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Roubille F, Labarre JP, Georger F, Galinier M, Herman F, Berdague P, Nogue E, Petroni T, Delbaere Q, Malak A, Robin M, Prunet E, Leclercq F, Pasquie JL, Papinaud L, Mercier G, Ricci JE, Cayla G, Duflos C. PRADOC: A Multicenter Randomized Controlled Trial to Assess the Efficiency of PRADO-IC, a Nationwide Pragmatic Transition Care Management Plan for Hospitalized Patients With Heart Failure in France. J Am Heart Assoc 2024; 13:e032931. [PMID: 39023055 DOI: 10.1161/jaha.123.032931] [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: 10/06/2023] [Accepted: 04/19/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND The PRADO-IC (Programme de Retour à Domicile après une Insuffisance Cardiaque) is a transition care program designed to improve the coordination of care between hospital and home that was generalized in France in 2014. The PRADO-IC consists of an administrative assistant who visits patients during hospitalization to schedule follow-up visits. The aim of the present study was to evaluate the PRADO-IC program based on the hypotheses provided by health authorities. METHODS AND RESULTS The PRADOC study is a multicenter, controlled, randomized, open-label, mixed-method trial of the transition program PRADO-IC versus usual management in patients hospitalized with heart failure (standard of care group; NCT03396081). A total of 404 patients were recruited between April 2018 and May 2021. The mean patient age was 75 years (±12 years) in both groups. The 2 groups were well balanced regarding severity indices. At discharge, patients homogeneously received the recommended drugs. There was no difference between groups regarding hospitalizations for acute heart failure at 1 year, with 24.60% in the standard of care group and 25.40% in the PRADO-IC group during the year following the index hospitalization (hazard ratio, 1.04 [95% CI, 0.69-1.56]; P=0.85) or cardiovascular mortality (hazard ratio, 0.67 [95% CI, 0.34-1.31]; P=0.24). CONCLUSIONS The PRADO-IC has not significantly improved clinical outcomes, though a trend toward reduced cardiovascular mortality is evident. These results will help in understanding how transitional care programs remain to be integrated in pathways of current patients, including telemonitoring, and to better tailor individualized approaches. REGISTRATION URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03396081.
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Affiliation(s)
- François Roubille
- PhyMedExp Université de Montpellier INSERM CNRS Cardiology Department INI-CRT CHU de Montpellier Montpellier France
| | | | | | - Michel Galinier
- Fédération des Services de Cardiologie CHU Toulouse-Rangueil Toulouse France
| | - Fanchon Herman
- Epidemiology and Clinical Research Department University Hospital University of Montpellier Montpellier France
| | | | - Erika Nogue
- Epidemiology and Clinical Research Department University Hospital University of Montpellier Montpellier France
| | - Thibaut Petroni
- Cardiology Clinique du Pont de Chaume ELSAN Montauban France
| | - Quentin Delbaere
- Department of Cardiology Montpellier University Hospital Montpellier France
| | - Alexandre Malak
- Department of Cardiology Montpellier University Hospital Montpellier France
| | - Marie Robin
- Department of Cardiology Montpellier University Hospital Montpellier France
| | - Elvira Prunet
- Department of Cardiology Nimes University Hospital Montpellier University Nimes France
| | - Florence Leclercq
- Department of Cardiology Montpellier University Hospital Montpellier France
| | - Jean-Luc Pasquie
- PhyMedExp Université de Montpellier INSERM CNRS Cardiology Department CHU de Montpellier Montpellier France
| | - Laurence Papinaud
- Direction Régionale du Service Médical Occitanie CNAM Montpellier France
| | - Grégoire Mercier
- Public Health Department Montpellier University Hospital Montpellier France
- UMR IDESP INSERM Montpellier University Montpellier France
| | - Jean-Etienne Ricci
- Department of Cardiology Nimes University Hospital Montpellier University Nimes France
| | - Guillaume Cayla
- Department of Cardiology Nimes University Hospital Montpellier University Nimes France
| | - Claire Duflos
- Public Health Department Montpellier University Hospital Montpellier France
- UMR IDESP INSERM Montpellier University Montpellier France
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Smith AB, Jung M, O'Donnell D, White FA, Pressler SJ. Pain, Return to Community Status, and 90-Day Mortality Among Hospitalized Patients With Heart Failure. J Cardiovasc Nurs 2024:00005082-990000000-00202. [PMID: 38915135 DOI: 10.1097/jcn.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Pain is common among patients with heart failure but has not been examined with short-term discharge outcomes. The purpose was to examine whether pain at discharge predicts return to community status and 90-day mortality among hospitalized patients with heart failure. METHODS Data from medical records of 2169 patients hospitalized with heart failure were analyzed in this retrospective cohort study. The independent variable was a diagnosis of pain at discharge. Outcomes were return to community status (yes/no) and 90-day mortality. Logistic regression was used to address aims. Covariates included age, gender, race, vital signs, comorbid symptoms, comorbid conditions, cardiac devices, and length of stay. RESULTS The sample had a mean age of 66.53 years, and was 57.4% women and 55.9% Black. Of 2169 patients, 1601 (73.8%) returned to community, and 117 (5.4%) died at or before 90 days. Patients with pain returned to community less frequently (69.6%) compared with patients without pain (75.2%), which was a statistically significant relationship (odds ratio, 0.74; 95% confidence interval, 0.57-0.97; P = .028). Other variables that predicted return to community status included age, comorbid conditions, dyspnea, fatigue, systolic blood pressure, and length of stay. Pain did not predict increased 90-day mortality. Variables that predicted mortality included age, liver disease, and systolic blood pressure. CONCLUSION Patients with pain were less likely to return to community but did not have higher 90-day mortality. Pain in combination with other symptoms and comorbid conditions may play a role in mortality if acute pain versus chronic pain can be stratified in a future study.
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Kozhuharov N, Michou E, Wussler D, Belkin M, Heinisch C, Lassus J, Siirilä-Waris K, Veli-Pekka H, Arenja N, Socrates T, Nowak A, Shrestha S, Willi JV, Strebel I, Gualandro DM, Rentsch K, Maeder MT, Münzel T, Tavares de Oliveira Junior M, von Eckardstein A, Breidthardt T, Mueller C. Quantifying Hemodynamic Cardiac Stress and Cardiomyocyte Injury in Normotensive and Hypertensive Acute Heart Failure. Biomedicines 2024; 12:1099. [PMID: 38791061 PMCID: PMC11118007 DOI: 10.3390/biomedicines12051099] [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: 03/12/2024] [Revised: 04/23/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The characterization of the different pathophysiological mechanisms involved in normotensive versus hypertensive acute heart failure (AHF) might help to develop individualized treatments. METHODS The extent of hemodynamic cardiac stress and cardiomyocyte injury was quantified by measuring the B-type natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP), and high-sensitivity cardiac troponin T (hs-cTnT) concentrations in 1152 patients presenting with centrally adjudicated AHF to the emergency department (ED) (derivation cohort). AHF was classified as normotensive with a systolic blood pressure (SBP) of 90-140 mmHg and hypertensive with SBP > 140 mmHg at presentation to the ED. Findings were externally validated in an independent AHF cohort (n = 324). RESULTS In the derivation cohort, with a median age of 79 years, 43% being women, 667 (58%) patients had normotensive and 485 (42%) patients hypertensive AHF. Hemodynamic cardiac stress, as quantified by the BNP and NT-proBNP, was significantly higher in normotensive as compared to hypertensive AHF [1105 (611-1956) versus 827 (448-1419) pg/mL, and 5890 (2959-12,162) versus 4068 (1986-8118) pg/mL, both p < 0.001, respectively]. Similarly, the extent of cardiomyocyte injury, as quantified by hs-cTnT, was significantly higher in normotensive AHF as compared to hypertensive AHF [41 (24-71) versus 33 (19-59) ng/L, p < 0.001]. A total of 313 (28%) patients died during 360 days of follow-up. All-cause mortality was higher in patients with normotensive AHF vs. patients with hypertensive AHF (hazard ratio 1.66, 95%CI 1.31-2.10; p < 0.001). Normotensive patients with a high BNP, NT-proBNP, or hs-cTnT had the highest mortality. The findings were confirmed in the validation cohort. CONCLUSION Biomarker profiling revealed a higher extent of hemodynamic stress and cardiomyocyte injury in patients with normotensive versus hypertensive AHF.
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Affiliation(s)
- Nikola Kozhuharov
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Cardiology, University Hospital Bern, University of Bern, Freiburgstrasse 20, 3010 Bern, Switzerland
| | - Eleni Michou
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Desiree Wussler
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Maria Belkin
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, 4001 Basel, Switzerland
| | - Corinna Heinisch
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Johan Lassus
- Heart and Lung Center, Department of Cardiology, Helsinki University Central Hospital, 00280 Helsinki, Finland
| | - Krista Siirilä-Waris
- Heart and Lung Center, Department of Cardiology, Helsinki University Central Hospital, 00280 Helsinki, Finland
| | - Harjola Veli-Pekka
- Department of Emergency Care, Helsinki University Hospital, 00280 Helsinki, Finland
| | - Nisha Arenja
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Cardiology, Solothurner Spitäler AG, 4500 Solothurn, Switzerland
| | - Thenral Socrates
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, 8091 Zürich, Switzerland
| | - Samyut Shrestha
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Julie Valerie Willi
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, 4001 Basel, Switzerland
| | - Ivo Strebel
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Danielle M. Gualandro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Heart Institute (INCOR), University of Sao Paulo Medical School, Sao Paulo 01246-000, Brazil
| | - Katharina Rentsch
- Department of Laboratory Medicine, University Hospital Basel, 4031 Basel, Switzerland
- Department of Laboratory Medicine, University Hospital Zurich, 8091 Zürich, Switzerland
| | - Micha T. Maeder
- Department of Cardiology, Kantonsspital St. Gallen, 9000 St. Gallen, Switzerland
| | - Thomas Münzel
- University Medical Center, Johannes Gutenberg University Mainz, 55122 Mainz, Germany
| | | | - Arnold von Eckardstein
- Institute for Emergency Medicine, University Hospital Zurich, University of Zurich, 8006 Zürich, Switzerland
| | - Tobias Breidthardt
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, University of Basel, 4001 Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
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Klein C, Boveda S, De Groote P, Galinier M, Jourdain P, Mansourati J, Pathak A, Roubille F, Sabatier R, Guedon-Moreau L. Remote management in patients with heart failure (from new onset to advanced): A practical guide. Arch Cardiovasc Dis 2024; 117:160-166. [PMID: 38092576 DOI: 10.1016/j.acvd.2023.11.013] [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: 07/07/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 02/20/2024]
Abstract
Heart failure is a chronic condition that affects millions of people worldwide and is associated with high morbidity and mortality. Remote monitoring, which includes the use of non-invasive connected devices, cardiac implantable electronic devices and haemodynamic monitoring systems, has the potential to improve outcomes for patients with heart failure. Despite the conceptual and clinical advantages, there are still limitations in the widespread use of these technologies. Moreover, a significant proportion of studies evaluating the benefit of remote monitoring in heart failure have focused on the limited area of prevention of rehospitalization after an episode of acute heart failure. A group of experts in the fields of heart failure and digital health worked on this topic in order to provide a practical paper for the use of remote monitoring in clinical practice at the different stages of the heart failure syndrome: (1) discovery of heart failure; (2) acute decompensation of chronic heart failure; (3) heart failure in stable period; and (4) advanced heart failure. A careful and critical analysis of the available literature was performed with the aim of providing caregivers with some recommendations on when and how to use remote monitoring in these different situations, specifying which variables are essential, optional or useless.
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Affiliation(s)
- Cédric Klein
- Department of Cardiovascular Medicine, CHU de Lille, 59000 Lille, France.
| | - Serge Boveda
- Heart Rhythm Department, clinique Pasteur, 31076 Toulouse, France
| | - Pascal De Groote
- Department of Cardiovascular Medicine, CHU de Lille, 59000 Lille, France; Inserm U1167, institut Pasteur de Lille, 59000 Lille, France
| | - Michel Galinier
- Cardiology Department, CHU de Toulouse, 31300 Toulouse, France; University Paul-Sabatier - Toulouse III, 31062 Toulouse, France
| | - Patrick Jourdain
- Covidom Regional Telemedicine Platform, AP-HP, Paris, France; Cardiology Department, University Hospital Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - Jacques Mansourati
- Department of Cardiology, CHU de Brest, 29200 Brest, France; University of Bretagne Occidentale, 29238 Brest, France
| | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, 98000 Monaco, Monaco
| | - François Roubille
- Cardiology Department, CHU de Montpellier, 34295 Montpellier, France; Inserm, PhyMedExp, CNRS, université de Montpellier, 34295 Montpellier, France
| | - Rémi Sabatier
- Cardiovascular Department, CHU de Caen Normandie, University of Caen-Normandie, 14000 Caen, France
| | - Laurence Guedon-Moreau
- Department of Cardiovascular Medicine, CHU de Lille, 59000 Lille, France; University of Lille, 59000 Lille, France
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Celik A, Surmeli AO, Demir M, Esen K, Camsari A. The diagnostic value of chest X-ray scanning by the help of Artificial Intelligence in Heart Failure (ART-IN-HF). Clin Cardiol 2023; 46:1562-1568. [PMID: 37654002 PMCID: PMC10716309 DOI: 10.1002/clc.24105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/29/2023] [Accepted: 07/16/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Typical signs of heart failure (HF), like increased cardiothoracic ratio (CTR) and pleural effusion, can be seen on X-ray. Artificial Intelligence (AI) can help in the early and quicker diagnosis of HF. OBJECTIVES The study's goal was to demonstrate that the AI interpretation of chest X-rays can assist the clinician in diagnosing HF. METHODS Patients older than 45 years were included in the study. The study analyzed 10 100 deidentified outpatient chest X-rays by AI algorithm. The AI-generated report was later verified by an independent radiologist. Patients with CTR > 0.5 and pleural effusion were marked as potential HF. Flagged patients underwent confirmatory tests, and those labeled as negative also underwent further investigations to rule out HF. RESULTS Out of 10 100, the AI algorithm detected 183 (1.8%) patients with increased CTR and pleural effusion on chest X-rays. One hundred and six out of 183 underwent diagnostic tests. Eighty-two (77%) out of 106 were diagnosed with HF according to current guidelines. From the remaining 9917 patients, 106 patients were randomly selected. Nine (8%) out of them were diagnosed with HF. The positive predictive value of AI for diagnosing HF is 77%, and the negative predictive value is 91%. More than half (54.9%) of newly diagnosed patients had HF with preserved ejection fraction. CONCLUSION HF is a risky condition with nonspecific symptoms that are difficult to diagnose, especially in the early stages. Using AI assistance for X-ray interpretation can be helpful for early diagnosis of HF especially HF with preserved ejection fraction.
