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Caira C, Ansalone G, Mancone M, Canali E, Pagliaro M, Fratarcangeli L, Aznaran CAC, Gatto MC, Di Pietro R, Fedele F. Heart failure and iron deficiency anemia in Italy: results from CARMES-1 registry. Future Cardiol 2013; 9:437-44. [DOI: 10.2217/fca.13.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To assess the prevalence of anemia and iron deficiency anemia in heart failure (HF) patients, to evaluate the effectiveness of current iron deficiency treatment strategies after discharge, and to analyze hospital readmissions and mortality rates in patients with and without anemia. Patients & methods: A patient registry-based, multicenter, retrospective, observational, cohort study of 418 hospitalized HF patients in Italy, monitored from 1 March 2010 to 30 March 2011. Results: Among patients with HF, 35.9% had anemia at admission; only 51.3% were treated with current iron deficiency treatment strategies during hospitalization and then only 29% of patients who were anemic at discharge were treated with iron at home. After a 4-week follow-up, only 11% of these patients reached the hemoglobin target value (study primary end point). However, current iron deficiency treatment strategies were not significantly associated with reduced risk of rehospitalization, but with a significantly reduced mortality rate after a 6-month follow-up (study secondary end points: 11.7 vs 51.7%; p < 0.0001). Conclusion: In HF patients, there is poor attention paid to anemia, its causes and treatment. Current iron deficiency treatment strategies are mismanaged and CARMES-1 demonstrated that they appear to be insufficient at improving patient outcome in terms of rehospitalization rate reduction, generating high costs, which could be avoided through an optimized treatment strategy. Therefore, more efficacious, efficient and cost–effective treatment strategies are required in Italy for HF patients with iron deficiency anemia to meet this unmet medical need.
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Affiliation(s)
- Carmen Caira
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiology and Geriatric Sciences, ‘Sapienza’ University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gerardo Ansalone
- U O C of Cardiology, Madre Giuseppina Vannini Hospital, via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiology and Geriatric Sciences, ‘Sapienza’ University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Emanuele Canali
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiology and Geriatric Sciences, ‘Sapienza’ University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Michela Pagliaro
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiology and Geriatric Sciences, ‘Sapienza’ University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Lara Fratarcangeli
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiology and Geriatric Sciences, ‘Sapienza’ University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Carlos Alberto Centurion Aznaran
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiology and Geriatric Sciences, ‘Sapienza’ University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Chiara Gatto
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiology and Geriatric Sciences, ‘Sapienza’ University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Riccardo Di Pietro
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiology and Geriatric Sciences, ‘Sapienza’ University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiology and Geriatric Sciences, ‘Sapienza’ University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
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3353
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Blair JEA, Huffman M, Shah SJ. Heart failure in North America. Curr Cardiol Rev 2013; 9:128-46. [PMID: 23597296 PMCID: PMC3682397 DOI: 10.2174/1573403x11309020006] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 11/13/2012] [Accepted: 12/03/2012] [Indexed: 01/08/2023] Open
Abstract
Heart failure is a major health problem that affects patients and healthcare systems worldwide. Within the continent of North America, differences in economic development, genetic susceptibility, cultural practices, and trends in risk factors and treatment all contribute to both inter-continental and within-continent differences in heart failure. The United States and Canada represent industrialized countries with similar culture, geography, and advanced economies and infrastructure. During the epidemiologic transition from rural to industrial in countries such as the United States and Canada, nutritional deficiencies and infectious diseases made way for degenerative diseases such as cardiovascular diseases, cancer, overweight/obesity, and diabetes. This in turn has resulted in an increase in heart failure incidence in these countries, especially as overall life expectancy increases. Mexico, on the other hand, has a less developed economy and infrastructure, and has a wide distribution in the level of urbanization as it becomes more industrialized. Mexico is under a period of epidemiologic transition and the etiology and incidence of heart failure is rapidly changing. Ethnic differences within the populations of the United States and Canada highlight the changing demographics of each country as well as potential disparities in heart failure care. Heart failure with preserved ejection fraction makes up approximately half of all hospital admissions throughout North America; however, important differences in demographics and etiology exist between countries. Similarly, acute heart failure etiology, severity, and management differ between countries in North America. The overall economic burden of heart failure continues to be large and growing worldwide, with each country managing this burden differently. Understanding the inter-and within-continental differences may help improve understanding of the heart failure epidemic, and may aid healthcare systems in delivering better heart failure prevention and treatment.
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Affiliation(s)
- John E A Blair
- San Antonio Military Medical Center, San Antonio, TX, USA.
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3354
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Glezeva N, Collier P, Voon V, Ledwidge M, McDonald K, Watson C, Baugh J. Attenuation of monocyte chemotaxis--a novel anti-inflammatory mechanism of action for the cardio-protective hormone B-type natriuretic peptide. J Cardiovasc Transl Res 2013; 6:545-57. [PMID: 23625718 DOI: 10.1007/s12265-013-9456-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/27/2013] [Indexed: 01/20/2023]
Abstract
B-type natriuretic peptide (BNP) is a prognostic and diagnostic marker for heart failure (HF). An anti-inflammatory, cardio-protective role for BNP was proposed. In cardiovascular diseases including pressure overload-induced HF, perivascular inflammation and cardiac fibrosis are, in part, mediated by monocyte chemoattractant protein (MCP)1-driven monocyte migration. We aimed to determine the role of BNP in monocyte motility to MCP1. A functional BNP receptor, natriuretic peptide receptor-A (NPRA) was identified in human monocytes. BNP treatment inhibited MCP1-induced THP1 (monocytic leukemia cells) and primary monocyte chemotaxis (70 and 50 %, respectively). BNP did not interfere with MCP1 receptor expression or with calcium. BNP inhibited activation of the cytoskeletal protein RhoA in MCP1-stimulated THP1 (70 %). Finally, BNP failed to inhibit MCP1-directed motility of monocytes from patients with hypertension (n = 10) and HF (n = 6) suggesting attenuation of this anti-inflammatory mechanism in chronic heart disease. We provide novel evidence for a direct role of BNP/NPRA in opposing human monocyte migration and support a role for BNP as a cardio-protective hormone up-regulated as part of an adaptive compensatory response to combat excess inflammation.
