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Eickholt C, Siekiera M, Kirmanoglou K, Rodenbeck A, Heussen N, Schauerte P, Lichtenberg A, Balzer J, Rassaf T, Perings S, Kelm M, Shin DI, Meyer C. Improvement of left ventricular function under cardiac resynchronization therapy goes along with a reduced incidence of ventricular arrhythmia. PLoS One 2012; 7:e48926. [PMID: 23152822 PMCID: PMC3495960 DOI: 10.1371/journal.pone.0048926] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 10/02/2012] [Indexed: 12/13/2022] Open
Abstract
Objectives The beneficial effects of cardiac resynchronization therapy (CRT) are thought to result from favorable left ventricular (LV) reverse remodeling, however CRT is only successful in about 70% of patients. Whether response to CRT is associated with a decrease in ventricular arrhythmias (VA) is still discussed controversially. Therefore, we investigated the incidence of VA in CRT responders in comparison with non-responders. Methods In this nonrandomized, two-center, observational study patients with moderate-to-severe heart failure, LV ejection fraction (LVEF) ≤35%, and QRS duration >120 ms undergoing CRT were included. After 6 months patients were classified as CRT responders or non-responders. Incidence of VA was compared between both groups by Kaplan-Meier analysis and Cox regression analysis. ROC analysis was performed to determine the aptitude of LVEF cut-off values to predict VA. Results In total 126 consecutive patients (64±11years; 67%male) were included, 74 were classified as responders and 52 as non-responders. While the mean LVEF at baseline was comparable in both groups (25±7% vs. 24±8%; P = 0.4583) only the responder group showed an improvement of LVEF (36±6% vs. 24±7; p<0.0001) under CRT. In total in 56 patients VA were observed during a mean follow-up of 28±14 months, with CRT responders experiencing fewer VA than non-responders (35% vs. 58%, p<0.0061). Secondary preventive CRT implantation was associated with a higher likelihood of VA. As determined by ROC analysis an increase of LVEF by >7% was found to be a predictor of a significantly lower incidence of VA (AUC = 0.606). Conclusions Improvement of left ventricular function under cardiac resynchronization therapy goes along with a reduced incidence of ventricular arrhythmia.
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Affiliation(s)
- Christian Eickholt
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmology and Angiology, Dusseldorf, Germany
| | - Marcus Siekiera
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmology and Angiology, Dusseldorf, Germany
| | - Kiriakos Kirmanoglou
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmology and Angiology, Dusseldorf, Germany
| | - Astrid Rodenbeck
- Division of Cardiology, Pulmology and Angiology, University Hospital RWTH-Aachen, Aachen, Germany
| | - Nicole Heussen
- Department of Medical Statistics, University Hospital RWTH-Aachen, Aachen, Germany
| | - Patrick Schauerte
- Division of Cardiology, Pulmology and Angiology, University Hospital RWTH-Aachen, Aachen, Germany
| | - Artur Lichtenberg
- Heinrich-Heine-University Duesseldorf, Department of Cardiovascular Surgery, Dusseldorf, Germany
| | - Jan Balzer
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmology and Angiology, Dusseldorf, Germany
| | - Tienush Rassaf
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmology and Angiology, Dusseldorf, Germany
| | - Stefan Perings
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmology and Angiology, Dusseldorf, Germany
| | - Malte Kelm
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmology and Angiology, Dusseldorf, Germany
| | - Dong-In Shin
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmology and Angiology, Dusseldorf, Germany
| | - Christian Meyer
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Department of Cardiology, Pulmology and Angiology, Dusseldorf, Germany
- * E-mail:
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Almenar L, Segovia J, Crespo-Leiro MG, Palomo J, Arizón JM, González-Vílchez F, Delgado J. Registro Español de Trasplante Cardiaco. XXIII Informe Oficial de la Sección de Insuficiencia Cardiaca y Trasplante Cardiaco de la Sociedad Española de Cardiología (1984-2011). Rev Esp Cardiol 2012; 65:1030-8. [DOI: 10.1016/j.recesp.2012.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/11/2012] [Indexed: 10/27/2022]