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Affiliation(s)
- Ahmet Celik
- Department of CardiologyMersin University Medical FacultyMersinTurkey
| | - Ali Orcun Surmeli
- Department of CardiologyMersin University Medical FacultyMersinTurkey
| | - Mustafa Demir
- Department of CardiologyMersin University Medical FacultyMersinTurkey
| | - Kaan Esen
- Department of RadiologyMersin University Medical FacultyMersinTurkey
| | - Ahmet Camsari
- Department of CardiologyMersin University Medical FacultyMersinTurkey
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Arfaras-Melainis A, Ventoulis I, Polyzogopoulou E, Boultadakis A, Parissis J. The current and future status of inotropes in heart failure management. Expert Rev Cardiovasc Ther 2023; 21:573-585. [PMID: 37458248 DOI: 10.1080/14779072.2023.2237869] [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: 04/09/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Heart failure (HF) is a complex syndrome with a wide range of presentations and acuity, ranging from outpatient care to inpatient management due to acute decompensated HF, cardiogenic shock or advanced HF. Frequently, the etiology of a patient's decompensation is diminished cardiac output and peripheral hypoperfusion. Consequently, there is a need for use of inotropes, agents that increase cardiac contractility, optimize hemodynamics and ensure adequate perfusion. AREAS COVERED Inotropes are divided into 3 major classes: beta agonists, phosphodiesterase III inhibitors and calcium sensitizers. Additionally, as data from prospective studies accumulates, novel agents are emerging, including omecamtiv mecarbil and istaroxime. The aim of this review is to summarize current data on the optimal use of inotropes and to provide an expert opinion regarding their current and future use in the management of HF. EXPERT OPINION The use of inotropes has long been linked to worsening mortality, tachyarrhythmias, increased myocardial oxygen consumption and ischemia. Therefore, individualized and evidence-based treatment plans for patients who require inotropic support are necessary. Also, better quality data on the use of existing inotropes is imperative, while the development of newer and safer agents will lead to more effective management of patients with HF in the future.
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Affiliation(s)
- Angelos Arfaras-Melainis
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Ptolemaida, Greece
| | - Effie Polyzogopoulou
- Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Boultadakis
- Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Parissis
- Emergency Department, Heart Failure Unit, Attikon University Hospital, Athens, Greece
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Ji L, Mishra M, De Geest B. The Role of Sodium-Glucose Cotransporter-2 Inhibitors in Heart Failure Management: The Continuing Challenge of Clinical Outcome Endpoints in Heart Failure Trials. Pharmaceutics 2023; 15:1092. [PMID: 37111578 PMCID: PMC10140883 DOI: 10.3390/pharmaceutics15041092] [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: 02/22/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
The introduction of sodium-glucose cotransporter-2 (SGLT2) inhibitors in the management of heart failure with preserved ejection fraction (HFpEF) may be regarded as the first effective treatment in these patients. However, this proposition must be evaluated from the perspective of the complexity of clinical outcome endpoints in heart failure. The major goals of heart failure treatment have been categorized as: (1) reduction in (cardiovascular) mortality, (2) prevention of recurrent hospitalizations due to worsening heart failure, and (3) improvement in clinical status, functional capacity, and quality of life. The use of the composite primary endpoint of cardiovascular death and hospitalization for heart failure in SGLT2 inhibitor HFpEF trials flowed from the assumption that hospitalization for heart failure is a proxy for subsequent cardiovascular death. The use of this composite endpoint was not justified since the effect of the intervention on both components was clearly distinct. Moreover, the lack of convincing and clinically meaningful effects of SGLT2 inhibitors on metrics of heart failure-related health status indicates that the effect of this class of drugs in HFpEF patients is essentially restricted to an effect on hospitalization for heart failure. In conclusion, SGLT2 inhibitors do not represent a substantial breakthrough in the management of HFpEF.
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Affiliation(s)
| | | | - Bart De Geest
- Centre for Molecular and Vascular Biology, Catholic University of Leuven, 3000 Leuven, Belgium; (L.J.); (M.M.)
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Sun H, Bai J, Sun Y, Zhen D, Fu D, Wang Y, Wei C. Oxymatrine attenuated isoproterenol-induced heart failure via the TLR4/NF-κB and MAPK pathways in vivo and in vitro. Eur J Pharmacol 2023; 941:175500. [PMID: 36627098 DOI: 10.1016/j.ejphar.2023.175500] [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: 10/09/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/09/2023]
Abstract
Oxymatrine (OMT) is a quinoline alkaloid isolated from the root of the Sophora flavescens that has a variety of biological activities. However, the effect and potential mechanism of OMT on isoproterenol (ISO)-induced heart failure (HF) are not clear. In this study, we found that OMT improved the survival of HL-1 cells induced by ISO. We also demonstrated that OMT significantly inhibited the levels of the inflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). OMT decreased the levels of the TLR4 and reduced the phosphorylation levels of nuclear factor-κB (NF-κB) inhibitor (IκB), p65, c-Jun N-terminal kinases (JNK) and p38. The inhibitory effect of the TLR4 inhibitor TAK242 on HL-1 cells was evaluated. The results showed that the effect of OMT on the phosphorylation levels of IκBα and p65 was enhanced in HL-1 cells treated with TAK242. Using animal models, OMT significantly reduced ISO-induced cardiac injury, myocardial necrosis, interstitial edema, and fibrosis. In addition, OMT attenuated TNF-α and IL-6 and inhibited the expression of TLR4/NF-κB and MAPK pathway-related proteins. This finding suggests that OMT may alleviate HF by interfering with the TLR4/NF-κB and MAPK pathways.
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Affiliation(s)
- Haijuan Sun
- Inner Mongolia Minzu University, Tongliao, Inner Mongolia, PR China; Inner Mongolia Key Laboratory of Mongolian Medicine Pharmacology for Cardio-Cerebral Vascular System, Tongliao, Inner Mongolia, PR China
| | - Jingjing Bai
- Inner Mongolia Minzu University, Tongliao, Inner Mongolia, PR China; Inner Mongolia Key Laboratory of Mongolian Medicine Pharmacology for Cardio-Cerebral Vascular System, Tongliao, Inner Mongolia, PR China
| | - Yuting Sun
- Inner Mongolia Minzu University, Tongliao, Inner Mongolia, PR China; Inner Mongolia Key Laboratory of Mongolian Medicine Pharmacology for Cardio-Cerebral Vascular System, Tongliao, Inner Mongolia, PR China
| | - Dong Zhen
- Inner Mongolia Minzu University, Tongliao, Inner Mongolia, PR China; Inner Mongolia Key Laboratory of Mongolian Medicine Pharmacology for Cardio-Cerebral Vascular System, Tongliao, Inner Mongolia, PR China
| | - Danni Fu
- Inner Mongolia Minzu University, Tongliao, Inner Mongolia, PR China; Inner Mongolia Key Laboratory of Mongolian Medicine Pharmacology for Cardio-Cerebral Vascular System, Tongliao, Inner Mongolia, PR China
| | - Yu Wang
- Inner Mongolia Minzu University, Tongliao, Inner Mongolia, PR China; Inner Mongolia Key Laboratory of Mongolian Medicine Pharmacology for Cardio-Cerebral Vascular System, Tongliao, Inner Mongolia, PR China.
| | - Chengxi Wei
- Inner Mongolia Minzu University, Tongliao, Inner Mongolia, PR China; Inner Mongolia Key Laboratory of Mongolian Medicine Pharmacology for Cardio-Cerebral Vascular System, Tongliao, Inner Mongolia, PR China.
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Trullàs JC, Morales-Rull JL, Casado J, Carrera-Izquierdo M, Sánchez-Marteles M, Conde-Martel A, Dávila-Ramos MF, Llácer P, Salamanca-Bautista P, Pérez-Silvestre J, Plasín MÁ, Cerqueiro JM, Gil P, Formiga F, Manzano L. Combining loop with thiazide diuretics for decompensated heart failure: the CLOROTIC trial. Eur Heart J 2023; 44:411-421. [PMID: 36423214 DOI: 10.1093/eurheartj/ehac689] [Citation(s) in RCA: 97] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/26/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
AIMS To evaluate whether the addition of hydrochlorothiazide (HCTZ) to intravenous furosemide is a safe and effective strategy for improving diuretic response in acute heart failure (AHF). METHODS AND RESULTS A prospective, double-blind, placebo-controlled trial, including patients with AHF randomized to receive HCTZ or placebo in addition to an intravenous furosemide regimen. The coprimary endpoints were changes in body weight and patient-reported dyspnoea 72 h after randomization. Secondary outcomes included metrics of diuretic response and mortality/rehospitalizations at 30 and 90 days. Safety outcomes (changes in renal function and/or electrolytes) were also assessed. Two hundred and thirty patients (48 women, 83 years) were randomized. Patients assigned to HCTZ were more likely to lose weight at 72 h than those assigned to placebo [2.3 vs. 1.5 kg; adjusted estimated difference (notionally 95 confidence interval) 1.14 (1.84 to 0.42); P 0.002], but there were no significant differences in patient-reported dyspnoea (area under the curve for visual analogue scale: 960 vs. 720; P 0.497). These results were similar 96 h after randomization. Patients allocated to HCTZ showed greater 24 h diuresis (1775 vs. 1400 mL; P 0.05) and weight loss for each 40 mg of furosemide (at 72 and at 96 h) (P 0.001). Patients assigned to HCTZ more frequently presented impaired renal function (increase in creatinine 26.5 moL/L or decrease in eGFR 50; 46.5 vs. 17.2; P 0.001), but hypokalaemia and hypokalaemia were similar between groups. There were no differences in mortality or rehospitalizations. CONCLUSION The addition of HCTZ to loop diuretic therapy improved diuretic response in patients with AHF.