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Affiliation(s)
- Nadezhda Glezeva
- School of Medicine and Medical Science, UCD Conway Institute for Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
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3355
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Janssens U, Reith S. [The chronic critically ill patient from the cardiologist's perspective]. Med Klin Intensivmed Notfmed 2013; 108:267-78. [PMID: 23612917 DOI: 10.1007/s00063-012-0193-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 02/22/2013] [Accepted: 02/26/2013] [Indexed: 11/29/2022]
Abstract
In recent years the prognosis and survival of chronic and acute heart failure (HF) patients has been steadily improving; however, many patients develop advanced chronic HF which is characterized by worsening of symptoms, unplanned hospital admission due to acute decompensation, development of complications, such as life-threatening arrhythmia and shorter life span. Optimal medical therapy is supplemented by interventional cardiology, cardiovascular implantable electronic devices (CIEDs), minimally invasive valve replacement or repair, circulatory mechanical support and heart transplantation. Medical indications and informed consent are essential prerequisites for successfully implementing treatment goals. For patients who are incapable of decisions a legally defined surrogate decision-maker has the same right to refuse or request the withdrawal of treatment as the patient would have if the patient had decision-making capability. As the use of circulatory mechanical support becomes increasingly more prevalent, ethical issues are likely to arise at an increasing rate, as will social and legal ramifications. The concept of turning off an implanted device as death nears is challenging because of ethical and technical concerns. The same holds true for CIEDs. A palliative care approach is applicable to heart failure patients and is particularly relevant to those with advanced disease. Palliative care should be integrated as part of a team approach to comprehensive HF care and should not be reserved for those who are expected to die within days or weeks.
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Affiliation(s)
- U Janssens
- Klinik für Innere Medizin, St. Antonius Hospital, Eschweiler.
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3356
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Abstract
Heart failure (HF) is a leading cause of morbidity and mortality worldwide. Management of HF involves accurate diagnosis and implementation of evidence-based treatment strategies. Costs related to the care of patients with HF have increased substantially over the past 2 decades, partly owing to new medications and diagnostic tests, increased rates of hospitalization, implantation of costly novel devices and, as the disease progresses, consideration for heart transplantation, mechanical circulatory support, and end-of-life care. Not surprisingly, HF places a huge burden on health-care systems, and widespread implementation of all potentially beneficial therapies for HF could prove unrealistic for many, if not all, nations. Cost-effectiveness analyses can help to quantify the relationship between clinical outcomes and the economic implications of available therapies. This Review is a critical overview of cost-effectiveness studies on key areas of HF management, involving pharmacological and nonpharmacological clinical therapies, including device-based and surgical therapeutic strategies.
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Affiliation(s)
- Luis E Rohde
- Postgraduate Program in Cardiovascular Science, Universidade Federal do Rio Grande do Sul, National Institute for Health Technology Assessment (IATS), CNPq, Av. Bento Gonçalves 9500, Porto Alegre, RS, Brazil
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3357
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Abstract
Historically, the USA and European countries have been the dominant figures in medical research. However, in the past 10 years, Asia has emerged as a new 'hot spot' for clinical research owing to the tremendous potential generated by steady economic growth, remarkable advances in research and development capacity, and an expanding population. However, investigators involved with the set-up and conduct of multicentre trials in such a vast and heterogeneous continent face huge challenges-bridging the fundamental differences between the Asian countries, such as languages, resources, regulatory procedural timelines, and the general understanding of clinical research. In this Perspectives article, we explain why Asia should be established as a hub for large multicentre trials, discuss the challenges involved, and highlight the importance of a strong collaborative infrastructure for multiple investigational sites in this culturally diverse continent.
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Affiliation(s)
- Joey S W Kwong
- Institute of Vascular Medicine, Li Ka Shing Institute of Health Sciences, S. H. Ho Cardiovascular Disease and Stroke Centre, Heart Education And Research Training (HEART) Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Sha Tin District, New Territories, Hong Kong, People's Republic of China
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3358
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Long-term blood pressure changes induced by the 2009 L'Aquila earthquake: assessment by 24 h ambulatory monitoring. Hypertens Res 2013; 36:795-8. [PMID: 23595046 DOI: 10.1038/hr.2013.37] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 01/21/2013] [Accepted: 01/23/2013] [Indexed: 02/08/2023]
Abstract
An increased rate of cardiovascular and cerebrovascular events has been described during and immediately after earthquakes. In this regard, few data are available on long-term blood pressure control in hypertensive outpatients after an earthquake. We evaluated the long-term effects of the April 2009 L'Aquila earthquake on blood pressure levels, as detected by 24 h ambulatory blood pressure monitoring. Before/after (mean±s.d. 6.9±4.5/14.2±5.1 months, respectively) the earthquake, the available 24 h ambulatory blood pressure monitoring data for the same patients were extracted from our database. Quake-related daily life discomforts were evaluated through interviews. We enrolled 47 patients (25 female, age 52±14 years), divided into three groups according to antihypertensive therapy changes after versus before the earthquake: unchanged therapy (n=24), increased therapy (n=17) and reduced therapy (n=6). Compared with before the quake, in the unchanged therapy group marked increases in 24 h (P=0.004), daytime (P=0.01) and nighttime (P=0.02) systolic blood pressure were observed after the quake. Corresponding changes in 24 h (P=0.005), daytime (P=0.01) and nighttime (P=0.009) diastolic blood pressure were observed. Daily life discomforts were reported more frequently in the unchanged therapy and increased therapy groups than the reduced therapy group (P=0.025 and P=0.018, respectively). In conclusion, this study shows that patients with unchanged therapy display marked blood pressure increments up to more than 1 year after an earthquake, as well as long-term quake-related discomfort. Our data suggest that particular attention to blood pressure levels and adequate therapy modifications should be considered after an earthquake, not only early after the event but also months later.
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3359
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Leick J, Szardien S, Liebetrau C, Willmer M, Fischer-Rasokat U, Kempfert J, Nef H, Rolf A, Walther T, Hamm C, Möllmann H. Mobile left ventricular thrombus in left ventricular dysfunction: case report and review of literature. Clin Res Cardiol 2013; 102:479-84. [PMID: 23584757 DOI: 10.1007/s00392-013-0565-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 04/03/2013] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Left ventricular (LV) thrombi carry a high risk of embolization. Therapeutic recommendations like treatment with low molecular heparin and intravenous unfractionated heparin (UFH), thrombolysis or surgical thrombectomy have failed to reach a consensus. CASE DESCRIPTION A 56-year-old female patient presented in cardiogenic shock to the emergency department. Echocardiography demonstrated a dilated LV with a severely depressed global systolic function and a large LV apical thrombus. Treatment with UFH was initiated as well as a treatment with catecholamines for stabilizing the patient's hemodynamic situation. On the follow-up echocardiographic examination, extensive free-floating parts of the thrombus could be documented. Given the high risk of embolization in a now hemodynamically stable situation, emergency surgical embolectomy was performed. DISCUSSION A conservative procedure might be useful for bridging till surgical treatment is available and/or the risk due to surgery is acceptable. CONCLUSION In absence of evidence-based guidelines for the treatment of LV thrombi, individualized management options concerning surgical, embolization and bleeding risk must be taken into account.