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Silverberg DS, Wexler D. Retrasar el inicio de diálisis para tratar la retención de líquidos grave en la insuficiencia cardiaca. Rev Esp Cardiol (Engl Ed) 2012; 65:975-6. [DOI: 10.1016/j.recesp.2012.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 05/20/2012] [Indexed: 10/28/2022]
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3454
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Borer JS, Böhm M, Ford I, Komajda M, Tavazzi L, Sendon JL, Alings M, Lopez-de-Sa E, Swedberg K. Effect of ivabradine on recurrent hospitalization for worsening heart failure in patients with chronic systolic heart failure: the SHIFT Study. Eur Heart J 2012; 33:2813-20. [PMID: 22927555 PMCID: PMC3498004 DOI: 10.1093/eurheartj/ehs259] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 07/25/2012] [Accepted: 07/27/2012] [Indexed: 11/13/2022] Open
Abstract
AIMS We explored the effect of treatment with ivabradine, a pure heart rate-slowing agent, on recurrent hospitalizations for worsening heart failure (HF) in the SHIFT trial. METHODS AND RESULTS SHIFT was a double-blind clinical trial in which 6505 patients with moderate-to-severe HF and left ventricular systolic dysfunction, all of whom had been hospitalized for HF during the preceding year, were randomized to ivabradine or to placebo on a background of guideline-recommended HF therapy (including maximized β-blockade). In total, 1186 patients experienced at least one additional HF hospitalization during the study, 472 suffered at least two, and 218 suffered at least 3. Patients with additional HF hospitalizations had more severe disease than those without. Ivabradine was associated with fewer total HF hospitalizations [902 vs. 1211 events with placebo; incidence rate ratio, 0.75, 95% confidence interval (CI), 0.65-0.87, P = 0.0002] during the 22.9-month median follow-up. Ivabradine-treated patients evidenced lower risk for a second or third additional HF hospitalization [hazard ratio (HR): 0.66, 95% CI, 0.55-0.79, P < 0.001 and HR: 0.71, 95% CI, 0.54-0.93, P = 0.012, respectively]. Similar observations were made for all-cause and cardiovascular hospitalizations. CONCLUSION Treatment with ivabradine, on a background of guidelines-based HF therapy, is associated with a substantial reduction in the likelihood of recurrent hospitalizations for worsening HF. This benefit can be expected to improve the quality of life and to substantially reduce health-care costs.
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Affiliation(s)
- Jeffrey S Borer
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn and New York, NY 10128-1152, USA.
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Atwater BD, Dai D, Allen-Lapointe NM, Al-Khatib SM, Zimmer LO, Sanders GD, Peterson ED. Is heart failure guideline adherence being underestimated? The impact of therapeutic contraindications. Am Heart J 2012; 164:750-755.e1. [PMID: 23137506 DOI: 10.1016/j.ahj.2012.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 08/15/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND Several studies based on claims data have reported underutilization of evidence-based heart failure (HF) therapies. The degree to which these estimates fail to account for therapeutic contraindications is unclear. METHODS We identified patients with HF and left ventricular ejection fraction ≤45% seen between January 1, 2010, and July 1, 2010, at a tertiary care Veterans Affairs Medical Center. Medical records were abstracted to evaluate utilization of and contraindications to β-blocker, angiotensin-converting enzyme inhibitor, aldosterone antagonist, anticoagulation for atrial fibrillation, implantable cardioverter-defibrillator, and cardiac resynchronization therapies. RESULTS Of the 178 patients with HF and an ejection fraction ≤45%, 78 (44%) received every guideline-recommended therapy. After accounting for medical contraindications, 77 (72%) of 107 patients received every guideline-recommended therapy. Adherence to recommendations for β-blocker (98%), angiotensin-converting enzyme inhibitor/angiotensin blocker (95%), and anticoagulation (97%) were better than adherence to implantable cardioverter-defibrillator (82%), cardiac resynchronization therapy (59%), or aldosterone antagonist (51%) recommendations. In adjusted analysis, lower New York Heart Association functional class and care by a cardiologist were associated with improved guideline adherence (P < .001). CONCLUSIONS Many patients with HF have therapeutic contraindications, and a failure to account for these may lead to a large underestimation of the true guideline adherence rates.