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Affiliation(s)
- Joan Carles Trullàs
- Internal Medicine Department, Hospital dOlot i comarcal de la Garrotxa, Girona, Av dels Pasos Catalans, 86, 17800 CA, Spain
- Laboratori de Reparaci i Regeneraci Tissular (TR2Lab), Facultat de Medicina, Universitat de VicUniversitat Central de Catalunya, Carretera de Roda, 70, 08500 Vic, Barcelona, CA, Spain
| | - José Luis Morales-Rull
- Internal Medicine Department, Heart Failure Unit, Hospital Universitari Arnau de Villanova, Institut de Recerca Biomdica (IRBLleida), Avinguda Alcalde Rovira Roure, 80, 25198 Lleida, Spain
| | - Jesús Casado
- Internal Medicine Department, Hospital Universitario de Getafe, Carretera de Madrid - Toledo, Km 12,500, 28905 Madrid, Spain
| | | | - Marta Sánchez-Marteles
- Internal Medicine Department, Hospital Clnico Universitario Lozano Blesa, Calle de San Juan Bosco, 15, 50009 Zaragoza, Spain
| | - Alicia Conde-Martel
- Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrn, C. Pl. Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - Melitón Francisco Dávila-Ramos
- Internal Medicine Department, Hospital Universitario Nuestra Seora de la Candelaria, Carretera Gerenal del Rosario, 145, 38010 Santa Cruz de Tenerife, Spain
| | - Pau Llácer
- Internal Medicine Department, Hospital de Manises, Avinguda de la Generalitat Valenciana, 50, 46940 Manises, Valencia, Spain
| | - Prado Salamanca-Bautista
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Avenida Dr. Fedriani, 3, 41009 Sevilla, Spain
| | - José Pérez-Silvestre
- Internal Medicine Department, Consorcio Hospital General Universitario de Valencia, Avinguda de les Tres Creus, 2, 46014 Valencia, Spain
| | - Miguel Ángel Plasín
- Internal Medicine Department, Mollet University Hospital, Ronda dels Pinetons, 6, 08100 Mollet Del Valles, Barcelona, Spain
| | - José Manuel Cerqueiro
- Internal Medicine Department, Hospital Universitario Lucus Augusti, Ra Dr. Ulises Romero, 1, 27003 Lugo, Spain
| | - Paloma Gil
- Internal Medicine Department, La Princesa University Hospital, Calle de Diego de Len, 62, 28006 Madrid, Spain
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, IDIBELL, Carrer de la Feixa Llarga, s/n, 08907 LHospitalet de Llobregat, Barcelona, Spain
| | - Luis Manzano
- Internal Medicine Department, Hospital Universitario Ramn y Cajal, IRYCIS, Universidad de Alcal, M-607, 9, 100, 28034 Madrid, Spain
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10
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Voorrips SN, Boorsma EM, Beusekamp JC, DE-Boer RA, Connelly MA, Dullaart RPF, VAN-DER-Meer P, VAN-Veldhuisen DJ, Voors AA, Damman K, Westenbrink BD. Longitudinal Changes in Circulating Ketone Body Levels in Patients With Acute Heart Failure: A Post Hoc Analysis of the EMPA-Response-AHF Trial. J Card Fail 2023; 29:33-41. [PMID: 36244653 DOI: 10.1016/j.cardfail.2022.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ketone bodies are endogenous fuels produced by the liver under conditions of metabolic or neurohormonal stress. Circulating ketone bodies are increased in patients with chronic heart failure (HF), yet little is known about the effect of acute HF on ketosis. We tested the hypothesis that ketogenesis is increased in patients with acute decompensated HF. METHODS AND RESULTS This was a post hoc analysis of 79 patients with acute HF included in the EMPA-RESPONSE-AHF trial, which compared sodium-dependent glucose-cotransporter protein 2 inhibitor treatment with empagliflozin for 30 days with placebo in patients with acute HF [NCT03200860]. Plasma concentrations of ketone bodies acetone, β-hydroxybutyrate, and acetoacetate were measured at baseline and 5 different timepoints. Changes in ketone bodies over time were monitored using repeated measures analysis of variance. In the total cohort, median total ketone body concentration was 251 µmol/L (interquartile range, 178-377 µmol/L) at baseline, which gradually decreased to 202 µmol/L (interquartile range, 156-240 µmol/L) at day 30 (P = .041). Acetone decreased from 60 µmol/L (interquartile range, 34-94 µmol/L) at baseline to 30 µmol/L (interquartile range, 21-42 µmol/L) ( P < .001), whereas β-hydroxybutyrate and acetoacetate remained stable over time. Higher acetone concentrations were correlated with higher N-terminal pro brain natriuretic peptide levels (r = 0.234; P = .039). Circulating ketone bodies did not differ between patients treated with empagliflozin or placebo throughout the study period. A higher acetone concentration at baseline was univariately associated with a greater risk of the composite end point, including in-hospital worsening HF, HF rehospitalizations, and all-cause mortality after 30 days. However, after adjustment for age and sex, acetone did not remain an independent predictor for the combined end point. CONCLUSIONS Circulating ketone body concentrations, and acetone in particular, were significantly higher during an episode of acute decompensated HF compared with after stabilization. Treatment with empagliflozin did not affect ketone body concentrations in patients with acute HF.
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Affiliation(s)
- S N Voorrips
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - E M Boorsma
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - J C Beusekamp
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - R A DE-Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands; Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - M A Connelly
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, North Carolina; and the
| | - R P F Dullaart
- Department of Internal Medicine, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - P VAN-DER-Meer
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - D J VAN-Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - A A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - K Damman
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - B D Westenbrink
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
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11
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Zehnder AR, Pedrosa Carrasco AJ, Etkind SN. Factors associated with hospitalisations of patients with chronic heart failure approaching the end of life: A systematic review. Palliat Med 2022; 36:1452-1468. [PMID: 36172637 PMCID: PMC9749018 DOI: 10.1177/02692163221123422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Heart failure has high mortality and is linked to substantial burden for patients, carers and health care systems. Patients with chronic heart failure frequently experience recurrent hospitalisations peaking at the end of life, but most prefer to avoid hospital. The drivers of hospitalisations are not well understood. AIM We aimed to synthesise the evidence on factors associated with all-cause and heart failure hospitalisations of patients with advanced chronic heart failure. DESIGN Systematic review of studies quantitatively evaluating factors associated with all-cause or heart failure hospitalisations in adult patients with advanced chronic heart failure. DATA SOURCES Five electronic databases were searched from inception to September 2020. Additionally, searches for grey literature, citation searching and hand-searching were performed. We assessed the quality of individual studies using the QualSyst tool. Strength of evidence was determined weighing number, quality and consistency of studies. Findings are reported narratively as pooling was not deemed feasible. RESULTS In 54 articles, 68 individual, illness-level, service-level and environmental factors were identified. We found high/moderate strength evidence for specialist palliative or hospice care being associated with reduced risk of all-cause and heart failure hospitalisations, respectively. Based on high strength evidence, we further identified black/non-white ethnicity as a risk factor for all-cause hospitalisations. CONCLUSION Efforts to integrate hospice and specialist palliative services into care may reduce avoidable hospitalisations in advanced heart failure. Inequalities in end-of-life care in terms of race/ethnicity should be addressed. Further research should investigate the causality of the relationships identified here.
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Affiliation(s)
- Aina R Zehnder
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,Rautipraxis, Zürich, Switzerland
| | | | - Simon N Etkind
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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12
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Melero-Muñoz FJ, Bueno-Delgado MV, Martínez-Carreras R, Maestre-Ferriz R, Beteta-Medina MÁ, Puebla-Martínez T, Bleda-Tomás AL, Sánchez-Nanclares G, Pérez-de-Zabala R, Álvarez-Leon M. Design and Development of a Heterogeneous Active Assisted Living Solution for Monitoring and Following Up with Chronic Heart Failure Patients in Spain. SENSORS (BASEL, SWITZERLAND) 2022; 22:8961. [PMID: 36433557 PMCID: PMC9695743 DOI: 10.3390/s22228961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/04/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
Heart failure is the most common disease among elderly people, and the risk increases with age. The use of smart Internet of Things (IoT) systems for monitoring patients with chronic heart failure (CHF) in a non-intrusive manner can result in better control of the disease, improving proactive healthcare through real-time and historical patient's data, promoting self-care in patients, reducing unneeded interaction between patients and doctors, reducing the number of hospitalizations and saving healthcare costs. This work presents an active assisted living (AAL) solution based on the IoT to provide a tele-assistance platform for CHF patients from the public health service of the region of Murcia in Spain, with formal and informal caregivers and health professionals also as key actors. In this article, we have detailed the methodology, results, and conclusions of the prevalidation phase for the set of IoT technologies to be integrated in the AAL platform, the first mandatory step before the deployment of a large-scale pilot that will lead to improving the innovation of the system from its current technology readiness level to the market. The work presented, in the framework of the H2020 Pharaon project, aims to serve as inspiration to the R&D community for the design, development, and deployment of AAL solutions based on heterogeneous IoT technologies, or similar approaches, for smart healthcare solutions in real healthcare institutions.
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Affiliation(s)
- Francisco José Melero-Muñoz
- Centro Tecnológico del Mueble y la Madera de Murcia, C/Perales s/n, 30510 Yecla, Spain
- Department of Information and Communication Technologies, Universidad Politécnica de Cartagena, Plaza Hospital 1, 30202 Cartagena, Spain
| | - María Victoria Bueno-Delgado
- Department of Information and Communication Technologies, Universidad Politécnica de Cartagena, Plaza Hospital 1, 30202 Cartagena, Spain
- E-Lighthouse Network Solutions S.L, C/Angel s/n, 30202 Cartagena, Spain
| | - Ramón Martínez-Carreras
- Department of Information and Communication Technologies, Universidad Politécnica de Cartagena, Plaza Hospital 1, 30202 Cartagena, Spain
| | - Rafael Maestre-Ferriz
- Centro Tecnológico del Mueble y la Madera de Murcia, C/Perales s/n, 30510 Yecla, Spain
| | | | - Tomás Puebla-Martínez
- Centro Tecnológico del Mueble y la Madera de Murcia, C/Perales s/n, 30510 Yecla, Spain
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13
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miR-212 Promotes Cardiomyocyte Hypertrophy through Regulating Transcription Factor 7 Like 2. Mediators Inflamm 2022; 2022:5187218. [PMID: 36060928 PMCID: PMC9433300 DOI: 10.1155/2022/5187218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/06/2022] [Indexed: 11/23/2022] Open
Abstract
To explore the role and possible mechanism of miRNA-212 in heart failure (HF). The rat model of abdominal aortic constriction was constructed, the changes of myocardial morphology were observed by hematoxylin-eosin (HE) staining, and the hypertrophy-related marker molecules were detected by quantitative real-time polymerase chain reaction (qRT-PCR). At the cellular level, phenylephrine and angiotensin II were added to induce cardiomyocyte hypertrophy. The overexpression of miR-212 adenovirus was constructed, and the expression of miR-212 was overexpressed, and its effect on cardiac hypertrophy (CH) was detected by immunofluorescence and qRT-PCR. Then, the mechanism of miR-212 regulating CH was verified by website prediction, luciferase reporter gene assay, qRT-PCR, and western blotting assay. In the successfully constructed rat model of abdominal aortic constriction and cardiomyocyte hypertrophy, ANP and myh7 were dramatically increased, myh6 expression was decreased, and miRNA-212 expression was increased. Overexpression of miRNA-212 in cardiomyocytes can promote cardiomyocyte hypertrophy, while knocking down miR-212 in cardiomyocytes can partially reverse cell hypertrophy. In addition, miR-212 targets TCF7L2 and inhibits the expression of this gene. miRNA-212 targets TCF7L2 and inhibits the expression of this gene, possibly through this pathway to promote cardiomyocyte hypertrophy.
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Sung PH, Chai HT, Yang CC, Chiang JY, Chen CH, Chen YL, Yip HK. Combined levosimendan and Sacubitril/Valsartan markedly protected the heart and kidney against cardiorenal syndrome in rat. Biomed Pharmacother 2022; 148:112745. [DOI: 10.1016/j.biopha.2022.112745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/11/2022] Open
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Ødegaard KM, Lirhus SS, Melberg HO, Hallén J, Halvorsen S. A nationwide registry study on heart failure in Norway from 2008 to 2018: variations in lookback period affect incidence estimates. BMC Cardiovasc Disord 2022; 22:88. [PMID: 35247979 PMCID: PMC8898410 DOI: 10.1186/s12872-022-02522-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 02/21/2022] [Indexed: 12/20/2022] Open
Abstract
Background The incidence of heart failure (HF) has declined in Europe during the past two decades. However, incidence estimates from registry-based studies may vary, partly because they depend on retrospective searches to exclude previous events. The aim of this study was to assess to what extent different lookback periods (LPs) affect temporal trends in incidence, and to identify the minimal acceptable LP. Further, we wanted to estimate temporal trends in incidence and prevalence of HF in a nationwide population, using the minimal acceptable LP.
Methods We identified all in- and out-patient contacts for HF in Norway during 2008 to 2018 from the Norwegian Patient Registry. To calculate the influence of varying LP on incident cases, we defined 2018 with 10 years of LP as a reference and calculated the relative difference by using one through 9 years of lookback. Temporal trends in incidence rates were estimated with sensitivity analyses applying varying LPs and different case definitions. Standardised incidence rates and prevalence were calculated by applying direct age- and sex-standardization to the 2013 European Standard Population. Results The overestimation of incident cases declined with increasing number of years included in the LP. Compared to a 10-year LP, application of 4, 6, and 8 years resulted in an overestimation of incident cases by 13.5%, 6.2% and 2.3%, respectively. Temporal trends in incidence were affected by the number of years in the LP and whether the LP was fixed or varied. Including all available data mislead to conclusions of declining incidence rates over time due to increasing LPs. Conclusions When taking the number of years with available data and HF mortality and morbidity into consideration, we propose that 6 years of fixed lookback is sufficient for identification of incident HF cases. HF incidence rates and prevalence increased from 2014 to 2018. Trial registration Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02522-y.
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16
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Detection of Left Ventricular Dysfunction on Axial Non-Contrast Chest CT. Eur J Radiol 2022; 150:110274. [DOI: 10.1016/j.ejrad.2022.110274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/11/2022] [Accepted: 03/15/2022] [Indexed: 11/21/2022]
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Role of ranolazine in heart failure: From cellular to clinic perspective. Eur J Pharmacol 2022; 919:174787. [PMID: 35114190 DOI: 10.1016/j.ejphar.2022.174787] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/25/2021] [Accepted: 01/25/2022] [Indexed: 12/17/2022]
Abstract
Ranolazine was approved by the US Food and Drug Administration as an antianginal drug in 2006, and has been used since in certain groups of patients with stable angina. The therapeutic action of ranolazine was initially attributed to inhibitory effects on fatty acids metabolism. As investigations went on, however, it developed that the main beneficial effects of ranolazine arise from its action on the late sodium current in the heart. Since late sodium currents were discovered to be involved in various heart pathologies such as ischemia, arrhythmias, systolic and diastolic dysfunctions, and all these conditions are associated with heart failure, ranolazine has in some way been tested either directly or indirectly on heart failure in numerous experimental and clinical studies. As the heart continuously remodels following any sort of severe injury, the inhibition by ranolazine of the underlying mechanisms of cardiac remodeling including ion disturbances, oxidative stress, inflammation, apoptosis, fibrosis, metabolic dysregulation, and neurohormonal impairment are discussed, along with unresolved issues. A projection of pathologies targeted by ranolazine from cellular level to clinical is provided in this review.