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Affiliation(s)
- Jürgen Leick
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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3360
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Portable recording for detecting sleep disorder breathing in patients under the care of a heart failure clinic. Clin Res Cardiol 2013; 102:535-42. [DOI: 10.1007/s00392-013-0563-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/03/2013] [Indexed: 10/27/2022]
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3361
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Salterain-Gonzalez N, Esteban-Fernández A, García-López M, Lavilla-Royo FJ, Gavira-Gómez JJ. Efficacy of tolvaptan in patients hospitalized for heart failure with refractory hyponatremia. Clinical experience in daily practice. ACTA ACUST UNITED AC 2013; 66:503-4. [PMID: 24776057 DOI: 10.1016/j.rec.2012.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 12/15/2012] [Indexed: 12/22/2022]
Affiliation(s)
- Nahikari Salterain-Gonzalez
- Unidad de Insuficiencia Cardiaca, Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Alberto Esteban-Fernández
- Unidad de Insuficiencia Cardiaca, Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
| | - Martín García-López
- Departamento de Nefrología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | | | - Juan J Gavira-Gómez
- Unidad de Insuficiencia Cardiaca, Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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3362
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Strategies for managing ACTH dependent mineralocorticoid excess induced by abiraterone. Cancer Treat Rev 2013; 39:966-73. [PMID: 23582279 DOI: 10.1016/j.ctrv.2013.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/01/2013] [Accepted: 03/06/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Abiraterone strongly inhibits androgen synthesis but may lead to an increase in mineralocorticoid hormones that may impair its long term tolerability in patients with prostate cancer. How to implement available therapies in the management and prevention of these potential side effects is a matter of current clinical research. METHODS The acute and long term consequences of mineralocorticoid excess and the effects of available treatments have been reviewed. Prospective studies in which abiraterone was employed were identified to assess the frequency and severity of the mineralocorticoid excess syndrome and the efficacy of ameliorating therapeutic approaches. RESULTS Glucocorticoids to inhibit the ACTH increase that drives mineralocorticoid synthesis and mineralocorticoid receptor (MR) antagonists can be used in the management of the abiraterone-induced mineralocorticoid excess syndrome. Phase I and II trials of abiraterone without additional therapies revealed that mineralocorticoid excess symptoms occur in the majority of patients. Eplerenone, a specific MR antagonist, seems to be effective but it does not control the mineralocorticoid excess. Glucorticoid supplementation to control ACTH drive is therefore needed. In several randomized trials the addition of prednisone (10mg daily) to abiraterone was not able to prevent mineralocorticoid excess syndrome in many cases and thus cannot be considered the gold standard. CONCLUSION At present, the best conceivable treatment for managing the abiraterone-induced mineralocorticoid excess consists of the administration of glucocorticoid replacement at the lowest effective dose ± MR antagonists and salt deprivation. The drug doses should be modulated by monitoring blood pressure, fluid retention and potassium levels during therapy.
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3363
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Bielecka-Dabrowa A, Mikhailidis DP, Rizzo M, von Haehling S, Rysz J, Banach M. The influence of atorvastatin on parameters of inflammation left ventricular function, hospitalizations and mortality in patients with dilated cardiomyopathy--5-year follow-up. Lipids Health Dis 2013; 12:47. [PMID: 23566246 PMCID: PMC3641983 DOI: 10.1186/1476-511x-12-47] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 03/31/2013] [Indexed: 12/22/2022] Open
Abstract
Background We assessed the influence of atorvastatin on selected indicators of an inflammatory condition, left ventricular function, hospitalizations and mortality in patients with dilated cardiomyopathy (DCM). Methods We included 68 DCM patients with left ventricular ejection fraction (LVEF) ≤40% treated optimally in a prospective, randomized study. They were observed for 5 years. Patients were divided into two groups: patients who were commenced on atorvastatin 40 mg daily for two months followed by an individually matched dose of 10 or 20 mg/day (group A), and patients who were treated according to current recommendations without statin therapy (group B). Results After 5-year follow-up we assessed 45 patients of mean age 59 ± 11 years - 22 patients in group A (77% male) and 23 patients in group B (82% male). Interleukin-6, tumor necrosis factor alpha, and uric acid concentrations were significantly lower in the statin group than in group B (14.96 ± 4.76 vs. 19.02 ± 3.94 pg/ml, p = 0.012; 19.10 ± 6.39 vs. 27.53 ± 7.39 pg/ml, p = 0.001, and 5.28 ± 0.48 vs. 6.53 ± 0.46 mg/dl, p = 0.001, respectively). In patients on statin therapy a reduction of N-terminal pro-brain natriuretic peptide concentration (from 1425.28 ± 1264.48 to 1098.01 ± 1483.86 pg/ml, p = 0.045), decrease in left ventricular diastolic (from 7.15 ± 0.90 to 6.67 ± 0.88 cm, p = 0.001) and systolic diameters (from 5.87 ± 0.92 to 5.17 ± 0.97, p = 0.001) in comparison to initial values were observed. We also showed the significant increase of LVEF in patients after statin therapy (from 32.0 ± 6.4 to 38.8 ± 8.8%, p = 0.016). Based on a comparison of curves using the log-rank test, the probability of survival to 5 years was significantly higher in patients receiving statins (p = 0.005). Conclusions Atorvastatin in a small dose significantly reduce levels of inflammatory cytokines and uric acid, improve hemodynamic parameters and improve 5-year survival in patients with DCM.
