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Rossi R, Coppi F, Sgura FA, Monopoli DE, Arrotti S, Talarico M, Boriani G. Effects of Ivabradine on Right Ventricular Systolic Function in Patients With Chronic Obstructive Pulmonary Disease and Cor Pulmonale. Am J Cardiol 2023; 207:179-183. [PMID: 37742537 DOI: 10.1016/j.amjcard.2023.08.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/27/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023]
Abstract
Cor pulmonale is a clinical syndrome associated with pulmonary hypertension, frequently complicated by congestive heart failure, commonly caused by chronic obstructive pulmonary disease (COPD). Most patients with cor pulmonale have tachycardia. However, heart rate (HR) reduction represents a primary treatment goal to improve the survival and quality of life in these patients. Ivabradine can selectively slow HR at rest and during exercise. In this prospective study, we tested the hemodynamic effects, invasively determined using right-sided cardiac catheterization, of reducing HR with ivabradine. We selected 18 patients (13 men [72.2%], mean age 67 ± 10 years) with COPD and cor pulmonale, presenting with sinus tachycardia. All patients performed clinical evaluation, electrocardiogram, spirometry, echocardiogram, 6-minute walking distance, and right-sided cardiac catheterization within 1 month of enrollment. All tests were repeated after 6 months of ivabradine treatment (median assumed dose 11.9 mg/die). We noticed a significant decrease of HR (from 98 ± 7 to 77 ± 8 beats/min, p = 0.0001), with a concomitant reduction of the congestion index (from 25.9 ± 5.1 to 19.4 ± 5.7 mm Hg, p = 0.001), and the consequent improvement of the right ventricular systolic performance (right ventricular stroke volume augmented from 56.7 ± 7.9 to 75.2 ± 8.6 ml/beat, p = 0.0001). This allows an improvement in clinical status and exercise tolerance (Borg scale score decreased from 5.2 ± 1.4 to 4.1 ± 1.3, p = 0.01 and the 6-minute walking distance increased to 252 ± 65 to 377 ± 59 m, p = 0.001). In conclusion, HR reduction significantly improves hemodynamic and clinical status of patients with tachycardia affected by COPD and cor pulmonale.
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Affiliation(s)
- Rosario Rossi
- Cardiology Unit, Policlinico di Modena Hospital, Modena, Italy; Pulmonary Hypertension Program, Competence Center for Rare Pulmonary Diseases, University of Modena and Reggio Emilia (UNIMORE), Modena, Italy.
| | - Francesca Coppi
- Cardiology Unit, Policlinico di Modena Hospital, Modena, Italy
| | | | | | | | - Marisa Talarico
- Cardiology Unit, Azienda Ospedaliera Pugliese-Ciaccio Hospital, Catanzaro, Italy
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Wang Z, Huang J, Zhang Y, Liu X, Shu T, Duan M, Wang H, Yin C, Cao J. A novel web-based calculator to predict 30-day all-cause in-hospital mortality for 7,202 elderly patients with heart failure in ICUs: a multicenter retrospective cohort study in the United States. Front Med (Lausanne) 2023; 10:1237229. [PMID: 37780569 PMCID: PMC10541310 DOI: 10.3389/fmed.2023.1237229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/07/2023] [Indexed: 10/03/2023] Open
Abstract
Background and aims Heart failure (HF) is a significant cause of in-hospital mortality, especially for the elderly admitted to intensive care units (ICUs). This study aimed to develop a web-based calculator to predict 30-day in-hospital mortality for elderly patients with HF in the ICU and found a relationship between risk factors and the predicted probability of death. Methods and results Data (N = 4450) from the MIMIC-III/IV database were used for model training and internal testing. Data (N = 2,752) from the eICU-CRD database were used for external validation. The Brier score and area under the curve (AUC) were employed for the assessment of the proposed nomogram. Restrictive cubic splines (RCSs) found the cutoff values of variables. The smooth curve showed the relationship between the variables and the predicted probability of death. A total of 7,202 elderly patients with HF were included in the study, of which 1,212 died. Multivariate logistic regression analysis showed that 30-day mortality of HF patients in ICU was significantly associated with heart rate (HR), 24-h urine output (24h UOP), serum calcium, blood urea nitrogen (BUN), NT-proBNP, SpO2, systolic blood pressure (SBP), and temperature (P < 0.01). The AUC and Brier score of the nomogram were 0.71 (0.67, 0.75) and 0.12 (0.11, 0.15) in the testing set and 0.73 (0.70, 0.75), 0.13 (0.12, 0.15), 0.65 (0.62, 0.68), and 0.13 (0.12, 0.13) in the external validation set, respectively. The RCS plot showed that the cutoff values of variables were HR of 96 bmp, 24h UOP of 1.2 L, serum calcium of 8.7 mg/dL, BUN of 30 mg/dL, NT-pro-BNP of 5121 pg/mL, SpO2 of 93%, SBP of 137 mmHg, and a temperature of 36.4°C. Conclusion Decreased temperature, decreased SpO2, decreased 24h UOP, increased NT-proBNP, increased serum BUN, increased or decreased SBP, fast HR, and increased or decreased serum calcium increase the predicted probability of death. The web-based nomogram developed in this study showed good performance in predicting 30-day in-hospital mortality for elderly HF patients in the ICU.
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Affiliation(s)
- Zhongjian Wang
- Artificial Intelligence Laboratory, Pharnexcloud Digital Technology (Chengdu) Co. Ltd., Chengdu, China
| | - Jian Huang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
| | - Yang Zhang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
| | - Xiaozhu Liu
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Tingting Shu
- Department of Cardiology, Daping Hospital, The Third Military Medical University (Army Medical University), Chongqing, China
| | - Minjie Duan
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
| | - Haolin Wang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macau, Macau SAR, China
| | - Junyi Cao
- Department of Medical Quality Control, The First People's Hospital of Zigong City, Zigong, China
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Böhm M, Abdin A, Slawik J, Mahfoud F, Borer J, Ford I, Swedberg K, Tavazzi L, Batailler C, Komajda M. Time to benefit of heart rate reduction with ivabradine in patients with heart failure and reduced ejection fraction. Eur J Heart Fail 2023; 25:1429-1435. [PMID: 37092340 DOI: 10.1002/ejhf.2870] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 04/25/2023] Open
Abstract
AIMS In the SHIFT (Systolic Heart failure treatment with the If inhibitor ivabradine Trial, ISRCTN70429960) study, ivabradine reduced cardiovascular death or heart failure (HF) hospitalizations in patients with HF and reduced ejection fraction (HFrEF) in sinus rhythm and with a heart rate (HR) ≥70 bpm. In this study, we sought to determine the clinical significance of the time durations of HR reduction and the significant treatment effect on outcomes among patients with HFrEF. METHODS AND RESULTS The time to statistically significant reduction of the primary outcome (HF hospitalization and cardiovascular death) and its components, all-cause death, and HF death, were assessed in a post-hoc analysis of the SHIFT trial in the overall population (HR ≥70 bpm) and at HR ≥75 bpm, representing the approved label in many countries. Compared to placebo, the primary outcome and HF hospitalizations were significantly reduced at 102 days, while there was no effect on cardiovascular death, all-cause death, and HF death at HR ≥70 bpm. In the population with a baseline HR ≥75 bpm, a reduction of the primary outcome occurred after 67 days, HF hospitalization after 78 days, cardiovascular death after 169 days, death from HF after 157 days and all-cause death after 169 days. CONCLUSION Treatment with ivabradine should not be deferred in patients in sinus rhythm with a HR of ≥70 bpm to reduce the primary outcome and HF hospitalizations, in particular in patients with HR ≥75 bpm. At HR ≥75 bpm, the time to risk reduction was shorter for reduction of hospitalization and mortality outcomes in patients with HFrEF after initiation of guideline-directed medication, including beta-blockers at maximally tolerated doses.
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Affiliation(s)
- Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Amr Abdin
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Jonathan Slawik
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Jeffrey Borer
- Division of Cardiovascular Medicine and the Howard Gilman Institute for Heart Valve Disease, State, University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Luigi Tavazzi
- Ettore Sansavini Health Science Foundation, Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA), Italy
| | - Cécile Batailler
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Michel Komajda
- Department of Cardiology, Groupe Hospitalier Paris Saint Joseph Paris, Paris Sorbonne University, Paris, France
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Anker SD, Usman MS, Anker MS, Butler J, Böhm M, Abraham WT, Adamo M, Chopra VK, Cicoira M, Cosentino F, Filippatos G, Jankowska EA, Lund LH, Moura B, Mullens W, Pieske B, Ponikowski P, Gonzalez-Juanatey JR, Rakisheva A, Savarese G, Seferovic P, Teerlink JR, Tschöpe C, Volterrani M, von Haehling S, Zhang J, Zhang Y, Bauersachs J, Landmesser U, Zieroth S, Tsioufis K, Bayes-Genis A, Chioncel O, Andreotti F, Agabiti-Rosei E, Merino JL, Metra M, Coats AJS, Rosano GMC. Patient phenotype profiling in heart failure with preserved ejection fraction to guide therapeutic decision making. A scientific statement of the Heart Failure Association, the European Heart Rhythm Association of the European Society of Cardiology, and the European Society of Hypertension. Eur J Heart Fail 2023; 25:936-955. [PMID: 37461163 DOI: 10.1002/ejhf.2894] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/26/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) represents a highly heterogeneous clinical syndrome affected in its development and progression by many comorbidities. The left ventricular diastolic dysfunction may be a manifestation of various combinations of cardiovascular, metabolic, pulmonary, renal, and geriatric conditions. Thus, in addition to treatment with sodium-glucose cotransporter 2 inhibitors in all patients, the most effective method of improving clinical outcomes may be therapy tailored to each patient's clinical profile. To better outline a phenotype-based approach for the treatment of HFpEF, in this joint position paper, the Heart Failure Association of the European Society of Cardiology, the European Heart Rhythm Association and the European Hypertension Society, have developed an algorithm to identify the most common HFpEF phenotypes and identify the evidence-based treatment strategy for each, while taking into account the complexities of multiple comorbidities and polypharmacy.