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Affiliation(s)
- Brett D Atwater
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
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3456
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Tait L, Roalfe AK, Mant J, Cowie MR, Deeks JJ, Iles R, Barton PM, Taylor CJ, Derit M, Hobbs FDR. The REFER (REFer for EchocaRdiogram) protocol: a prospective validation of a clinical decision rule, NT-proBNP, or their combination, in the diagnosis of heart failure in primary care. Rationale and design. BMC Cardiovasc Disord 2012; 12:97. [PMID: 23110558 PMCID: PMC3519731 DOI: 10.1186/1471-2261-12-97] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 10/17/2012] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Heart failure is a major cause of mortality and morbidity. As mortality rates are high, it is important that patients seen by general practitioners with symptoms suggestive of heart failure are identified quickly and treated appropriately. Identifying patients with heart failure or deciding which patients need further tests is a challenge. All patients with suspected heart failure should be diagnosed using objective tests such as echocardiography, but it is expensive, often delayed, and limited by the significant skill shortage of trained echocardiographers. Alternative approaches for diagnosing heart failure are currently limited. Clinical decision tools that combine clinical signs, symptoms or patient characteristics are designed to be used to support clinical decision-making and validated according to strict methodological procedures. The REFER Study aims to determine the accuracy and cost-effectiveness of our previously derived novel, simple clinical decision rule, a natriuretic peptide assay, or their combination, in the triage for referral for echocardiography of symptomatic adult patients who present in general practice with symptoms suggestive of heart failure. METHODS/DESIGN This is a prospective, Phase II observational, diagnostic validation study of a clinical decision rule, natriuretic peptides or their combination, for diagnosing heart failure in primary care. Consecutive adult primary care patients 55 years of age or over presenting to their general practitioner with a chief complaint of recent new onset shortness of breath, lethargy or peripheral ankle oedema of over 48 hours duration, with no obvious recurrent, acute or self-limiting cause will be enrolled. Our reference standard is based upon a three step expert specialist consensus using echocardiography and clinical variables and tests. DISCUSSION Our clinical decision rule offers a potential solution to the diagnostic challenge of providing a timely and accurate diagnosis of heart failure in primary care. Study results will provide an evidence-base from which to develop heart failure care pathway recommendations and may be useful in standardising care. If demonstrated to be effective, the clinical decision rule will be of interest to researchers, policy makers and general practitioners worldwide. TRIAL REGISTRATION ISRCTN17635379.
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Affiliation(s)
- Lynda Tait
- Primary Care Clinical Sciences, Primary Care Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Andrea K Roalfe
- Primary Care Clinical Sciences, Primary Care Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Jonathan Mant
- General Practice & Primary Care Research Unit, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 OSR, UK
| | - Martin R Cowie
- Imperial College London (Royal Brompton Hospital), London, SW3 6LY, UK
| | - Jonathan J Deeks
- Public Health, Epidemiology and Biostatistics, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Rachel Iles
- Primary Care Clinical Sciences, Primary Care Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Pelham M Barton
- Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Clare J Taylor
- Primary Care Clinical Sciences, Primary Care Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Marites Derit
- Primary Care Clinical Sciences, Primary Care Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - FD Richard Hobbs
- Department of General Practice, University of Oxford, 23-38 Hythe Bridge Street, Oxford, OX1 2ET, UK
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Nikolaou M, Parissis J, Yilmaz MB, Seronde MF, Kivikko M, Laribi S, Paugam-Burtz C, Cai D, Pohjanjousi P, Laterre PF, Deye N, Poder P, Cohen-Solal A, Mebazaa A. Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J 2012; 34:742-9. [DOI: 10.1093/eurheartj/ehs332] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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3459
