre Severo Ochoa, Madrid, Spain
| | - Abelardo Aguilera
- Molecular Biology Unit and Nephrology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain
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100
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Safi S, Korang SK, Nielsen EE, Sethi NJ, Feinberg J, Gluud C, Jakobsen JC. Beta-blockers for heart failure. Hippokratia 2017. [DOI: 10.1002/14651858.cd012897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Sanam Safi
- Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Steven Kwasi Korang
- Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Emil Eik Nielsen
- Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Naqash J Sethi
- Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Joshua Feinberg
- Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Denmark DK-2100
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Denmark DK-2100
- Holbaek Hospital; Department of Cardiology; Holbaek Denmark 4300
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