2801
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Stanek KM, Gunstad J, Paul RH, Poppas A, Jefferson AL, Sweet LH, Hoth KF, Haley AP, Forman DE, Cohen RA. Longitudinal cognitive performance in older adults with cardiovascular disease: evidence for improvement in heart failure. J Cardiovasc Nurs 2009; 24:192-7. [PMID: 19390336 PMCID: PMC2700621 DOI: 10.1097/jcn.0b013e31819b54de] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and particularly heart failure (HF) have been associated with cognitive impairment in cross-sectional studies, but it is unclear how cognitive impairment progresses over time in older adults with these conditions. OBJECTIVE The aim of this study was to prospectively examine cognitive function in patients with HF versus other forms of CVD. METHOD Seventy-five older adults (aged 53-84 years) with CVD underwent Doppler echocardiogram to evaluate cardiac status and 2 administrations of the Dementia Rating Scale (DRS), a test of global cognitive functioning, 12 months apart. RESULTS Although DRS performance did not statistically differ between groups at either administration, a significant between-group difference in the rate of cognitive change emerged (lambda = 0.87; F = 10.50; P = .002; omega 2 = 0.11). Follow-up analyses revealed that patients with HF improved significantly on global DRS performance, whereas patients with other forms of CVD remained stable. More specifically, patients with HF showed improvement on subscales of attention, initiation/perseveration, and conceptualization. Exploratory analyses indicated that higher diastolic blood pressure at baseline was associated with improved DRS performance in patients with HF (r = 0.38; P = .02). CONCLUSIONS Patients with HF exhibited modest cognitive improvements during 12 months, particularly in attention and executive functioning. Higher diastolic blood pressure at baseline was associated with improvement. These results suggest that cognitive impairment in patients with HF may be modifiable and that improved blood pressure control may be an important contributor to improved function. Further prospective studies are needed to replicate results and determine underlying mechanisms.
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Affiliation(s)
- Kelly M Stanek
- Department of Psychology, Kent State University, Kent, Ohio 44242, USA.
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2802
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Setoguchi S, Nohria A, Rassen JA, Stevenson LW, Schneeweiss S. Maximum potential benefit of implantable defibrillators in preventing sudden death after hospital admission because of heart failure. CMAJ 2009; 180:611-6. [PMID: 19289804 DOI: 10.1503/cmaj.080769] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Implantable defibrillators are recommended for the prevention of sudden cardiac death in patients with heart failure. However, criteria to identify those who would benefit most from this therapy are lacking. We assessed the maximum potential benefit of preventing sudden death in patients with repeated hospital admissions because of heart failure. METHODS Using a cohort assembled from an administrative database, we identified 14,374 patients admitted to hospital for the first time because of heart failure between Jan. 1, 2000, and Dec. 31, 2004. We followed subsequent admissions related to heart failure as well as mortality and causes of death to Mar. 31, 2006. We regarded all out-of-hospital cardiac deaths as sudden deaths. We calculated the maximum potential benefit of preventing sudden death by subtracting the observed survival after each hospital admission from the hypothetical survival whereby all out-of-hospital cardiac deaths were assumed to be preventable. RESULTS The mean age of the cohort was 77 years, 45% were women, 11% had cerebrovascular disease, and 21% had chronic kidney disease. Out-of-hospital cardiac deaths constituted 13.7% (1226/8967) of all deaths during 32,055 person-years of follow-up. The median survival declined with each subsequent hospital admission related to heart failure. The hypothetical prevention of all out-of-hospital deaths prolonged life by 0.63 (95% confidence interval [CI] 0.49 to 0.77) years after the first hospital admission. This potential benefit dropped to 0.28 (95% CI 0.10 to 0.46) years after 3 hospital admissions related to heart failure. Among patients less than 65 years old, and older patients without kidney disease, dementia or cancer, more than 50% survived longer than 2 years until they had 2 or 3 hospital admissions related to heart failure. INTERPRETATION The use of implantable defibrillators to prevent sudden death would provide limited benefit among older patients with comorbidities and among patients with multiple hospital admissions related to heart failure.
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Affiliation(s)
- Soko Setoguchi
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02130, USA.
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2803
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The use of echocardiography in predicting heart failure in patients with coronary artery disease. Curr Cardiol Rep 2009; 11:155-6. [PMID: 19379634 DOI: 10.1007/s11886-009-0023-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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2804
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Donal E, Lund LH, Linde C, Edner M, Lafitte S, Persson H, Bauer F, Ohrvik J, Ennezat PV, Hage C, Löfman I, Juilliere Y, Logeart D, Derumeaux G, Gueret P, Daubert JC. Rationale and design of the Karolinska-Rennes (KaRen) prospective study of dyssynchrony in heart failure with preserved ejection fraction. Eur J Heart Fail 2009; 11:198-204. [PMID: 19168519 DOI: 10.1093/eurjhf/hfn025] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFPEF) is common but not well understood. Electrical dyssynchrony in systolic heart failure is harmful. Little is known about the prevalence and the prognostic impact of dyssynchrony in HFPEF. METHODS AND RESULTS We have designed a prospective, multicenter, international, observational study to characterize HFPEF and to determine whether electrical or mechanical dyssynchrony affects prognosis. Patients presenting with acute heart failure (HF) will be screened so as to identify 400 patients with HFPEF. Inclusion criteria will be: acute presentation with Framingham criteria for HF, left ventricular ejection fraction>or=45%, brain natriuretic peptide (BNP)>100 pg/mL or NT-proBNP>300 pg/mL. Once stabilized, 4-8 weeks after the index presentation, patients will return and undergo questionnaires, serology, ECG, and Doppler echocardiography. Thereafter, patients will be followed for mortality and HF hospitalization every 6 months for at least 18 months. Sub-studies will focus on echocardiographic changes from the acute presentation to the stable condition and on exercise echocardiography, cardiopulmonary exercise testing, and serological markers. CONCLUSION KaRen aims to characterize electrical and mechanical dyssynchrony and to assess its prognostic impact in HFPEF. The results might improve our understanding of HFPEF and generate answers to the question whether dyssynchrony could be a target for therapy in HFPEF.