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Solomon SD, Zile M, Pieske B, Voors A, Shah A, Kraigher-Krainer E, Shi V, Bransford T, Takeuchi M, Gong J, Lefkowitz M, Packer M, McMurray JJV. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet 2012; 380:1387-95. [PMID: 22932717 DOI: 10.1016/s0140-6736(12)61227-6] [Citation(s) in RCA: 852] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Heart failure with preserved ejection fraction is associated with substantial morbidity and mortality, but effective treatments are lacking. We assessed the efficacy and safety of LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), in patients with this disorder. METHODS PARAMOUNT was a phase 2, randomised, parallel-group, double-blind multicentre trial in patients with New York Heart Association (NYHA) class II-III heart failure, left ventricular ejection fraction 45% or higher, and NT-proBNP greater than 400 pg/mL. Participants were randomly assigned (1:1) by central interactive voice response system to LCZ696 titrated to 200 mg twice daily or valsartan titrated to 160 mg twice daily, and treated for 36 weeks. Investigators and participants were masked to treatment assignment. The primary endpoint was change in NT-proBNP, a marker of left ventricular wall stress, from baseline to 12 weeks; analysis included all patients randomly assigned to treatment groups who had a baseline and at least one postbaseline assessment. This trial is registered at Clinicaltrials.gov, number NCT00887588. FINDINGS 149 patients were randomly assigned to LCZ696 and 152 to valsartan; 134 in the LCZ696 group and 132 in the valsartan group were included in analysis of the primary endpoint. NT-proBNP was significantly reduced at 12 weeks in the LCZ696 group compared with the valsartan group (LCZ696: baseline, 783 pg/mL [95% CI 670-914], 12 weeks, 605 pg/mL [512-714]; valsartan: baseline, 862 pg/mL [733-1012], 12 weeks, 835 [710-981]; ratio LCZ696/valsartan, 0·77, 95% CI 0·64-0·92, p=0·005). LCZ696 was well tolerated with adverse effects similar to those of valsartan; 22 patients (15%) on LCZ696 and 30 (20%) on valsartan had one or more serious adverse event. INTERPRETATION In patients with heart failure with preserved ejection fraction, LCZ696 reduced NT-proBNP to a greater extent than did valsartan at 12 weeks and was well tolerated. Whether these effects would translate into improved outcomes needs to be tested prospectively. FUNDING Novartis.
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Affiliation(s)
- Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Bhattacharyya S, Khattar R, Lloyd G, Senior R. Implementation of echocardiographic contrast agents into clinical practice: a United Kingdom National Health Service Survey on behalf of the British Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2012; 14:550-4. [PMID: 23063926 DOI: 10.1093/ehjci/jes212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The administration of echocardiographic contrast agents has been shown to improve accuracy and be cost-effective in patients with suboptimal endocardial definition. We sought to investigate the implementation of contrast agents in clinical practice. METHODS AND RESULTS An electronic questionnaire was devised to determine the use of contrast ultrasound agents in clinical practice and sent electronically to echocardiography departments at each national health service hospital within the UK. Out of 198, 107 departments responded (54%). Out of 673,121 echocardiograms, 25,834 (3.8%) were performed with contrast. Out of 551 echocardiography machines, 358 (65%) were suitable for contrast use. Of the sonographers, out of 711, 112 (15.8%) could perform i.v. cannulation and 42 (5.9%) could administer contrast independently. The median time for an echocardiographic examination was 30 min (inter-quartile range 30-45 min). Significant predictors of contrast use were the presence of a consultant cardiologist with subspecialty training in echocardiography (odds ratio 8.7, P = 0.004), the presence of a stress echocardiography service (odds ratio 2.3, P = 0.004), and the presence of a physician during the day (odds ratio 3.0, P = 0.04). Reasons for impediment in administering contrast were staff training (34.6%), extra time required for a contrast study (29.9%), and the expense of contrast (18.7%). CONCLUSION The use of echocardiographic contrast agents within routine echocardiographic practice in the UK is limited to <4% of all transthoracic echocardiographic studies. Major barriers to the implementation of contrast use are the absence of cardiac imaging specialists directly supervising echocardiography departments and the training of sonographers to independently administer contrast.
