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Maury E, Belmans A, Bogaerts K, Vancayzeele S, Jansen M. Real-life effectiveness of sacubitril/valsartan in older Belgians with heart failure, reduced ejection fraction and most severe symptoms. Sci Rep 2024; 14:13512. [PMID: 38866873 PMCID: PMC11169478 DOI: 10.1038/s41598-024-64243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Abstract
We assessed the real-world effectiveness of sacubitril/valsartan in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF) with an emphasis on those with older age (≥ 75 years) or with New York Heart Association (NYHA) class IV, for whom greater uncertainty existed regarding clinical outcomes. We conducted a retrospective cohort study based on patient-level linkage of electronic healthcare datasets. Data from all adults with HFrEF in Belgium receiving a prescription for sacubitril/valsartan between 01-November-2016 and 31-December-2018 were collected, with a follow-up of > 6 years. The total study population comprised 5446 patients, older than the PARADIGM-HF trial participants, and with higher NYHA class (all P < 0.0001). NYHA class improved following sacubitril/valsartan initiation (P < 0.0001 baseline vs. reassessment). Most concomitant medications were reduced. Remarkably, the risk of hospitalization for a cardiovascular reason and for HF was reduced by > 26% in the overall cohort, and in subgroups of patients ≥ 75 years, with NYHA class III/IV (all P < 0.0001) or with NYHA class IV (P < 0.05), vs. baseline. All-cause mortality did not increase in real-world patients with NYHA class III/IV. The results support the long-term beneficial effects of sacubitril/valsartan in older patients and in those experiencing the most severe symptoms.
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Affiliation(s)
- Eléonore Maury
- Medical Department, Novartis Pharma NV/SA, Medialaan 40 Bus 1, 1800, Vilvoorde, Belgium.
| | - Ann Belmans
- Department of Public Health and Primary Care, I-BioStat, KU Leuven, Leuven, Belgium
- UHasselt, I-BioStat, Hasselt, Belgium
| | - Kris Bogaerts
- Department of Public Health and Primary Care, I-BioStat, KU Leuven, Leuven, Belgium
- UHasselt, I-BioStat, Hasselt, Belgium
| | - Stefaan Vancayzeele
- Medical Department, Novartis Pharma NV/SA, Medialaan 40 Bus 1, 1800, Vilvoorde, Belgium
| | - Mieke Jansen
- Medical Department, Novartis Pharma NV/SA, Medialaan 40 Bus 1, 1800, Vilvoorde, Belgium
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Yuguchi T, Nakajima K, Takaoka H, Shimokawa T. Usefulness of Clinical Frailty Scale for Comprehensive Geriatric Assessment of Older Heart Failure Patients. Circ Rep 2024; 6:127-133. [PMID: 38606420 PMCID: PMC11004034 DOI: 10.1253/circrep.cr-24-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 04/13/2024] Open
Abstract
Background: Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic process to identify the physical, psychological, and social functions of patients with frailty. The Clinical Frailty Scale (CFS) might aid in effectively identifying older patients with heart failure (HF) and frailty who would then reap maximum benefits from the CGA. Methods and Results: A single-centre prospective cohort study that enrolled consecutive hospitalised patients (age ≥75 years) with HF was conducted. The Barthel index (BI), Mini Mental State Examination (MMSE), the Charlson comorbidity index (CCI), and the COntrolling NUTritional (CONUT) for CGA was used. Among 190 enrolled patients (mean age, 85.4 years; 47.9% male), all-cause mortality (primary endpoint) occurred in 45 patients and HF-related rehospitalization (secondary endpoint) in 59 patients within 1 year. The cumulative incidence of all-cause mortality was significantly higher in the high CFS group (low 6.3%, high 30.5%, P<0.001). However, the cumulative incidence of HF-related rehospitalization was not significantly different (low 26.3%, high 32.0%, P=0.304). The multivariable analysis revealed that the CFS group was independently associated with the risk of all-cause mortality. CFS showed a strong correlation with the BI and moderate correlation with the MMSE. Conclusions: The CFS was associated with all-cause mortality within 1 year and was correlated with frailty domains of CGA.