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Abstract
BACKGROUND Pharmacotherapies such as loop diuretics are the cornerstone treatment for acute heart failure (AHF), but resistance and poor response can occur. Ultrafiltration (UF) is an alternative therapy to reduce congestion, however its benefits, efficacy and safety are unclear. OBJECTIVES To assess the effects of UF compared to diuretic therapy on clinical outcomes such as mortality and rehospitalisation rates. SEARCH METHODS We undertook a systematic search in June 2021 of the following databases: CENTRAL, MEDLINE, Embase, Web of Science CPCI-S and ClinicalTrials.gov. We also searched the WHO ICTRP platform in October 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared UF to diuretics in adults with AHF. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We contacted study authors for any further information, and language interpreters to translate texts. We assessed risk of bias in included studies using Risk of Bias 2 (RoB2) tool and assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 14 trials involving 1190 people. We included people who had clinical signs of acute hypervolaemia. We excluded critically unwell people such as those with ischaemia or haemodynamic instability. Mean age ranged from 57.5 to 75 years, and the setting was a mix of single and multi-centre. Two trials researched UF as a complimentary therapy to diuretics, while the remaining trials withheld diuretic use during UF. There was high risk of bias in some studies, particularly with deviations from the intended protocols from high cross-overs as well as missing outcome data for long-term follow-up. We are uncertain about the effect of UF on all-cause mortality at 30 days or less (risk ratio (RR) 0.61, 95% confidence interval (CI) 0.13 to 2.85; 3 studies, 286 participants; very low-certainty evidence). UF may have little to no effect on all-cause mortality at the longest available follow-up (RR 1.00, 95% CI 0.73 to 1.36; 9 studies, 987 participants; low-certainty evidence). UF may reduce all-cause rehospitalisation at 30 days or less (RR 0.76, 95% CI 0.53 to 1.09; 3 studies, 337 participants; low-certainty evidence). UF may slightly reduce all-cause rehospitalisation at longest available follow-up (RR 0.91, 95% CI 0.79 to 1.05; 6 studies, 612 participants; low-certainty evidence). UF may reduce heart failure-related rehospitalisation at 30 days or less (RR 0.62, 95% CI 0.37 to 1.04; 2 studies, 395 participants; low-certainty evidence). UF probably reduces heart failure-related rehospitalisation at longest available follow-up, with a number needed to treat for an additional beneficial effect (NNTB) of 10 (RR 0.69, 95% CI 0.53 to 0.90; 4 studies, 636 participants; moderate-certainty evidence). No studies measured need for mechanical ventilation. UF may have little or no effect on serum creatinine change at 30 days since discharge (mean difference (MD) 14%, 95% CI -12% to 40%; 1 study, 221 participants; low-certainty evidence). UF may increase the risk of new initiation of renal replacement therapy at longest available follow-up (RR 1.42, 95% CI 0.42 to 4.75; 4 studies, 332 participants; low-certainty evidence). There is an uncertain effect of UF on the risk of complications from central line insertion in hospital (RR 4.16, 95% CI 1.30 to 13.30; 6 studies, 779 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS: This review summarises the latest evidence on UF in AHF. Moderate-certainty evidence shows UF probably reduces heart failure-related rehospitalisation in the long term, with an NNTB of 10. UF may reduce all-cause rehospitalisation at 30 days or less and at longest available follow-up. The effect of UF on all-cause mortality at 30 days or less is unclear, and it may have little effect on all-cause mortality in the long-term. While UF may have little or no effect on serum creatinine change at 30 days, it may increase the risk of new initiation of renal replacement therapy in the long term. The effect on complications from central line insertion is unclear. There is insufficient evidence to determine the true impact of UF on AHF. Future research should evaluate UF as an adjunct therapy, focusing on outcomes such as heart failure-related rehospitalisation, cardiac mortality and renal outcomes at medium- to long-term follow-up.
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Affiliation(s)
- Mehul Srivastava
- Institute of Health Informatics Research, University College London, London, UK
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Nicholas Harrison
- Department of Emergency Medicine, Division of Research, Indiana University School of Medicine, Indianapolis, MI-Michigan, USA
| | | | - Audrey R Tan
- Institute of Health Informatics Research, University College London, London, UK
| | - Mandy Law
- Department of Nephrology, Royal Melbourne Hospital, Parkville, Australia
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Long-Term Outpatient Care and Rehospitalizations in Patients after Cardiac Electrotherapy Device Implantation. Medicina (B Aires) 2022; 58:medicina58020151. [PMID: 35208475 PMCID: PMC8879931 DOI: 10.3390/medicina58020151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: Cardiovascular implantable electronic device (CIED) treatment is widely used in modern cardiology. Indications for this type of treatment are increasing. However, a significant proportion of CIED implantation patients require subsequent hospitalization for cardiovascular reasons. Older age and the associated complex clinical picture necessitate multidisciplinary outpatient specialist care for these patients. The aim of this study was to analyze the reasons for subsequent hospitalizations in the cardiology department and the impact of outpatient specialty care on these hospitalizations. To the best of our knowledge, there are no such studies in the available literature. Materials and Methods: This study was conducted on a population of patients treated with CIED. Reasons for subsequent hospitalizations were divided into clinically and statistically valid groups according to the main diagnosis. Using an electronic database, causes of hospitalization were determined based on this diagnosis. Using data on consultations at outpatient specialty clinics, a logistic regression model was created for the probability of subsequent hospitalization for cardiovascular causes according to the specialty of the clinic. Results: The 9-year follow-up included a population of 2071 patients treated with CIED. During the follow-up period, 508 patients (approximately 24.5%) required subsequent hospitalization for cardiovascular reasons. The most common leading causes were heart failure, atrial fibrillation, and coronary artery disease. The need for consultation at outpatient specialty clinics increased the likelihood of hospitalization. Moreover, the need to consult patients in nephrology outpatient, pulmonary disease outpatient, and orthopedic outpatient clinics was the most significant. Conclusions: The use of electronic implantable cardiovascular devices is a very important part of therapy in modern cardiology. The methods for their use are constantly being improved. However, they represent only one stage of cardiac treatment. After CIED procedures, patients require further care in both inpatient and outpatient specialty care settings. In this paper, we outline the reasons for subsequent hospitalizations and the importance of outpatient specialty care in this context. Effective organization of care after CIED procedures may be important in reducing the most expensive component of this care, that is, inpatient treatment.
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Ventoulis I, Arfaras-Melainis A, Parissis J, Polyzogopoulou E. Cognitive Impairment in Acute Heart Failure: Narrative Review. J Cardiovasc Dev Dis 2021; 8:jcdd8120184. [PMID: 34940539 PMCID: PMC8703678 DOI: 10.3390/jcdd8120184] [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: 11/20/2021] [Revised: 12/11/2021] [Accepted: 12/12/2021] [Indexed: 12/03/2022] Open
Abstract
Cognitive impairment (CI) represents a common but often veiled comorbidity in patients with acute heart failure (AHF) that deserves more clinical attention. In the AHF setting, it manifests as varying degrees of deficits in one or more cognitive domains across a wide spectrum ranging from mild CI to severe global neurocognitive disorder. On the basis of the significant negative implications of CI on quality of life and its overwhelming association with poor outcomes, there is a compelling need for establishment of detailed consensus guidelines on cognitive screening methods to be systematically implemented in the population of patients with heart failure (HF). Since limited attention has been drawn exclusively on the field of CI in AHF thus far, the present narrative review aims to shed further light on the topic. The underlying pathophysiological mechanisms of CI in AHF remain poorly understood and seem to be multifactorial. Different pathophysiological pathways may come into play, depending on the clinical phenotype of AHF. There is some evidence that cognitive decline closely follows the perturbations incurred across the long-term disease trajectory of HF, both along the time course of stable chronic HF as well as during episodes of HF exacerbation. CI in AHF remains a rather under recognized scientific field that poses many challenges, since there are still many unresolved issues regarding cognitive changes in patients hospitalized with AHF that need to be thoroughly addressed.
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Affiliation(s)
- Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece
- Correspondence: or (I.V.); (A.A.-M.); Tel.: +30-6973018788 (I.V.); +1-347-920-8875 (A.A.-M.)
| | - Angelos Arfaras-Melainis
- Heart Failure Unit and University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462 Athens, Greece; (J.P.); (E.P.)
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Correspondence: or (I.V.); (A.A.-M.); Tel.: +30-6973018788 (I.V.); +1-347-920-8875 (A.A.-M.)
| | - John Parissis
- Heart Failure Unit and University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462 Athens, Greece; (J.P.); (E.P.)
| | - Eftihia Polyzogopoulou
- Heart Failure Unit and University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462 Athens, Greece; (J.P.); (E.P.)
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Vicha M, Skala T, Jelinek L, Pavlu L, Jarkovsky J, Dusek L, Benesova K, Taborsky M. Pharmacotherapy of diabetes mellitus in patients with heart failure - a nation-wide analysis of contemporary treatment. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021. [PMID: 34897297 DOI: 10.5507/bp.2021.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM Retrospective national sub-analysis of antidiabetic pharmacotherapy in patients with diabetes mellitus (DM) and heart failure (HF) based on data reported to the National Register of Paid Health Services in the Czech Republic between 2012-2018. METHODOLOGY AND RESULTS In 2012, there were 75,022 patients with HF and DM (i.e. 42.5% of patients with HF), 6 years later 117,265 (i.e. 41.0% of HF patients in 2018). The most represented antidiabetic drug was metformin (45.6%). Of the insulins and analogues, glargine showed the largest positive trend (5.8% 2012; 14.8% 2018). Empagliflozin was the most prescribed SGLT-2 inhibitor (1.8% in 2018). A decrease in prescribing was observed for saxagliptin (0.5% 2012; 0.1% 2018) and for sulfonylurea derivates - gliclazide (13.0% 2012; 10.3% in 2018) and glimepiride (12.9% 2012; 9.0% 2018). Linagliptin was the most prescribed dipeptidyl peptidase inhibitor (0.7% 2012; 6.8% 2018). CONCLUSION In the Czech Republic, between 2012 and 2008, there was an increase in prevalence of patients with heart failure and concomitant diabetes mellitus, their proportion being similar. In correspondence with other registries, metformin was used mostly. A positive trend was observed in prescription of DDP-4 and SGLT-2 inhibitors, while there was a significant decrease in patients taking sulfonylureas.
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Affiliation(s)
- Marek Vicha
- Department of Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Tomas Skala
- Department of Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Libor Jelinek
- Department of Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Ludek Pavlu
- Department of Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Jiri Jarkovsky
- Institute of Health Information and Statistics of the Czech Republic, Palackeho nam. 4, P.O.BOX 60, Prague, Czech Republic.,Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ladislav Dusek
- Institute of Health Information and Statistics of the Czech Republic, Palackeho nam. 4, P.O.BOX 60, Prague, Czech Republic.,Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Klara Benesova
- Institute of Health Information and Statistics of the Czech Republic, Palackeho nam. 4, P.O.BOX 60, Prague, Czech Republic.,Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Milos Taborsky
- Department of Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
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22
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Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, Bax JJ, Leipsic JA, Blanke P, Blackstone EH, Finn MT, Kapadia S, Linke A, Mack MJ, Makkar R, Mehran R, Popma JJ, Reardon M, Rodes-Cabau J, Van Mieghem NM, Webb JG, Cohen DJ, Leon MB. Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. Eur Heart J 2021; 42:1825-1857. [DOI: 10.1093/eurheartj/ehaa799] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/22/2020] [Accepted: 09/24/2020] [Indexed: 12/17/2022] Open
Abstract
Abstract
Aims
The Valve Academic Research Consortium (VARC), founded in 2010, was intended to (i) identify appropriate clinical endpoints and (ii) standardize definitions of these endpoints for transcatheter and surgical aortic valve clinical trials. Rapid evolution of the field, including the emergence of new complications, expanding clinical indications, and novel therapy strategies have mandated further refinement and expansion of these definitions to ensure clinical relevance. This document provides an update of the most appropriate clinical endpoint definitions to be used in the conduct of transcatheter and surgical aortic valve clinical research.
Methods and results
Several years after the publication of the VARC-2 manuscript, an in-person meeting was held involving over 50 independent clinical experts representing several professional societies, academic research organizations, the US Food and Drug Administration (FDA), and industry representatives to (i) evaluate utilization of VARC endpoint definitions in clinical research, (ii) discuss the scope of this focused update, and (iii) review and revise specific clinical endpoint definitions. A writing committee of independent experts was convened and subsequently met to further address outstanding issues. There were ongoing discussions with FDA and many experts to develop a new classification schema for bioprosthetic valve dysfunction and failure. Overall, this multi-disciplinary process has resulted in important recommendations for data reporting, clinical research methods, and updated endpoint definitions. New definitions or modifications of existing definitions are being proposed for repeat hospitalizations, access site-related complications, bleeding events, conduction disturbances, cardiac structural complications, and bioprosthetic valve dysfunction and failure (including valve leaflet thickening and thrombosis). A more granular 5-class grading scheme for paravalvular regurgitation (PVR) is being proposed to help refine the assessment of PVR. Finally, more specific recommendations on quality-of-life assessments have been included, which have been targeted to specific clinical study designs.
Conclusions
Acknowledging the dynamic and evolving nature of less-invasive aortic valve therapies, further refinements of clinical research processes are required. The adoption of these updated and newly proposed VARC-3 endpoints and definitions will ensure homogenous event reporting, accurate adjudication, and appropriate comparisons of clinical research studies involving devices and new therapeutic strategies.