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Affiliation(s)
- Sanjeev Bhattacharyya
- Department of Cardiology and Echocardiography Laboratory, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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Pérez de la sota E. Asistencia circulatoria en 2012 y las nuevas guías de insuficiencia cardíaca. CIRUGIA CARDIOVASCULAR 2012. [DOI: 10.1016/s1134-0096(12)70025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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3463
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Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Popescu BA, Von Segesser L, Badano LP, Bunc M, Claeys MJ, Drinkovic N, Filippatos G, Habib G, Kappetein AP, Kassab R, Lip GY, Moat N, Nickenig G, Otto CM, Pepper J, Piazza N, Pieper PG, Rosenhek R, Shuka N, Schwammenthal E, Schwitter J, Mas PT, Trindade PT, Walther T. Guidelines on the management of valvular heart disease (version 2012). Eur J Cardiothorac Surg 2012; 42:S1-44. [DOI: 10.1093/ejcts/ezs455] [Citation(s) in RCA: 1024] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Vanagas G, Umbrasienė J, Šlapikas R. Effectiveness of telemedicine and distance learning applications for patients with chronic heart failure. A protocol for prospective parallel group non-randomised open label study. BMJ Open 2012; 2:e001346. [PMID: 23015599 PMCID: PMC3467609 DOI: 10.1136/bmjopen-2012-001346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 08/28/2012] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Chronic heart failure in Baltic Sea Region is responsible for more hospitalisations than all forms of cancer combined and is one of the leading causes of hospitalisations in elderly patients. Frequent hospitalisations, along with other direct and indirect costs, place financial burden on healthcare systems. We aim to test the hypothesis that telemedicine and distance learning applications is superior to the current standard of home care. METHODS AND ANALYSIS Prospective parallel group non-randomised open label study in patients with New York Heart Association (NYHA) II-III chronic heart failure will be carried out in six Baltic Sea Region countries. The study is organised into two 6-month follow-up periods. The first 6-month period is based on active implementation of tele-education and/or telemedicine for patients in two groups (active run period) and one standard care group (passive run period). The second 6-month period of observation will be based on standard care model (passive run period) to all three groups. Our proposed practice change is based on translational research with empirically supported interventions brought to practice and aims to find the home care model that is most effective to patient needs. ETHICS AND DISSEMINATION This study has been approved by National Bioethics Committee (2011-03-07; Registration No: BE-2-11). TRIAL REGISTRATION This study has been registered in Australian New Zealand Clinical Trials Registry (ANZCTR) with registration number ACTRN12611000834954.
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Affiliation(s)
- Giedrius Vanagas
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jelena Umbrasienė
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimvydas Šlapikas
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences “Kauno Klinikos”, Kaunas, Lithuania
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Schau T, Koglek W, Brandl J, Seifert M, Meyhöfer J, Neuss M, Grimm G, Bitschnau R, Butter C. Baseline vectorcardiography as a predictor of invasively determined acute hemodynamic response to cardiac resynchronization therapy. Clin Res Cardiol 2012; 102:129-38. [DOI: 10.1007/s00392-012-0506-5] [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] [Received: 08/14/2011] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
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Tomaschitz A, Fahrleitner-Pammer A, Pieske B, Verheyen N, Amrein K, Ritz E, Kienreich K, Horina JH, Schmidt A, Kraigher-Krainer E, Colantonio C, Meinitzer A, Pilz S. Effect of eplerenone on parathyroid hormone levels in patients with primary hyperparathyroidism: a randomized, double-blind, placebo-controlled trial. BMC Endocr Disord 2012; 12:19. [PMID: 22974443 PMCID: PMC3515510 DOI: 10.1186/1472-6823-12-19] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 08/31/2012] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Increasing evidence suggests the bidirectional interplay between parathyroid hormone and aldosterone as an important mechanism behind the increased risk of cardiovascular damage and bone disease observed in primary hyperparathyroidism. Our primary object is to assess the efficacy of the mineralocorticoid receptor-blocker eplerenone to reduce parathyroid hormone secretion in patients with parathyroid hormone excess. METHODS/DESIGN Overall, 110 adult male and female patients with primary hyperparathyroidism will be randomly assigned to eplerenone (25 mg once daily for 4 weeks and 4 weeks with 50 mg once daily after dose titration] or placebo, over eight weeks. Each participant will undergo detailed clinical assessment, including anthropometric evaluation, 24-h ambulatory arterial blood pressure monitoring, echocardiography, kidney function and detailed laboratory determination of biomarkers of bone metabolism and cardiovascular disease.The study comprises the following exploratory endpoints: mean change from baseline to week eight in (1) parathyroid hormone(1-84) as the primary endpoint and (2) 24-h systolic and diastolic ambulatory blood pressure levels, NT-pro-BNP, biomarkers of bone metabolism, 24-h urinary protein/albumin excretion and echocardiographic parameters reflecting systolic and diastolic function as well as cardiac dimensions, as secondary endpoints. DISCUSSION In view of the reciprocal interaction between aldosterone and parathyroid hormone and the potentially ensuing target organ damage, the EPATH trial is designed to determine whether eplerenone, compared to placebo, will effectively impact on parathyroid hormone secretion and improve cardiovascular, renal and bone health in patients with primary hyperparathyroidism. TRIAL REGISTRATION ISRCTN33941607.