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Affiliation(s)
- Tadashi Yuguchi
- Department of Intensive Care Medicine, Nara Prefecture General Medical Center Nara Japan
- Department of Internal Medicine, Division of Cardiovascular Medicine, Aijinkai Takatsuki General Hospital Takatsuki Japan
| | - Kenji Nakajima
- Department of Internal Medicine, Division of Cardiovascular Medicine, Aijinkai Takatsuki General Hospital Takatsuki Japan
| | - Hideyuki Takaoka
- Department of Internal Medicine, Division of Cardiovascular Medicine, Aijinkai Takatsuki General Hospital Takatsuki Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University Wakayama Japan
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3
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Chen X, Guo X, Zheng Y, Lv C. Heart function grading evaluation based on heart sounds and convolutional neural networks. Phys Eng Sci Med 2023; 46:279-288. [PMID: 36625996 DOI: 10.1007/s13246-023-01216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/22/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
Accurate and rapid cardiac function assessment is critical for disease diagnosis and treatment strategy. However, the current cardiac function assessment methods have their adaptability and limitations. Heart sounds (HS) can reflect changes in heart function. Therefore, HS signals were proposed to assess cardiac function, and a specially designed pruning convolutional neural network (CNN) was applied to recognize subjects' cardiac function at different levels in this paper. Firstly, the adaptive wavelet denoising algorithm and logistic regression based hidden semi-Markov model were utilized for signal denoising and segmentation. Then, the continuous wavelet transform (CWT) was employed to convert the preprocessed HS signals into spectra as input to the convolutional neural network, which can extract features automatically. Finally, the proposed method was compared with AlexNet, Resnet50, Xception, GhostNet and EfficientNet to verify the superiority of the proposed method. Through comprehensive comparison, the proposed approach achieves the best classification performance with an accuracy of 94.34%. The study indicates HS analysis is a non-invasive and effective method for cardiac function classification, which has broad research prospects.
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Affiliation(s)
- Xiao Chen
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, 400044, Chongqing, China
| | - Xingming Guo
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, 400044, Chongqing, China.
| | - Yineng Zheng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China
| | - Chengcong Lv
- Key Laboratory of Biorheology Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, 400044, Chongqing, China
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The Impact of Complete Revascularization in Symptomatic Severe Left Ventricular Dysfunction between Coronary Artery Bypass Graft and Percutaneous Coronary Intervention. Cardiol Res Pract 2023; 2023:9226722. [PMID: 36896424 PMCID: PMC9991473 DOI: 10.1155/2023/9226722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/04/2023] Open
Abstract
Objective The study aimed to compare the clinical outcomes between the patients receiving coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) for the patients with symptomatic severe left ventricular (LV) dysfunction and coronary artery disease (CAD). Methods Between February 2007 and February 2020, a total of 745 patients who received coronary artery angiography for reduced LV ejection fraction (LVEF) < 40% and symptomatic New York Heart Association (NYHA) functional class ≥ 3 were recruited. The patients (N = 236) who were diagnosed with dilated cardiomyopathy or valvular heart disease without coronary artery stenosis, those with prior history of CABG or valvular surgery (N = 59), those who presented ST-segment elevated myocardial infarction (STEMI), those with a CAD and SYNTAX score of ≦ 22 (N = 175), those who received emergent CABG for coronary perforation (N = 3), and those who had NYHA class ≦ 2 (N = 65) were excluded. Finally, 116 patients with reduced LVEF and those who had a SYNTAX score >22, who received CABG (N = 47) and PCI (N = 69), were recruited for this study. Results There was no significant difference in the incidence values of in-hospital course and those of in-hospital mortality, acute kidney injury, and postprocedural hemodialysis. There was no significant difference in the 1-yearfollow-up of recurrent MI, revascularization, or stroke between the groups. The 1-year heart failure (HF) hospitalization rate was significantly lower in the CABG group than in all patients of the PCI group (13.2% vs. 33.3%; p = 0.035); however, there was no significant difference in the same variable between the CABG group and the complete revascularization subgroup (13.2% vs. 28.2%; p = 0.160). The revascularization index (RI) was significantly higher in the CABG group than in all patients of the PCI group or complete revascularization subgroup (0.93 ± 0.12 vs. 0.71 ± 0.25; p < 0.001) and (0.93 ± 0.12 vs. 0.86 ± 0.13; p = 0.019). The 3-year HF hospitalization rate was significantly lower in the CABG group than in all patients of the PCI group (16.2% vs. 42.2%; p = 0.008); however, there was no difference in the same variable between the CABG group and the complete revascularization subgroup (16.2% vs. 35.1%; p = 0.109). Conclusions In patients with symptomatic (NYHA class ≥ 3) severe LV dysfunction and CAD, CABG brought less HF admission when compared to patients in the PCI group, but this did not differ when compared to the complete revascularization subgroup. Therefore, an extensive revascularization, achieved by CABG or PCI, is associated with a lower HF hospitalization rate during the 3-yearfollow-up period in such populations.