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Affiliation(s)
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | - Nicolo Piazza
- McGill University Health Centre, Montreal, QC, Canada
| | - Maria C Alu
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
| | - Tamim Nazif
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
| | - Philippe Pibarot
- Quebec Heart & Lung Institute, Laval University, Quebec, QC, Canada
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic and Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew T Finn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Michael J Mack
- Baylor Scott & White Heart Hospital Plano, Plano, TX, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - John G Webb
- Department of Cardiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - David J Cohen
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
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23
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Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, Bax JJ, Leipsic JA, Blanke P, Blackstone EH, Finn MT, Kapadia S, Linke A, Mack MJ, Makkar R, Mehran R, Popma JJ, Reardon M, Rodes-Cabau J, Van Mieghem NM, Webb JG, Cohen DJ, Leon MB. Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research. J Am Coll Cardiol 2021; 77:2717-2746. [PMID: 33888385 DOI: 10.1016/j.jacc.2021.02.038] [Citation(s) in RCA: 475] [Impact Index Per Article: 158.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS The Valve Academic Research Consortium (VARC), founded in 2010, was intended to (i) identify appropriate clinical endpoints and (ii) standardize definitions of these endpoints for transcatheter and surgical aortic valve clinical trials. Rapid evolution of the field, including the emergence of new complications, expanding clinical indications, and novel therapy strategies have mandated further refinement and expansion of these definitions to ensure clinical relevance. This document provides an update of the most appropriate clinical endpoint definitions to be used in the conduct of transcatheter and surgical aortic valve clinical research. METHODS AND RESULTS Several years after the publication of the VARC-2 manuscript, an in-person meeting was held involving over 50 independent clinical experts representing several professional societies, academic research organizations, the US Food and Drug Administration (FDA), and industry representatives to (i) evaluate utilization of VARC endpoint definitions in clinical research, (ii) discuss the scope of this focused update, and (iii) review and revise specific clinical endpoint definitions. A writing committee of independent experts was convened and subsequently met to further address outstanding issues. There were ongoing discussions with FDA and many experts to develop a new classification schema for bioprosthetic valve dysfunction and failure. Overall, this multi-disciplinary process has resulted in important recommendations for data reporting, clinical research methods, and updated endpoint definitions. New definitions or modifications of existing definitions are being proposed for repeat hospitalizations, access site-related complications, bleeding events, conduction disturbances, cardiac structural complications, and bioprosthetic valve dysfunction and failure (including valve leaflet thickening and thrombosis). A more granular 5-class grading scheme for paravalvular regurgitation (PVR) is being proposed to help refine the assessment of PVR. Finally, more specific recommendations on quality-of-life assessments have been included, which have been targeted to specific clinical study designs. CONCLUSIONS Acknowledging the dynamic and evolving nature of less-invasive aortic valve therapies, further refinements of clinical research processes are required. The adoption of these updated and newly proposed VARC-3 endpoints and definitions will ensure homogenous event reporting, accurate adjudication, and appropriate comparisons of clinical research studies involving devices and new therapeutic strategies.
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Affiliation(s)
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Nicolo Piazza
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Maria C Alu
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
| | - Tamim Nazif
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
| | - Philippe Pibarot
- Quebec Heart & Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic and Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew T Finn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Michael J Mack
- Baylor Scott & White Heart Hospital Plano, Plano, Texas, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey J Popma
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael Reardon
- Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Josep Rodes-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec, Quebec, Canada
| | | | - John G Webb
- Department of Cardiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - David J Cohen
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA.
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24
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Human amniotic membrane mesenchymal stem cells exert cardioprotective effects against isoproterenol (ISO)-induced myocardial injury through suppression of inflammation and modulation of inflammatory MAPK/NF-κB pathway. Cell Tissue Bank 2021; 23:67-77. [PMID: 33733423 DOI: 10.1007/s10561-021-09915-x] [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: 05/09/2020] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
A common cause of mortality around the world is ischemic myocardial injury. The study was conducted to examine the ability of amniotic membrane mesenchymal stem cells (AMSCs) for protection against isoproterenol (ISO)-induced myocardial injury and attempted to show the possible mechanisms by which AMSCs that can be linked to inhibition of inflammation by targeting inflammatory MAPK/NF-κB pathway. Model was established by subcutaneous injection of 170 mg/kg/day of ISO for four consecutive days. Flow cytometry and echocardiography were carried out to evaluate characterization of hAMSCs and cardiac function, respectively. The expression of inflammatory cytokines was determined using ELISA assay. The activities of NF-κB and phosphorylated p38 MAPK were measured using immunohistochemical assessments. The results showed that ISO administration was resulted in cardiac dysfunction, increased levels of inflammatory cytokines that reversed by intramyocardially administration of AMSCs (P < 0. 05). Cardioprotective effects of AMSCs were associated with a significant decreased expression of NF-κB and reduced levels of phosphorylated p38 MAPK (P < 0. 05). In conclusion, our finding showed that intramyocardially administration of AMSCs could contribute to improvement of heart function and inhibition of inflammation in the site of injury by targeting inflammatory MAPK/NF-κB pathway.
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25
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Massaro AR. Neurological complications of heart failure. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:77-89. [PMID: 33632459 DOI: 10.1016/b978-0-12-819814-8.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Heart failure (HF) is a major global cause of death with increasing absolute worldwide numbers of HF patients. HF results from the interaction between cardiovascular aging with specific risk factors, comorbidities, and disease modifiers. The failing heart and neuronal injury have a bidirectional interaction requiring specific management strategies. Decreased cardiac output has been associated with lower brain volumes. Cerebral blood flow (CBF) may normalize following heart transplantation among severe HF patients. Stroke and cognitive impairment remain the main neurologic conditions associated with HF. However, HF patients may also suffer from chronic cerebral hypoperfusion. It seems likely that HF-related ischemic strokes are primarily the result of cardiac embolism. Atrial fibrillation (AF) is present in half of stroke patient with HF. The increased risk of hemorrhagic strokes is less well characterized and likely multifactorial, but may in part reflect a higher use of long-term antithrombotic therapy. The steady improvement of neuroimaging techniques has demonstrated an increased prevalence of silent ischemic lesions among HF patients. The populations most likely to benefit from long-term anticoagulant therapy are HF patients with AF. Cognitive impairment in HF can have a variety of clinical manifestations from mild memory problems to dementia.
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26
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Escobar C, Varela L, Palacios B, Capel M, Sicras A, Sicras A, Hormigo A, Alcázar R, Manito N, Botana M. Costs and healthcare utilisation of patients with heart failure in Spain. BMC Health Serv Res 2020; 20:964. [PMID: 33081776 PMCID: PMC7576860 DOI: 10.1186/s12913-020-05828-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Increasing the knowledge about heart failure (HF) costs and their determinants is important to ascertain how HF management can be optimized, leading to a significant decrease of HF costs. This study evaluated the cumulative costs and healthcare utilisation in HF patients in Spain. METHODS Observational, retrospective, population-based study using BIG-PAC database, which included data from specialized and primary care of people ≥18 years, from seven autonomous communities in Spain, who received care for HF between 2015 and 2019. The healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. RESULTS We identified 17,163 patients with HF (year 2015: mean age 77.3 ± 11.8 years, 53.5% men, 51.7% systolic HF, 43.6% on NYHA functional class II). During the 2015-2019 period, total HF associated costs reached 15,373 Euros per person, being cardiovascular disease hospitalizations the most important determinant (75.8%), particularly HF hospitalizations (51.0%). Total medication cost accounted for 7.0% of the total cost. During this period, there was a progressive decrease of cardiovascular disease hospital costs per year (from 2834 Euros in 2015 to 2146 Euros in 2019, P < 0.001), as well as cardiovascular and diabetic medication costs. CONCLUSIONS During the 2015-2019 period, costs of HF patients in Spain were substantial, being HF hospitalizations the most important determinant. Medication costs represented only a small proportion of total costs. Improving HF management, particularly through the use of drugs that reduce HF hospitalization may be helpful to reduce HF burden.
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Affiliation(s)
| | | | | | | | - Antoni Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Aram Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | | | | | - Nicolás Manito
- Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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27
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Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail 2020; 22:1342-1356. [PMID: 32483830 PMCID: PMC7540043 DOI: 10.1002/ejhf.1858] [Citation(s) in RCA: 911] [Impact Index Per Article: 227.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022] Open
Abstract
The heart failure syndrome has first been described as an emerging epidemic about 25 years ago. Today, because of a growing and ageing population, the total number of heart failure patients still continues to rise. However, the case mix of heart failure seems to be evolving. Incidence has stabilized and may even be decreasing in some populations, but alarming opposite trends have been observed in the relatively young, possibly related to an increase in obesity. In addition, a clear transition towards heart failure with a preserved ejection fraction has occurred. Although this transition is partially artificial, due to improved recognition of heart failure as a disorder affecting the entire left ventricular ejection fraction spectrum, links can be made with the growing burden of obesity‐related diseases and with the ageing of the population. Similarly, evidence suggests that the number of patients with heart failure may be on the rise in low‐income countries struggling under the double burden of communicable diseases and conditions associated with a Western‐type lifestyle. These findings, together with the observation that the mortality rate of heart failure is declining less rapidly than previously, indicate we have not reached the end of the epidemic yet. In this review, the evolving epidemiology of heart failure is put into perspective, to discern major trends and project future directions.
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Affiliation(s)
- Amy Groenewegen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arend Mosterd
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Arno W Hoes
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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28
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Srivastava M, Harrison N, Caetano AFSMA, Tan AR, Law M. Ultrafiltration for acute heart failure. Hippokratia 2020. [DOI: 10.1002/14651858.cd013593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Mehul Srivastava
- Emergency and Trauma Centre; The Alfred Hospital; Melbourne Australia
| | - Nicholas Harrison
- Department of Emergency Medicine; Wayne State University; Detroit MI- MICHIGAN USA
| | | | - Audrey R Tan
- Institute of Health Informatics Research; University College London; London UK
| | - Mandy Law
- Department of Nephrology; Royal Melbourne Hospital; Parkville Australia
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29
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Ferreira JP, Kraus S, Mitchell S, Perel P, Piñeiro D, Chioncel O, Colque R, de Boer RA, Gomez-Mesa JE, Grancelli H, Lam CSP, Martinez-Rubio A, McMurray JJV, Mebazaa A, Panjrath G, Piña IL, Sani M, Sim D, Walsh M, Yancy C, Zannad F, Sliwa K. World Heart Federation Roadmap for Heart Failure. Glob Heart 2020; 14:197-214. [PMID: 31451235 DOI: 10.1016/j.gheart.2019.07.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 12/26/2022] Open
Affiliation(s)
- João Pedro Ferreira
- National Institute of Health and Medical Research, Center for Clinical Multidisciplinary Research, University of Lorraine, Regional University Hospital of Nancy, Nancy, France
| | - Sarah Kraus
- Groote Schuur Hospital and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Pablo Perel
- London School of Tropical Hygiene and Medicine, London, United Kingdom
| | - Daniel Piñeiro
- Division of Medicine, Hospital de Clínicas Department of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Ovidiu Chioncel
- Institute of Emergency for Cardiovascular Diseases "C.C. Iliescu" Bucharest, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania
| | - Roberto Colque
- Coronary Care Unit, Sanatorio Allende Cerro, Cordoba, Argentina
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Hugo Grancelli
- Cardiology Department, Sanatorio Trinidad Palermo, Buenos Aires, Argentina
| | | | - Antoni Martinez-Rubio
- Department of Cardiology, University Hospital Sabadell Autonomous, University of Barcelona, Barcelona, Spain
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Alexandre Mebazaa
- Université de Paris, Paris, France; U942 MASCOT (cardiovascular MArkers in Stress COndiTions), National Institute of Health and Medical Research, France; Department of Anesthesia, Burn, Intensive Care, Saint Louis Lariboisière Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gurusher Panjrath
- Department of Medicine /Cardiology, George Washington University School of Medicine, George Washington University, Washington, DC, USA
| | - Ileana L Piña
- Wayne State University, Michigan, USA; Wayne State University, Michigan, USA
| | - Mahmoud Sani
- Department of Medicine, Bayero University Kano, Kano, Nigeria; Aminu Kano Teaching Hospital, Kano State, Kano, Nigeria
| | - David Sim
- Department of Cardiology, Heart Failure Program at the National Heart Center Singapore, Singapore
| | - Mary Walsh
- Department of Heart Failure and Cardiac Transplantation, St. Vincent Heart Center, Indianapolis, IN, USA
| | - Clyde Yancy
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Faiez Zannad
- Department of Cardiology, Centre d'Investigation Clinique (CIC), Centre Hospitalier Universitaire, University Henri Poincaré, Nancy, France
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Cardiology and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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30
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Konev AA, Kharitonov AV, Rozov FN, Altshuler EP, Serebryanaya DV, Lassus J, Harjola VP, Katrukha AG, Postnikov AB. CT-IGFBP-4 as a novel prognostic biomarker in acute heart failure. ESC Heart Fail 2020; 7:434-444. [PMID: 31967738 PMCID: PMC7160480 DOI: 10.1002/ehf2.12590] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/05/2019] [Accepted: 11/25/2019] [Indexed: 12/11/2022] Open
Abstract
Aims Insulin‐like growth factor binding protein‐4 (IGFBP‐4) fragments have been shown to predict the risk of major adverse cardiovascular events, including segment‐elevation myocardial infarction, in patients with acute coronary syndrome. We evaluated the prognostic value of the carboxy‐terminal fragment of IGFBP‐4 (CT‐IGFBP‐4) for all‐cause mortality in emergency room patients with acute heart failure (AHF). Methods and results CT‐IGFBP‐4, N‐terminal pro brain natriuretic peptide (NT‐proBNP), and C‐reactive protein (CRP) were measured at admission from the lithium‐heparin plasma of 156 patients with AHF. All‐cause mortality was recorded for 1 year. Receiver operator characteristic (ROC) curves, Kaplan–Meier, and Cox proportional hazard ratio analyses were performed to evaluate the prognostic value of the various clinical variables, CT‐IGFBP‐4, NT‐proBNP, CRP, and their combinations. During 1 year of follow‐up, 52 (33.3%) patients died. CT‐IGFBP‐4 only weakly correlated with NT‐proBNP (Pearson correlation coefficient r = 0.16, P = 0.044) and did not correlate with CRP (r = 0.08, P = 0.35), emphasizing the different nature of these biomarkers. The receiver operator characteristic area under the curve (ROC AUC) of CT‐IGFBP‐4 for the prediction of all‐cause mortality (0.727) was significantly higher than that of NT‐proBNP (0.680, P = 0.045) and CRP (0.669, P = 0.016). The combination of CT‐IGFBP‐4, NT‐proBNP, and CRP predicted mortality significantly better (ROC AUC = 0.788) than any of the biomarkers alone (P < 0.01 for all). The addition of CT‐IGFBP‐4 to a clinical prediction model that included age, gender, systolic blood pressure, creatinine, and sodium levels, as well as the history of previous heart failure, coronary artery disease, and hypertension significantly improved the mortality risk prediction (ROC AUC 0.774 vs. 0.699, P = 0.025). Cox hazard analysis indicated that elevated CT‐IGFBP‐4 was independently associated with 1 year mortality (hazard ratio 3.26, P = 0.0008) after adjustment for age, gender, history of previous heart failure, coronary artery disease, hypertension, chronic kidney failure, history of diabetes, heart rate, haemoglobin, plasma sodium, NT‐proBNP, CRP, cystatin C, and elevated cardiac troponin I or T. Patients with increased levels of either two or three of the biomarkers CT‐IGFBP‐4, NT‐proBNP, and CRP had significantly higher mortality risk (adjusted hazard ratio 10.04, P < 0.0001) than patients with increased levels of one or none of the biomarkers. Conclusions CT‐IGFBP‐4 was independently associated with all‐cause mortality in patients with AHF. Compared with single biomarkers, the combination of CT‐IGFBP‐4, NT‐proBNP, and CRP improved the prediction of all‐cause mortality in patients with AHF.