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Affiliation(s)
- Erwan Donal
- Cardiology, CHU Pontchaillou, 35033 Rennes, France.
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2805
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Clinical features and prognosis of heart failure in women. A 5-year prospective study. Int J Cardiol 2009; 133:327-35. [DOI: 10.1016/j.ijcard.2007.12.113] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 11/12/2007] [Accepted: 12/16/2007] [Indexed: 11/16/2022]
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2806
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Costantino G, Rusconi AM, Duca PG, Guzzetti S, Bossi I, Del Medico M, Pisano G, Bulgheroni M, Solbiati M, Furlan R, Montano N. Eligibility criteria in heart failure randomized controlled trials: a gap between evidence and clinical practice. Intern Emerg Med 2009; 4:117-22. [PMID: 18690492 DOI: 10.1007/s11739-008-0180-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 07/08/2008] [Indexed: 01/06/2023]
Abstract
The aim of the present study was to compare the characteristics of patients referred to our heart failure outpatient clinic with those of patients enrolled in clinical trials on heart failure pharmacological treatment. Thus, we estimated the proportion of patients admitted to our heart failure outpatient clinic who would have been included in randomized controlled trials evaluating the effects of medical treatments on heart failure mortality, published over a 10 years period (1993-2003). Sixteen studies (n = 45276) and 299 consecutive outpatients, were included. On average, only 34% of the outpatients would have been included in at least one of the 16 trials (8-71%). The main reasons for exclusion were: NYHA class (70% were in NYHA class II), ejection fraction (29% had EF > 35%), co-morbidity (51% had co-morbidity, mainly renal failure, COPD, and disthyroidism), age (22% were older than 80 years), and occurrence of a recent acute event (50% experienced an ischemic coronary syndrome, revascularization, pulmonary edema, or stroke in the prior 6 months). These results underline the crucial role of patient selection in clinical trials, raising uncertainties about the complete applicability of trial results to clinical practice.
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Affiliation(s)
- Giorgio Costantino
- Division of Internal Medicine II, L. Sacco Hospital, University of Milan, Via GB Grassi 74, Milan, Italy.
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2807
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Tzanetos K, Leong D, Wu RC. Office management of patients with diastolic heart failure. CMAJ 2009; 180:520-7. [PMID: 19255076 DOI: 10.1503/cmaj.081048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Katina Tzanetos
- Department of Medicine, Division of General Internal Medicine, University Health Network, University of Toronto, Toronto, Ontario
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2808
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2809
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Amato JL, Amato JL. Irbesartan for heart failure with preserved ejection fraction. N Engl J Med 2009; 360:1256-7; author reply 1258-9. [PMID: 19297582 DOI: 10.1056/nejmc082716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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2810
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Abstract
Despite advances in management of heart failure, the condition remains a major public-health issue, with high prevalence, poor clinical outcomes, and large health-care costs. Risk factors are well known and, thus, preventive strategies should have a positive effect on disease burden. Treatment of established systolic chronic heart failure includes use of agents that block the renin-angiotensin-aldosterone and sympathetic nervous systems to prevent adverse remodelling, to reduce symptoms and prolong survival. Diuretics are used to achieve and maintain euvolaemia. Devices have a key role in management of advanced heart failure and include cardiac resynchronisation in patients with evidence of cardiac dyssynchrony and implantation of a cardioverter defibrillator in individuals with low ejection fraction. Approaches for treatment of acute heart failure and heart failure with preserved ejection fraction are supported by little clinical evidence. Emerging strategies for heart failure management include individualisation of treatment, novel approaches to diagnosis and tracking of therapeutic response, pharmacological agents aimed at new targets, and cell-based and gene-based methods for cardiac regeneration.
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Affiliation(s)
- Henry Krum
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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2811
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Enhancement of the endothelial NO synthase attenuates experimental diastolic heart failure. Basic Res Cardiol 2009; 104:499-509. [PMID: 19255799 DOI: 10.1007/s00395-009-0014-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Revised: 02/03/2009] [Accepted: 02/04/2009] [Indexed: 01/04/2023]
Abstract
BACKGROUND Diastolic heart failure is a rising problem with a high incidence and similar mortality and morbidity compared to patients with systolic heart failure. Nevertheless, the underlying pathophysiology is still debated. AIM We investigated the effect of pharmacological enhancement of endothelial nitric oxide synthase (eNOS) on experimental diastolic heart failure (DHF). METHODS DHF was induced in 60 DAHL salt-sensitive rats by salt diet in 8-week-old animals. 30 were treated with the eNOS enhancer AVE3085 (DHFeNOS) and 30 with placebo (DHF). Rats with normal salt intake served as controls. RESULTS AND CONCLUSION Diastolic dysfunction with increased diastolic stiffness constant and increased left ventricular (LV) pressure was analyzed by invasive pressure-volume loop measurements in the DHF group compared to controls. Cardiac hypertrophy as indicated by LV mass measurements by echocardiography, and increased cardiac collagen content as measured by immunohistochemistry were associated with an increased activation state of calcineurin, AKT, ERK(1/2), but not JNK and p38 kinases. Titin isoforms were not altered in this model of DHF. Treatment with AVE3085 significantly increased eNOS mRNA and protein levels in the cardiac tissue and decreases NAD(P)H oxidase subunits p22phox and gp91phox. Diastolic dysfunction was attenuated and cardiac hypertrophy and fibrosis were improved in comparison with untreated DHF animals. This was associated with a normalized activation state of calcineurin, AKT and ERK(1/2). Therefore, we suggest that targeting the NO system might yield a future therapeutic aim for the treatment of DHF.