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Affiliation(s)
- Stefan D Anker
- Department of Cardiology, Deutsches Herzzentrum der Charité (Campus CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Markus S Anker
- Deutsches Herzzentrum der Charité, Klinik fär Kardiologie, Angiologie und Intensivmedizin (Campus CBF), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | | | - Marianna Adamo
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Francesco Cosentino
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ewa A Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Brenda Moura
- Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal; Serviço de Cardiologia, Hospital das Forças Armadas-Pólo do Porto, Porto, Portugal
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk and Faculty of Medicine and Life Sciences, University Hasselt, Belgium
| | - Burkert Pieske
- Berlin-Brandenburgische Gesellschaft für Herz-Kreislauferkrankungen (BBGK), Berlin, Germany
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Cardiology Department, Wroclaw Medical University, Wroclaw, Poland
| | - Jose R Gonzalez-Juanatey
- Cardiology Department, Hospital Clínico Universitario, Santiago de Compostela, IDIS, CIBERCV, Santiago de Compostela, Spain
| | - Amina Rakisheva
- Department of Cardiology, Scientific Institution of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Petar Seferovic
- Department Faculty of Medicine, University of Belgrade, Belgrade & Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, CA, USA
| | - Carsten Tschöpe
- Department of Cardiology, Deutsches Herzzentrum der Charité (Campus CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine (CVK), Charité Universitätsmedizin, Berlin, Germany
| | - Maurizio Volterrani
- Cardio-Pulmonary Department, San Raffaele Open University of Rome; Exercise Science and Medicine, IRCCS San Raffaele - Rome, Italy
| | | | - Jian Zhang
- Fuwai Hospital Chinese Academic of Medical Science, Beijing, China
| | - Yuhui Zhang
- Fuwai Hospital Chinese Academic of Medical Science, Beijing, China
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Klinik fär Kardiologie, Angiologie und Intensivmedizin (Campus CBF), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Berlin, Germany
| | - Shelley Zieroth
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba Winnipeg, Winnipeg, Manitoba, Canada
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, CIBERCV, Barcelona, Spain
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Felicita Andreotti
- Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
- Catholic University Medical School, Rome, Italy
| | - Enrico Agabiti-Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Jose L Merino
- Department of Cardiology, La Paz University Hospital, IdiPaz, Universidad Autonoma, Madrid, Spain
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Giuseppe M C Rosano
- Cardio-Pulmonary Department, San Raffaele Open University of Rome; Exercise Science and Medicine, IRCCS San Raffaele - Rome, Italy
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Inoue T, Matsunaga K, Kobayashi W, Minamino T. Successful treatment with ivabradine in a β-blocker-refractory patient with acute decompensated heart failure with reduced ejection fraction. Clin Case Rep 2023; 11:e6890. [PMID: 36879680 PMCID: PMC9984869 DOI: 10.1002/ccr3.6890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/12/2022] [Accepted: 01/03/2023] [Indexed: 03/06/2023] Open
Abstract
Ivabradine is an established treatment for chronic heart failure with reduced ejection fraction (HFrEF); however, it is not used for acute heart failure treatment. Negative inotropic effects (NIE) often limit the up-titration of β-blockers. Contrarily, ivabradine has no NIE, and enables β-blockers usage for treating patients with acute decompensated HFrEF.
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Affiliation(s)
- Tomoko Inoue
- Department of Cardiorenal and Cerebrovascular Medicine Faculty of Medicine Kagawa University Kagawa Japan
| | - Keiji Matsunaga
- Department of Cardiorenal and Cerebrovascular Medicine Faculty of Medicine Kagawa University Kagawa Japan
| | - Waki Kobayashi
- Department of Cardiorenal and Cerebrovascular Medicine Faculty of Medicine Kagawa University Kagawa Japan
| | - Tetsuo Minamino
- Department of Cardiorenal and Cerebrovascular Medicine Faculty of Medicine Kagawa University Kagawa Japan
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Mahfooz K, Vasavada AM, Joshi A, Pichuthirumalai S, Andani R, Rajotia A, Hans A, Mandalia B, Dayama N, Younas Z, Hafeez N, Bheemisetty N, Patel Y, Tumkur Ranganathan H, Sodala A. Waterpipe Use and Its Cardiovascular Effects: A Systematic Review and Meta-Analysis of Case-Control, Cross-Sectional, and Non-Randomized Studies. Cureus 2023; 15:e34802. [PMID: 36915837 PMCID: PMC10008028 DOI: 10.7759/cureus.34802] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/09/2023] [Indexed: 02/11/2023] Open
Abstract
Approximately 100 million people globally smoke cigarettes, making it a significant and quickly spreading global tobacco epidemic. Substance use disorders are frequently evaluated by non-randomized studies. Tobacco use and its impacts on the cardiovascular system were the subjects of a comprehensive search across five electronic databases: Cochrane, MEDLINE, Scopus, Embase, and PubMed. The findings demonstrated that waterpipe smokers in comparison to non-smokers have immediate elevations in heart rate and blood pressure, lower levels of high-density lipoprotein, higher levels of low-density lipoprotein, higher levels of triglycerides, higher levels of fasting blood glucose, and a higher heart rate. Users of waterpipes and cigarettes had similar average heart rates, blood pressure, and lipid levels, with the exception that waterpipe smokers had greater total cholesterol. Smoking a waterpipe has significant negative effects on the cardiovascular system comparable to cigarette smoking, and non-randomized studies proved to yield substantial evidence related to its cardiovascular effects. Such study designs can be used to evaluate substance use and its cardiovascular impact.
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Affiliation(s)
- Kamran Mahfooz
- Internal Medicine, Lincoln Medical Center, New York, USA
| | - Advait M Vasavada
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Medicine, Shri M. P. Shah Government Medical College, Jamnagar, IND
| | - Arpit Joshi
- Medicine, B. J. (Byramjee Jeejeebhoy) Medical, Ahmedabad, IND
| | | | - Rupesh Andani
- Internal Medicine, Jeevandhara Hospital, Jamnagar, IND
| | | | - Aakash Hans
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Bilvesh Mandalia
- House Officer, Lokmanya Tilak Municipal General Hospital and Medical College, Sion Mumbai, Mumbai, IND
| | - Neeraj Dayama
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Zara Younas
- Medicine, King Edward Medical University, Lahore, PAK
| | | | - Niharika Bheemisetty
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Yash Patel
- Medicine, Gujarat Cancer Society Medical College, Ahmedabad, IND
| | | | - Ashok Sodala
- Medicine, Shri M. P. Shah Government Medical College, Jamnagar, IND
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Edrissi C, Rathfoot C, Knisely K, Sanders CB, Goodwin R, Nathaniel SI, Nathaniel T. Age Stratification in Acute Ischemic Stroke Patients with Heart Failure. J Clin Med 2022; 12:jcm12010038. [PMID: 36614839 PMCID: PMC9821452 DOI: 10.3390/jcm12010038] [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: 10/14/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Purpose. Heart failure (HF) is considered one of the major risk factors associated with the severity of acute ischemic stroke(AIS). The risk factors associated with stroke severity in AIS with a history of HF is not fully understood. Methods. A prospectively maintained database from comprehensive stroke centers in PRISMA Health Upstate Sc, was analyzed for patients with AIS and a history of HF from January 2010 to 30 June 2016. The primary outcome was risk factors associated with a National Institute of Health Stroke Scale score (NIHSS) < 7 indicating lower severity and a score ≥ 7 indicating high severity for 65−74 age category and ≥75 years age category for AIS-HF patients. Univariate analysis was used to determine risk factors based on age categories and stroke severities, while multivariable analysis was used to adjust for the effect of confounding variables. Results: A total 367 AIS-HF patients were identified in this study, 113 patients were between 65−74 years old, while 254 patients were in the ≥75 years old age category. In the adjusted analysis for 65−74 age category, history of smoking (OR = 0.105, 95% Confidence interval (CI): 0.018−0.614, p = 0.012), triglycerides (Odd ratio(OR) = 0.993, 95% (CI): 0.987−0.999, p = 0.019), and International Normalized Ratio (INR) (OR = 0.454, 95% CI: 0.196−1.050, p = 0.045), and direct admission treatment (OR = 0.355, 95% CI: 0.137−0.920, p = 0.033) were associated with a lower stroke severity, elevated heart rate (OR = 1.032, 95% CI: 1.009−1.057, p = 0.007) was associated with a higher stroke severity. For the ≥75 years old age category, previous stroke (OR = 2.297, 95% CI: 1.171−9.852, p = 0.024), peripheral vascular disease (OR = 6.784, 95% CI: 1.242−37.065, p = 0.027), heart rate (OR = 1.035, 95% CI: 1.008−1.063, p = 0.012), and systolic blood pressure (OR = 1.023, 95% CI: 1.005−1.041, p = 0.012) were associated with a higher severe stroke severity. Conclusions: After adjusting for the effect of potential confounders, more risk factors were associated with a high severity of stroke among ≥75 years old compared with 65−74 years old AIS-HF patients. Elevated heart rate was an independent risk factor associated with stroke severity in 65−74 and ≥75 years old AIS-HF patients. Elevated heart rate and other identified risk factors should be managed to reduce stroke severity among elderly AIS-HF patients.