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3364
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KREUZER JOERG, LENNERZ CARSTEN, DIETL JOSEFU, BEIER THOMAS, STRAUCH ALEXEJ, SEMMLER VERENA, BADRAN HAITHAM, ZRENNER BERNHARD, KOLB CHRISTOF. Are Plasma Natriuretic Peptide Levels Influenced by Automatic Pacemaker Algorithms for Ventricular Pacing Minimization? Pacing Clin Electrophysiol 2013; 36:424-32. [DOI: 10.1111/pace.12070] [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: 05/11/2012] [Revised: 10/26/2012] [Accepted: 10/30/2012] [Indexed: 12/01/2022]
Affiliation(s)
- JOERG KREUZER
- Abteilung für Kardiologie; St Vincenz Krankenhaus; Limburg; Germany
| | - CARSTEN LENNERZ
- Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Faculty of Medicine; Technische Universität München; Munich; Germany
| | - JOSEF U. DIETL
- Medizinische Klinik; Krankenhaus Landshut-Achdorf; Landshut; Germany
| | - THOMAS BEIER
- I. Medizinische Abteilung; Rotkreuzklinikum München; Munich; Germany
| | - ALEXEJ STRAUCH
- Abteilung für Kardiologie; St Vincenz Krankenhaus; Limburg; Germany
| | - VERENA SEMMLER
- Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Faculty of Medicine; Technische Universität München; Munich; Germany
| | | | | | - CHRISTOF KOLB
- Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Faculty of Medicine; Technische Universität München; Munich; Germany
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3365
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Cygankiewicz I. Implantable cardioverter defibrillator outcome: beyond ejection fraction? Europace 2013; 15:467-70. [DOI: 10.1093/europace/eus347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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3366
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Minimal dose for effective clinical outcome and predictive factors for responsiveness to carvedilol: Japanese chronic heart failure (J-CHF) study. Int J Cardiol 2013; 164:238-44. [DOI: 10.1016/j.ijcard.2012.11.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 10/23/2012] [Accepted: 11/10/2012] [Indexed: 11/19/2022]
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3367
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Aribas A, Akilli H, Alibasic H, Kayrak M. Management of a 112-year-old patient with STEMI: A case-based short literature review. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2012.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3368
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Sato Y. Angiotensin II receptor blockers for patients with chronic heart failure: The next step forward. J Cardiol 2013; 61:307-8. [DOI: 10.1016/j.jjcc.2012.12.017] [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: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
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3369
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The mortality prediction of NT-proBNP in elderly patients with heart failure. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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3370
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Actualización en insuficiencia cardiaca, trasplante cardiaco, cardiopatías congénitas y cardiología clínica. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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3371
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Abstract
Hypertension is recognized as a major risk factor for cardiovascular and renal diseases and represents the leading cause of mortality worldwide. In spite of proven benefits of hypertension treatment, blood pressure control rates are poor, even in high-income countries with virtually full-access to therapies. Nearly 75% of hypertensive patients do not achieve adequate control with monotherapy, thus needing combination treatment. Strategies to improve blood pressure control include the prompt shift from monotherapy to combination therapy, the initial treatment with a two-drug combination, and the use of fixed-dose combinations in a single pill. Currently, preferred combinations include a renin-angiotensin blocker, either an angiotensin-converting enzyme inhibitor or an angiotensin-receptor blocker plus a calcium channel blocker or a diuretic. Some patients will also require a triple combination to achieve blood pressure control.
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3372
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Taniguchi T, Ohtani T, Mizote I, Kanzaki M, Ichibori Y, Minamiguchi H, Asano Y, Sakata Y, Komuro I. Switching from carvedilol to bisoprolol ameliorates adverse effects in heart failure patients with dizziness or hypotension. J Cardiol 2013; 61:417-22. [PMID: 23548374 DOI: 10.1016/j.jjcc.2013.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/21/2013] [Accepted: 01/25/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Treatment with carvedilol is an established primary therapy for patients with heart failure (HF). However, its most common adverse effects, dizziness and hypotension, often discourage continuation or dosage increase. The aim of this study was to examine whether switching to bisoprolol from carvedilol would help to avoid adverse symptoms and signs related to carvedilol administration. METHODS AND SUBJECTS Data were retrospectively collected from 23 patients with HF [age 57±18 years, left ventricular ejection fraction (LVEF) 33±15%] who could not increase the dosage of carvedilol because of dizziness or hypotension, defined as systolic blood pressure<90 mmHg. Before and immediately after, and 6 months after switching to bisoprolol, we examined symptoms, vital signs, laboratory data, and New York Heart Association functional class. Furthermore, left ventricular (LV) dimension and ejection fraction (EF) were evaluated in 19 patients using echocardiography. RESULTS All 13 patients with dizziness (100%) and 9 of 16 with hypotension (56%) were relieved of adverse symptoms or signs. The mean dose of carvedilol before switching was 5.60±3.43 mg. Immediately after the switch, the mean dose of bisoprolol was 1.84±1.08 mg and then increased to 3.13±1.74 mg after 6 months (p<0.01). At 6-month follow-up examinations, LV function determined by LVEF was significantly improved, which was accompanied by increased exercise tolerance. CONCLUSION Switching from carvedilol to bisoprolol may help with continuation of β-blocker treatment as well as dosage increase in HF patients with adverse symptoms or signs, allowing them to reach the target dose.
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Affiliation(s)
- Tatsunori Taniguchi
- Division of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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3373
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Rossi R, Crupi N, Coppi F, Monopoli D, Sgura F. Importance of the time of initiation of mineralocorticoid receptor antagonists on risk of mortality in patients with heart failure. J Renin Angiotensin Aldosterone Syst 2013; 16:119-25. [PMID: 23539659 DOI: 10.1177/1470320313482603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 02/14/2013] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Several studies have definitively shown the benefit of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure (HF). However, very few prior studies examined the relationship between the timing of initiation of MRAs and prognosis. In addition, on this topic, there is no information regarding the specific population of patients suffering a first episode of decompensated congestive HF. METHODS We studied a homogenous cohort of patients discharged alive from our hospital after a first episode of decompensated congestive HF, in order to clarify the association between time of aldosterone receptor antagonist (ARA) initiation (within the first 90 days after hospital discharge) and mortality. Our population was composed of a series of consecutive patients. All-cause mortality was compared between patients who initiated MRAs at discharge (early group) and those who initiated MRAs one month later and up to 90 days after discharge (delayed group). We used prescription time distribution matching to control for survival difference between groups. RESULTS The early and delayed groups consisted of 365 and 320 patients, respectively. During the one-year follow-up, a significant difference in mortality was demonstrated between groups. Adjusted hazard ratios (HRs) for early versus delayed initiation were 1.72 (95% confidence interval (CI) 0.96 to 2.84) at six months, and 1.93 (95% CI 1.18 to 3.14) at one year. CONCLUSIONS Delay of MRA initiation up to 30 to 90 days after discharge implies a significant increase in mortality compared with MRA initiation at discharge, after a first episode of decompensate congestive HF.