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Muhammed A, Abdelazeem M, Elewa MG, Sharief M, Ammar A. Primary prevention implantable cardioverter-defibrillator use in non-ischemic dilated cardiomyopathy based on arrhythmic risk stratification and left ventricular reverse remodeling prediction. Heart Fail Rev 2023; 28:229-240. [PMID: 35587303 PMCID: PMC9902308 DOI: 10.1007/s10741-022-10246-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 02/07/2023]
Abstract
Sudden cardiac death (SCD) and significant ventricular arrhythmias in patients with dilated cardiomyopathy (DCM) have been markedly reduced over the last couple of decades as a result of the advances in pharmacological and non-pharmacological treatment. Primary prevention implantable cardioverter-defibrillator (ICD) plays an important role in the treatment of patients at risk of SCD caused by ventricular arrhythmias. However, the arrhythmic risk stratification in patients with DCM remains extremely challenging, and the decision for primary prevention ICD implantation based on left ventricular ejection fraction (LVEF) solely appears to be insufficient. This review provides an update on current evidence for primary prevention ICD implantation, arrhythmic risk stratification, and left ventricular reverse remodeling (LVRR) prediction in patients with DCM in addition to most recent guideline recommendations for primary prevention ICD implantation in DCM patients and a proposed multiparametric algorithm based on arrhythmic risk stratification and left ventricular reverse remodeling (LVRR) prediction to better identify patients who are likely to benefit from primary prevention ICD.
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Affiliation(s)
- Ahmed Muhammed
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Mohamed Abdelazeem
- grid.7269.a0000 0004 0621 1570Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt ,grid.240845.f0000 0004 0380 0425Department of Medicine, St. Elizabeth’s Medical Center, Boston, MA USA ,grid.67033.310000 0000 8934 4045Department of Medicine, Tufts University School of Medicine, Boston, MA USA
| | - Mohamed Gamaleldin Elewa
- grid.7269.a0000 0004 0621 1570Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Sharief
- grid.469958.fCardiology Department, Mansoura University Hospital, El Mansoura, Egypt ,grid.440181.80000 0004 0456 4815Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Ahmed Ammar
- grid.7269.a0000 0004 0621 1570Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt ,grid.430729.b0000 0004 0486 7170Cardiology Department, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
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6
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Błaziak M, Urban S, Wietrzyk W, Jura M, Iwanek G, Stańczykiewicz B, Kuliczkowski W, Zymliński R, Pondel M, Berka P, Danel D, Biegus J, Siennicka A. An Artificial Intelligence Approach to Guiding the Management of Heart Failure Patients Using Predictive Models: A Systematic Review. Biomedicines 2022; 10:biomedicines10092188. [PMID: 36140289 PMCID: PMC9496386 DOI: 10.3390/biomedicines10092188] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/19/2022] [Accepted: 08/27/2022] [Indexed: 11/23/2022] Open
Abstract
Heart failure (HF) is one of the leading causes of mortality and hospitalization worldwide. The accurate prediction of mortality and readmission risk provides crucial information for guiding decision making. Unfortunately, traditional predictive models reached modest accuracy in HF populations. We therefore aimed to present predictive models based on machine learning (ML) techniques in HF patients that were externally validated. We searched four databases and the reference lists of the included papers to identify studies in which HF patient data were used to create a predictive model. Literature screening was conducted in Academic Search Ultimate, ERIC, Health Source Nursing/Academic Edition and MEDLINE. The protocol of the current systematic review was registered in the PROSPERO database with the registration number CRD42022344855. We considered all types of outcomes: mortality, rehospitalization, response to treatment and medication adherence. The area under the receiver operating characteristic curve (AUC) was used as the comparator parameter. The literature search yielded 1649 studies, of which 9 were included in the final analysis. The AUCs for the machine learning models ranged from 0.6494 to 0.913 in independent datasets, whereas the AUCs for statistical predictive scores ranged from 0.622 to 0.806. Our study showed an increasing number of ML predictive models concerning HF populations, although external validation remains infrequent. However, our findings revealed that ML approaches can outperform conventional risk scores and may play important role in HF management.