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Affiliation(s)
- Camron Edrissi
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
| | - Chase Rathfoot
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
| | - Krista Knisely
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
| | | | - Richard Goodwin
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
| | - Samuel I. Nathaniel
- Department of Biology, North Greenville University, Tigerville, SC 29688, USA
| | - Thomas Nathaniel
- School of Medicine-Greenville, University of South Carolina, Greenville, SC 29605, USA
- Correspondence: ; Tel.: +1-86-44559846; Fax: +1-86-44558404
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Abstract
Despite the number of available methods to predict prognosis in patients with heart failure, prognosis remains poor, likely because of marked patient heterogeneity and varied heart failure etiologies. Thus, identification of novel prognostic indicators to stratify risk in patients with heart failure is of paramount importance. The spleen is emerging as a potential novel prognostic indicator for heart failure. In this article, we provide an overview of the current prognostic tools used for heart failure. We then introduce the spleen as a potential novel prognostic indicator, before outlining the structure and function of the spleen and introducing the concept of the cardiosplenic axis. This is followed by a focused discussion on the function of the spleen in the immune response and in hemodynamics, as well as a review of what is known about the usefulness of the spleen as an indicator of heart failure. Expert insight into the most effective spleen-related measurement indices for the prognostication of patients with heart failure is provided, and suggestions on how these could be measured in clinical practice are considered. In future, studies in humans will be required to draw definitive links between specific splenic measurements and different heart failure manifestations, as well as to determine whether splenic prognostic measurements differ between heart failure classes and etiologies. These contributions will provide a step forward in our understanding of the usefulness of the spleen as a prognostic predictor in heart failure.
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Baka T, Repova K, Luptak I, Simko F. Ivabradine in the management of COVID-19-related cardiovascular complications: A perspective. Curr Pharm Des 2022; 28:1581-1588. [DOI: 10.2174/1381612828666220328114236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
Abstract
Abstract:
Besides acute respiratory distress syndrome, acute cardiac injury is a major complication in severe coronavirus disease 2019 (COVID-19) and associates with a poor clinical outcome. Acute cardiac injury with COVID-19 can be of various etiologies, including myocardial ischemia or infarction and myocarditis, and may compromise cardiac function, resulting in acute heart failure or cardiogenic shock. Systemic inflammatory response increases heart rate (HR), which disrupts the myocardial oxygen supply/demand balance and worsens cardiac energy efficiency, thus further deteriorating the cardiac performance of the injured myocardium. In fact, the combination of elevated resting HR and markers of inflammation synergistically predicts adverse cardiovascular prognosis. Thus, targeted HR reduction may potentially be of benefit in cardiovascular pathologies associated with COVID-19. Ivabradine is a drug that selectively reduces HR via If current inhibition in the sinoatrial node without a negative effect on inotropy. Besides selective HR reduction, ivabradine was found to exert various beneficial pleiotropic effects, either HR-dependent or HR-independent, including anti-inflammatory, anti-atherosclerotic, anti-oxidant and antiproliferative actions and the attenuation of endothelial dysfunction and neurohumoral activation. Cardioprotection by ivabradine has already been indicated in cardiovascular pathologies that are prevalent with COVID-19, including myocarditis, acute coronary syndrome, cardiogenic shock or cardiac dysautonomia. Here, we suggest that ivabradine may be beneficial in the management of COVID-19-related cardiovascular complications.
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Affiliation(s)
- Tomas Baka
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Kristina Repova
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Ivan Luptak
- Cardiovascular Medicine Section, Boston University School of Medicine, Boston, MA, USA
- Myocardial Biology Unit, Boston University School of Medicine, Boston, MA, USA
| | - Fedor Simko
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
- Cardiovascular Medicine Section, Boston University School of Medicine, Boston, MA, USA
- Myocardial Biology Unit, Boston University School of Medicine, Boston, MA
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10
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Piantoni C, Paina M, Molla D, Liu S, Bertoli G, Jiang H, Wang Y, Wang Y, Wang Y, DiFrancesco D, Barbuti A, Bucchi A, Baruscotti M. Chinese natural compound decreases pacemaking of rabbit cardiac sinoatrial cells by targeting second messenger regulation of f-channels. eLife 2022; 11:75119. [PMID: 35315774 PMCID: PMC8940175 DOI: 10.7554/elife.75119] [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: 10/29/2021] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Tongmai Yangxin (TMYX) is a complex compound of the Traditional Chinese Medicine (TCM) used to treat several cardiac rhythm disorders; however, no information regarding its mechanism of action is available. In this study we provide a detailed characterization of the effects of TMYX on the electrical activity of pacemaker cells and unravel its mechanism of action. Single-cell electrophysiology revealed that TMYX elicits a reversible and dose-dependent (2/6 mg/ml) slowing of spontaneous action potentials rate (−20.8/–50.2%) by a selective reduction of the diastolic phase (−50.1/–76.0%). This action is mediated by a negative shift of the If activation curve (−6.7/–11.9 mV) and is caused by a reduction of the cyclic adenosine monophosphate (cAMP)-induced stimulation of pacemaker channels. We provide evidence that TMYX acts by directly antagonizing the cAMP-induced allosteric modulation of the pacemaker channels. Noticeably, this mechanism functionally resembles the pharmacological actions of muscarinic stimulation or β-blockers, but it does not require generalized changes in cytoplasmic cAMP levels thus ensuring a selective action on rate. In agreement with a competitive inhibition mechanism, TMYX exerts its maximal antagonistic action at submaximal cAMP concentrations and then progressively becomes less effective thus ensuring a full contribution of If to pacemaker rate during high metabolic demand and sympathetic stimulation.
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Affiliation(s)
- Chiara Piantoni
- Department of Biosciences, The Cell Physiology Lab and "Centro Interuniversitario di Medicina Molecolare e Biofisica Applicata", Università degli Studi di Milano, Milano, Italy
| | - Manuel Paina
- Department of Biosciences, The Cell Physiology Lab and "Centro Interuniversitario di Medicina Molecolare e Biofisica Applicata", Università degli Studi di Milano, Milano, Italy
| | - David Molla
- Department of Biosciences, The Cell Physiology Lab and "Centro Interuniversitario di Medicina Molecolare e Biofisica Applicata", Università degli Studi di Milano, Milano, Italy
| | - Sheng Liu
- Department of Physiology and Pathophysiology, School of Basic Medical Science, Tianjin Medical University, Tianjin, China
| | - Giorgia Bertoli
- Department of Biosciences, The Cell Physiology Lab and "Centro Interuniversitario di Medicina Molecolare e Biofisica Applicata", Università degli Studi di Milano, Milano, Italy
| | - Hongmei Jiang
- Department of Physiology and Pathophysiology, School of Basic Medical Science, Tianjin Medical University, Tianjin, China
| | - Yanyan Wang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yi Wang
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yi Wang
- Institute of Traditional Chinese Medicine Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Dario DiFrancesco
- Department of Biosciences, The Cell Physiology Lab and "Centro Interuniversitario di Medicina Molecolare e Biofisica Applicata", Università degli Studi di Milano, Milano, Italy
| | - Andrea Barbuti
- Department of Biosciences, The Cell Physiology Lab and "Centro Interuniversitario di Medicina Molecolare e Biofisica Applicata", Università degli Studi di Milano, Milano, Italy
| | - Annalisa Bucchi
- Department of Biosciences, The Cell Physiology Lab and "Centro Interuniversitario di Medicina Molecolare e Biofisica Applicata", Università degli Studi di Milano, Milano, Italy
| | - Mirko Baruscotti
- Department of Biosciences, The Cell Physiology Lab and "Centro Interuniversitario di Medicina Molecolare e Biofisica Applicata", Università degli Studi di Milano, Milano, Italy
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11
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Abebaw Moyehodie Y, Wale Muluneh M. Determinants of Longitudinal Measure Pulse Rate of Chronic Heart Failure Patients at Felege Hiwot Referral Hospital, Ethiopia: A Longitudinal Modeling Data Analysis. Int J Gen Med 2022; 15:3483-3496. [PMID: 35378913 PMCID: PMC8976500 DOI: 10.2147/ijgm.s355377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Heart rate is a significant modifiable factor in lowering mortality in heart failure patients. The heart rate, often known as the pulse rate, is the number of times the heart beats in a given amount of time. Irregular pulse rate or heart block are all measured using heart rate data. A higher heart rate has been associated with worse clinical outcomes. The main purpose of this study was to identify factors associated with the longitudinal pulse rate of congestive heart failure patients. Methods Hospital-based retrospective studies were conducted among 249 congestive heart failure patients who were 18 years old or older and who were on treatment follow-up from first February 2016 to thirty-one December 2017 in Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia. Results Data were explored using descriptive statistics, individual and mean profile plots, and analyzed using linear mixed models. Out of the total 249 patients, 139 (55.8%) were females. The majority 179 (71.9%) of the CHF patients were rural residents. 65 (26.1%) patients had Hypertension, 30 (12.5%) patients had Diabetes Mellitus, 58 (23.3%) patients had Pneumonia. Thus age, LVEF, follow-up time in a month had a negative significant effect whereas NYHA class, male gender, pneumonia had a positive significant effect on the average evaluation of pulse rate of patients. The time interaction effect of NYHA Class (Time* NYHA Class), and LVEF (Time*LVEF) had a significant effect on average pulse rate evolution. Conclusion The variables age, LVEF, and follow-up time were negatively associated whereas, male gender, NYHA class, and presence of pneumonia were positively associated with the progression change of pulse rate of patients rate of progression of pulse rate decreases over time. Furthermore, health professionals give more attention to patients who are NYHA class IV, had low LVEF, pneumonic patients to reduce pulse rate during the follow-up time.