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2812
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Solal AC, Tournoux F, Beauvais F, Tartiere JM. Comment évaluer et traiter l’insuffisance cardiaque à fraction d’éjection préservée. Therapie 2009; 64:101-9. [DOI: 10.2515/therapie/2009012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/14/2008] [Accepted: 12/06/2008] [Indexed: 11/20/2022]
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2813
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Maeder MT, Kaye DM. Heart Failure With Normal Left Ventricular Ejection Fraction. J Am Coll Cardiol 2009; 53:905-18. [DOI: 10.1016/j.jacc.2008.12.007] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 12/02/2008] [Accepted: 12/08/2008] [Indexed: 10/21/2022]
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2814
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2815
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Ly D, Alex FZ, Christopher H. Cost Effectiveness Analysis of a Hypertension Management Program in Patients With Type 2 Diabetes. J Clin Hypertens (Greenwich) 2009; 11:116-24. [DOI: 10.1111/j.1751-7176.2009.00082.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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2816
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Rubinshtein R, Glockner JF, Feng D, Araoz PA, Kirsch J, Syed IS, Oh JK. Comparison of magnetic resonance imaging versus Doppler echocardiography for the evaluation of left ventricular diastolic function in patients with cardiac amyloidosis. Am J Cardiol 2009; 103:718-23. [PMID: 19231340 DOI: 10.1016/j.amjcard.2008.10.039] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 10/24/2008] [Accepted: 10/24/2008] [Indexed: 11/29/2022]
Abstract
To assess the role of magnetic resonance imaging (MRI) in the assessment of diastolic function, diastolic mitral inflow parameters using MRI and transthoracic Doppler echocardiography (echocardiography) were compared in patients with cardiac amyloidosis. Thirty-eight patients (age 60 +/- 12 years; 32% women) in sinus rhythm with cardiac amyloidosis (biopsy-proven systemic amyloidosis and positive echocardiographic and contrast-enhanced cardiac MRI findings) were evaluated. Cine phase-contrast MRI images of mitral inflow were obtained in the left ventricle to quantify diastolic blood flow. MRI measurements of diastolic parameters were compared (Spearman's rank correlation) with echocardiographic diastolic mitral inflow velocity parameters. Additional analysis was performed comparing MRI findings in patients with a restrictive echocardiographic diastolic filling pattern (n = 23) versus those without (n = 15). For the 38 patients, early diastolic (E) peak velocity was 61 +/- 26 cm/s using MRI versus 79 +/- 21 using echocardiography (Spearman's rank correlation 0.55, p = 0.0004), and late diastolic (A) peak velocity was 46 +/- 22 cm/s using MRI versus 47 +/- 22 cm/s using echocardiography (Spearman's rank correlation 0.54, p = 0.0005). E/A ratio was 1.55 +/- 0.9 using MRI and 2.25 +/- 1.4 using echocardiography (Spearman's rank correlation 0.75, p <0.0001). Deceleration times in both modalities showed good correlation (MRI, 180 +/- 44 ms vs echocardiography, 179 +/- 49; Spearman's rank correlation 0.61, p = 0.0001). MRI E/A ratio for peak velocities was significantly higher in patients with restrictive echocardiographic patterns (1.95 +/- 1.0) versus those without (0.93 +/- 0.3; p = 0.0003). Two of 23 patients with a restrictive echocardiographic pattern had an MRI E/A ratio <1. In conclusion, mitral inflow peak velocities, deceleration times, and E/A ratios detected using phase-contrast MRI in patients with cardiac amyloidosis showed moderately good correlation with echocardiography and identified most patients with restrictive echocardiographic patterns.