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Affiliation(s)
- Mikołaj Błaziak
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Correspondence: (M.B.); (W.K.); Tel.: +48-71-733-11-12 (M.B.)
| | - Szymon Urban
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Weronika Wietrzyk
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Maksym Jura
- Department of Physiology and Pathophysiology, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Gracjan Iwanek
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Bartłomiej Stańczykiewicz
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Wiktor Kuliczkowski
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Correspondence: (M.B.); (W.K.); Tel.: +48-71-733-11-12 (M.B.)
| | - Robert Zymliński
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Maciej Pondel
- Institute of Information Systems in Economics, Wroclaw University of Economics and Business, 53-345 Wroclaw, Poland
| | - Petr Berka
- Department of Information and Knowledge Engineering, Prague University of Economics and Business, W. Churchill Sq. 1938/4, 130 67 Prague, Czech Republic
| | - Dariusz Danel
- Department of Anthropology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Agnieszka Siennicka
- Department of Physiology and Pathophysiology, Wroclaw Medical University, 50-368 Wroclaw, Poland
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7
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Ward T, Brown T, Lewis RD, Kliess MK, de Arellano AR, Quinn CM. The Cost Effectiveness of Patiromer for the Treatment of Hyperkalaemia in Patients with Chronic Kidney Disease with and without Heart Failure in Ireland. PHARMACOECONOMICS - OPEN 2022; 6:757-771. [PMID: 35925491 PMCID: PMC9440184 DOI: 10.1007/s41669-022-00357-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Hyperkalaemia can be a life-threatening condition, particularly in patients with advanced chronic kidney disease with and without heart failure. Renin-angiotensin-aldosterone system inhibitor therapy offers cardiorenal protection in chronic kidney disease and heart failure; however, it may also cause hyperkalaemia subsequently resulting in down-titration or discontinuation of treatment. Hence, there is an unmet need for hyperkalaemia treatment in patients with chronic kidney disease with and without heart failure to enable renin-angiotensin-aldosterone system inhibitor use in this patient population. In this study, we develop a de novo disease progression and cost-effectiveness model to evaluate the clinical and economic outcomes associated with the use of patiromer for the treatment of hyperkalaemia in patients with chronic kidney disease with and without heart failure. METHODS A Markov model was developed using data from the OPAL-HK trial to assess the health economic impact of patiromer therapy in comparison to standard of care in controlling hyperkalaemia in patients with advanced chronic kidney disease with and without heart failure in the Irish setting. The model was designed to predict the natural history of chronic kidney disease and heart failure and quantify the costs and benefits associated with the use of patiromer for hyperkalaemia management over a lifetime horizon from a payer perspective. RESULTS Treatment with patiromer was associated with an increase in discounted life-years (8.62 vs 8.37) and an increase in discounted quality-adjusted life-years (6.15 vs 5.95). Incremental discounted costs were predicted at €4979 per patient, with an incremental cost-effectiveness ratio of €25,719 per quality-adjusted life-year gained. Patients remained taking patiromer treatment for an average of 7.7 months, with treatment associated with reductions in the overall clinical event incidence and a delay in chronic kidney disease progression. Furthermore, patiromer was associated with lower overall rates of hospitalisation, major adverse cardiovascular events, dialysis, renin-angiotensin-aldosterone system inhibitor discontinuation episodes and renin-angiotensin-aldosterone system inhibitor down-titration episodes. At a willingness-to-pay threshold of €45,000 per quality-adjusted life-year in Ireland, treatment with patiromer was estimated to have a 100% chance of cost effectiveness compared with standard of care. CONCLUSIONS This study has demonstrated an economic case for the reimbursement of patiromer for the treatment of hyperkalaemia in patients with chronic kidney disease with and without heart failure in Ireland. Patiromer was estimated to improve life expectancy and quality-adjusted life expectancy, whilst incurring marginal additional costs when compared with current standard of care. Results are predominantly attributed to the ability of patiromer to enable the continuation of renin-angiotensin-aldosterone system inhibitor treatment whilst also reducing potassium levels.
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Affiliation(s)
- Thomas Ward
- Health Economics and Outcomes Research Ltd., Rhymney House, Unit A, Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8RB, UK
- Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Tray Brown
- Health Economics and Outcomes Research Ltd., Rhymney House, Unit A, Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8RB, UK.