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Affiliation(s)
- Rosario Rossi
- Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Italy
| | - Nicola Crupi
- Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Italy
| | - Francesca Coppi
- Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Italy
| | - Daniel Monopoli
- Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Italy
| | - Fabio Sgura
- Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Italy
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3374
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Borlaug BA. Heart failure with preserved and reduced ejection fraction: different risk profiles for different diseases. Eur Heart J 2013; 34:1393-5. [PMID: 23539340 DOI: 10.1093/eurheartj/eht117] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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3375
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Balta S, Demırkol S, Celik T. Coenzyme Q10 supplementation may improve diastolic heart functions especially coronary artery disease patients. Hemodial Int 2013; 17:467-8. [PMID: 23527797 DOI: 10.1111/hdi.12037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3376
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Vellone E, Riegel B, D'Agostino F, Fida R, Rocco G, Cocchieri A, Alvaro R. Structural equation model testing the situation-specific theory of heart failure self-care. J Adv Nurs 2013; 69:2481-92. [DOI: 10.1111/jan.12126] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2013] [Indexed: 01/09/2023]
Affiliation(s)
| | - Barbara Riegel
- School of Nursing; University of Pennsylvania; Philadelphia USA
| | | | - Roberta Fida
- Department of Psychology; “Sapienza” University; Rome Italy
| | - Gennaro Rocco
- Center of Excellence for Nursing Scholarship; Rome Italy
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3377
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Predictors of cardiac resynchronization therapy response: the pivotal role of electrocardiogram. ScientificWorldJournal 2013; 2013:837086. [PMID: 23576908 PMCID: PMC3615583 DOI: 10.1155/2013/837086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 02/21/2013] [Indexed: 11/18/2022] Open
Abstract
Heart failure affects millions of patients all over the world, and its treatment is a major clinical challenge. Cardiac dyssynchrony is common among patients with advanced heart failure. Resynchronization therapy is a major advancement in heart failure management, but unfortunately not all patients respond to this therapy. Hence, many diagnostic tests have been used to predict the response and prognosis after cardiac resynchronization therapy. In this paper we summarize the usefulness of different diagnostic modalities with special emphasis on the role of surface electrocardiogram as a major predictor of response to cardiac resynchronization therapy.
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3378
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Cowie MR, Sarkar S, Koehler J, Whellan DJ, Crossley GH, Tang WHW, Abraham WT, Sharma V, Santini M. Development and validation of an integrated diagnostic algorithm derived from parameters monitored in implantable devices for identifying patients at risk for heart failure hospitalization in an ambulatory setting. Eur Heart J 2013; 34:2472-80. [PMID: 23513212 PMCID: PMC3743068 DOI: 10.1093/eurheartj/eht083] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We developed and validated a heart failure (HF) risk score combining daily measurements of multiple device-derived parameters. METHODS Heart failure patients from clinical studies with implantable devices were used to form two separate data sets. Daily HF scores were estimated by combining changes in intra-thoracic impedance, atrial fibrillation (AF) burden, rapid rate during AF, %CRT pacing, ventricular tachycardia, night heart rate, heart rate variability, and activity using a Bayesian model. Simulated monthly follow-ups consisted of looking back at the maximum daily HF risk score in the preceding 30 days, categorizing the evaluation as high, medium, or low risk, and evaluating the occurrence of HF hospitalizations in the next 30 days. We used an Anderson-Gill model to compare survival free from HF events in the next 30 days based on risk groups. RESULTS The development data set consisted of 921 patients with 9790 patient-months of data and 91 months with HF hospitalizations. The validation data set consisted of 1310 patients with 10 655 patient-months of data and 163 months with HF hospitalizations. In the validation data set, 10% of monthly evaluations in 34% of the patients were in the high-risk group. Monthly diagnostic evaluations in the high-risk group were 10 times (adjusted HR: 10.0; 95% CI: 6.4-15.7, P < 0.001) more likely to have an HF hospitalization (event rate of 6.8%) in the next 30 days compared with monthly evaluations in the low-risk group (event rate of 0.6%). CONCLUSION An HF score based on implantable device diagnostics can identify increased risk for HF hospitalization in the next 30 days.
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Affiliation(s)
- Martin R Cowie
- National Heart and Lung Institute, Imperial College, London, UK.
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3379
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Eurich DT, Weir DL, Majumdar SR, Tsuyuki RT, Johnson JA, Tjosvold L, Vanderloo SE, McAlister FA. Comparative safety and effectiveness of metformin in patients with diabetes mellitus and heart failure: systematic review of observational studies involving 34,000 patients. Circ Heart Fail 2013; 6:395-402. [PMID: 23508758 DOI: 10.1161/circheartfailure.112.000162] [Citation(s) in RCA: 241] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is an ongoing controversy regarding the safety and effectiveness of metformin in the setting of heart failure (HF). Therefore, we undertook a systematic review of the trial and nontrial evidence for metformin in patients with diabetes mellitus and HF. METHODS AND RESULTS We conducted a comprehensive search for controlled studies, evaluating the association between metformin and morbidity and mortality in people with diabetes mellitus and HF. Two reviewers independently identified citations, extracted data, and evaluated quality. Risk estimates were abstracted and pooled where appropriate. As measures of overall safety, we examined all-cause mortality and all-cause hospitalizations. Nine cohort studies were included; no randomized controlled trials were identified. Most (5 of 9) studies were published in 2010 and were of good quality. Metformin was associated with reduced mortality compared with controls (mostly sulfonylurea therapy): 23% versus 37% (pooled adjusted risk estimates: 0.80; 0.74-0.87; I(2)=15%; P<0.001). No increased risk was observed for metformin in those with reduced left ventricular ejection fraction (mortality pooled adjusted risk estimate: 0.91; 0.72-1.14; I(2)=0%; P=0.34), nor in those with HF and chronic kidney disease (pooled adjusted risk estimate: 0.81; 0.64-1.02; P=0.08). Metformin was associated with a small reduction in all-cause hospitalizations (pooled adjusted risk estimate: 0.93; 0.89-0.98; I(2)=0%; P=0.01). Metformin was not associated with increased risk of lactic acidosis. CONCLUSIONS The totality of evidence indicates that metformin is at least as safe as other glucose-lowering treatments in patients with diabetes mellitus and HF and even in those with reduced left ventricular ejection fraction or concomitant chronic kidney disease. Until trial data become available, metformin should be considered the treatment of choice for patients with diabetes mellitus and HF.
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Affiliation(s)
- Dean T Eurich
- Department of Public Health Sciences, School of Public Health, Li Ka Shing Center, University of Alberta, Edmonton, Alberta, Canada.