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Affiliation(s)
- Ronen Rubinshtein
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
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2817
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Clinical variables affecting survival in patients with decompensated diastolic versus systolic heart failure. Clin Res Cardiol 2009; 98:224-32. [DOI: 10.1007/s00392-009-0746-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 01/08/2009] [Indexed: 10/21/2022]
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2818
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Shyu KG. Serotonin 5-HT2B receptor in cardiac fibroblast contributes to cardiac hypertrophy: a new therapeutic target for heart failure? Circ Res 2009; 104:1-3. [PMID: 19118279 DOI: 10.1161/circresaha.108.191122] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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2819
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Duygu H, Akman L, Ozerkan F, Akercan F, Zoghi M, Nalbantgil S, Erturk U, Akilli A, Onder R, Akin M. Comparison of the effects of new and conventional hormone replacement therapies on left ventricular diastolic function in healthy postmenopausal women: a Doppler and ultrasonic backscatter study. Int J Cardiovasc Imaging 2009; 25:387-96. [DOI: 10.1007/s10554-009-9429-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 01/09/2009] [Indexed: 11/28/2022]
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2820
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Liang CS, Delehanty JD. Increasing post-myocardial infarction heart failure incidence in elderly patients a call for action. J Am Coll Cardiol 2009; 53:21-3. [PMID: 19118719 DOI: 10.1016/j.jacc.2008.09.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
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2821
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Reply. J Am Coll Cardiol 2009. [DOI: 10.1016/j.jacc.2008.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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2822
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Rusinaru D, Buiciuc O, Leborgne L, Slama M, Massy Z, Tribouilloy C. Relation of serum sodium level to long-term outcome after a first hospitalization for heart failure with preserved ejection fraction. Am J Cardiol 2009; 103:405-10. [PMID: 19166698 DOI: 10.1016/j.amjcard.2008.09.091] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 09/16/2008] [Accepted: 09/16/2008] [Indexed: 11/25/2022]
Abstract
Hyponatremia is a predictor of adverse short-term outcomes in patients with acute heart failure (HF). The impact of hyponatremia on long-term survival in patients with HF with preserved ejection fraction (HFPEF) has not been evaluated. Our aim was to prospectively assess the impact of baseline natremia and changes in sodium level during hospitalization on 7-year outcome in 358 patients surviving a first hospitalization for HFPEF. On admission, hyponatremia (sodium <136 mEq/L) was diagnosed in 91 patients (25.4%). Baseline hyponatremia was associated with an increased risk of overall (hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.50 to 2.61) and cardiovascular mortality (HR 1.92, 95% CI 1.36 to 2.73). After adjustment for covariates, the relations remained significant. Seven-year relative survival (observed/expected survival) of hyponatremic patients was lower than that of patients with normal baseline natremia (31% vs 63%). The association of sodium and risk of death appeared linear across quartiles of baseline natremia and slightly stronger at the lowest of sodium values. At discharge, 45 patients with low baseline sodium had normal natremia (49%) and 46 had persistent hyponatremia (51%). Patients with normalized natremia at discharge had excess 7-year overall mortality compared with the normonatremic group (HR 1.50, 95% CI 1.03 to 2.19). Patients with persistent hyponatremia had the lowest 7-year survival (HR 2.67, 95% CI 1.89 to 3.78). After adjustment for covariates, patients with persistent hyponatremia had an impressive increase in relative risk of overall mortality compared with patients with normal baseline natremia. In conclusion, hyponatremia is a powerful predictor of long-term mortality in patients with HFPEF. Patients with HFPEF and persistent hyponatremia are at high risk of adverse outcomes.
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2823
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Sorrell VL, Kalra N, Ramaraj R. Impact of Diastolic Dysfunction on Heart Failure-Related Hospitalizations. J Am Coll Cardiol 2009; 53:457; author reply 457-8. [DOI: 10.1016/j.jacc.2008.09.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 09/12/2008] [Accepted: 09/16/2008] [Indexed: 11/25/2022]
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2824
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Takeda Y, Sakata Y, Higashimori M, Mano T, Nishio M, Ohtani T, Hori M, Masuyama T, Kaneko M, Yamamoto K. Noninvasive Assessment of Wall Distensibility With the Evaluation of Diastolic Epicardial Movement. J Card Fail 2009; 15:68-77. [DOI: 10.1016/j.cardfail.2008.09.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 07/14/2008] [Accepted: 09/12/2008] [Indexed: 10/21/2022]
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2825
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de Groote P, Isnard R, Clerson P, Jondeau G, Galinier M, Assyag P, Demil N, Ducardonnet A, Thebaut JF, Komajda M. Improvement in the management of chronic heart failure since the publication of the updated guidelines of the European Society of Cardiology. Eur J Heart Fail 2009; 11:85-91. [DOI: 10.1093/eurjhf/hfn005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pascal de Groote
- Pôle de Cardiologie et Maladies Vasculaires; CHRU de Lille, Université de Lille 2; France
| | - Richard Isnard
- Department of Cardiology; Université Pierre et Marie Curie-Paris VI, AP-HP, Pitie Salpetriere Hospital; 75651 Paris Cedex 13 France
| | | | - Guillaume Jondeau
- Service de Cardiologie, Hôpital Bichat, AP-HP; Université Denis Diderot, Paris VII; Paris France
| | - Michel Galinier
- Fédération des Services de Cardiologie, CHU Rangueil; Toulouse France
| | - Patrick Assyag
- Services de Cardiologie; Hôpital Saint Antoine; Paris France
| | | | | | | | - Michel Komajda
- Department of Cardiology; Université Pierre et Marie Curie-Paris VI, AP-HP, Pitie Salpetriere Hospital; 75651 Paris Cedex 13 France
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2826
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Jhund PS, Macintyre K, Simpson CR, Lewsey JD, Stewart S, Redpath A, Chalmers JWT, Capewell S, McMurray JJV. Long-term trends in first hospitalization for heart failure and subsequent survival between 1986 and 2003: a population study of 5.1 million people. Circulation 2009; 119:515-23. [PMID: 19153268 DOI: 10.1161/circulationaha.108.812172] [Citation(s) in RCA: 397] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We examined whether population-level hospitalization rates for heart failure (HF) and subsequent survival have continued to improve since the turn of the century. We also examined trends in the prescribing of evidence-based pharmacological treatment for HF. METHODS AND RESULTS All patients in Scotland hospitalized with a first episode of HF between 1986 and 2003 were followed up until death or the end of 2004. Prescriptions of evidence-based treatments issued from 1997 to 2003 by a sample of primary care practices were also examined. A total of 116 556 individuals (52.6% women) had a first hospital discharge for HF. Age-adjusted first hospitalization rates for HF (per 100 000; 95% CI in parentheses) rose from 124 (119 to 129) in 1986 to 162 (157 to 168) in 1994 and then fell to 105 (101 to 109) in 2003 in men; in women, they rose from 128 (123 to 132) in 1986 to 160 (155 to 165) in 1993, falling to 101 (97 to 105) in 2003. Case-fatality rates fell steadily over the period. Adjusted 30-day case-fatality rates fell after discharge (adjusted odds [2003 versus 1986] 0.59 [95% CI 0.45 to 0.63] in men and 0.77 [95% CI 0.67 to 0.88] in women). Adjusted 1- and 5-year survival improved similarly. Median survival increased from 1.33 to 2.34 years in men and from 1.32 to 1.79 years in women. Age-adjusted prescribing rates for angiotensin-converting enzyme inhibitors, beta-blockers, and spironolactone increased from 1997 to 2003 (all P<0.0001 for trend). CONCLUSIONS After rising between 1986 and 1994, rates of first hospitalization for HF declined. Case-fatality rates also fell. Prescribing rates for HF therapies increased from 1997 to 2003. These findings suggest that improvements in the prevention and treatment of HF may have had progressive, sustained effects on outcomes at the population level; however, prognosis remains poor in HF.