| | - Ruth D Lewis
- Health Economics and Outcomes Research Ltd., Rhymney House, Unit A, Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8RB, UK
| | - Melodi Kosaner Kliess
- Health Economics and Outcomes Research Ltd., Rhymney House, Unit A, Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8RB, UK
| | | | - Carol M Quinn
- Vifor Pharma Group, Medical Department, Glattbrugg, Switzerland
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Influence of diabetes on mortality and ICD therapies in ICD recipients: a systematic review and meta-analysis of 162,780 patients. Cardiovasc Diabetol 2022; 21:143. [PMID: 35906611 PMCID: PMC9338523 DOI: 10.1186/s12933-022-01580-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background The influence of diabetes on the mortality and risk of implantable cardioverter defibrillator (ICD) therapies is still controversial, and a comprehensive assessment is lacking. We performed this systematic review and meta-analysis to address this controversy. Methods We systematically searched the PubMed, Embase, Web of Science and Cochrane Library databases to collect relevant literature. Fixed and random effects models were used to estimate the hazard ratio (HR) with 95% CIs. Results Thirty-six articles reporting on 162,780 ICD recipients were included in this analysis. Compared with nondiabetic ICD recipients, diabetic ICD recipients had higher all-cause mortality (HR = 1.45, 95% CI 1.36–1.55). The subgroup analysis showed that secondary prevention patients with diabetes may suffer a higher risk of all-cause mortality (HR = 1.89, 95% CI 1.56–2.28) (for subgroup analysis, P = 0.03). Cardiac mortality was also higher in ICD recipients with diabetes (HR = 1.68, 95% CI 1.35–2.08). However, diabetes had no significant effect on the risks of ICD therapies, including appropriate or inappropriate therapy, appropriate or inappropriate shock and appropriate anti-tachycardia pacing (ATP). Diabetes was associated with a decreased risk of inappropriate ATP (HR = 0.56, 95% CI 0.39–0.79). Conclusion Diabetes is associated with an increased risk of mortality in ICD recipients, especially in the secondary prevention patients, but does not significantly influence the risks of ICD therapies, indicating that the increased mortality of ICD recipients with diabetes may not be caused by arrhythmias. The survival benefits of ICD treatment in diabetes patients are limited. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01580-y.
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9
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Vîjîiac A, Onciul S, Deaconu S, Vătășescu R, Guzu C, Verinceanu V, Scărlătescu A, Zamfir D, Petre I, Scafa-Udriște A, Dorobanţu M. Three-dimensional right ventriculo-arterial coupling as an independent determinant of severe heart failure symptoms in patients with dilated cardiomyopathy. Echocardiography 2022; 39:194-203. [PMID: 34997602 DOI: 10.1111/echo.15288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/03/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Right ventricular-pulmonary artery coupling (RVPAC) is a predictor of outcome in pulmonary hypertension. However, the role of this parameter in dilated cardiomyopathy (DCM) remains to be established. The aim of this study was to assess the contribution of RVPAC to the occurrence of severe heart failure (HF) symptoms in patients with DCM using three-dimensional (3D) echocardiography. METHODS We prospectively screened 139 outpatients with DCM, 105 of whom were enrolled and underwent 3D echocardiographic assessment. RVPAC was estimated non-invasively as the 3D right ventricular stroke volume (SV) to end-systolic volume (ESV) ratio. Severe HF symptoms were defined by New York Heart Association (NYHA) class III or IV. We evaluated differences in RVPAC across NYHA classes and the ability of RVPAC to predict severe symptoms. RESULTS Mean left ventricular (LV) ejection fraction was 28±7%. Mean RVPAC was 0.77±0.30 and it was significantly more impaired with increasing symptom severity (p = 0.001). RVPAC was the only independent determinant of severe HF symptoms, after adjusting for age, diuretic use, LV systolic function, LV diastolic function, and pulmonary artery systolic pressure (OR 0.035 [95% CI, 0.004-0.312], p = 0.003). By receiver-operating characteristic analysis, the RVPAC cut-off value for predicting severely symptomatic status was 0.54 (area under the curve = 0.712, p < 0.001). CONCLUSION 3D echocardiographic SV/ESV ratio is an independent correlate of severe HF symptoms in patients with DCM. 3D RVPAC might prove to be a useful risk stratification tool for these patients, should it be further validated in larger studies.