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Affiliation(s)
- Yikeber Abebaw Moyehodie
- Department of Statistics, Debre Tabor University, Debre Tabor, Ethiopia
- Correspondence: Yikeber Abebaw Moyehodie, Department of Statistics, Debre Tabor University, Debre Tabor, Ethiopia, Email
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12
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Li L, Xiong Y, Hu Z, Yao Y. Effect of Renal Denervation for the Management of Heart Rate in Patients With Hypertension: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 8:810321. [PMID: 35111831 PMCID: PMC8801499 DOI: 10.3389/fcvm.2021.810321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/21/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: The effect of renal denervation (RDN) on heart rate (HR) in patients with hypertension had been investigated in many studies, but the results were inconsistent. This meta-analysis was performed to evaluate the efficacy of RDN on HR control. Methods: Databases, such as PubMed, EMBASE, Cochrane, and ClinicalTrials.gov, were searched until September 2021. Randomized controlled trials (RCTs) or non-RCTs of RDN in hypertensive patients with outcome indicators, such as HR, were selected. Weighted mean difference (WMD) was calculated for evaluating the changes in HR from baseline using fixed-effects or random-effects models. The Spearman's correlation coefficients were used to identify the relationship between the changes of HR and systolic blood pressure (SBP). Results: In the current meta-analysis, 681 subjects from 16 individual studies were included. This study showed that RDN could reduce office HR in patients with hypertension [WMD = −1.93 (95% CI: −3.00 to −0.85, p < 0.001)]. In addition, 24-h HR and daytime HR were decreased after RDN [WMD = −1.73 (95% CI: −3.51 to −0.31, p = 0.017) and −2.67 (95% CI: −5.02 to −0.32, p = 0.026) respectively], but nighttime HR was not significantly influenced by RDN (WMD = −2.08, 95% CI: −4.57 to 0.42, p = 0.103). We found that the reduction of HR was highly related to the decrease of SBP (r = 0.658, p < 0.05). Conclusion: Renal denervation could reduce office, 24-h, and daytime HR, but does not affect nighttime HR. And the effect is highly associated with blood pressure (BP) control. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021283065.
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13
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Tomiyama H, Nakano H, Takahashi T, Fujii M, Shiina K, Matsumoto C, Chikamori T, Yamashina A. Heart rate modulates the relationship of augmented systolic blood pressure with the blood natriuretic peptide levels. ESC Heart Fail 2021; 8:3957-3963. [PMID: 34323018 PMCID: PMC8497200 DOI: 10.1002/ehf2.13540] [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: 12/18/2020] [Revised: 06/01/2021] [Accepted: 07/13/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Augmented central systolic blood pressure (cSBP), which is known to affect the cardiac afterload, is an independent risk factor for cardiovascular disease. While an inverse relationship is known to exist between the heart rate (HR) and the cSBP, it has not yet been clarified if the HR also modulates the association between the cSBP and the cardiac afterload. The present study was conducted to clarify whether the association of the cSBP with the serum levels of the N-terminal fragment B-type natriuretic peptide (NT-proBNP) differs between subjects with high and low HRs, using data obtained from the same subjects on two occasions (2009 and 2012) so as to confirm their consistency. METHODS AND RESULTS The radial augmentation index, systolic pressure at the second peak of the radial pressure waveform (SBP2), and serum NT-proBNP levels were measured and analysed in a worksite cohort of 2000 middle-aged men in 2009 and in 2012. The subjects were divided into three groups by the HR (i.e. ≤69, 70-79, and ≥80 b.p.m.). While the serum NT-proBNP levels were similar among the three groups, the radial augmentation index increased (from 61 ± 12% to 72 ± 13%, P < 0.01 in 2009 and from 61 ± 13% to 73 ± 12%, P < 0.01 in 2012) and the SBP1-2 decreased (from 18 ± 7 to 13 ± 7 mmHg, P < 0.01 in 2009 and from 19 ± 7 to 13 ± 6 mmHg, P < 0.01 in 2012) significantly with decreasing HR. After the adjustment, the SBP2 showed a significant association with the serum NT-proBNP levels in the overall study population [non-standardized coefficient (B) = 0.005, standard error (SE) = 0.001, P < 0.01 in 2009 (n = 2257) and B = 0.004, SE = 0.001, P < 0.01 in 2012 (n = 1986)]. In subgroup analyses, the SBP2 showed a significant association with the serum NT-proBNP levels [B = 0.004, SE = 0.002, P = 0.02 in 2009 (n = 1291) and B = 0.005, SE = 0.001, P < 0.01 in 2012 (n = 1204)] only in the subject group with an HR of ≤69 b.p.m. CONCLUSIONS In middle-aged Japanese men, the relationship between the cSBP and the cardiac afterload appears to differ depending on the HR; the results of our analysis showed that the relationship between the cSBP and the cardiac overload may be more pronounced and strongly significant in patients with low HRs as compared with patients with high HRs.
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Affiliation(s)
- Hirofumi Tomiyama
- Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hiroki Nakano
- Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takamichi Takahashi
- Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Masatsune Fujii
- Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kazuki Shiina
- Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Chisa Matsumoto
- Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Taishiro Chikamori
- Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Akira Yamashina
- Department of Cardiology and Division of Preemptive Medicine for Vascular Damage, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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14
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Izumida T, Imamura T, Fukui T, Koi T, Ueno Y, Hori M, Nakagaito M, Tanaka S, Kataoka N, Ushijima R, Nakamura M, Sobajima M, Fukuda N, Ueno H, Kinugawa K. How to Estimate the Optimal Heart Rate in Patients with Heart Failure with Preserved Ejection Fraction. Int Heart J 2021; 62:816-820. [PMID: 34276013 DOI: 10.1536/ihj.20-788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ideal heart rate (HR), particularly for those with heart failure with preserved ejection fraction (HFpEF), remains unknown. We hypothesized that cardiac output would be maximum when the overlap between E-wave and A-wave at the trans-mitral flow is "zero" in the Doppler echocardiography. We retrospectively investigated the association among the overlap length between two waves, actual HR, and other echocardiographic parameters to construct a formula for estimating theoretically ideal HR among those with HFpEF. In total, 48 HFpEF patients were included (70-year-olds, 18 males). Given the results of multivariate linear regression analyses, the overlap length was estimated as follows: -1,050 + 8.4 × (HR [bpm]) + 0.6 × (deceleration time [millisecond]) + 1.7 × (A-width [millisecond]), which had a strong agreement with the actually measured overlap length (r = 0.86, P < 0.001). Theoretically ideal HR was calculated by substituting zero into the estimated overlap length as follows: 125 - 0.07 × (deceleration time [millisecond]) - 0.20 × (A-width [millisecond]). In the validation cohort including another 143 HFpEF patients, the estimated overlap using the formula again had a strong agreement with the actually measured overlap (r = 0.72, P < 0.001). In this study, we proposed a novel formula for calculating theoretically ideal HR, consisting of deceleration time and A-width, in the HFpEF cohort. Clinical implication to optimize the HR targeting the theoretically ideal HR should be investigated in prospective studies.
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Affiliation(s)
| | | | - Takuya Fukui
- Second Department of Internal Medicine, University of Toyama
| | - Takatoshi Koi
- Second Department of Internal Medicine, University of Toyama
| | - Yohei Ueno
- Second Department of Internal Medicine, University of Toyama
| | - Masakazu Hori
- Second Department of Internal Medicine, University of Toyama
| | | | - Shuhei Tanaka
- Second Department of Internal Medicine, University of Toyama
| | - Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama
| | | | - Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama
| | - Mitsuo Sobajima
- Second Department of Internal Medicine, University of Toyama
| | - Nobuyuki Fukuda
- Second Department of Internal Medicine, University of Toyama
| | - Hiroshi Ueno
- Second Department of Internal Medicine, University of Toyama
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15
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Izumida T, Imamura T, Ueno Y, Tanaka S, Kataoka N, Nakamura M, Kinugawa K. Impact of optimal heart rate on left ventricular reverse remodeling and functional improvement in patients with systolic heart failure. Heart Vessels 2021; 36:1688-1693. [PMID: 33956182 DOI: 10.1007/s00380-021-01864-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022]
Abstract
Heart rate modulation therapy using ivabradine reduces mortality and morbidity in patients with systolic heart failure, whereas too reduced heart rate seems to worsen the clinical outcome. The optimal heart rate during heart rate modulation therapy remains unknown. Consecutive patients with left ventricular ejection fraction < 50% who received echocardiographic assessments and simultaneous heart rate measurements were retrospectively investigated. Theoretically ideal heart rate was calculated using a previously proposed formula: 93 - 0.13 × (deceleration time [msec]). Impacts of heart rate on the 1-year echocardiographic left ventricular reverse remodeling were compared among the three groups stratified by the heart rate status: optimal heart rate group (within 10 bpm of ideal heart rate), below-optimal heart rate group (< 10 bpm of ideal heart rate), and above-optimal heart rate group (> 10 bpm of ideal heart rate). A total of 75 patients (70 years old, 60 men) were included. There were no significant differences in the baseline characteristics among the three groups, except for the higher prevalence of tolvaptan use and higher plasma B-type natriuretic peptide level in the below-optimal heart rate group. Left ventricular end-diastolic diameter (from 55 to 54) and left ventricular ejection fraction (from 39 to 46) improved significantly only in the optimal heart rate group at 1-year follow-up (p < 0.05 for both). Optimal heart rate, which was calculated using a formula consisting of deceleration time, was associated with cardiac reverse remodeling in patients with systolic heart failure. Prospective study to investigate the implication of deceleration time-guided aggressive heart rate optimization is the next concern.
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Affiliation(s)
- Toshihide Izumida
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan.
| | - Yohei Ueno
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Shuhei Tanaka
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
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16
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Kazama S, Kondo T, Shibata N, Hiraiwa H, Nishiyama I, Kato T, Sawamura A, Kimura Y, Oishi H, Kuwayama T, Morimoto R, Okumura T, Shimizu K, Murohara T. Clinical impact of heart rate change in patients with acute heart failure in the early phase. ESC Heart Fail 2021; 8:2982-2990. [PMID: 33934546 PMCID: PMC8318482 DOI: 10.1002/ehf2.13388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/19/2021] [Accepted: 04/12/2021] [Indexed: 12/13/2022] Open
Abstract
Aims Patients with acute heart failure (AHF) often present with an increased heart rate (HR), and the HR changes dramatically after initial treatment for AHF. However, the HR change after admission and the relationship between HR change in the early phase and prognosis have not been fully elucidated. Methods and results From a multicentre AHF registry, we retrospectively evaluated 1527 consecutive patients admitted with AHF. HR change (%) was calculated by [HR (at admission) − HR (24 h after admission)] × 100∕HR (at admission). The median HR change was 15.1% (range, 2.0–28.4%). The HR decreased most in the first 24 h and then gradually thereafter [admission: 98 (81–117) b.p.m., 24 h: 80 (70–92) b.p.m., 48 h: 78 (68–90) b.p.m., and 72 h: 77 (67–88) b.p.m.]. In Kaplan–Meier analysis, the cumulative event‐free rates in the composite endpoint of death and rehospitalization due to AHF showed better according to larger HR change (P = 0.012, log rank). Cox proportional hazards analysis showed that HR change was a prognostic factor for composite endpoint adjusted by age and sex [hazard ratio, 0.995; 95% confidence interval (CI), 0.991–0.998; P = 0.006]. HR change was associated with outcome adjusted by age and sex in patients with sinus rhythm (hazard ratio, 0.993; 95% CI, 0.988–0.999; P = 0.015), but not in patients with atrial fibrillation (hazard ratio, 0.996; 95% CI, 0.990–1.002; P = 0.15). Conclusions A decrease in HR in the first 24 h after admission indicates better prognosis in patients with AHF, although the prognostic influence may differ between patients with sinus rhythm and those with atrial fibrillation.