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Affiliation(s)
- Alexey A Konev
- HyTest Ltd, Intelligate 1, Joukahaisenkatu 6, Turku, 20520, Finland
| | - Alexey V Kharitonov
- HyTest Ltd, Intelligate 1, Joukahaisenkatu 6, Turku, 20520, Finland.,Faculty of Biology, Moscow State University, Moscow, Russian Federation
| | - Fedor N Rozov
- HyTest Ltd, Intelligate 1, Joukahaisenkatu 6, Turku, 20520, Finland
| | - Evgeny P Altshuler
- HyTest Ltd, Intelligate 1, Joukahaisenkatu 6, Turku, 20520, Finland.,Faculty of Biology, Moscow State University, Moscow, Russian Federation
| | - Daria V Serebryanaya
- HyTest Ltd, Intelligate 1, Joukahaisenkatu 6, Turku, 20520, Finland.,Faculty of Biology, Moscow State University, Moscow, Russian Federation
| | - Johan Lassus
- Cardiology, University of Helsinki, Heart and Lung Center, Helsinki University Hospital, Finland
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Finland
| | - Alexey G Katrukha
- HyTest Ltd, Intelligate 1, Joukahaisenkatu 6, Turku, 20520, Finland.,Faculty of Biology, Moscow State University, Moscow, Russian Federation
| | - Alexander B Postnikov
- HyTest Ltd, Intelligate 1, Joukahaisenkatu 6, Turku, 20520, Finland.,Faculty of Biology, Moscow State University, Moscow, Russian Federation
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A Context-oriented Communication Algorithm for Advance Care Planning: A Model to Assist Palliative Care in Heart Failure. J Cardiovasc Nurs 2019; 33:446-452. [PMID: 28248746 DOI: 10.1097/jcn.0000000000000396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Access to consultation or referral for decisions about advance care planning (ACP) is limited, particularly for nonmalignant models pertinent to palliative care in heart failure (HF). OBJECTIVES The aim of this study was to solicit professional opinions about the feasibility of using an exemplary context-oriented communication algorithm for ACP discussions. METHODS Using a panel of expert physicians and nurses in cardiovascular care, a 3-round Delphi study was conducted to evaluate the proposed model. RESULTS A consensus was determined based on a content validity ratio (CVR) of 0.318 or greater, a critical value for selection of an item scored as important (≥4 on a 5-point Likert scale). A total of 50, 44, and 38 experts in Korea completed each round, respectively. Item evaluation did not differ across rounds (Friedman χ > P = .05), except for timing of the ACP discussion. A lack of consensus was observed on the issue of after HF diagnosis for right timing of the ACP discussion across rounds (CVRs from -0.80 to -0.83); consensus was reached on the expectation of a terminal state (CVRs from 0.60 to 0.78). Content validity ratios were moderately high for Korean advance directive, ranging from 0.59 to 0.91. Experts also reached consensus about each of 5 steps of a communication model-patients' determination of decisional capacity (CVR, 0.72-1.0), awareness (CVR, 0.95-1.0), willingness for advance care planning (CVR, 0.76-0.84), family dynamics (CVR, 0.92-1.0) and patient readiness for advance care planning (CVR, 0.76-0.95). CONCLUSIONS A context-oriented communication model could be used to facilitate the decision-making process for palliative care and continuity of care in HF.
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Eid RA, Eleawa SM, Alkhateeb MA, Aldera H, Zaki MSA, Al-Shraim M, Saeed MA, El-Kott AF, Alaa Eldeen M, Alassiri M, Alshehri MM, Salem Al-Shudiefat AAR, Khalil MA. Chronic consumption of a high-fat diet rich in corn oil activates intrinsic cell death pathway and induces several ultrastructural changes in the atria of healthy and type 1 diabetic rat. Clin Exp Pharmacol Physiol 2019; 46:1111-1123. [PMID: 31398260 DOI: 10.1111/1440-1681.13158] [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: 05/29/2019] [Revised: 07/28/2019] [Accepted: 08/04/2019] [Indexed: 11/27/2022]
Abstract
This study investigates the effect of chronic consumption of a high-fat diet rich in corn oil (CO-HFD) on atrial cells ultrastructure, antioxidant levels and markers of intrinsic cell death of both control and type 1 diabetes mellitus (T1DM)-induced rats. Adult male rats (10 rats/group) were divided into four groups: control fed standard diet (STD) (3.82 kcal/g, 9.4% fat), CO-HFD (5.4 kcal/g, 40% fat), T1DM fed STD, and T1DM + CO-HFD. CO-HFD and T1DM alone or in combination impaired systolic and diastolic functions of rats and significantly reduced levels of GSH and the activity of SOD, enhanced lipid peroxidation, increased protein levels of P53, Bax, cleaved caspase-3, and ANF and decreased levels of Bcl-2 in their atria. Concomitantly, atrial cells exhibited fragmentation of the myofibrils, disorganized mitochondria, decreased number of atrionatriuretic factor (ANF) granules, and loss of gap junctions accompanied by changes in capillary walls. Among all treatments, the severity of all these findings was more severe in T1DM and most profound in the atria of T1DM + CO-HFD. In conclusion, chronic consumption of CO-HFD by T1DM-induced rats elicits significant biochemical and ultrastructural damage to rat atrial cells accompanied by elevated oxidative stress and mitochondria-mediated cell death.
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Affiliation(s)
- Refaat A Eid
- Department of Pathology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Samy M Eleawa
- Department of Applied Medical Sciences, College of Health Sciences, PAAET, Shuwaikh, Kuwait
| | - Mahmoud A Alkhateeb
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hussain Aldera
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Mohamed Samir Ahmed Zaki
- Department of Anatomy, College of Medicine, King Khalid University, Abha, Saudi Arabia.,Department of Histology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mubarak Al-Shraim
- Department of Pathology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mansour A Saeed
- Department of Anatomy, College of Medicine, King Khalid University, Abha, Saudi Arabia.,Department of Histology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Attalla Farag El-Kott
- Department of Biology, College of Science, King Khalid University, Abha, Saudi Arabia.,Department of Zoology, Faculty of Science, Damanhour University, Damanhour, Egypt
| | - Muhammad Alaa Eldeen
- Physiology Section, Biology Department, Faculty of Science, Zagazig University, Zagazig, Egypt
| | - Mohammed Alassiri
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Majed M Alshehri
- Central Laboratories, King Faisal Medical City (Southern Region), Abha, Saudi Arabia
| | | | - Mohammad A Khalil
- Department of Basic Medical Science, Faculty of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
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Yaku H, Kato T, Morimoto T, Inuzuka Y, Tamaki Y, Ozasa N, Yamamoto E, Yoshikawa Y, Kitai T, Taniguchi R, Iguchi M, Kato M, Takahashi M, Jinnai T, Ikeda T, Nagao K, Kawai T, Komasa A, Nishikawa R, Kawase Y, Morinaga T, Toyofuku M, Seko Y, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Shizuta S, Ono K, Sato Y, Kuwahara K, Kimura T. Association of Mineralocorticoid Receptor Antagonist Use With All-Cause Mortality and Hospital Readmission in Older Adults With Acute Decompensated Heart Failure. JAMA Netw Open 2019; 2:e195892. [PMID: 31225889 PMCID: PMC6593642 DOI: 10.1001/jamanetworkopen.2019.5892] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Scarce data are available on the association of mineralocorticoid receptor antagonist (MRA) use with outcomes in acute decompensated heart failure (ADHF). OBJECTIVE To investigate the association of MRA use with all-cause mortality and hospital readmission in patients with ADHF. DESIGN, SETTING, AND PARTICIPANTS This cohort study examines participants enrolled in the Kyoto Congestive Heart Failure (KCHF) registry, a physician-initiated, prospective, multicenter cohort study of consecutive patients admitted for ADHF, between October 1, 2014, and March 31, 2016, into 1 of 19 secondary and tertiary hospitals throughout Japan. To balance the baseline characteristics associated with the selection of MRA use, a propensity score-matched cohort design was used, yielding 2068 patients. Data analysis was conducted from April to August 2018. EXPOSURES Prescription of MRA at discharge from the index hospitalization. MAIN OUTCOMES AND MEASURES Composite of all-cause death or heart failure hospitalization after discharge. RESULTS Among 3717 patients hospitalized for ADHF, 1678 patients (45.1%) had received MRA at discharge and 2039 (54.9%) did not. After propensity score matching, 2068 patients (with a median [interquartile range] age of 80 [72-86] years, and of whom 937 [45.3%] were women) were included. In the matched cohort (n = 1034 in each group), the cumulative 1-year incidence of the primary outcome was statistically significantly lower in the MRA use group than in the no MRA use group (28.4% vs 33.9%; hazard ratio [HR], 0.81; 95% CI, 0.70-0.93; P = .003). Of the components of the primary outcome, the cumulative 1-year incidence of heart failure hospitalization was significantly lower in the MRA use group than in the no MRA use group (18.7% vs 24.8%; HR, 0.70; 95% CI, 0.60-0.86; P < .001), whereas no difference in mortality was found between the 2 groups (15.6% vs 15.8%; HR, 0.98; 95% CI, 0.82-1.18; P = .85). No difference in all-cause hospitalization was observed between the 2 groups (35.3% vs 38.2%; HR, 0.88; 95% CI, 0.77-1.01; P = .07). In additional analyses that stratified by left ventricular ejection fraction, the association of MRA use with the primary outcome was statistically significant in patients with left ventricular ejection fraction of 40% or greater. CONCLUSIONS AND RELEVANCE Use of MRA at discharge from ADHF hospitalization did not appear to be associated with lower mortality but was associated with a lower risk of heart failure readmission. This finding suggests that MRA treatment at discharge may have minimal, if any, clinical advantages.