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Affiliation(s)
- Aura Vîjîiac
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Emergency Clinical Hospital, Bucharest, Romania
| | - Sebastian Onciul
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Emergency Clinical Hospital, Bucharest, Romania
| | - Silvia Deaconu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Emergency Clinical Hospital, Bucharest, Romania
| | - Radu Vătășescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Emergency Clinical Hospital, Bucharest, Romania
| | | | | | | | | | - Ioana Petre
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Emergency Clinical Hospital, Bucharest, Romania
| | - Alexandru Scafa-Udriște
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Emergency Clinical Hospital, Bucharest, Romania
| | - Maria Dorobanţu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Emergency Clinical Hospital, Bucharest, Romania
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10
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Toniolo M, Muser D, Grilli G, Burelli M, Rebellato L, Daleffe E, Facchin D, Imazio M. Oral procainamide as pharmacological treatment of recurrent and refractory ventricular tachyarrhythmias: A single-center experience. Heart Rhythm O2 2022; 2:840-847. [PMID: 34988535 PMCID: PMC8710645 DOI: 10.1016/j.hroo.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Antiarrhythmic therapy for recurrent ventricular arrhythmias in patients who have undergone catheter ablation, and in whom amiodarone and/or beta-blockers were ineffective or contraindicated, is a controversial issue. Objective The present study sought to evaluate the efficacy and tolerability of oral procainamide in patients with recurrent ventricular arrhythmias when the standard therapy strategy had failed. Methods All patients treated with procainamide for recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) in our institution between January 2010 and May 2019 were enrolled. The primary endpoint was the total number of implantable cardioverter-defibrillator (ICD) interventions after the beginning of procainamide therapy. Secondary endpoints were the total number of VTs and VFs recorded on the ICDs' controls and discontinuation of therapy. The events occurring during procainamide treatment were compared with a matched-duration period before the initiation of therapy with procainamide. Patients therefore served as self-controls. Results A total of 34 consecutive patients (32 male, 94.1%; mean age 74.4 ± 9.7 years) were included in the retrospective analysis. The mean time of procainamide treatment was 12.9 ± 13.7 months (median 9 [2-20] months). The mean dose of procainamide was 1207 ± 487 mg/day. Procainamide therapy significantly decreased ICD interventions (median 5 [0-22.5] vs 15.5 [3-32.25], P < .05). Procainamide also decreased the total number of VT/VF episodes (median 5.5 [0.75-30] vs 19 [7.5-30], P < .05). Only 3 patients (8.8%) presented severe side effects (dyspnea or hypotension), requiring discontinuation of therapy. Conclusion Oral procainamide was associated with a significant decrease in ICD therapies and ventricular arrhythmias, showing an acceptable profile of tolerability.
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Affiliation(s)
- Mauro Toniolo
- Cardiology Division, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Daniele Muser
- Cardiology Division, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Giulia Grilli
- Cardiology Division, University Hospital S. Maria della Misericordia, Udine, Italy.,Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Massimo Burelli
- Cardiology Division, University Hospital S. Maria della Misericordia, Udine, Italy.,Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Luca Rebellato
- Cardiology Division, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Elisabetta Daleffe
- Cardiology Division, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Domenico Facchin
- Cardiology Division, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Massimo Imazio
- Cardiology Division, University Hospital S. Maria della Misericordia, Udine, Italy
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11
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Pooranachandran V, Nicolson W, Vali Z, Li X, Ng GA. Non-invasive markers for sudden cardiac death risk stratification in dilated cardiomyopathy. Heart 2021; 108:998-1004. [PMID: 34670824 DOI: 10.1136/heartjnl-2021-319971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/23/2021] [Indexed: 11/03/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is a common yet challenging cardiac disease. Great strides have been made in improving DCM prognosis due to heart failure but sudden cardiac death (SCD) due to ventricular arrhythmias remains significant and challenging to predict. High-risk patients can be effectively managed with implantable cardioverter defibrillators (ICDs) but because identification of what is high risk is very limited, many patients unnecessarily experience the morbidity associated with an ICD implant and many others are not identified and have preventable mortality. Current guidelines recommend use of left ventricular ejection fraction and New York Heart Association class as the main markers of risk stratification to identify patients who would be at higher risk of SCD. However, when analysing the data from the trials that these recommendations are based on, the number of patients in whom an ICD delivers appropriate therapy is modest. In order to improve the effectiveness of therapy with an ICD, the patients who are most likely to benefit need to be identified. This review article presents the evidence behind current guideline-directed SCD risk markers and then explores new potential imaging, electrophysiological and genetic risk markers for SCD in DCM.