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Affiliation(s)
- Shingo Kazama
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Naoki Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | | | - Toshiaki Kato
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Akinori Sawamura
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Yuki Kimura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hideo Oishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tasuku Kuwayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kiyokazu Shimizu
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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17
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Böhm M, Schumacher H, Teo KK, Lonn EM, Mahfoud F, Ukena C, Mann JFE, Mancia G, Redon J, Schmieder RE, Sliwa K, Marx N, Weber MA, Williams B, Yusuf S. Resting heart rate and cardiovascular outcomes in diabetic and non-diabetic individuals at high cardiovascular risk analysis from the ONTARGET/TRANSCEND trials. Eur Heart J 2021; 41:231-238. [PMID: 30590564 DOI: 10.1093/eurheartj/ehy808] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/26/2018] [Accepted: 11/13/2018] [Indexed: 12/15/2022] Open
Abstract
AIMS Resting heart rate (RHR) has been shown to be associated with cardiovascular outcomes in various conditions. It is unknown whether different levels of RHR and different associations with cardiovascular outcomes occur in patients with or without diabetes, because the impact of autonomic neuropathy on vascular vulnerability might be stronger in diabetes. METHODS AND RESULTS We examined 30 937 patients aged 55 years or older with a history of or at high risk for cardiovascular disease and after myocardial infarction, stroke, or with proven peripheral vascular disease from the ONTARGET and TRANSCEND trials investigating ramipril, telmisartan, and their combination followed for a median of 56 months. We analysed the association of mean achieved RHR on-treatment with the primary composite outcome of cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure, the components of the composite primary outcome, and all-cause death as continuous and categorical variables. Data were analysed by Cox regression analysis, ANOVA, and χ2 test. These trials were registered with ClinicalTrials.gov.number NCT00153101. Patients were recruited from 733 centres in 40 countries between 1 December 2001 and 31 July 2008 (ONTARGET) and 1 November 2001 until 30 May 2004 (TRANSCEND). In total, 19 450 patients without diabetes and 11 487 patients with diabetes were stratified by mean RHR. Patients with diabetes compared to no diabetes had higher RHRs (71.8 ± 9.0 vs. 67.9 ± 8.8, P < 0.0001). In the categories of <60 bpm, 60 ≤ 65 bpm, 65 ≤ 70 bpm, 70 ≤ 75 bpm, 75 ≤ 80 bpm and ≥80 bpm, non-diabetic patients had an increased hazard of the primary outcome with mean RHR of 75 ≤ 80 bpm (adjusted hazard ratio [HR] 1.17 (1.01-1.36)) compared to RHR 60 ≤ 65 bpm. For patients with in-trial RHR ≥80 bpm the hazard ratios were highest (diabetes: 1.96 (1.64-2.34), no diabetes: 1.73 (1.49-2.00), For cardiovascular death hazards were also clearly increased at RHR ≥80 bpm (diabetes [1.99, (1.53-2.58)], no diabetes [1.73 (1.38-2.16)]. Similar results were obtained for hospitalization for heart failure and all-cause death while the effect of RHR on myocardial infarction and stroke was less pronounced. Results were robust after adjusting for various risk indicators including beta-blocker use and atrial fibrillation. No significant association to harm was observed at lower RHR. CONCLUSION Mean RHR above 75-80 b.p.m. was associated with increased risk for cardiovascular outcomes except for stroke. Since in diabetes, high RHR is associated with higher absolute event numbers and patients have higher RHRs, this association might be of particular clinical importance in diabetes. These data suggest that RHR lowering in patients with RHRs above 75-80 b.p.m. needs to be studied in prospective trials to determine if it will reduce outcomes in diabetic and non-diabetic patients at high cardiovascular risk. CLINICAL TRIAL REGISTRATION http://clinicaltrials.gov.Unique identifier: NCT00153101.
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Affiliation(s)
- Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, 66421 Homburg/Saar, Germany
| | | | - Koon K Teo
- Population Health Research Institute, McMaster University, Hamilton, Ontario L8L 2X2, Canada
| | - Eva M Lonn
- Population Health Research Institute, McMaster University, Hamilton, Ontario L8L 2X2, Canada
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, 66421 Homburg/Saar, Germany
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, 66421 Homburg/Saar, Germany
| | - Johannes F E Mann
- KfH Kidney Centre, Menzinger Str. 44, 80638 München, Germany.,Department of Nephrology and Hypertension, University Hospital, Friedrich-Alexander University, Schlossplatz 4, 91054 Erlangen/Nuremberg, Germany
| | - Giuseppe Mancia
- University of Milano-Bicocca, Istituto Clinico Universitario Policlinico di Monza, Piazza dell'Ateneo Nuovo, 1, 20126 Milano, Italy
| | - Josep Redon
- Hypertension Unit, Hospital CIínico Universitario, University of Valencia, Av. de Blasco Ibáñez, 13, 46010 València, Spain
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital, Friedrich-Alexander University, Schlossplatz 4, 91054 Erlangen/Nuremberg, Germany
| | - Karen Sliwa
- Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa & IIDMM, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
| | - Nikolaus Marx
- Department of Internal Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen
| | - Michael A Weber
- Downstate College of Medicine, State University of New York, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Bryan Williams
- University College London (UCL), Institute of Cardiovascular Science, National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, 149 Tottenham Court Road, London W1T 7D, UK
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario L8L 2X2, Canada
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18
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Linz D, Loffler KA, Sanders P, Catcheside P, Anderson CS, Zheng D, Quan W, Barnes M, Redline S, McEvoy RD, Baumert M. Low Prognostic Value of Novel Nocturnal Metrics in Patients With OSA and High Cardiovascular Event Risk: Post Hoc Analyses of the SAVE Study. Chest 2020; 158:2621-2631. [PMID: 32679239 DOI: 10.1016/j.chest.2020.06.072] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Traditional methods for the quantification of OSA severity may not encapsulate potential relationships between hypoxemia in OSA and cardiovascular risk. RESEARCH QUESTION Do novel nocturnal oxygen saturation (Spo2) metrics have prognostic value in patients with OSA and high cardiovascular event risk? STUDY DESIGN AND METHODS We conducted post hoc analyses of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial. In 2687 individuals, Cox proportional hazards models that were stratified for treatment allocation were used to determine the associations between clinical characteristics, pulse oximetry-derived metrics that were designed to quantify sustained and episodic features of hypoxemia, and cardiovascular outcomes. Metrics included oxygen desaturation index, time <90% Spo2, average Spo2 for the entire recording (mean Spo2), average Spo2 during desaturation events (desaturation Spo2), average baseline Spo2 interpolated across episodic desaturation events (baseline Spo2), episodic desaturation event duration and desaturation/resaturation-time ratio, and mean and SD of pulse rate. RESULTS Neither apnea-hypopnea index, oxygen desaturation index, nor any of the novel Spo2 metrics were associated with the primary SAVE composite cardiovascular outcome. Mean and baseline Spo2 were associated with heart failure (hazard ratio [HR], 0.81; 95% CI, 0.69-0.95; P = .009; and HR, 0.78; 95% CI, 0.67-0.90; P = .001, respectively) and myocardial infarction (HR, 0.86; 95% CI, 0.77-0.95; P = .003; and HR, 0.81; 95% CI, 0.73-0.90; P < .001, respectively). Desaturation duration and desaturation/resaturation time ratio, with established risk factors, predicted future heart failure (area under the curve, 0.86; 95% CI, 0.79-0.93). INTERPRETATION Apnea-hypopnea index and oxygen desaturation index were not associated with cardiovascular outcomes. In contrast, the pattern of oxygen desaturation was associated with heart failure and myocardial infarction. However, concomitant risk factors remained the predominant determinants for secondary cardiovascular events and thus deserve the most intensive management.