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Affiliation(s)
- Hidenori Yaku
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Yasutaka Inuzuka
- Department of Cardiovascular Medicine, Shiga General Hospital, Shiga, Japan
| | - Yodo Tamaki
- Division of Cardiology, Tenri Hospital, Nara, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Toshikazu Jinnai
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Shiga, Japan
| | - Tomoyuki Ikeda
- Department of Cardiology, Hikone Municipal Hospital, Shiga, Japan
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Takafumi Kawai
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Komasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yuichi Kawase
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
| | - Takashi Morinaga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yuta Seko
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yutaka Furukawa
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University Graduate School of Medicine, Shiga, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Vacunación del paciente cardiópata. ¿Hasta cuándo esperar? Respuesta. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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35
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Vaccination in Patients With Heart Disease. How Long Should We Wait? Response. ACTA ACUST UNITED AC 2019; 72:516. [PMID: 30792014 DOI: 10.1016/j.rec.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/19/2018] [Indexed: 11/21/2022]
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Abstract
Objective: To analyze health-related cost of heart failure (HF) and to evaluate health-related source utilization aiming to provide data on the economic burden of HF in actual clinical practice in Turkey. Methods: The study used the Delphi process of seeking expert consensus of opinion including 11 cardiologists who are experienced in HF. The standardized questionnaire comprised items to reflect the opinion of the expert panelists on the distribution of the HF patients in terms of demographic and clinical characteristics and background disease states. Costs related to out-patient follow-up, in-patient follow-up, medications, and other therapies were also evaluated. Results: 34.1% of the HF patients were in the age range of 60–69 years, and 62.3% were males. Coronary heart disease was the leading cause of HF (59.6%); 63.6% of the HF patients had reduced ejection fraction (rEF) and 42.3% were in New York Heart Association (NYHA)-II class. Approximately 75 % of the patients were followed up by a cardiology unit. The total annual visit number was estimated as 3.41. Approximately 32% of HF patients were hospitalized 1.64 times a year, for an average of 6.77 days each time. The total annual costs of all HF patients and HF-rEF patients were estimated as 1.537 TL and as 2.141 TL, respectively. Conclusion: The analysis demonstrating the magnitude of the economic impact of HF management on Turkey’s healthcare system may help facilitate health and social policy interventions to improve the prevention and treatment of HF. (Anatol J Cardiol 2016; 16: 554-62)
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Jia Z, Chen Z, Xu H, Armah MA, Teng P, Li W, Jian D, Ma L, Ni Y. Pressure Overload-induced Cardiac Hypertrophy Varies According to Different Ligation Needle Sizes and Body Weights in Mice. Arq Bras Cardiol 2018; 110:568-576. [PMID: 30226916 PMCID: PMC6023638 DOI: 10.5935/abc.20180088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/24/2017] [Indexed: 01/16/2023] Open
Abstract
Background The cardiac hypertrophy (CH) model for mice has been widely used, thereby
providing an effective research foundation for CH exploration. Objective To research the effects of CH modeling under abdominal aortic constriction
(AAC) using different needles and weights in mice. Methods Four needles with different external diameters (0.35, 0.40, 0.45, and 0.50
mm) were used for AAC. 150 male C57BL/6 mice were selected according to body
weight (BW) and divided into 3 weight levels: 18 g, 22 g, and 26 g (n = 50
in each group). All weight levels were divided into 5 groups: a sham group
(n = 10) and 4 AAC groups using 4 ligation intensities (n = 10 per group).
After surgery, survival rates were recorded, echocardiography was performed,
hearts were dissected and used for histological detection, and data were
statistically analyzed, P < 0.05 was considered statistically
significant. Results All mice died in the following AAC groups: 18g/0.35 mm, 22 g/0.35 mm, 26
g/0.35 mm, 22 g/0.40 mm, and 26 g/0.40 mm. All mice with AAC, those ligated
with a 0.50-mm needle, and those that underwent sham operation survived.
Different death rates occurred in the following AAC groups: 18 g/0.40 mm, 18
g/0.45 mm, 18 g/0.50 mm, 22 g/45 mm, 22 g/0.50 mm, 26 g/0.45 mm, and 26
g/0.50 mm. The heart weight/body weight ratios (5.39 ± 0.85, 6.41
± 0.68, 4.67 ± 0.37, 5.22 ± 0.42, 4.23 ± 0.28,
5.41 ± 0.14, and 4.02 ± 0.13) were significantly increased
compared with those of the sham groups for mice with the same weight
levels. Conclusion A 0.45-mm needle led to more obvious CH than did 0.40-mm and 0.50-mm needles
and caused extraordinary CH in 18-g mice.
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Affiliation(s)
- Zhen Jia
- Department of Cardio-Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang - China
| | - Zhijun Chen
- Department of Cardio-Thoracic Surgery, Zhoushan Hospital, Zhejiang - China
| | - Hongfei Xu
- Department of Cardio-Thoracic Surgery, Zhoushan Hospital, Zhejiang - China
| | - Malik Akuffu Armah
- Department of Cardio-Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang - China
| | - Peng Teng
- Department of Cardio-Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang - China
| | - Weidong Li
- Department of Cardio-Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang - China
| | - Dongdong Jian
- Department of Cardio-Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang - China
| | - Liang Ma
- Department of Cardio-Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang - China
| | - Yiming Ni
- Department of Cardio-Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang - China
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Zhao G. Significance of non-coding circular RNAs and micro RNAs in the pathogenesis of cardiovascular diseases. J Med Genet 2018; 55:713-720. [PMID: 30177556 PMCID: PMC6252363 DOI: 10.1136/jmedgenet-2018-105387] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022]
Abstract
Heart failure, coronary artery disease and myocardial infarction are the most prominent cardiovascular diseases contributing significantly to death worldwide. In the majority of situations, except for surgical interventions and transplantation, there are no reliable therapeutic approaches available to address these health problem. Despite several advances that led to the development of biomarkers and therapies based on the renin–angiotensin system, adrenergic pathways, etc, more definitive and consistent biomarkers and specific target based molecular therapies are still being sought. Recent advances in the field of genomic research has helped in identifying non-coding RNAs, including circular RNAs, piRNAs, micro RNAs, and long non-coding RNAs, that play a significant role in the regulation of gene expression and function and have direct impact on pathophysiological mechanisms. This new knowledge is currently being explored with much hope for the development of novel treatments and biomarkers. Circular RNAs and micro RNAs have been described in myocardium and aortic valves and were shown to be involved in the regulation of pathophysiological processes that potentially contribute to cardiovascular diseases. Approximately 32 000 human exonic circular RNAs have been catalogued and their functions are still being ascertained. In the heart, circular RNAs were shown to bind micro RNAs in a specific manner and regulate the expression of transcription factors and stress response genes, and expression of these non-coding RNAs were found to change in conditions such as cardiac hypertrophy, heart failure and cardiac remodelling, reflecting their significance as diagnostic and prognostic biomarkers. In this review, we address the present state of understanding on the biogenesis, regulation and pathophysiological roles of micro and circular RNAs in cardiovascular diseases, and on the potential future perspectives on their use as biomarkers and therapeutic agents.
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Affiliation(s)
- Guoan Zhao
- The Cardiovascular Research Center, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
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Justice CN, Derbala MH, Baich TM, Kempton AN, Guo AS, Ho TH, Smith SA. The Impact of Pazopanib on the Cardiovascular System. J Cardiovasc Pharmacol Ther 2018; 23:387-398. [PMID: 29706106 PMCID: PMC6257996 DOI: 10.1177/1074248418769612] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pazopanib is an approved treatment for renal cell carcinoma and a second-line treatment for nonadipocytic soft-tissue sarcoma. However, its clinical efficacy is limited by its cardiovascular side effects. Pazopanib and other vascular endothelial growth factor receptor tyrosine kinase inhibitors have been associated with the development of hypertension, QT interval prolongation, and other cardiovascular events; however, these mechanisms are largely unknown. Gaining a deeper understanding of these mechanisms is essential for the development of appropriate surveillance strategies and possible diagnostic biomarkers to allow us to monitor patients and modulate therapy prior to significant cardiac insult. This approach will be vital in keeping patients on these life-saving therapies and may be applicable to other tyrosine kinase inhibitors as well. In this review, we provide a comprehensive overview of the preclinical and clinical side effects of pazopanib with a focus on the mechanisms responsible for its toxicity to the cardiovascular system.
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Affiliation(s)
- Cody N. Justice
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Mohamed H. Derbala
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Tesla M. Baich
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Amber N. Kempton
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Aaron S. Guo
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
| | - Thai H. Ho
- Mayo Clinic Scottsdale, Arizona, Phoenix, AZ, USA
| | - Sakima A. Smith
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, USA
- Division of Cardiology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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41
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Bilchick K, Moss T, Welch T, Levy W, Stukenborg G, Lawlor BT, Reigle J, Thomas SC, Brady C, Bergin JD, Kennedy JLW, Abuannadi M, Scully K, Mazimba S. Improving Heart Failure Readmission Costs and Outcomes With a Hospital-to-Home Readmission Intervention Program. Am J Med Qual 2018; 34:127-135. [PMID: 30024279 DOI: 10.1177/1062860618788436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A retrospective cohort study was performed of the Hospital-to-Home (H2H) program, a rapid clinic follow-up program for patients with recent heart failure (HF) admissions at the University of Virginia Health System. There were 6761 hospitalizations among 4685 patients (age 67.5 ± 14.2 years, 43.9% female), and 759 had H2H follow-up. Thirty day mortality after the initial HF hospitalization was lower in H2H patients (1.84% vs 3.13%; P = .049), and this difference remained significant after adjustment in a multivariable logistic regression model (odds ratio = 0.56 [95% CI = 0.31-099]; P = .046). There also was a 24% reduction in readmission days within the first 30 days after the index admission ( P < .0001), and readmission cost savings were found to be greater than the costs of staffing the H2H clinic. In summary, the H2H program is cost-effective, with significant improvements in survival, readmission days, and readmission costs over 30 days.
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Affiliation(s)
- Kenneth Bilchick
- 1 University of Virginia Health System, Charlottesville, Virginia
| | - Travis Moss
- 1 University of Virginia Health System, Charlottesville, Virginia
| | - Timothy Welch
- 1 University of Virginia Health System, Charlottesville, Virginia
| | - Wayne Levy
- 2 University of Washington, Seattle, Washington
| | - George Stukenborg
- 3 University of Virginia School of Medicine, Charlottesville, Virginia
| | - Bryan T Lawlor
- 1 University of Virginia Health System, Charlottesville, Virginia
| | - Juanita Reigle
- 1 University of Virginia Health System, Charlottesville, Virginia
| | - S Craig Thomas
- 1 University of Virginia Health System, Charlottesville, Virginia
| | - Carolyn Brady
- 1 University of Virginia Health System, Charlottesville, Virginia
| | - James D Bergin
- 1 University of Virginia Health System, Charlottesville, Virginia
| | | | | | - Kenneth Scully
- 1 University of Virginia Health System, Charlottesville, Virginia
| | - Sula Mazimba
- 1 University of Virginia Health System, Charlottesville, Virginia
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Siddiqui WJ, Kohut AR, Hasni SF, Goldman JM, Silverman B, Kelepouris E, Eisen HJ, Aggarwal S. Readmission rate after ultrafiltration in acute decompensated heart failure: a systematic review and meta-analysis. Heart Fail Rev 2018; 22:685-698. [PMID: 28900774 DOI: 10.1007/s10741-017-9650-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Significance of ultrafiltration in acute decompensated heart failure remains unclear. We performed meta-analysis to determine its role in reducing readmissions after acute decompensated heart failure. MEDLINE was searched using PUBMED from inception to March 22, 2017 for prospective randomized control trials comparing ultrafiltration to diuretics in acute decompensated heart failure. Five hundred ninety studies were found; nine studies with 820 patients were included. Studies with renal replacement therapy bar ultrafiltration, chronic decompensated heart failure, and non-English language were excluded. RevMan Version 5.3 was used for analysis. The primary outcomes analyzed were cumulative and 90 days readmissions secondary to heart failure and all-cause readmissions. Baseline characteristics were similar. One hundred eighty-eight patients were readmitted with heart failure, 77 vs 111 favoring ultrafiltration; risk ratio (RR) = 0.71 (95% confidence interval (CI), 0.49-1.02, p = 0.07, I 2 = 47%). Ninety days readmissions were 43 vs 67 favoring ultrafiltration; RR = 0.65 (95%CI, 0.47-0.90, p = 0.01, I 2 = 0%). Ultrafiltration showed significantly higher fluid removal and weight loss. Hypotension was common in ultrafiltration (24 vs 13, OR = 2.06, 95%CI = 0.98-4.32, p = 0.06, I 2 = 0%). Ultrafiltration showed reduced 90 days heart failure readmissions and trend towards reduced cumulative hospital readmissions. Renal and cardiovascular outcomes and hospital stay were similar.
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Affiliation(s)
- Waqas Javed Siddiqui
- Department of Medicine, Division of Nephrology and Hypertension, Drexel University College of Medicine, Philadelphia, PA, 19102, USA. .,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA.
| | - Andrew R Kohut
- Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - Syed F Hasni
- Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - Jesse M Goldman
- Department of Medicine, Division of Nephrology and Hypertension, Drexel University College of Medicine, Philadelphia, PA, 19102, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - Benjamin Silverman
- Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - Ellie Kelepouris
- Department of Medicine, Division of Nephrology and Hypertension, Drexel University College of Medicine, Philadelphia, PA, 19102, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - Howard J Eisen
- Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - Sandeep Aggarwal
- Department of Medicine, Division of Nephrology and Hypertension, Drexel University College of Medicine, Philadelphia, PA, 19102, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
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43
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Velmurugan BK, Chang R, Marthandam Asokan S, Chang C, Day C, Lin Y, Lin Y, Kuo W, Huang C. A minireview of E4BP4/NFIL3 in heart failure. J Cell Physiol 2018; 233:8458-8466. [DOI: 10.1002/jcp.26790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/30/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Bharath Kumar Velmurugan
- Toxicology and Biomedicine Research Group, Faculty of Applied Sciences Ton Duc Thang University Ho Chi Minh City Vietnam
| | - Ruey‐Lin Chang
- College of Chinese Medicine, School of Post‐Baccalaureate Chinese Medicine China Medical University Taichung Taiwan
| | | | - Chih‐Fen Chang
- Department of Internal Medicine, Division of Cardiology Taichung Armed Force Taichung General Hospital Taichung Taiwan
| | | | - Yueh‐Min Lin
- Department of Pathology Changhua Christian Hospital Changhua Taiwan
- Department of Medical Technology, Jen‐Teh Junior College of Medicine Nursing and Management Miaoli Taiwan
| | - Yuan‐Chuan Lin
- Graduate Institute of Basic Medical Science China Medical University Taichung Taiwan
| | - Wei‐Wen Kuo
- Department of Biological Science and Technology China Medical University Taichung Taiwan
| | - Chih‐Yang Huang
- Graduate Institute of Basic Medical Science China Medical University Taichung Taiwan
- Graduate Institute of Chinese Medical Science China Medical University Taichung Taiwan
- Department of Biological Science and Technology Asia University Taichung Taiwan
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44
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Kadoglou NPE, Parissis J, Seferovic P, Filippatos G. Vaccination in Heart Failure: An Approach to Improve Outcomes. ACTA ACUST UNITED AC 2018; 71:697-699. [PMID: 29627277 DOI: 10.1016/j.rec.2018.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 02/13/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Nikolaos P E Kadoglou
- Centre for Statistics in Medicine - Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - John Parissis
- Heart Failure Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Petar Seferovic
- Belgrade University School of Medicine, Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Gerasimos Filippatos
- Heart Failure Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece; School of Medicine, University of Cyprus, Nicosia, Cyprus.
