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Kono H, Kuramitsu S, Fukunaga M, Korai K, Nagashima M, Hiroshima K, Ando K. Outcomes of left bundle branch area pacing compared to His bundle pacing and right ventricular apical pacing in Japanese patients with bradycardia. J Arrhythm 2024; 40:333-341. [PMID: 38586856 PMCID: PMC10995588 DOI: 10.1002/joa3.12997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 04/09/2024] Open
Abstract
Background His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) emerge as better alternatives to right ventricular apical pacing (RVAP) in patients with bradycardia requiring permanent cardiac pacing. We aimed to compare the clinical outcomes of LBBAP, HBP, and RVAP in Japanese patients with bradycardia. Methods A total of 424 patients who underwent successful pacemaker implantation (HBP, n = 53; LBBAP, n = 75; and RVAP, n = 296) were retrospectively enrolled in this study. The primary study endpoint was the cumulative incidence of heart failure hospitalization (HFH) during the follow-up. Results The success rate for implantation was higher in the LBBAP group than in the HBP group (94.9% and 81.5%, respectively). Capture threshold increase >1V during the follow-up occurred in the HBP and RVAP groups (9.4% and 5.1%, respectively), while it did not in the LBBAP group. The cumulative incidence of HFH was significantly lower in the LBBAP group than the RVAP (adjusted hazard ratio, 0.12 [95% confidence interval: 0.02-0.86]; p = .034); it did not differ between the HBP and RVAP groups (adjusted hazard ratio, 0.48 [95% confidence interval: 0.17-1.34]; p = .16). Advanced age, mean percent right ventricular pacing (per 10% increase), left ventricular ejection fraction <50%, and RVAP were associated with HFH. Conclusions Compared to RVAP and HBP, LBBAP appeared more feasible and effective in patients with bradycardia requiring permanent cardiac pacing.
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Affiliation(s)
- Hiroyuki Kono
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Shoichi Kuramitsu
- Department of Cardiovascular MedicineSapporo Cardiovascular Clinic, Sapporo Heart CenterSapporoJapan
| | - Masato Fukunaga
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Kengo Korai
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | | | | | - Kenji Ando
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
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Wang GG, Wang SJ, Qin J, Li CS, Yu XZ, Shen H, Yang LP, Fu Y, Zheng YA, Zhao B, Yu DM, Qin FJ, Zhou DG, Li Y, Liu FJ, Li W, Zhao W, Gao X, Wang Z, Jin M, Zeng H, Li Y, Wang GX, Zhou H, Sun XL, Wang PB, Woo KS. Characteristics, Management, and Outcomes of Acute Heart Failure in the Emergency Department: A Multicenter Registry Study with 1-year Follow-up in a Chinese Cohort in Beijing. Chin Med J (Engl) 2017; 130:1894-1901. [PMID: 28776539 PMCID: PMC5555121 DOI: 10.4103/0366-6999.211880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The emergency department (ED) has a pivotal influence on the management of acute heart failure (AHF), but data concerning current ED management are scarce. This Beijing AHF Registry Study investigated the characteristics, ED management, and short- and long-term clinical outcomes of AHF. METHODS This prospective, multicenter, observational study consecutively enrolled 3335 AHF patients who visited 14 EDs in Beijing from January 1, 2011, to September 23, 2012. Baseline data on characteristics and management were collected in the EDs. Follow-up data on death and readmissions were collected until November 31, 2013, with a response rate of 92.80%. The data were reported as median (interquartile range) for the continuous variables, or as number (percentage) for the categorical variables. RESULTS The median age of the enrolled patients was 71 (58-79) years, and 46.84% were women. In patients with AHF, coronary heart disease (43.27%) was the most common etiology, and myocardium ischemia (30.22%) was the main precipitant. Most of the patients in the ED received intravenous treatments, including diuretics (79.28%) and vasodilators (74.90%). Fewer patients in the ED received neurohormonal antagonists, and 25.94%, 31.12%, and 33.73% of patients received angiotensin converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, and spironolactone, respectively. The proportions of patients who were admitted, discharged, left against medical advice, and died were 55.53%, 33.58%, 7.08%, and 3.81%, respectively. All-cause mortalities at 30 days and 1 year were 15.30% and 32.27%, respectively. CONCLUSIONS Substantial details on characteristics and ED management of AHF were investigated. The clinical outcomes of AHF patients were dismal. Thus, further investigations of ED-based therapeutic approaches for AHF are needed.