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Affiliation(s)
- Dominik Linz
- Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Department of Cardiology, Maastricht University Medical Centre, Maastricht, Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, The Netherlands; Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Kelly A Loffler
- Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Prashanthan Sanders
- Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Peter Catcheside
- Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Craig S Anderson
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Danni Zheng
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - WeiWei Quan
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Rui Jin Hospital and Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mary Barnes
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University, Adelaide, Australia; Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, University of Adelaide, Adelaide, Australia
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19
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Yuan G, Jing Y, Wang T, Fernandes VS, Xin W. The bitter taste receptor agonist-induced negative chronotropic effects on the Langendorff-perfused isolated rat hearts. Eur J Pharmacol 2020; 876:173063. [DOI: 10.1016/j.ejphar.2020.173063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/29/2020] [Accepted: 03/10/2020] [Indexed: 11/27/2022]
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20
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Chamarthi B, Vinik A, Ezrokhi M, Cincotta AH. Circadian-timed quick-release bromocriptine lowers elevated resting heart rate in patients with type 2 diabetes mellitus. Endocrinol Diabetes Metab 2020; 3:e00101. [PMID: 31922028 PMCID: PMC6947713 DOI: 10.1002/edm2.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/09/2019] [Accepted: 10/20/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Sympathetic nervous system (SNS) overactivity is a risk factor for insulin resistance and cardiovascular disease (CVD). We evaluated the impact of bromocriptine-QR, a dopamine-agonist antidiabetes medication, on elevated resting heart rate (RHR) (a marker of SNS overactivity in metabolic syndrome), blood pressure (BP) and the relationship between bromocriptine-QR's effects on RHR and HbA1c in type 2 diabetes subjects. DESIGN AND SUBJECTS RHR and BP changes were evaluated in this post hoc analysis of data from a randomized controlled trial in 1014 type 2 diabetes subjects randomized to bromocriptine-QR vs placebo added to standard therapy (diet ± ≤2 oral antidiabetes medications) for 24 weeks without concomitant antihypertensive or antidiabetes medication changes, stratified by baseline RHR (bRHR). RESULTS In subjects with bRHR ≥70 beats/min, bromocriptine-QR vs placebo reduced RHR by -3.4 beats/min and reduced BP (baseline 130/79; systolic, diastolic, mean arterial BP reductions [mm Hg]: -3.6 [P = .02], -1.9 [P = .05], -2.5 [P = .02]). RHR reductions increased with higher baseline HbA1c (bHbA1c) (-2.7 [P = .03], -5 [P = .002], -6.1 [P = .002] with bHbA1c ≤7, >7, ≥7.5%, respectively] in the bRHR ≥70 group and more so with bRHR ≥80 (-4.5 [P = .07], -7.8 [P = .015], -9.9 [P = .005]). Subjects with bRHR <70 had no significant change in RHR or BP. With bHbA1c ≥7.5%, %HbA1c reductions with bromocriptine-QR vs placebo were -0.50 (P = .04), -0.73 (P = .005) and -1.22 (P = .008) with bRHR <70, ≥70 and ≥80, respectively. With bRHR ≥70, the magnitude of bromocriptine-QR-induced RHR reduction was an independent predictor of bromocriptine-QR's HbA1c lowering effect. CONCLUSION Bromocriptine-QR lowers elevated RHR with concurrent decrease in BP and hyperglycaemia. These findings suggest a potential sympatholytic mechanism contributing to bromocriptine-QR's antidiabetes effect and potentially its previously demonstrated effect to reduce CVD events.
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Affiliation(s)
| | - Aaron Vinik
- Eastern Virginia Medical School Strelitz Diabetes CenterNorfolkVirginia
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21
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Optimization of Heart Failure Treatment by Heart Rate Reduction. INTERNATIONAL JOURNAL OF HEART FAILURE 2020; 2:1-11. [PMID: 36263079 PMCID: PMC9536732 DOI: 10.36628/ijhf.2019.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/12/2019] [Indexed: 11/18/2022]
Abstract
Heart failure (HF) treatment should be optimized in addition to guideline-directed and recommended drugs to achieve an appropriate heart rate (i.e. 50−60 bpm) by ivabradine in patients with a heart rate >70 bpm in sinus rhythm and with an ejection fraction ≤35%. Heart rate reduction was to reduce cardiovascular death and HF hospitalization dependent on baseline resting heart rate. In particular in patients at a heart rate >75 bpm, a reduction in cardiovascular death, all-cause death, HF death, HF hospitalization and all-cause hospitalization has been observed. The optimal heart rate achieved appears to be between 50−60 bpm, if well tolerated as in these patients the lowest event rate is observed on treatment. Heart rate reduction is, therefore, a treatable risk factor in chronic HF. Observational studies support the concept that it is a risk indicator in other cardiovascular and non-cardiovascular conditions. Whether heart rate reduction is also modifying risk in other conditions than chronic HF should be explored in prospective clinical trials.
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22
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Tomasoni D, Adamo M, Lombardi CM, Metra M. Highlights in heart failure. ESC Heart Fail 2019; 6:1105-1127. [PMID: 31997538 PMCID: PMC6989277 DOI: 10.1002/ehf2.12555] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in recent studies in patients hospitalized for acute HF. More recently, dapagliflozin and prevention of adverse-outcomes in DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HF research are summarized and reviewed in this article.
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Affiliation(s)
- Daniela Tomasoni
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
| | - Marianna Adamo
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
| | - Carlo Mario Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaCardiothoracic DepartmentCivil HospitalsBresciaItaly
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23
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Bouabdallaoui N, O'Meara E, Bernier V, Komajda M, Swedberg K, Tavazzi L, Borer JS, Bohm M, Ford I, Tardif JC. Beneficial effects of ivabradine in patients with heart failure, low ejection fraction, and heart rate above 77 b.p.m. ESC Heart Fail 2019; 6:1199-1207. [PMID: 31591826 PMCID: PMC6989297 DOI: 10.1002/ehf2.12513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/01/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022] Open
Abstract
Aims Ivabradine has been approved in heart failure with reduced ejection fraction (HFrEF) and elevated heart rate despite guideline‐directed medical therapy (GDMT) to reduce cardiovascular (CV) death and hospitalization for worsening HF. The median value of 77 b.p.m. is the lower bound selected for the regulatory approval in Canada, South Africa, and Australia. Patient‐reported outcomes (PROs) including symptoms, quality of life, and global assessment are considered of major interest in the global plan of care of patients with HF. However, the specific impact of GDMT, and specifically ivabradine, on PRO remains poorly studied. In the subgroup of patients from the Systolic Heart failure treatment with the If inhibitor ivabradine Trial (SHIFT) who had heart rate above the median of 77 b.p.m. (pre‐specified analysis) and for whom the potential for improvement was expected to be larger, we aimed (i) to evaluate the effects of ivabradine on PRO (symptoms, quality of life, and global assessment); (ii) to consolidate the effects of ivabradine on the primary composite endpoint of CV death and hospitalization for HF; and (iii) to reassess the effects of ivabradine on left ventricular (LV) remodelling. Methods and results Comparisons were made according to therapy, and proportional hazards models (adjusted for baseline beta‐blocker therapy) were used to estimate the association between ivabradine and various outcomes. In SHIFT, n = 3357 (51.6%) patients had a baseline heart rate > 77 b.p.m. After a median follow‐up of 22.9 months (inter‐quartile range 18–28 months), ivabradine on top of GDMT improved symptoms (28% vs. 23% improvement in New York Heart Association functional class, P = 0.0003), quality of life (5.3 vs. 2.2 improvement in Kansas City Cardiomyopathy Questionnaire overall summary score, P = 0.005), and global assessment [from both patient (improved in 72.3%) and physician (improved in 61.0%) perspectives] significantly more than did placebo (both P < 0.0001). Ivabradine induced a 25% reduction in the combined endpoint of CV death and hospitalization for HF (hazard ratio 0.75; P < 0.0001), which translates into a number of patients needed to be treated for 1 year of 17. Patients under ivabradine treatment demonstrated a significant reduction in LV dimensions when reassessed at 8 months (P < 0.05). Conclusions In patients with chronic HFrEF, sinus rhythm, and a heart rate > 77 b.p.m. while on GDMT, the present analysis brings novel insights into the role of ivabradine in improving the management of HFrEF, particularly with regard to PRO (ISRCTN70429960).
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Affiliation(s)
- Nadia Bouabdallaoui
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, H1T 1C8, Quebec, Canada
| | - Eileen O'Meara
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, H1T 1C8, Quebec, Canada
| | - Virginie Bernier
- Scientific and Medical Affairs, Servier Canada Inc., Laval, Quebec, Canada
| | - Michel Komajda
- Department of Cardiology, Paris Saint Joseph Hospital, Paris, France
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Jeffrey S Borer
- Howard Gilman and Schiavone Institutes, State University of New York Downstate Medical Center, New York, NY, USA
| | - Michael Bohm
- Internal Medicine Clinic III, Saarland University Clinic, Saarland University, Homburg, Saar, Germany
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, H1T 1C8, Quebec, Canada
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24
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Metra M. April 2019 at a glance: prediction of heart failure, left atrial function, cardio-oncology. Eur J Heart Fail 2019; 21:393-394. [PMID: 30969475 DOI: 10.1002/ejhf.1260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 12/02/2016] [Accepted: 12/13/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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25
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Sarocchi M, Arboscello E, Ghigliotti G, Murialdo R, Bighin C, Gualandi F, Sicbaldi V, Balbi M, Brunelli C, Spallarossa P. Ivabradine in Cancer Treatment-Related Left Ventricular Dysfunction. Chemotherapy 2019; 63:315-320. [PMID: 30840967 DOI: 10.1159/000495576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/19/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients developing cancer treatment-related left ventricular dysfunction (CTrLVD) require a prompt therapy. Hypotension, dizziness, and fatigue often limit the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and β-blockers (BB) in cancer patients who may already be afflicted by these symptoms. Ivabradine is a heart rate-lowering drug that does not cause hypotension and may be used in heart failure with reduced left ventricular ejection fraction (LVEF). OBJECTIVE The aim of this paper was to investigate the role of ivabradine to treat CTrLVD. METHODS A retrospective analysis in a cohort of 30 patients with CTrLVD (LVEF < 50%) receiving ivabradine on top of the maximal tolerated dose of ACEi/ARB and BB was performed. We evaluated cardiovascular treatment, oncologic treatment, LVEF, functional class (New York Heart Association [NYHA]), and fatigue during the study period. RESULTS Ivabradine was initially started at the dose of 2.5 mg/b.i.d. in most patients and then carefully titrated. Hypotension (70%) and fatigue (77%) were the main causes limiting the treatment with ACEi/ARB and BB. After a mean follow-up of 6.5 months, LVEF increased from 45.1% (SD = 6.4) to 53.2% (SD = 3.9; p < 0.001). When patients were analyzed according to the type of cancer therapy, no difference in LVEF changes across the groups was found. NYHA class ameliorated in 11 patients, while fatigue improved in 8 patients. No serious cardiovascular side effects were reported. CONCLUSIONS The ability to improve symptoms and LVEF in unfit cancer patients makes ivabradine a reasonable pharmacological tool for treating CTrLVD.