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Affiliation(s)
- Andreas Tomaschitz
- Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Burkert Pieske
- Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Nicolas Verheyen
- Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Karin Amrein
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Eberhard Ritz
- Department of Medicine, Division of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Kienreich
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Jörg H Horina
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Albrecht Schmidt
- Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | | | - Caterina Colantonio
- Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
- Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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3469
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Fabbri G, Maggioni AP. A review of the epidemiological profile of patients with atrial fibrillation and heart failure. Expert Rev Cardiovasc Ther 2012; 10:1133-40. [PMID: 23098149 DOI: 10.1586/erc.12.110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) and atrial fibrillation (AF) are cardiovascular diseases that have a continuously increasing prevelance and both often coexist. The presence of AF in HF patients has been reported as being between 10 and 50% depending on the different study settings. AF patients have a different clinical profile: they are older, with more severe HF and comorbidities than those without AF. Despite this poor clinical profile, observational studies report a lower use of the recommended treatments such as angiotensin-converting enzyme inhibitors and β-blockers. Clinical trials using antiarrhythmic drugs for rhythm control have failed to demonstrate the clinical advantage of a rhythm control approach over one for rate control. The prognostic role of AF in HF remains controversial, while the impact of new AF has been shown to be associated with an adverse outcome.
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3470
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Zannad F, Gattis Stough W, Rossignol P, Bauersachs J, McMurray JJV, Swedberg K, Struthers AD, Voors AA, Ruilope LM, Bakris GL, O'Connor CM, Gheorghiade M, Mentz RJ, Cohen-Solal A, Maggioni AP, Beygui F, Filippatos GS, Massy ZA, Pathak A, Piña IL, Sabbah HN, Sica DA, Tavazzi L, Pitt B. Mineralocorticoid receptor antagonists for heart failure with reduced ejection fraction: integrating evidence into clinical practice. Eur Heart J 2012; 33:2782-95. [PMID: 22942339 DOI: 10.1093/eurheartj/ehs257] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Mineralocorticoid receptor antagonists (MRAs) improve survival and reduce morbidity in patients with heart failure, reduced ejection fraction (HF-REF), and mild-to-severe symptoms, and in patients with left ventricular systolic dysfunction and heart failure after acute myocardial infarction. These clinical benefits are observed in addition to those of angiotensin converting enzyme inhibitors or angiotensin receptor blockers and beta-blockers. The morbidity and mortality benefits of MRAs may be mediated by several proposed actions, including antifibrotic mechanisms that slow heart failure progression, prevent or reverse cardiac remodelling, or reduce arrhythmogenesis. Both eplerenone and spironolactone have demonstrated survival benefits in individual clinical trials. Pharmacologic differences exist between the drugs, which may be relevant for therapeutic decision making in individual patients. Although serious hyperkalaemia events were reported in the major MRA clinical trials, these risks can be mitigated through appropriate patient selection, dose selection, patient education, monitoring, and follow-up. When used appropriately, MRAs significantly improve outcomes across the spectrum of patients with HF-REF.
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Affiliation(s)
- Faiez Zannad
- INSERM, Centre d'Investigation Clinique 9501 and Unité 961, Centre Hospitalier Universitaire, France.
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3471
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Dobreanu D, Dagres N, Svendsen JH, Marinskis G, Bongiorni MG, Blomstrom-Lundqvist C. Approach to cardiac resyncronization therapy. Europace 2012; 14:1359-62. [DOI: 10.1093/europace/eus260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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3472
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Donal E, Bernard A, Daubert JC. Will mechanical dyssynchrony one day impact our management of chronic heart failure patients? Eur Heart J Cardiovasc Imaging 2012; 14:93-4. [PMID: 22918404 DOI: 10.1093/ehjci/jes170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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3473
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Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Popescu BA, Von Segesser L, Badano LP, Bunc M, Claeys MJ, Drinkovic N, Filippatos G, Habib G, Kappetein AP, Kassab R, Lip GY, Moat N, Nickenig G, Otto CM, Pepper J, Piazza N, Pieper PG, Rosenhek R, Shuka N, Schwammenthal E, Schwitter J, Mas PT, Trindade PT, Walther T. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012; 33:2451-96. [PMID: 22922415 DOI: 10.1093/eurheartj/ehs109] [Citation(s) in RCA: 2622] [Impact Index Per Article: 218.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
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- Service de Cardiologie, Hospital Bichat AP-HP, 46 rue Henri Huchard, 75018 Paris, France.