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Affiliation(s)
- Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, United Kingdom
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2827
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Borlaug BA. Treatment of heart failure with preserved ejection fraction. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2009; 11:79-87. [DOI: 10.1007/s11936-009-0009-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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2828
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Ong HS, Sze CWC, Koh TW, Coppack SW. How 40 kilograms of fluid retention can be overlooked: two case reports. CASES JOURNAL 2009; 2:33. [PMID: 19133159 PMCID: PMC2628868 DOI: 10.1186/1757-1626-2-33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 01/08/2009] [Indexed: 11/10/2022]
Abstract
INTRODUCTION With a rising incidence of severe obesity in developed nations, heart failure, a well-recognised co-morbidity, is becoming more common. CASE PRESENTATION We describe two recent patients encountered, a 64 year old and a 42 year old, who are both severely obese and presented with fluid retention of approximately 40 kilograms. Assessment revealed that the explanation of the gross clinical features were relatively subtle cardiac abnormalities. These cases illustrate how fluid retention in severe obesity can differ from that seen in 'traditional' heart failure in terms of clinical assessment and management. CONCLUSION Severe obesity can result in insidious fluid retention, which can be easily overlooked until large volumes of fluid have accumulated. Cardiac abnormalities are usually found in these patients, but may be relatively subtle, leading to current debate in the definition and classification of heart failure. These scenarios are increasingly being encountered in clinical practice. Recognition, assessment and treatment of the 'clinical syndrome of heart failure' in severe obesity is often difficult.
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Affiliation(s)
- Hon Shing Ong
- East London Obesity Service (c/o Dr Simon Coppack), Centre for Diabetes and Metabolic Medicine, Barts and The London School of Medicine, London, E1 2AT, United Kingdom.
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2829
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Ohte N, Narita H, Iida A, Wakami K, Asada K, Fukuta H, Kato T, Hyano J, Kimura G. Impaired myocardial oxidative metabolism in the remote normal region in patients in the chronic phase of myocardial infarction and left ventricular remodeling. J Nucl Cardiol 2009; 16:73-81. [PMID: 19152131 DOI: 10.1007/s12350-008-9006-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 08/04/2008] [Accepted: 08/05/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Left ventricular (LV) remodeling occurs in the remote normal region in the LVs after myocardial infarction (MI) and is closely involved in heart failure. METHODS We assessed myocardial oxygen consumption using a clearance rate constant K (mono) for the time activity curves of (11)C-acetate in 15 patients with a prior anterior wall MI, 8 with a prior inferior wall MI, and 10 age-matched normal control subjects. LV end-systolic volume index (ESVI) was determined by echocardiography. RESULTS The LVESVI was significantly greater in patients with an anterior and inferior MI than in control subjects. The heart rate systolic pressure product did not differ among the groups. K (mono) in the remote normal region in patients with an anterior MI was significantly less than that in the corresponding area in control subjects (0.055 +/- 0.005 vs 0.065 +/- 0.008 min(-1), P < .001). K (mono) in the remote normal region in those with an inferior MI was also significantly less compared with controls (0.054 +/- 0.007 vs 0.069 +/- 0.010 min(-1), P < .01). CONCLUSION In patients with a prior MI and LV remodeling, myocardial oxidative metabolism is apparently impaired in the remote normal region where augmented myocardial energy production is needed against the increased end-systolic wall stress caused by LV dilatation.