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3380
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Delnoy PP, Ritter P, Naegele H, Orazi S, Szwed H, Zupan I, Goscinska-Bis K, Anselme F, Martino M, Padeletti L. Association between frequent cardiac resynchronization therapy optimization and long-term clinical response: a post hoc analysis of the Clinical Evaluation on Advanced Resynchronization (CLEAR) pilot study. Europace 2013; 15:1174-81. [PMID: 23493410 PMCID: PMC3718358 DOI: 10.1093/europace/eut034] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims The long-term clinical value of the optimization of atrioventricular (AVD) and interventricular (VVD) delays in cardiac resynchronization therapy (CRT) remains controversial. We studied retrospectively the association between the frequency of AVD and VVD optimization and 1-year clinical outcomes in the 199 CRT patients who completed the Clinical Evaluation on Advanced Resynchronization study. Methods and results From the 199 patients assigned to CRT-pacemaker (CRT-P) (New York Heart Association, NYHA, class III/IV, left ventricular ejection fraction <35%), two groups were retrospectively composed a posteriori on the basis of the frequency of their AVD and VVD optimization: Group 1 (n = 66) was composed of patients ‘systematically’ optimized at implant, at 3 and 6 months; Group 2 (n = 133) was composed of all other patients optimized ‘non-systematically’ (less than three times) during the 1 year study. The primary endpoint was a composite of all-cause mortality, heart failure-related hospitalization, NYHA functional class, and Quality of Life score, at 1 year. Systematic CRT optimization was associated with a higher percentage of improved patients based on the composite endpoint (85% in Group 1 vs. 61% in Group 2, P < 0.001), with fewer deaths (3% in Group 1 vs. 14% in Group 2, P = 0.014) and fewer hospitalizations (8% in Group 1 vs. 23% in Group 2, P = 0.007), at 1 year. Conclusion These results further suggest that AVD and VVD frequent optimization (at implant, at 3 and 6 months) is associated with improved long-term clinical response in CRT-P patients.
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3381
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Nickenig G, Mohr F, Kelm M, Kuck KH, Boekstegers P, Hausleiter J, Schillinger W, Brachmann J, Lange R, Reichenspurner H. Konsensus der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung – und der Deutschen Gesellschaft für Thorax-, Herz- und Gefäßchirurgie zur Behandlung der Mitralklappeninsuffizienz. KARDIOLOGE 2013. [DOI: 10.1007/s12181-013-0488-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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3382
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Japp AG, Pettit SJ. Remodeling in heart failure: from the left ventricle to service delivery. Expert Rev Cardiovasc Ther 2013; 11:285-7. [PMID: 23469907 DOI: 10.1586/erc.12.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Over the past three decades, advances in our understanding of heart failure pathophysiology have spurred the development of effective therapies for patients with heart failure and led to improved clinical outcomes. Further progress now requires increased provision of existing evidence-based therapies together with continued exploration of underlying pathogenic mechanisms and therapeutic targets. This was reflected at the 2012 Annual Autumn Meeting of the British Society for Heart Failure, attended by over 500 delegates from around the world with strong representation from all heart failure disciplines. The conference included a dedicated session on 'cardiac remodeling in left ventricular systolic dysfunction' as well as presentations on the latest evidence-based therapies in heart failure and aspects of service delivery within the UK.
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Affiliation(s)
- Alan G Japp
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
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3383
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Bjurman C, Jensen J, Petzold M, Hammarsten O, Fu MLX. Assessment of a multimarker strategy for prediction of mortality in older heart failure patients: a cohort study. BMJ Open 2013; 3:bmjopen-2012-002254. [PMID: 23474790 PMCID: PMC3612770 DOI: 10.1136/bmjopen-2012-002254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Primarily to develop a multimarker score for prediction of 3-year mortality in older patients with decompensated heart failure (HF). DESIGN Prospective cohort study. SETTING Secondary care. Single centre. PATIENTS AND BIOMARKERS: 131 patients, aged ≥65 years, with decompensated HF were included. Assessment of biomarkers was performed at discharge. PRIMARY OUTCOME MEASURE 3-year mortality. RESULTS Mean age was 73±11 years; mean left ventricular ejection fraction , 43±14%; 53% were male. The 3-year mortality was 53.4%. The following N-terminal brain natriuretic peptide (NTproBNP) levels could optimally stratify mortality: <2000 ng/l (n=39), 30.8% mortality; 2000-8000 ng/l (n=58), 51.7% mortality; and >8000 ng/l (n=34), 82.4% mortality. However, in the 2000-8000 ng/l range, NTproBNP levels had low-prognostic capacity, based on the area under the receiver operating characteristic curve (AUC=0.53; 95% CI 0.40 to 0.67). In this group, multivariate analysis identified age, cystatin C (CysC), and troponin T (TnT) levels as independent risk factors. A risk score based on these three risk factors separated a high-risk and low-risk groups within the NTproBNP range of 2000-8000 ng/l. The score exhibited a significantly higher AUC (0.75; 95% CI 0.62 to 0.86) than NTproBNP alone (p=0.03) in this NTproBNP group and had similar prognostic capacity as NTproBNP in patients below or above this NTproBNP range (p=0.57). Net reclassification improvement and integrated discriminatory improvement in the group with NTproBNP levels between 2000 and 8000 ng/l was 54% and 23%, respectively, and in the whole cohort 22% and 11%, respectively. CONCLUSIONS Our results suggested that, to assess risk in HF, older patients required significantly higher levels of NTproBNP than younger patients. Furthermore, a risk score that included TnT and CysC at discharge, and age could improve risk stratification for mortality in older patients with HF in particular when NTproBNP was moderately elevated.
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Affiliation(s)
- Christian Bjurman
- Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, Gothenburg, Sweden
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3384
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Duncan A, Cunnington C. A holistic approach to managing a patient with heart failure. Future Cardiol 2013; 9:189-92. [PMID: 23463971 DOI: 10.2217/fca.13.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Despite varied and complex therapeutic strategies for managing patients with heart failure, the prognosis may remain poor in certain groups. Recognition that patients with heart failure frequently require input from many care groups formed the basis of The British Society of Heart Failure Annual Autumn Meeting in London (UK), in November 2012, entitled: 'Heart failure: a multidisciplinary approach'. Experts in cardiology, cardiac surgery, general practice, care of the elderly, palliative care and cardiac imaging shared their knowledge and expertise. The 2-day symposium was attended by over 500 participants from the UK, Europe and North America, and hosted physicians, nurses, scientists, trainees and representatives from the industry, as well as patient and community groups. The symposium, accredited by the Royal College of Physicians and the Royal College of Nursing, focused on the multidisciplinary approach to heart failure, in particular, current therapeutic advances, cardiac remodeling, palliative care, atrial fibrillation, heart rate-lowering therapies, management of acute heart failure and the management of patients with mitral regurgitation and heart failure.
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Affiliation(s)
- Alison Duncan
- The Royal Brompton Hospital, Sydney Street, London, Greater London, SW3 6NP, UK.