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3474
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Assessment of serum cotinine in patients with chronic heart failure: self-reported versus objective smoking behaviour. Clin Res Cardiol 2012; 102:95-101. [DOI: 10.1007/s00392-012-0499-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 07/24/2012] [Indexed: 10/28/2022]
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3475
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Almeida P, Rodrigues J, Lourenço P, Maciel MJ, Bettencourt P. Prognostic significance of applying the European Society of Cardiology consensus algorithm for heart failure with preserved systolic function diagnosis. Clin Cardiol 2012; 35:770-6. [PMID: 22886726 DOI: 10.1002/clc.22044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 07/06/2012] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The diagnosis of heart failure with preserved left ventricular ejection fraction (HFpEF) is challenging. Although diagnostic criteria have been proposed, limited information exists concerning its implication on prognosis. We aimed to evaluate the prognostic significance of applying the European Society of Cardiology algorithm for HFpEF diagnosis, namely the tissue Doppler imaging information, in patients with acute heart failure (HF). HYPOTHESIS The application of the European Society of Cardiology algorithm for HFpEF diagnosis, identifies a group of HF patients with high morbidity and mortality. METHODS Consecutive patients admitted due to acute HF were recruited. The European Society of Cardiology algorithm was used in the HFpEF diagnosis. Patients were followed for a 6-month period and mortality and rehospitalization due to HF were recorded. RESULTS A total of 491 patients were included in this registry. Mean patient age was 78 years and 63% were women; 177 patients had HFpEF and 314 had HF with reduced ejection fraction (HFrEF). Of the HFpEF patients, 44.8% had an E/E' ratio >15 and 1.8% had an E/E' ratio <8. Patients with HFpEF and those with HFrEF had a similarly dismal prognosis when considering all-cause mortality, and morbidity and mortality, but there was a trend for better survival when HF death was the outcome in analysis (hazard ratio 1.63 [95% confidence interval: 0.95-2.80, P = 0.08]). CONCLUSIONS The use of objective criteria for diagnosis of HFpEF identifies patients with similar outcomes as patients with HFrEF; this observation increases the robustness of the diagnostic criteria for HFpEF. The use of objective criteria for the diagnosis of HFpEF identifies patients with a similarly ominous prognosis as patients with HFrEF; this observation increases the robustness of the diagnostic criteria for HFpEF. Identifying these patients based on objective criteria, as we did, is an important step for future investigation, namely drugs, warranted to the HFpEF approach.
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Affiliation(s)
- Pedro Almeida
- Department of Cardiology, Centro Hospitalar São João, University of Porto, Porto, Portugal
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3476
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3477
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3478
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Atherton JJ. Chronic heart failure: we are fighting the battle, but are we winning the war? SCIENTIFICA 2012; 2012:279731. [PMID: 24278681 PMCID: PMC3820562 DOI: 10.6064/2012/279731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 10/31/2012] [Indexed: 05/04/2023]
Abstract
Heart failure represents an end-stage phenotype of a number of cardiovascular diseases and is generally associated with a poor prognosis. A number of organized battles fought over the last two to three decades have resulted in considerable advances in treatment including the use of drugs that interfere with neurohormonal activation and device-based therapies such as implantable cardioverter defibrillators and cardiac resynchronization therapy. Despite this, the prevalence of heart failure continues to rise related to both the aging population and better survival in patients with cardiovascular disease. Registries have identified treatment gaps and variation in the application of evidenced-based practice, including the use of echocardiography and prescribing of disease-modifying drugs. Quality initiatives often coupled with multidisciplinary, heart failure disease management promote self-care and minimize variation in the application of evidenced-based practice leading to better long-term clinical outcomes. However, to address the rising prevalence of heart failure and win the war, we must also turn our attention to disease prevention. A combined approach is required that includes public health measures applied at a population level and screening strategies to identify individuals at high risk of developing heart failure in the future.