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Affiliation(s)
- Matteo Sarocchi
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | - Giorgio Ghigliotti
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Roberto Murialdo
- Internal Medicine Unit, San Martino Policlinic Hospital, Genoa, Italy
| | - Claudia Bighin
- Medical Oncology Unit, San Martino Policlinic Hospital, Genoa, Italy
| | | | - Vera Sicbaldi
- Internal Medicine Unit, San Martino Policlinic Hospital, Genoa, Italy
| | - Manrico Balbi
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Claudio Brunelli
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paolo Spallarossa
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy,
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26
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Kakehi K, Iwanaga Y, Watanabe H, Sonobe T, Akiyama T, Shimizu S, Yamamoto H, Miyazaki S. Modulation of Sympathetic Activity and Innervation With Chronic Ivabradine and β-Blocker Therapies: Analysis of Hypertensive Rats With Heart Failure. J Cardiovasc Pharmacol Ther 2019; 24:387-396. [PMID: 30786751 DOI: 10.1177/1074248419829168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Whether the reduction of heart rate with ivabradine (IVA) could affect sympathetic activation and cardiac innervation in heart failure (HF) remains unknown. PURPOSE The present study assessed the chronic effects of IVA and β-blocker on the systemic and local sympathetic nervous systems of hypertensive animals with HF. METHODS AND RESULTS The Dahl salt-sensitive rats received chronic IVA, bisoprolol (BIS), or placebo (CTL) therapy. The survival of the animal models with IVA and BIS significantly improved (median; 19.7 in IVA and 19.7 in BIS vs 17.0 weeks in CTL, P < .001). A similar decrease in 24-hour heart rate (mean; 305 in IVA and 329 in BIS vs 388 beats/min in CTL, P < .001) without effect on blood pressure, and an improvement in the left ventricular dysfunction (mean fractional shortening; 56.7% in IVA and 47.8% in BIS vs 39.0% in CTL, P < .001) were observed in the animals with IVA and BIS. However, a negative inotropic effect was only observed in the animals with BIS. Excessive urinary noradrenaline excretion in animals with CTL was only suppressed with the use of IVA (mean; 1.35 μg/d in IVA and 1.95 μg/d in BIS vs 2.27 μg/d in CTL, P = .002). In contrast, atrial noradrenaline and acetylcholine depletion in the animals with CTL improved and the tyrosine hydroxylase expression in the both atria were restored with the use of both IVA and BIS. CONCLUSIONS IVA therapy improved the survival of hypertensive animals with HF. Furthermore, it was associated with the amelioration of systemic sympathetic activation and cardiac sympathetic and parasympathetic nerve innervations. Chronic β-blocker therapy with negative inotropic effects had beneficial effects only on cardiac innervations.
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Affiliation(s)
- Kazuyoshi Kakehi
- 1 Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Yoshitaka Iwanaga
- 1 Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Heitaro Watanabe
- 1 Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Takashi Sonobe
- 2 Department of Cardiac Physiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tsuyoshi Akiyama
- 2 Department of Cardiac Physiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shuji Shimizu
- 3 Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiromi Yamamoto
- 1 Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Shunichi Miyazaki
- 1 Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
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27
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Böhm M, Mahfoud F, Townsend RR, Kandzari DE, Pocock S, Ukena C, Weber MA, Hoshide S, Patel M, Tyson CC, Weil J, Agdirlioglu T, Fahy M, Kario K. Ambulatory heart rate reduction after catheter-based renal denervation in hypertensive patients not receiving anti-hypertensive medications: data from SPYRAL HTN-OFF MED, a randomized, sham-controlled, proof-of-concept trial. Eur Heart J 2019; 40:743-751. [DOI: 10.1093/eurheartj/ehy871] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/22/2018] [Accepted: 12/18/2018] [Indexed: 01/01/2023] Open
Affiliation(s)
- Michael Böhm
- Department of Internal Medicine III, University Hospital of Saarland, Saarland University, Kirrberger Street 1, Homburg/Saar, Germany
| | - Felix Mahfoud
- Department of Internal Medicine III, University Hospital of Saarland, Saarland University, Kirrberger Street 1, Homburg/Saar, Germany
| | - Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - David E Kandzari
- Department of Interventional Cardiology, Piedmont Heart Institute, 275 Collier Rd NW #500, Atlanta, GA, USA
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel St, Bloomsbury, London, UK
| | - Christian Ukena
- Department of Internal Medicine III, University Hospital of Saarland, Saarland University, Kirrberger Street 1, Homburg/Saar, Germany
| | - Michael A Weber
- Department of Medicine, SUNY Downstate College of Medicine, 450 Clarkson Ave, Brooklyn, NY, USA
| | - Satoshi Hoshide
- Department of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Tochigi-ken, Japan
| | - Manesh Patel
- Department of Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, USA
| | - Crystal C Tyson
- Department of Internal Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC, USA
| | - Joachim Weil
- Department of Cardiology, Sana Cardiomed Heart Center, Kronsforder Allee 71, Lübeck, Germany
| | - Tolga Agdirlioglu
- Department of Cardiology, Sana Cardiomed Heart Center, Kronsforder Allee 71, Lübeck, Germany
| | | | - Kazuomo Kario
- Department of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Tochigi-ken, Japan
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28
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Dinatolo E, Sciatti E, Anker MS, Lombardi C, Dasseni N, Metra M. Updates in heart failure: what last year brought to us. ESC Heart Fail 2018; 5:989-1007. [PMID: 30570225 PMCID: PMC6300825 DOI: 10.1002/ehf2.12385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Elisabetta Dinatolo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Edoardo Sciatti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Markus S. Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Berlin‐Brandenburg Center for Regenerative Therapies (BCRT), DZHK (German Centre for Cardiovascular Research), partner site BerlinCharité—Universitätsmedizin BerlinBerlinGermany
| | - Carlo Lombardi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Nicolò Dasseni
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
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29
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Lopatin YM, Cowie MR, Grebennikova AA, Sisakian HS, Pagava ZM, Hayrapetyan HG, Abdullaev TA, Voronkov LG, Chesnikova AI, Tseluyko VI, Tarlovskaya EI, Dadashova GM, Berkinbaev SF, Glezer MG, Koziolova NA, Rakisheva AG, Kipiani ZV, Kurlyanskaya AK. Optimization of heart rate lowering therapy in hospitalized patients with heart failure: Insights from the Optimize Heart Failure Care Program. Int J Cardiol 2018; 260:113-117. [PMID: 29622423 DOI: 10.1016/j.ijcard.2017.12.093] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Hospitalization is an opportunity to optimize heart failure (HF) therapy. As optimal treatment for hospitalized HF patients in sinus rhythm with heart rate≥70bpm is unclear, we investigated the impact of combined beta-blocker (BB) and ivabradine versus BBs alone on short and longer term mortality and rehospitalization. METHODS AND RESULTS A retrospective analysis was performed on 370 hospitalized HF patients with heart rate≥70bpm (150 BB+ivabradine, 220 BB alone) in the Optimize Heart Failure Care Program in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Russia, Ukraine, and Uzbekistan, from October 2015 to April 2016. RESULTS At 1month, 3months, 6months and 12months, there were fewer deaths, HF hospitalizations and overall hospitalizations in patients on BB+ivabradine vs BBs alone. At 12months, all-cause mortality or HF hospitalization was significantly lower with BB+ivabradine than BBs (adjusted hazard ratio [HR] 0.45 (95% confidence interval [CI] 0.32-0.64, P<0.0001). Significantly greater improvement was seen in quality of life (QOL) from admission to 12months with BB+ivabradine vs BBs alone (P=0.0001). With BB+ivabradine, significantly more patients achieved ≥50% target doses of BBs at 12months than on admission (82.0% vs 66.6%, P=0.0001), but the effect was non-significant with BBs alone. CONCLUSIONS Heart rate lowering therapy with BB+ivabradine started in hospitalized HF patients (heart rate≥70bpm) is associated with reduced overall mortality and re-hospitalization over the subsequent 12months. A prospective randomized trial is needed to confirm the advantages of this strategy.
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Affiliation(s)
- Yuri M Lopatin
- Volgograd State Medical University, Volgograd Regional Cardiology Centre, 106, Universitetsky Prospect, Volgograd 400008, Russian Federation.
| | - Martin R Cowie
- Imperial College London (Royal Brompton Hospital), Sydney Street, London SW3 6HP, United Kingdom.
| | - Anna A Grebennikova
- Volgograd State Medical University, Volgograd Regional Cardiology Centre, 106, Universitetsky Prospect, Volgograd 400008, Russian Federation
| | - Hamayak S Sisakian
- University State Hospital 1, Yerevan State Medical University, 2, Koryun Street, Yerevan 375025, Armenia
| | - Zurab M Pagava
- Centre of Vascular and Heart Diseases, 5, Lubliana Street, Tbilisi, Georgia
| | | | | | - Leonid G Voronkov
- National Scientific Center Strazhesko Institute of Cardiology, National Academy of Medical Sciences, 5, Narodnogo Opolchenia Street, Kyiv 03680, Ukraine
| | - Anna I Chesnikova
- Rostov State Medical University, 29, Nahichevansky Avenue, Rostov-on-Don 344022, Russian Federation
| | - Vira I Tseluyko
- Kharkiv Medical Academy of Postgraduate Education, 58, Korchahintsiv Street, Kharkiv 61176, Ukraine
| | - Ekaterina I Tarlovskaya
- Nizhny Novgorod State Medical Academy, 10/1, Minin & Pozharsky Square, Nizhny Novgorod 603950, Russian Federation
| | - Gülnaz M Dadashova
- Scientific Research Institute of Cardiology, 316, Tbilisi Avenue, Baku, AZ1012, Azerbaijan
| | - Salim F Berkinbaev
- Scientific Research Institute of Cardiology and Internal Diseases, 120, Aiteke Bi Street, Almaty 050000, Kazakhstan
| | - Maria G Glezer
- I.M. Sechenov First Moscow State Medical University, 2, Bolshaya Pirogovskaya Street, Moscow 119991, Russian Federation
| | - Natalia A Koziolova
- Perm State Medical Academy, 39, Petropavlovskaya v Street, Perm 614000, Russian Federation
| | - Amina G Rakisheva
- Scientific Research Institute of Cardiology and Internal Diseases, 120, Aiteke Bi Street, Almaty 050000, Kazakhstan
| | | | - Alena K Kurlyanskaya
- Republican Scientific and Practical Centre of Cardiology, 110B, R. Luxemburg Street, Minsk 220036, Belarus
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30
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Koshy AN, Sajeev JK, Nerlekar N, Brown AJ, Rajakariar K, Zureik M, Wong MC, Roberts L, Street M, Cooke J, Teh AW. Utility of photoplethysmography for heart rate estimation among inpatients. Intern Med J 2018; 48:587-591. [PMID: 29722189 DOI: 10.1111/imj.13777] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/02/2017] [Accepted: 11/20/2017] [Indexed: 12/23/2022]
Abstract
The accuracy of photoplethysmography (PPG) for heart rate (HR) estimation in cardiac arrhythmia is unknown. PPG-HR was evaluated in 112 hospitalised inpatients (cardiac arrhythmias (n = 60), sinus rhythm (n = 52)) using a continuous electrocardiogram monitoring as a reference standard. Strong agreement was observed in sinus rhythm HR < 100 and atrial flutter (bias 1 beat), modest agreement in sinus tachycardia (bias 24 beats) and complete heart block (bias -6 beats) and weak agreement with significant HR underestimation was seen in atrial fibrillation (bias 23 beats). Routine utilisation of PPG for HR estimation may delay early recognition of clinical deterioration in certain arrhythmias and sinus tachycardia.