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Affiliation(s)
- Vivetha Pooranachandran
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Will Nicolson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Zakariyya Vali
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Xin Li
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,School of Engineering, University of Leicester College of Science and Engineering, Leicester, UK
| | - G Andre Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK .,NIHR Leicester Biomedical Research Centre, Leicester, UK.,Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
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12
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Chang G, Zhang W, Zhang M, Ding G. Clinical Value of Circulating ZFAS1 and miR-590-3p in the Diagnosis and Prognosis of Chronic Heart Failure. Cardiovasc Toxicol 2021; 21:880-888. [PMID: 34319554 DOI: 10.1007/s12012-021-09678-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
Long non-coding RNAs (lncRNAs) have been reported to be involved in the development of various cardiovascular diseases, including chronic heart failure (CHF). In this study, we aimed to investigate the role of ZFAS1/miR-590-3p axis in the diagnosis and prognosis of CHF. The expression of ZFAS1 and miR-590-3p in the serum samples of CHF was measured using quantitative real-time polymerase chain reaction. Pearson correlation coefficient was applied to analyze the correlation between ZFAS1 and miR-590-3p. The receiver operating characteristic (ROC) curve was used to examine the diagnostic accuracy of ZFAS1, miR-590-3p, and brain natriuretic peptide (BNP). The Kaplan-Meier curve and Cox regression analysis were used to assess the prognostic value of ZFAS1 and miR-590-3p in CHF. This study found that the serum levels of ZFAS1 were significantly higher, while miR-590-3p levels were significantly lower in CHF. ROC results indicated that the combined diagnostic accuracy of ZFAS1 + miR-590-3p + BNP was significantly higher than that of these indicators used alone. Kaplan- Meier results showed that patients with low expression of miR-590-3p or high expression of ZFAS1 had poor prognosis. In conclusion, CHF patients had increased ZFAS1 and decreased miR-590-3p expression. ZFAS1 and miR-590-3p might serve as novel non-invasive diagnostic and prognostic markers for patients with CHF.
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Affiliation(s)
- Guannan Chang
- Department of Cardiology, Yidu Central Hospital of Weifang, No. 4138 Linglongshan South Road, Qingzhou City, 262500, Shandong, China.
| | - Wenqing Zhang
- Department of Geriatrics, Yidu Central Hospital of Weifang, Weifang, 262500, Shandong, China
| | - Meicheng Zhang
- Department of Cardiology, Yidu Central Hospital of Weifang, No. 4138 Linglongshan South Road, Qingzhou City, 262500, Shandong, China
| | - Gang Ding
- Department of Science and Education, Yidu Central Hospital of Weifang, Weifang, 262500, Shandong, China
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13
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Orzechowski P, Piotrowicz R, Zareba W, Pencina MJ, Kowalik I, Komar E, Opolski G, Banach M, Główczyńska R, Szalewska D, Pluta S, Irzmański R, Kalarus Z, Piotrowicz E. Antiarrhythmic effect of 9-week hybrid comprehensive telerehabilitation and its influence on cardiovascular mortality in long-term follow-up - subanalysis of the TELEREHabilitation in Heart Failure Patients randomized clinical trial. Arch Med Sci 2021; 18:293-306. [PMID: 35316910 PMCID: PMC8924820 DOI: 10.5114/aoms/136563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/11/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Cardiac rehabilitation is a component of heart failure (HF) management, but its effect on ventricular arrhythmias is not well understood. We analyzed the antiarrhythmic effect of a 9-week hybrid comprehensive telerehabilitation (HCTR) program and its influence on long-term cardiovascular mortality in HF patients taken from the TELEREHabilitation in Heart Failure Patients (TELEREH-HF) trial. Material and methods We evaluated the presence of non-sustained ventricular tachycardia (nsVT) and frequent premature ventricular complexes ≥ 10 beats/hour (PVCs ≥ 10) in 24-hour ECG monitoring at baseline and after 9-week HCTR or usual care (UC) of 773 HF patients (NYHA I-III, LVEF ≤ 40%). Functional response for HCTR was assessed by changes - delta (Δ) - in peak oxygen consumption (pVO2) as a result of comparing pVO2 from the beginning and the end of the program. Results Among 143 patients with nsVT, arrhythmia subsided in 30.8% after HCTR. Similarly, among 165 patients randomized to UC who had nsVT 34.5% did not show it after 9 weeks (p = 0.481). There was no significant difference in the decrease in PVC ≥ 10 over 9 weeks between randomization arms (14.9% vs. 17.8%, respectively p = 0.410). Functional response for HCTR in ΔpVO2 > 2.0 ml/kg/min did not affect occurrence of arrhythmias. Multivariable analysis did not identify HCTR as an independent factor determining improvement of nsVT or PVCs ≥ 10. However, only in the HCTR group, the achievement of the antiarrhythmic effect significantly reduced the cardiovascular mortality in 2-year follow-up (p < 0.001). Conclusions Significant improvement in physical capacity after 9 weeks of HCTR did not correlate with the antiarrhythmic effect in terms of incidence of nsVT or PVCs ≥ 10. An antiarrhythmic effect after the 9-week HCTR affected long-term cardiovascular mortality in HF patients.