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45
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Ma T, Zhu D, Chen D, Zhang Q, Dong H, Wu W, Lu H, Wu G. Sulforaphane, a Natural Isothiocyanate Compound, Improves Cardiac Function and Remodeling by Inhibiting Oxidative Stress and Inflammation in a Rabbit Model of Chronic Heart Failure. Med Sci Monit 2018. [PMID: 29527002 PMCID: PMC5859672 DOI: 10.12659/msm.906123] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background The aim of this study was to investigate the effects of sulforaphane (SFN), a natural isothiocyanate compound, in a rabbit ascending aortic cerclage model of chronic heart failure (CHF). Material/Methods Thirty New Zealand White rabbits were divided into the sham operation group (n=10), the CHF group (n=10), and the CHF + SFN group (n=10) treated with subcutaneous SFN (0.5 mg/kg) for five days per week for 12 weeks. After 12 weeks, echocardiography and biometric analysis were performed, followed by the examination of the rabbit hearts. Enzyme-linked immunosorbent assay (ELISA) and Western blot were used to detect levels of inflammatory cytokines, superoxide dismutase (SOD), and malondialdehyde (MDA). Results In the CHF group, compared with the sham operation group, there was an increase in the heart weight to body weight ratio (HW/BW), the left ventricular weight to body weight ratio (LVW/BW), the left ventricular end diastolic diameter (LVEDD), the left ventricular end systolic diameter (LVESD), plasma brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) levels, the cardiac collagen volume fraction (CVF), apoptotic index, expression levels of collagen I, collagen III, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and malondialdehyde (MDA) in the myocardial tissue, and a decrease in the left ventricular shortening fraction (LVFS) and left ventricular ejection fraction (LVEF), and cardiac superoxide dismutase (SOD) activity. These changes were corrected in the SFN-treated group. Conclusions In a rabbit model of CHF, treatment with SFN improved cardiac function and remodeling by inhibiting oxidative stress and inflammation.
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Affiliation(s)
- Tongliang Ma
- Department of Emergency Internal Medicine, The People's Hospital of Bozhou, Bozhou, Anhui, China (mainland)
| | - Decai Zhu
- Department of Emergency Internal Medicine, The People's Hospital of Bozhou, Bozhou, Anhui, China (mainland)
| | - Duoxue Chen
- Department of Cardiology, The People's Hospital of Bozhou, Bozhou, Anhui, China (mainland)
| | - Qiaoyun Zhang
- Department of Emergency Internal Medicine, The People's Hospital of Bozhou, Bozhou, Anhui, China (mainland)
| | - Huifang Dong
- Department of Emergency Internal Medicine, The People's Hospital of Bozhou, Bozhou, Anhui, China (mainland)
| | - Wenwu Wu
- Department of Emergency Internal Medicine, The People's Hospital of Bozhou, Bozhou, Anhui, China (mainland)
| | - Huihe Lu
- Department of Cardiology, Nantong First People's Hospital, Nantong, Jiangsu, China (mainland)
| | - Guangfu Wu
- Department of Emergency Internal Medicine, The People's Hospital of Bozhou, Bozhou, Anhui, China (mainland)
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46
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Ambrosy AP, Gheorghiade M. Real-world dosing of evidence-based medications for heart failure: embracing guideline recommendations and clinical judgement. Eur J Heart Fail 2017; 19:1424-1426. [DOI: 10.1002/ejhf.915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/22/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Andrew P. Ambrosy
- Division of Cardiology; Duke University Medical Center; Durham NC USA
- Duke Clinical Research Institute; Durham NC USA
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Feinberg School of Medicine; Northwestern University; Chicago IL USA
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47
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Berthon B, Dansette PM, Tanter M, Pernot M, Provost J. An integrated and highly sensitive ultrafast acoustoelectric imaging system for biomedical applications. Phys Med Biol 2017; 62:5808-5822. [PMID: 28436918 DOI: 10.1088/1361-6560/aa6ee7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Direct imaging of the electrical activation of the heart is crucial to better understand and diagnose diseases linked to arrhythmias. This work presents an ultrafast acoustoelectric imaging (UAI) system for direct and non-invasive ultrafast mapping of propagating current densities using the acoustoelectric effect. Acoustoelectric imaging is based on the acoustoelectric effect, the modulation of the medium's electrical impedance by a propagating ultrasonic wave. UAI triggers this effect with plane wave emissions to image current densities. An ultrasound research platform was fitted with electrodes connected to high common-mode rejection ratio amplifiers and sampled by up to 128 independent channels. The sequences developed allow for both real-time display of acoustoelectric maps and long ultrafast acquisition with fast off-line processing. The system was evaluated by injecting controlled currents into a saline pool via copper wire electrodes. Sensitivity to low current and low acoustic pressure were measured independently. Contrast and spatial resolution were measured for varying numbers of plane waves and compared to line per line acoustoelectric imaging with focused beams at equivalent peak pressure. Temporal resolution was assessed by measuring time-varying current densities associated with sinusoidal currents. Complex intensity distributions were also imaged in 3D. Electrical current densities were detected for injected currents as low as 0.56 mA. UAI outperformed conventional focused acoustoelectric imaging in terms of contrast and spatial resolution when using 3 and 13 plane waves or more, respectively. Neighboring sinusoidal currents with opposed phases were accurately imaged and separated. Time-varying currents were mapped and their frequency accurately measured for imaging frame rates up to 500 Hz. Finally, a 3D image of a complex intensity distribution was obtained. The results demonstrated the high sensitivity of the UAI system proposed. The plane wave based approach provides a highly flexible trade-off between frame rate, resolution and contrast. In conclusion, the UAI system shows promise for non-invasive, direct and accurate real-time imaging of electrical activation in vivo.
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Affiliation(s)
- Beatrice Berthon
- Institut Langevin, ESPCI Paris, PSL Research University, CNRS UMR 7587, INSERM U979, Paris, France
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48
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Lüers C, Edelmann F, Wachter R, Pieske B, Mende M, Angermann C, Ertl G, Düngen HD, Störk S. Prognostic impact of diastolic dysfunction in systolic heart failure-A cross-project analysis from the German Competence Network Heart Failure. Clin Cardiol 2017; 40:667-673. [PMID: 28467622 DOI: 10.1002/clc.22710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We investigated the modifying role and prognostic importance of diastolic dysfunction (DD) in patients with heart failure and systolic dysfunction (SD). HYPOTHESIS The echocardiographic evaluation of diastolic function in patients with SD provides further prognostic information. METHODS From the German Competence Network Heart Failure, 1046 heart failure patients with reduced left ventricular ejection fraction (LVEF; <50%) were echocardiographically studied and followed for a median of 5 years. SD was subdivided into nonsevere (LVEF 36%-49%) and severe (LVEF ≤35%); DD was subdivided into nonsevere (E/E' <15) and severe (E/E' ≥15). RESULTS In general, severe SD was associated with higher hazard ratios (HRs; 2-fold to 3.5-fold) for all endpoints (all-cause death, cardiac death, cardiovascular hospitalization, duration of hospitalization). Patients with severe SD had a 2.5-fold risk of death (95% confidence interval [CI]: 1.84-3.47, P < 0.001), and patients with severe DD showed a 1.8-fold risk (95% CI: 1.17-2.61, P = 0.004). Furthermore, we observed a strong interaction of SD and DD: concomitant severe DD in patients with moderate SD increased risk substantially (HR: 1.73, 95% CI: 1.16-2.6, P = 0.007); by contrast, in patients with severe SD, additional presence of severe DD added little or no risk (HR for interaction: 0.5-1.2). CONCLUSIONS In heart failure patients with reduced LVEF, the evaluation of diastolic function provides additional prognostic information. Although severe SD generally increased the risk for all endpoints, the degree of DD and its impact as a prognostic marker for overall and cardiovascular mortality appeared of particular relevance in subjects with nonsevere SD.
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Affiliation(s)
- Claus Lüers
- University of Oldenburg, European Medical School Oldenburg-Groningen, Germany
| | - Frank Edelmann
- Department of Cardiology and Pneumology, University of Göttingen, Germany.,Department of Cardiology, Campus Virchow, Charité University, Berlin, Germany
| | - Rolf Wachter
- Department of Cardiology and Pneumology, University of Göttingen, Germany
| | - Burkert Pieske
- Department of Cardiology, Campus Virchow, Charité University, Berlin, Germany
| | | | - Christiane Angermann
- Comprehensive Heart Failure Center, University of Würzburg, and Department of Internal Medicine Cardiology, University Hospital Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University of Würzburg, and Department of Internal Medicine Cardiology, University Hospital Würzburg, Germany
| | - Hans-Dirk Düngen
- Department of Cardiology, Campus Virchow, Charité University, Berlin, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, and Department of Internal Medicine Cardiology, University Hospital Würzburg, Germany
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Filippatos G, Farmakis D, Metra M, Cotter G, Davison BA, Felker GM, Greenberg BH, Hua TA, Pang PS, Ponikowski P, Qian M, Severin TA, Voors AA, Teerlink JR. Serelaxin in acute heart failure patients with and without atrial fibrillation: a secondary analysis of the RELAX-AHF trial. Clin Res Cardiol 2017; 106:444-456. [PMID: 28150186 PMCID: PMC5511317 DOI: 10.1007/s00392-016-1074-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/27/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Atrial fibrillation (AFib) is a common comorbidity in HF and affects patients' outcome. We sought to assess the effects of serelaxin in patients with and without AFib. METHODS In a post hoc analysis of the RELAX-AHF trial, we compared the effects of serelaxin on efficacy end points, safety end points and biomarkers in 1161 patients with and without AFib on admission electrocardiogram. RESULTS AFib was present in 41.3% of patients. Serelaxin had a similar effect in patients with and without AFib, including dyspnea relief by visual analog scale through day 5 [mean change in area under the curve, 541.11 (33.79, 1048.44), p = 0.0366 in AFib versus 361.80 (-63.30, 786.90), p = 0.0953 in non-AFib, interaction p = 0.5954] and all-cause death through day 180 [HR = 0.42 (0.23, 0.77), p = 0.0051 in AFib versus 0.90 (0.53, 1.52), p = 0.6888 in non-AFib, interaction p = 0.0643]. Serelaxin was similarly safe in the two groups and induced similar reductions in biomarkers of cardiac, renal and hepatic damage. Stroke occurred more frequently in AFib patients (2.8 vs. 0.8%, p = 0.0116) and there was a trend for lower stroke incidence in the serelaxin arm in AFib patients (odds ratios, 0.31, p = 0.0759 versus 3.88, p = 0.2255 in non-AFib, interaction p = 0.0518). CONCLUSIONS Serelaxin was similarly safe and efficacious in improving short- and long-term outcomes and inducing organ protection in acute HF patients with and without AFib.
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Affiliation(s)
- Gerasimos Filippatos
- National and Kapodistrian University of Athens, Medical School, Athens, Greece. .,Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, 1 Rimini St, 12462, Athens, Greece.
| | - Dimitrios Farmakis
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | | | | | | | - Tsushung A Hua
- Novartis Pharmaceuticals Corporation, New Hanover, NJ, USA
| | - Peter S Pang
- Indiana University School of Medicine and Regenstrief Institute, Indianapolis, IN, USA
| | | | - Min Qian
- Columbia University, New York, NY, USA
| | | | | | - John R Teerlink
- University of California-San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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50
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Wang H, Cai J. The role of microRNAs in heart failure. Biochim Biophys Acta Mol Basis Dis 2016; 1863:2019-2030. [PMID: 27916680 DOI: 10.1016/j.bbadis.2016.11.034] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/26/2016] [Accepted: 11/29/2016] [Indexed: 12/12/2022]
Abstract
MicroRNAs are small non-coding RNA molecules that regulate gene expression by inhibiting mRNA translation and/or inducing mRNA degradation. In the past decade, many in vitro and in vivo studies have explored the involvement of microRNAs in various cardiovascular diseases. In this paper, studies focused upon the target genes and functionality of miRNAs in the pathophysiological processes of heart failure are reviewed. The selected miRNAs are categorized according to the biological relevance of their target genes in relation to four cardiovascular pathologies, namely angiogenesis, cardiac hypertrophy, fibrosis and apoptosis. This review illustrates the involvement of miRNAs in different biological signaling pathways and provides an overview of current understanding of the roles of miRNAs in cardiovascular health and diseases. This article is part of a Special Issue entitled: Genetic and epigenetic control of heart failure - edited by Jun Ren & Megan Yingmei Zhang.
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Affiliation(s)
- Hongjiang Wang
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
| | - Jun Cai
- State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Hypertension Center, Fuwai Hospital, Xicheng District, North Lishi Road No. 167, Beijing 100037, China.
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