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Affiliation(s)
- Anoop N Koshy
- Department of Cardiology, Monash University, Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - Jithin K Sajeev
- Department of Cardiology, Monash University, Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine, Monash University and Monash Heart, Monash Health, Melbourne, Victoria, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Department of Medicine, Monash University and Monash Heart, Monash Health, Melbourne, Victoria, Australia
| | - Kevin Rajakariar
- Department of Cardiology, Monash University, Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - Mark Zureik
- Department of Cardiology, Monash University, Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - Michael C Wong
- Department of Cardiology, Monash University, Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - Louise Roberts
- Department of Cardiology, Monash University, Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - Maryann Street
- Department of Cardiology, Monash University, Eastern Health Clinical School, Melbourne, Victoria, Australia.,Deakin University, Geelong, Victoria, Australia
| | - Jennifer Cooke
- Department of Cardiology, Monash University, Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - Andrew W Teh
- Department of Cardiology, Monash University, Eastern Health Clinical School, Melbourne, Victoria, Australia.,Department of Cardiology, The University of Melbourne, Austin Hospital Clinical School, Melbourne, Victoria, Australia
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31
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Wang NC, Hussain A, Adelstein EC, Althouse AD, Sharbaugh MS, Jain SK, Shalaby AA, Voigt AH, Saba S. Myocardial recovery after cardiac resynchronization therapy in left bundle branch block-associated idiopathic nonischemic cardiomyopathy: A NEOLITH II substudy. Ann Noninvasive Electrocardiol 2018; 24:e12603. [PMID: 30267454 DOI: 10.1111/anec.12603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 07/26/2018] [Accepted: 08/08/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Baseline predictors of myocardial recovery after cardiac resynchronization therapy (CRT) in left bundle branch block (LBBB)-associated idiopathic nonischemic cardiomyopathy (NICM) are unknown. METHODS A retrospective study included subjects with idiopathic NICM, left ventricular ejection fraction (LVEF) ≤35%, and LBBB. Myocardial recovery was defined as post-CRT LVEF ≥50%. Logistic regression analyses described associations between baseline characteristics and myocardial recovery. Cox regression analyses estimated the hazard ratio (HR) between myocardial recovery status and adverse clinical events. RESULTS In 105 subjects (mean age 61 years, 44% male, mean initial LVEF 22.6% ± 6.6%, 81% New York Heart Association class III, and 98% CRT-defibrillators), myocardial recovery after CRT was observed in 56 (54%) subjects. Hypertension, heart rate, and serum blood urea nitrogen (BUN) had negative associations with myocardial recovery in univariable analyses. These associations persisted in multivariable analysis: hypertension (odds ratio (OR), 0.40; 95% confidence interval (CI), 0.17-0.95; p = 0.04), heart rate (OR per 10 bpm, 0.69; 95% CI, 0.48-0.997; p = 0.048), and serum BUN (OR per 1 mg/dl, 0.94; 95% CI, 0.88-0.99; p = 0.04). Subjects with post-CRT LVEF ≥50%, when compared to <50%, had lower risk for adverse clinical events (heart failure hospitalization, appropriate implantable cardioverter-defibrillator shock, appropriate anti-tachycardia pacing therapy, ventricular assist device implantation, heart transplantation, and death) over a median follow-up of 75.9 months (HR, 0.38; 95% CI, 0.16-0.88; p = 0.02). CONCLUSION In LBBB-associated idiopathic NICM, myocardial recovery after CRT was associated with absence of hypertension, lower heart rate, and lower serum BUN. Those with myocardial recovery had fewer adverse clinical events.
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Affiliation(s)
- Norman C Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Aliza Hussain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Evan C Adelstein
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew D Althouse
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael S Sharbaugh
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandeep K Jain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alaa A Shalaby
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew H Voigt
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samir Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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32
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Restoration of cardiac function after anaemia-induced heart failure in zebrafish. J Mol Cell Cardiol 2018; 121:223-232. [PMID: 30009777 DOI: 10.1016/j.yjmcc.2018.07.128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 06/28/2018] [Accepted: 07/11/2018] [Indexed: 01/22/2023]
Abstract
AIMS New therapeutic approaches are needed to fight against the growing epidemic of heart failure. Unlike mammals, zebrafish possess the incredible ability to regenerate cardiac tissue after acute trauma such as apical resection. Yet, the ability of zebrafish to recover after a chronic stress leading to heart failure has not been reported. The aim of this study was to test whether zebrafish can recover a normal cardiac function after anaemia-induced heart failure. METHODS AND RESULTS Eight- to ten-month-old zebrafish were treated with phenylhydrazine hydrochloride, an anaemia inducer, to generate heart failure. Treatment was stopped after 5 weeks and fish were followed-up for 3 weeks. Assessment of ventricular function by ultrasound at the end of the treatment revealed an increase in ventricle diameter (+47%) and a decrease in heart rate (-36%) and fractional shortening (-30%). A decrease in swim capacity was also observed (-31%). Tissue staining showed a thickening of the ventricular wall (5-fold), cell apoptosis and proliferation but no fibrosis. Expression of foetal genes, angiogenic factor and inflammation markers was increased, and β-adrenergic receptor-1 was decreased. Three weeks after phenylhydrazine hydrochloride withdrawal, all parameters returned to baseline and the fish recovered a normal cardiac function, tissue morphology and gene expression. CONCLUSIONS Zebrafish are able to completely recover from anaemia-induced heart failure. This model represents a unique opportunity to investigate the mechanisms of cardiac repair and may lead to the discovery of novel therapeutic targets of heart failure.
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Metra M. June 2018 at a glance: peripartum cardiomyopathy and pathophysiology, prognosis, and device therapy of heart failure. Eur J Heart Fail 2018; 20:949-950. [DOI: 10.1002/ejhf.1004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties Radiological Sciences, and Public Health, University of Brescia Italy
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34
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Di Mauro M, Petroni R, Clemente D, Foschi M, Tancredi F, Camponetti V, Gallina S, Calafiore AM, Penco M, Romano S. Clinical profile of patients with heart failure can predict rehospitalization and quality of life. J Cardiovasc Med (Hagerstown) 2018; 19:98-104. [PMID: 29342024 DOI: 10.2459/jcm.0000000000000619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this retrospective study was to identify clinical, humoral and echocardiographic variables predicting rehospitalization and poor quality of life (QOL) in patients with reduced or mid-range ejection fraction heart failure. METHODS From 2009 to 2012, 310 patients were admitted having signs and symptoms of heart failure with reduced ejection fraction. All the patients were followed by phone, calling the patients or the referring general practitioner. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used as the instrument to evaluate QOL: MLHFQ less than 24 is a good QOL, 24-45 is moderate QOL and more than 45 is poor QOL. The primary event was poor QOL and/or rehospitalization at 4 years. RESULTS Seventy-nine patients died at median time of 21 months; 4-year survival was 72 ± 3%. Rehospitalization due to heart failure was recorded in 60 cases. Among 231 survivors, MLHFQ score was good in 99 (42%), moderate in 50 (21%) and poor in 88 (37%). Four-year freedom from death, poor QOL or rehospitalization was 51 ± 3%. Multivariable analysis identified the following risk factors: heart rate at discharge at least 70 bpm, ischemic heart disease, atrial fibrillation, hypercholesterolemia, chronic pulmonary disease, N-terminal pro brain natriuretic peptide at discharge, severe tricuspid regurgitation and mitral regurgitation more than moderate. CONCLUSION Clinical, laboratory and echocardiographic profile is crucial to predict long-term QOL of patients admitted for heart failure.
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Affiliation(s)
- Michele Di Mauro
- Department of Cardiology, Cardiovascular Disease, University of L'Aquila, L'Aquila.,Department of Cardiology, Madonna del Ponte API Institute, Lanciano
| | - Renata Petroni
- Department of Cardiology, Cardiovascular Disease, University of L'Aquila, L'Aquila
| | - Daniela Clemente
- Department of Cardiology, Cardiovascular Disease, University of L'Aquila, L'Aquila
| | | | | | | | | | - Antonio M Calafiore
- Department of Cardiac Surgery, Pope John Paul II Foundation, Campobasso, Italy
| | - Maria Penco
- Department of Cardiology, Cardiovascular Disease, University of L'Aquila, L'Aquila
| | - Silvio Romano
- Department of Cardiology, Cardiovascular Disease, University of L'Aquila, L'Aquila
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