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Affiliation(s)
- Piotr Orzechowski
- Telecardiology Center, National Institute of Cardiology, Warsaw, Poland
| | - Ryszard Piotrowicz
- National Institute of Cardiology, Warsaw, Poland
- College of Rehabilitation, Warsaw, Poland
| | - Wojciech Zareba
- Department of Medicine, University of Rochester Medical Center, Rochester, USA
| | - Michael J. Pencina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, USA
| | | | - Ewa Komar
- Military Institute of Medicine, Warsaw, Poland
| | - Grzegorz Opolski
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
| | - Renata Główczyńska
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Dominika Szalewska
- Chair and Clinic of Rehabilitation Medicine, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | | | - Robert Irzmański
- Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Lodz, Lodz, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Division of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Ewa Piotrowicz
- Telecardiology Center, National Institute of Cardiology, Warsaw, Poland
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14
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Briongos-Figuero S, Estévez A, Pérez ML, Martínez-Ferrer JB, García E, Viñolas X, Arenal Á, Alzueta J, Muñoz-Aguilera R. Prognostic role of NYHA class in heart failure patients undergoing primary prevention ICD therapy. ESC Heart Fail 2019; 7:279-283. [PMID: 31823514 PMCID: PMC7083467 DOI: 10.1002/ehf2.12548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/06/2019] [Accepted: 09/29/2019] [Indexed: 12/28/2022] Open
Abstract
Aims Concerns about the prognostic value of NYHA functional class (FC) in heart failure (HF) patients carrying a prophylactic implantable cardioverter defibrillator (ICD) are still present. We aimed to compare whether mortality and arrhythmic risk were different, in a cohort of HF patients undergoing ICD‐only implant, according to their FC. Methods and results HF patients with left ventricle ejection fraction (LVEF) ≤35%, undergoing first prophylactic ICD‐only implant were collected from a multicentre nationwide registry (2006–2015). Six hundred and twenty‐one patients were identified (101 patients in NYHA I; 411 in NYHA II; 109 in NYHA III). After a mean follow‐up of 4.4 years (±2.1), 126 patients died (20.3%). All‐cause mortality risk was higher in symptomatic patients: 13.9% in NYHA I patients, 18.3% in NYHA II patients (HR: 1.8, 95% CI 1.1–3.2), and 32.9% in NYHA III patients (HR: 3.9, 95% CI 2.1–7.3). Seventy‐eight out of all deaths were due to cardiovascular causes (12.6%). Cardiovascular mortality risk was also higher in symptomatic patients: 6.9% in NYHA I patients, 11% in NYHA II patients (HR: 2.2, 95% CI 1.1–4.9), and 23.9% in NYHA III (HR: 5.5, 95% CI 2.4–12.7). One hundred and seventeen patients received a first appropriate ICD therapy (19.4%). Arrhythmia free survival did not differ among study groups [20.8% in NYHA I patients, 18.7% in NYHA II (HR: 1.1, 95% CI 0.6–1.7) and 20.8% in NYHA III patients (HR: 1.3, 95% CI 0.7–2.5)]. NYHA class independently predicted cardiovascular mortality (NYHA III vs. NYHA I: HR, 4.7; 95% CI, 1.7–12.8, P = 0.002; NYHA II vs. NYHA I: HR, 2.1, 95% CI, 1.0–5.6, P = 0.05) but not all‐cause death (NYHA III vs. NYHA I: HR: 1.8, 95% CI 0.8–3.9, P = 0.11; NYHA II vs. NYHA I: HR, 1.1, 95% CI 0.6–2.2, P = 0.71;). Atrial fibrillation, chronic kidney disease, and diabetes emerged as predictors of both all‐cause death [(HR: 1.8, 95% CI 1.2–2.8, P = 0.005), (HR: 2.2, 95% CI 1.4–3.4, P < 0.001), (HR: 2.0, 95% CI 1.3–3.1, P = 0.001), respectively] and cardiovascular mortality [(HR: 1.8, 95% CI 1.1–3.1, P = 0.02), (HR: 3.1, 95% CI 1.8–5.4, P < 0.001), (HR: 1.7, 95% CI 1.1–3, P = 0.032), respectively]. Conclusions Mortality in HF patients undergoing prophylactic ICD implantation was higher in symptomatic patients. NYHA functional class along with other comorbidities might be helpful to identify a subgroup of ICD carriers with poorer prognosis and higher risk of cardiovascular death.
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Affiliation(s)
- Sem Briongos-Figuero
- Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
| | - Alvaro Estévez
- Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
| | - M Luisa Pérez
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Enrique García
- Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | - Ángel Arenal
- Hospital Universitario Gregorio Marañón, Madrid, Spain
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