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Affiliation(s)
- Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
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2830
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Yamamoto K, Sakata Y, Ohtani T, Takeda Y, Mano T. Heart Failure With Preserved Ejection Fraction What is Known and Unknown. Circ J 2009; 73:404-10. [DOI: 10.1253/circj.cj-08-1073] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kazuhiro Yamamoto
- The Center for Advanced Medical Engineering and Informatics, Osaka University
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tomohito Ohtani
- The Center for Advanced Medical Engineering and Informatics, Osaka University
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yasuharu Takeda
- The Center for Advanced Medical Engineering and Informatics, Osaka University
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Toshiaki Mano
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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2831
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Okura H, Kubo T, Asawa K, Toda I, Yoshiyama M, Yoshikawa J, Yoshida K. Elevated E/E' Predicts Prognosis in Congestive Heart Failure Patients With Preserved Systolic Function. Circ J 2009; 73:86-91. [PMID: 19015586 DOI: 10.1253/circj.cj-08-0457] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Iku Toda
- Division of Cardiology, Bell Land General Hospital
| | - Minoru Yoshiyama
- Department of Internal Medicine and Cardiology, Osaka City University School of Medicine
| | - Junichi Yoshikawa
- Department of Internal Medicine and Cardiology, Osaka Ekisaikai Hospital
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2832
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Affiliation(s)
- Waleed Al-Habeeb
- From the Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Al-Admawi
- From the Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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2833
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2834
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Flaherty JD, Bax JJ, De Luca L, Rossi JS, Davidson CJ, Filippatos G, Liu PP, Konstam MA, Greenberg B, Mehra MR, Breithardt G, Pang PS, Young JB, Fonarow GC, Bonow RO, Gheorghiade M. Acute Heart Failure Syndromes in Patients With Coronary Artery Disease. J Am Coll Cardiol 2009; 53:254-63. [DOI: 10.1016/j.jacc.2008.08.072] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 08/08/2008] [Accepted: 08/27/2008] [Indexed: 10/21/2022]
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2835
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Miyagishima K, Hiramitsu S, Kimura H, Mori K, Ueda T, Kato S, Kato Y, Ishikawa S, Iwase M, Morimoto SI, Hishida H, Ozaki Y. Long Term Prognosis of Chronic Heart Failure Reduced vs Preserved Left Ventricular Ejection Fraction. Circ J 2009; 73:92-9. [DOI: 10.1253/circj.cj-07-1016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kenji Miyagishima
- Divison of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine
| | - Shinya Hiramitsu
- Divison of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine
| | - Hisashi Kimura
- Divison of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine
| | - Kazumasa Mori
- Divison of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine
| | - Tomoya Ueda
- Divison of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine
| | - Shigeru Kato
- Divison of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine
| | - Yasuchika Kato
- Divison of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine
| | - Shiho Ishikawa
- Divison of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine
| | - Masatsugu Iwase
- Divison of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine
| | - Shin-ichiro Morimoto
- Divison of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine
| | - Hitoshi Hishida
- Divison of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine
| | - Yukio Ozaki
- Divison of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine
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2836
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Quinones MA. Role of Echocardiography in Predicting Onset of Heart Failure in Patients With Stable Coronary Artery Disease. JACC Cardiovasc Imaging 2009; 2:21-3. [DOI: 10.1016/j.jcmg.2008.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 10/15/2008] [Indexed: 11/30/2022]
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2837
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Jug B, Vene N, Salobir BG, Šebeštjen M, Šabovic M, Keber I. Procoagulant State in Heart Failure With Preserved Left Ventricular Ejection Fraction. Int Heart J 2009; 50:591-600. [DOI: 10.1536/ihj.50.591] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Borut Jug
- Department of Vascular Diseases, Clinic of Internal Medicine, University Clinical Center Ljubljana
| | - Nina Vene
- Department of Vascular Diseases, Clinic of Internal Medicine, University Clinical Center Ljubljana
| | | | - Miran Šebeštjen
- Department of Vascular Diseases, Clinic of Internal Medicine, University Clinical Center Ljubljana
| | - Mišo Šabovic
- Department of Vascular Diseases, Clinic of Internal Medicine, University Clinical Center Ljubljana
| | - Irena Keber
- Department of Vascular Diseases, Clinic of Internal Medicine, University Clinical Center Ljubljana
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2838
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Ouzounian M, Tu JV, Austin PC, Chong A, Liu PP, Lee DS. Statin therapy and clinical outcomes in heart failure: a propensity-matched analysis. J Card Fail 2008; 15:241-8. [PMID: 19327626 DOI: 10.1016/j.cardfail.2008.10.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 10/09/2008] [Accepted: 10/21/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND The influence of statin therapy in heart failure (HF) has been of considerable interest. The objective of this study was to determine if statins are associated with improved outcomes in patients discharged after hospitalization for HF. METHODS Patients admitted to Ontario hospitals between 1999 and 2001 with HF were identified in the Enhanced Feedback For Effective Cardiac Treatment study. Propensity score methods were used to assess 5-year outcomes in the overall cohort as well as in 4 subgroups: those with coronary artery disease (CAD) or without (NoCAD), and those with preserved ejection fraction (HFPEF) or with reduced ejection fraction (HFREF). Of the 6451 HF patients, 1121 were discharged with a prescription for a statin. RESULTS In propensity analysis stratified on matched pairs in a Cox proportional hazards model, statins were associated with improved mortality at 5 years overall (hazard ratio [HR] 0.85, P = .05) and in those with CAD (HR 0.79, P = .008). Similarly, statins were associated with lower risk of the combined end point in the CAD group (HR 0.85, P = .045). CONCLUSIONS Among patients with HF discharged from hospital, statin therapy was associated with improved outcomes, particularly in patients with CAD. Stratification by ejection fraction did not differentially impact the effect of statins in patients with HF.