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3385
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Choudhary R, Di Somma S, Maisel AS. Biomarkers for Diagnosis and Prognosis of Acute Heart Failure. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2013. [DOI: 10.1007/s40138-013-0009-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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3386
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Whitty JA, Stewart S, Carrington MJ, Calderone A, Marwick T, Horowitz JD, Krum H, Davidson PM, Macdonald PS, Reid C, Scuffham PA. Patient preferences and willingness-to-pay for a home or clinic based program of chronic heart failure management: findings from the Which? trial. PLoS One 2013; 8:e58347. [PMID: 23505491 PMCID: PMC3591337 DOI: 10.1371/journal.pone.0058347] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 02/04/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Beyond examining their overall cost-effectiveness and mechanisms of effect, it is important to understand patient preferences for the delivery of different modes of chronic heart failure management programs (CHF-MPs). We elicited patient preferences around the characteristics and willingness-to-pay (WTP) for a clinic or home-based CHF-MP. METHODOLOGY/PRINCIPAL FINDINGS A Discrete Choice Experiment was completed by a sub-set of patients (n = 91) enrolled in the WHICH? trial comparing home versus clinic-based CHF-MP. Participants provided 5 choices between hypothetical clinic and home-based programs varying by frequency of nurse consultations, nurse continuity, patient costs, and availability of telephone or education support. Participants (aged 71±13 yrs, 72.5% male, 25.3% NYHA class III/IV) displayed two distinct preference classes. A latent class model of the choice data indicated 56% of participants preferred clinic delivery, access to group CHF education classes, and lower cost programs (p<0.05). The remainder preferred home-based CHF-MPs, monthly rather than weekly visits, and access to a phone advice service (p<0.05). Continuity of nurse contact was consistently important. No significant association was observed between program preference and participant allocation in the parent trial. WTP was estimated from the model and a dichotomous bidding technique. For those preferring clinic, estimated WTP was ≈AU$9-20 per visit; however for those preferring home-based programs, WTP varied widely (AU$15-105). CONCLUSIONS/SIGNIFICANCE Patient preferences for CHF-MPs were dichotomised between a home-based model which is more likely to suit older patients, those who live alone, and those with a lower household income; and a clinic-based model which is more likely to suit those who are more socially active and wealthier. To optimise the delivery of CHF-MPs, health care services should consider their patients' preferences when designing CHF-MPs.
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Affiliation(s)
- Jennifer A Whitty
- Centre for Applied Health Economics, School of Medicine, Griffith Health Institute, Griffith University, Meadowbrook, Queensland, Australia.
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3387
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Erdmann E. [Cardiac failure]. MMW Fortschr Med 2013; 155:40. [PMID: 23614194 DOI: 10.1007/s15006-013-0223-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- E Erdmann
- Klinik für Kardiologie, Angiologie, Pneumologie und Int. Intensivmedizin am Herzzentrum der Univ. Köln
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3388
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Tian Y, Zhang P, Li X, Gao Y, Zhu T, Wang L, Li D, Wang J, Yuan C, Guo J. True complete left bundle branch block morphology strongly predicts good response to cardiac resynchronization therapy. ACTA ACUST UNITED AC 2013; 15:1499-506. [DOI: 10.1093/europace/eut049] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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3389
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3390
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Grado de conocimiento sobre su enfermedad cardiaca entre los pacientes hospitalizados. Rev Esp Cardiol (Engl Ed) 2013. [DOI: 10.1016/j.recesp.2012.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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3391
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Barreiro M, Velasco E, Renilla A, Torres F, Martín M, de la Hera JM. Knowledge of cardiac disease among hospitalized patients. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2013; 66:229-230. [PMID: 24775463 DOI: 10.1016/j.rec.2012.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 07/25/2012] [Indexed: 06/03/2023]
Affiliation(s)
- Manuel Barreiro
- Área del Corazón, Hospital Central de Asturias, Oviedo, Asturias, Spain.
| | - Elena Velasco
- Área del Corazón, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | - Alfredo Renilla
- Área del Corazón, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | - Francisco Torres
- Área del Corazón, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | - María Martín
- Área del Corazón, Hospital Central de Asturias, Oviedo, Asturias, Spain
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3392
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Parenica J, Spinar J, Vitovec J, Widimsky P, Linhart A, Fedorco M, Vaclavik J, Miklik R, Felsoci M, Horakova K, Cihalik C, Malek F, Spinarova L, Belohlavek J, Kettner J, Zeman K, Dušek L, Jarkovsky J. Long-term survival following acute heart failure: the Acute Heart Failure Database Main registry (AHEAD Main). Eur J Intern Med 2013; 24:151-60. [PMID: 23219321 DOI: 10.1016/j.ejim.2012.11.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 11/09/2012] [Accepted: 11/11/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The in-hospital mortality of patients with acute heart failure (AHF) is reported to be 12.7% and mortality on day 30 after admission 17.2%. Less information is known about the long-term prognosis of those patients discharged after hospitalization. As such, the aim of this study was to investigate long-term survival in a cohort of patients who had been hospitalized for AHF and then discharged. METHODS The AHEAD Main registry includes 4153 patients hospitalized for AHF in 7 different medical centers, each with its own cathlab, in the Czech Republic. Patient survival rates were evaluated in 3438 patients who had survived to day 30 after admission, and were used as a measurement of long-term survival. RESULTS The most common etiologies were acute coronary syndrome (32.3%) and chronic ischemic heart disease (20.1%). The survival rate after day 30 following admission was 79.7% after 1 year and 64.5% after 3 years. No statistically significant difference in syndromes was found in survival after day 30. Independent predictors of a worse prognosis were defined as follows: age>70 years, comorbidities, severe left ventricular systolic dysfunction, valvular disease or ACS as an etiology of AHF. A better prognosis was defined for de-novo AHF patients, and those who were taking ACE inhibitors at the time of discharge. In a sub-analysis, high levels of natriuretic peptides were the most powerful predictors of high-risk, long-term mortality. CONCLUSION The AHEAD Main registry provides up-to-date information on the long-term prognosis of patients hospitalized with AHF. The 3-year survival of patients following day 30 of admission was 64.5%. Higher age, LV dysfunction, comorbidities and high levels of natriuretic peptides were the most powerful predictors of worse prognosis in long-term survival.