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Affiliation(s)
- John J. Atherton
- Cardiology Department, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4006, Australia
- School of Medicine, University of Queensland, Brisbane, QLD 4006, Australia
- *John J. Atherton:
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3479
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Langenickel TH, Dole WP. Angiotensin receptor-neprilysin inhibition with LCZ696: a novel approach for the treatment of heart failure. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.ddstr.2013.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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3480
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Górski A, Weber-Dabrowska B. The potential role of endogenous bacteriophages in controlling invading pathogens. Cell Mol Life Sci 2005; 62:511-9. [PMID: 15747058 PMCID: PMC11365883 DOI: 10.1007/s00018-004-4403-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bacteriophages (phages) are omnipresent in our environment, and recent studies highlight their potential impact on the microbial world. Phages can also be present in mammalian organisms, including man (intestines, oral cavity, urine, sputum and serum). Data are available which suggest that those endogenous phages could play an important role in eliminating bacteria and regulating the body ecosystem. Furthermore, our most recent findings suggest that phages can exert immunosuppressive action in the gut, helping control local inflammatory and autoimmune reactions, and demonstrate anticancer activity. We hypothesize that phages could act in concert with the immune system in immunosurveillance against bacteria, viruses and cancer.
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Affiliation(s)
- Andrzej Górski
- L. Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53114, Wroclaw, Poland.
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3481
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Wu X, Burgess SM. Integration target site selection for retroviruses and transposable elements. Cell Mol Life Sci 2004; 61:2588-96. [PMID: 15526164 DOI: 10.1007/s00018-004-4206-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
When a retrovirus infects a cell, its RNA genome is reverse transcribed into a double-stranded DNA, which is then permanently integrated into the host chromosome. Integration is one of the essential steps in the retroviral life cycle. Many transposable elements also move around and integrate into the host genome as part of their life cycle, some through RNA intermediates and some through 'cut and paste' mechanisms. Integration of retroviruses and transposable elements into 'sensitive areas' of the genome can cause irreparable damage. On the other hand, because of their ability to integrate permanently, and the relatively efficient rates of transgenesis, retroviruses and transposable elements are widely used as gene delivery tools in basic research and gene therapy trials. Recent events in gene therapy treatments for X-linked severe combined immunity deficiencies (X-SCID) have highlighted both the promise and some of the risks involved with utilizing retroviruses. Nine of 11 children were successfully treated for X-SCID using a retrovirus carrying the gene mutated in this disease. However, later two of these children developed leukemias because of retroviral integrations in the putative oncogene LMO2 [1]. A third child has also been demonstrated to have an integration in LMO2, but is as of yet nonsymptomatic [2]. It is a bit difficult to explain the high frequency of integrations into the same gene using a random model of retroviral integration, and there has been evidence for decades that retroviral integrations may not be random. But the data were somewhat limited in their power to determine the precise nature of the integration biases. The completion of the human genome sequence coupled with sensitive polymerase chain reaction techniques and an ever-decreasing cost of sequencing has given a powerful new tool to the study of integration site selection. In this review, we describe the findings from several recent global surveys of target site selection by retroviruses and transposable elements, and discuss the possible ramifications of these findings to both mechanisms of action and to the use of these elements as gene therapy vectors.
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Affiliation(s)
- X Wu
- Laboratory of Molecular Technology, Scientific Application International Inc., National Cancer Institute at Frederick, 915 Tollhouse Ave., Frederick, Maryland 21701, USA
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3482
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Abstract
The concept that atrial natriuretic peptide (ANP) and the closely related peptides BNP and CNP might be involved in the ontogeny of several organ systems emerged in the late 1980s. While many of the reported in vitro actions have not been examined in the context of organ development in vivo, recent studies demonstrate that mice which lack or overexpress natriuretic peptides or receptors exhibit pronounced skeletal growth defects. This article discusses how natriuretic peptides and other factors appear to regulate bone growth as an example of how natriuretic peptides might participate in the ontogeny of other organ systems. Evidence indicating that natriuretic peptides regulate neural development is then reviewed. Natriuretic peptides and receptors exhibit complex expression patterns in the developing nervous system, where they have been shown to act on neural cells as early as at the embryonic neural tube stage. Interestingly, both bone and brain growth appear to utilize primarily CNP and the CNP-specific type B receptor, and perhaps the type C receptor. In vitro data indicate that CNP may act on developing neurons, astrocytes and Schwann cells like a classical growth factor, regulating proliferation, patterning, phenotypic specification, survival and axonal pathfinding. Natriuretic peptides might also have roles in the vascularization of the embryonic brain, establishment of the blood-brain and blood-nerve barriers, and perhaps in nerve regeneration.
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Affiliation(s)
- J A Waschek
- Department of Psychiatry, David Geffen School of Medicine, University of California at Los Angeles, 68-225 NPI, 760 Westwood Plaza, Los Angeles, California 90024, USA.
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