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Affiliation(s)
- Maral Ouzounian
- Heart & Stroke/Richard Lewar Centre for Excellence, University of Toronto, Toronto, Ontario, Canada
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2839
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Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O'Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008; 119:e21-181. [PMID: 19075105 DOI: 10.1161/circulationaha.108.191261] [Citation(s) in RCA: 1356] [Impact Index Per Article: 84.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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2840
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Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, Anderson S, Donovan M, Iverson E, Staiger C, Ptaszynska A. Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med 2008; 359:2456-67. [PMID: 19001508 DOI: 10.1056/nejmoa0805450] [Citation(s) in RCA: 1396] [Impact Index Per Article: 87.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Approximately 50% of patients with heart failure have a left ventricular ejection fraction of at least 45%, but no therapies have been shown to improve the outcome of these patients. Therefore, we studied the effects of irbesartan in patients with this syndrome. METHODS We enrolled 4128 patients who were at least 60 years of age and had New York Heart Association class II, III, or IV heart failure and an ejection fraction of at least 45% and randomly assigned them to receive 300 mg of irbesartan or placebo per day. The primary composite outcome was death from any cause or hospitalization for a cardiovascular cause (heart failure, myocardial infarction, unstable angina, arrhythmia, or stroke). Secondary outcomes included death from heart failure or hospitalization for heart failure, death from any cause and from cardiovascular causes, and quality of life. RESULTS During a mean follow-up of 49.5 months, the primary outcome occurred in 742 patients in the irbesartan group and 763 in the placebo group. Primary event rates in the irbesartan and placebo groups were 100.4 and 105.4 per 1000 patient-years, respectively (hazard ratio, 0.95; 95% confidence interval [CI], 0.86 to 1.05; P=0.35). Overall rates of death were 52.6 and 52.3 per 1000 patient-years, respectively (hazard ratio, 1.00; 95% CI, 0.88 to 1.14; P=0.98). Rates of hospitalization for cardiovascular causes that contributed to the primary outcome were 70.6 and 74.3 per 1000 patient-years, respectively (hazard ratio, 0.95; 95% CI, 0.85 to 1.08; P=0.44). There were no significant differences in the other prespecified outcomes. CONCLUSIONS Irbesartan did not improve the outcomes of patients with heart failure and a preserved left ventricular ejection fraction. (ClinicalTrials.gov number, NCT00095238.)
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Affiliation(s)
- Barry M Massie
- University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco 94121, USA.
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2841
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Detaint D, Maalouf J, Tribouilloy C, Mahoney DW, Schaff HV, Tajik AJ, Enriquez-Sarano M. Congestive heart failure complicating aortic regurgitation with medical and surgical management: A prospective study of traditional and quantitative echocardiographic markers. J Thorac Cardiovasc Surg 2008; 136:1549-57. [DOI: 10.1016/j.jtcvs.2008.07.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 06/10/2008] [Accepted: 07/22/2008] [Indexed: 01/09/2023]
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2842
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Guía de práctica clínica de la Sociedad Europea de Cardiología (ESC) para el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica (2008). Rev Esp Cardiol 2008. [DOI: 10.1016/s0300-8932(08)75740-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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2843
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Zile MR, Bourge RC, Bennett TD, Stevenson LW, Cho YK, Adamson PB, Aaron MF, Aranda JM, Abraham WT, Smart FW, Kueffer FJ. Application of Implantable Hemodynamic Monitoring in the Management of Patients With Diastolic Heart Failure: A Subgroup Analysis of the COMPASS-HF Trial. J Card Fail 2008; 14:816-23. [DOI: 10.1016/j.cardfail.2008.07.235] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 07/16/2008] [Accepted: 07/21/2008] [Indexed: 01/08/2023]
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2844
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Lim YJ, Yamamoto K, Ichikawa M, Iwata A, Hayashi T, Nakata T, Masuyama T, Mishima M. Elevation of the ratio of transmitral E velocity to early diastolic mitral annular velocity continues even after recovery from acute stage in patients with diastolic heart failure. J Cardiol 2008; 52:254-60. [DOI: 10.1016/j.jjcc.2008.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 06/28/2008] [Accepted: 07/10/2008] [Indexed: 10/21/2022]
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2845
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Schmaltz HN, Southern DA, Maxwell CJ, Knudtson ML, Ghali WA. Patient sex does not modify ejection fraction as a predictor of death in heart failure: insights from the APPROACH cohort. J Gen Intern Med 2008; 23:1940-6. [PMID: 18830763 PMCID: PMC2596502 DOI: 10.1007/s11606-008-0804-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 04/08/2008] [Accepted: 08/20/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Normal and low ejection fraction (EF) heart failure patients appear to have similar outcomes. OBJECTIVE The object of this study was to determine whether sex modifies the effects of left ventricular EF on prevalent heart failure mortality. DESIGN Prospective cohort study. PATIENTS Patients (n = 6, 095) with a diagnosis of heart failure and a measure of EF undergoing cardiac catheterization in Alberta, Canada between April 1999 and December 2004; follow-up continued through October 2005. MEASUREMENTS All-cause mortality was assessed in analyses stratified by patient sex and EF (<or=50% vs. >50%). MAIN RESULTS Overall, female heart failure patients were older, had more hypertension, valvular disease, less systolic impairment and coronary artery disease. Baseline medication use was similar in the four sex-EF groups. Low EF heart failure mortality over 6.5 years was slightly higher but was not significantly modified by patient sex. This relationship remained unchanged after adjustment for differences in baseline characteristics and process of care (women normal EF, reference group; men normal EF adjusted HR 1.1, 95% CI 0.9-1.3; women low EF adjusted HR 1.5, 95% CI 1.1-2.0; men low EF adjusted HR 1.6, 95% CI 1.2-2.1). CONCLUSIONS Patient sex did not appear to modify the negative effects of low EF on long-term survival in this prospective study of prevalent heart failure. The small absolute difference in survival between low and normal EF heart failure highlights the need for further research into optimal therapy for the latter, a less well-understood condition.