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Affiliation(s)
- Jiri Parenica
- Department of Internal Medicine, Cardiology Division, University Hospital Brno, Jihlavska 20, Brno 625 00, Czech Republic
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Gasparini M, Boriani G. Letter by Gasparini and Boriani Regarding Article, “Cardiac Resynchronization Therapy in Patients With Permanent Atrial Fibrillation: Results From the Resynchronization for Ambulatory Heart Failure Trial (RAFT)”. Circ Heart Fail 2013; 6:e22. [DOI: 10.1161/circheartfailure.112.972612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Effect of serelaxin on cardiac, renal, and hepatic biomarkers in the Relaxin in Acute Heart Failure (RELAX-AHF) development program: correlation with outcomes. J Am Coll Cardiol 2013; 61:196-206. [PMID: 23273292 DOI: 10.1016/j.jacc.2012.11.005] [Citation(s) in RCA: 341] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 11/03/2012] [Accepted: 11/05/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to assess the effects of serelaxin on short-term changes in markers of organ damage and congestion and relate them to 180-day mortality in patients with acute heart failure. BACKGROUND Hospitalization for acute heart failure is associated with high post-discharge mortality, and this may be related to organ damage. METHODS The Pre-RELAX-AHF (Relaxin in Acute Heart Failure) phase II study and RELAX-AHF phase III study were international, multicenter, double-blind, placebo-controlled trials in which patients hospitalized for acute heart failure were randomized within 16 h to intravenous placebo or serelaxin. Each patient was followed daily to day 5 or discharge and at days 5, 14, and 60 after enrollment. Vital status was assessed through 180 days. In RELAX-AHF, laboratory evaluations were performed daily to day 5 and at day 14. Plasma levels of biomarkers were measured at baseline and days 2, 5, and 14. All-cause mortality was assessed as a safety endpoint in both studies. RESULTS Serelaxin reduced 180-day mortality, with similar effects in the phase II and phase III studies (combined studies: N = 1,395; hazard ratio: 0.62; 95% confidence interval: 0.43 to 0.88; p = 0.0076). In RELAX-AHF, changes in markers of cardiac (high-sensitivity cardiac troponin T), renal (creatinine and cystatin-C), and hepatic (aspartate transaminase and alanine transaminase) damage and of decongestion (N-terminal pro-brain natriuretic peptide) at day 2 and worsening heart failure during admission were associated with 180-day mortality. Serelaxin administration improved these markers, consistent with the prevention of organ damage and faster decongestion. CONCLUSIONS Early administration of serelaxin was associated with a reduction of 180-day mortality, and this occurred with fewer signs of organ damage and more rapid relief of congestion during the first days after admission.
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Coats CJ, Gallagher MJ, Foley M, O'Mahony C, Critoph C, Gimeno J, Dawnay A, McKenna WJ, Elliott PM. Relation between serum N-terminal pro-brain natriuretic peptide and prognosis in patients with hypertrophic cardiomyopathy. Eur Heart J 2013; 34:2529-37. [DOI: 10.1093/eurheartj/eht070] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Adlbrecht C, Hülsmann M, Neuhold S, Strunk G, Pacher R. Prognostic utility of the Seattle Heart Failure Score and amino terminal pro B-type natriuretic peptide in varying stages of systolic heart failure. J Heart Lung Transplant 2013; 32:533-8. [PMID: 23453573 DOI: 10.1016/j.healun.2013.01.1048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/08/2013] [Accepted: 01/25/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Cardiac transplantation represents the best procedure to improve long-term clinical outcome in advanced chronic heart failure (CHF), if pre-selection criteria are sufficient to outweigh the risk of the failing heart over the risk of transplantation. Although the cornerstone of success, risk assessment in heart transplant candidates is still under-investigated. Amino terminal pro B-type natriuretic peptide (NT-proBNP) is regarded as the best predictor of outcome in CHF, and the Seattle Heart Failure Score (SHFS), including clinical markers, is widely used if NT-proBNP is unavailable. METHODS The present study assessed the predictive value for all-cause death of the SHFS in CHF patients and compared it with NT-proBNP in a multivariate model including established baseline parameters known to predict survival. RESULTS A total of 429 patients receiving stable HF-specific pharmacotherapy were included and monitored for 53.4 ± 20.6 months. Of these, 133 patients (31%) died during follow-up. Several established predictors of death on univariate analysis proved significant for the total study cohort. Systolic pulmonary arterial pressure (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.02-1.05); p < 0.001, Wald 15.1), logNT-proBNP (HR, 1.51; 95% CI, 1.22-1.86; p < 0.001, Wald 14.9), and the SHFS (HR, 0.99; 95% CI, 0.99-1.00; p < 0.001, Wald 12.6) remained within the stepwise multivariate Cox regression model as independent predictors of all-cause death. Receiver operating characteristic curve analysis revealed an area under the curve of 0.802 for logNT-proBNP and 0.762 for the SHFS. CONCLUSIONS NT-proBNP is a more potent marker to identify patients at the highest risk. If the NT-proBNP measurement is unavailable, the SHFS may serve as an adequate clinical surrogate to predict all-cause death.
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Affiliation(s)
- Christopher Adlbrecht
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
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Cardiovascular imaging: new directions in an evolving landscape. Can J Cardiol 2013; 29:257-9. [PMID: 23439017 DOI: 10.1016/j.cjca.2013.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 01/22/2013] [Indexed: 11/20/2022] Open
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Mazza A, Bendini MG, Leggio M, Riva U, Ciardiello C, Valsecchi S, De Cristofaro R, Giordano G. Incidence and predictors of heart failure hospitalization and death in permanent pacemaker patients: a single-centre experience over medium-term follow-up. Europace 2013; 15:1267-72. [DOI: 10.1093/europace/eut041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Understanding the mechanisms amenable to CRT response: from pre-operative multimodal image data to patient-specific computational models. Med Biol Eng Comput 2013; 51:1235-50. [PMID: 23430328 DOI: 10.1007/s11517-013-1044-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 02/02/2013] [Indexed: 01/18/2023]
Abstract
This manuscript describes our recent developments towards better understanding of the mechanisms amenable to cardiac resynchronization therapy response. We report the results from a full multimodal dataset corresponding to eight patients from the euHeart project. The datasets include echocardiography, MRI and electrophysiological studies. We investigate two aspects. The first one focuses on pre-operative multimodal image data. From 2D echocardiography and 3D tagged MRI images, we compute atlas based dyssynchrony indices. We complement these indices with presence and extent of scar tissue and correlate them with CRT response. The second one focuses on computational models. We use pre-operative imaging to generate a patient-specific computational model. We show results of a fully automatic personalized electromechanical simulation. By case-per-case discussion of the results, we highlight the potential and key issues of this multimodal pipeline for the understanding of the mechanisms of CRT response and a better patient selection.
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