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2846
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Why and when do patients with heart failure and normal left ventricular ejection fraction die? Analysis of >600 deaths in a community long-term study. Am Heart J 2008; 156:1184-90. [PMID: 19033017 DOI: 10.1016/j.ahj.2008.07.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Accepted: 07/10/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of the study was to examine the causes of the death of patients with heart failure (HF) and evaluate the differences in this respect between patients with and without depression of left ventricular ejection fraction (LVEF). METHOD All patients hospitalized with HF between 1995 and 2002 in the cardiology service of a tertiary hospital were assessed. LVEF was evaluated by echocardiography during hospitalization and was considered normal when it was > or =50%. After a mean follow-up time of 3.7 +/- 2.8 years, 615 cases had terminated in death. RESULTS The most common cause was refractory HF, both in the whole group (39%) and in both the subgroups defined with respect to LVEF (normal and depressed). There was no statistically significant difference between the normal and depressed subgroups as regard the distribution of deaths, although the depressed group showed a somewhat greater incidence of sudden death (21% as against 16% in the normal group) and a somewhat smaller incidence of death due to refractory HF (37% as against 47%). However, in the depressed LVEF group, the cumulative risk of death due to acute myocardial infarction in the first 1.5 years first increased rapidly and then more slowly, whereas the reverse pattern was held in the normal left ventricular systolic function group, in which it was the cumulative risks of death from noncardiovascular or vascular noncardiac causes that initially increased more rapidly than later. CONCLUSIONS The spectrum of causes of death among patients with HF who have been hospitalized is independent of LVEF in the long term. In the short term, there are differences between patients with normal LVEF and depressed LVEF as regard the dynamics of the risks of death from acute myocardial infarction, noncardiac vascular causes, and noncardiovascular causes. These results may help orient the short-term and long-term management of HF, especially for patients with normal LVEF, for whom there is still no well-established consensus strategy.
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2847
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Influence of coronary artery disease and coronary revascularization status on outcomes in patients with acute heart failure syndromes: A report from OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failur. Eur J Heart Fail 2008; 10:1215-23. [DOI: 10.1016/j.ejheart.2008.09.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/27/2008] [Accepted: 09/25/2008] [Indexed: 11/19/2022] Open
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2848
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Abstract
The pathological myocardial hypertrophy associated with hypertension contains the seed for further maladaptive development. Increased myocardial oxygen consumption, impaired epicardial coronary perfusion, ventricular fibrosis and remodelling, abnormalities in long-axis function and torsion, cause, to a varying degree, a mixture of systolic and diastolic abnormalities. In addition, chronotropic incompetence and peripheral factors such as lack of vasodilator reserve and reduced arterial compliance further affect cardiac output particularly on exercise. Many of these factors are common to hypertensive heart failure with a normal ejection fraction as well as systolic heart failure. There is increasing evidence that these apparently separate phenotypes are part of a spectrum of heart failure differing only in the degree of ventricular remodelling and volume changes. Furthermore, dichotomizing heart failure into systolic and diastolic clinical entities has led to a paucity of clinical trials of therapies for heart failure with a normal ejection fraction. Therapies aimed at reversing myocardial fibrosis, and targets outside the heart such as enhancing vasodilator reserve and improving chronotropic incompetence deserve further study and may improve the exercise capacity of hypertensive heart failure patients. Hypertension heart disease with heart failure is simply not a dysfunction of systole and diastole. Other peripheral factors including heart rate and vasodilator response with exercise may deserve equal attention in an attempt to develop more effective treatments for this disorder.
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2849
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Deswal A, Bozkurt B. Treatment of patients with heart failure and preserved ejection fraction. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2008; 10:516-28. [DOI: 10.1007/s11936-008-0044-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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2850
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Cardiorenal syndrome in heart failure: a cardiologist's perspective. Can J Cardiol 2008; 24 Suppl B:25B-9B. [PMID: 18629386 DOI: 10.1016/s0828-282x(08)71027-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
One of the most important comorbidities in heart failure is renal dysfunction. Diminished estimated glomerular filtration rate is a potent predictor of cardiovascular mortality and complications. On the other hand, worsening heart failure or acute decompensated heart failure can accelerate worsening of renal function--the so-called cardiorenal syndrome. Risk factors include hypertension, diabetes, elderly age, and prior history of heart or renal failure. The pathophysiology of the cardiorenal syndrome involves intrarenal hemodynamics, transrenal perfusion pressure and systemic neurohormonal factors. Clinical management of the patient with cardiorenal syndrome includes the challenge of diuretic resistance, which may involve correcting the underlying cause, combination diuretics or diuretic infusions. The key to improved outcome is the optimization of proven heart failure therapies. The use of vasodilator therapy is the current mainstay of treatment. Nesiritide, or recombinant B-type natriuretic peptide, has courted controversy regarding its role in cardiorenal syndrome. However, data are emerging that low doses appear to be renal-protective. Other more recent strategies include ultrafiltration, vasopressin antagonists and adenosine antagonists. All of these newer modalities promise more rapid volume removal, but their ultimate impact on survival or preservation of renal function is unknown at the present time. Because of the complex nature of these patients, and the compromised outcome, it is important that cardiologists, nephrologists and internists all work together toward the common goal of protecting the patient with cardiorenal syndrome, and use the best available evidence for management.
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