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Affiliation(s)
- Guo-Gan Wang
- Emergency and Critical Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Si-Jia Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jian Qin
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chun-Sheng Li
- Department of Emergency, Beijing Chao Yang Hospital, Beijing 100020, China
| | - Xue-Zhong Yu
- Department of Emergency, Peking Union Medical College Hospital, Beijing 100032, China
| | - Hong Shen
- Department of Emergency, The General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Li-Pei Yang
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yan Fu
- Department of Emergency, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Ya-An Zheng
- Department of Emergency, Peking University Third Hospital, Beijing 100083, China
| | - Bin Zhao
- Department of Emergency, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Dong-Min Yu
- Department of Emergency, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Fu-Jun Qin
- Department of Emergency, Fangshan District Liangxiang Hospital, Beijing 102400, China
| | - De-Gui Zhou
- Department of Emergency, The Hospital of Shunyi District, Beijing 101300, China
| | - Ying Li
- Department of Emergency, People's Hospital of Beijing Daxing District, Beijing 102600, China
| | - Fu-Jun Liu
- Department of Emergency, The Luhe Teaching Hospital of the Capital Medical University, Beijing 101100, China
| | - Wei Li
- Medical Research and Biometrics Centre, National Centre for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Xishan Institute of Fuwai Hospital, Beijing 102300, China
| | - Wei Zhao
- Information Technology Centre, Fuwai Hospital, Beijing 100037, China
| | - Xin Gao
- Emergency and Critical Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zheng Wang
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ming Jin
- Department of Emergency, Beijing Chao Yang Hospital, Beijing 100020, China
| | - Hong Zeng
- Department of Emergency, Beijing Chao Yang Hospital, Beijing 100020, China
| | - Yi Li
- Department of Emergency, Peking Union Medical College Hospital, Beijing 100032, China
| | - Guo-Xing Wang
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hong Zhou
- Department of Emergency, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xiao-Lu Sun
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Peng-Bo Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Heart Center, First Hospital of Tsinghua University, Beijing 100016, China
| | - Kam-Sang Woo
- Department of Medicine and Therapeutics, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong 999077, China
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Köksel U, Erbasan O, Bayezid Ö, Kemaloğlu C, Özçobanoğlu S, Gölbaşı İ, Türkay C. Thrombosis in Continuous Flow Left Ventricular Assist Devices: Our Clinical Experience With Medical and Surgical Management. Transplant Proc 2016; 48:2162-7. [DOI: 10.1016/j.transproceed.2016.04.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 04/25/2016] [Indexed: 11/30/2022]
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Ezekowitz JA, Becher H, Belenkie I, Clark AM, Duff HJ, Friedrich MG, Haykowsky MJ, Howlett JG, Kassiri Z, Kaul P, Kim DH, Knudtson ML, Light PE, Lopaschuk GD, McAlister FA, Noga ML, Oudit GY, Paterson DI, Quan H, Schulz R, Thompson RB, Weeks SG, Anderson TJ, Dyck JRB. The Alberta Heart Failure Etiology and Analysis Research Team (HEART) study. BMC Cardiovasc Disord 2014; 14:91. [PMID: 25063541 PMCID: PMC4222863 DOI: 10.1186/1471-2261-14-91] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/16/2014] [Indexed: 01/06/2023] Open
Abstract
Background Nationally, symptomatic heart failure affects 1.5-2% of Canadians, incurs $3 billion in hospital costs annually and the global burden is expected to double in the next 1–2 decades. The current one-year mortality rate after diagnosis of heart failure remains high at >25%. Consequently, new therapeutic strategies need to be developed for this debilitating condition. Methods/Design The objective of the Alberta HEART program (http://albertaheartresearch.ca) is to develop novel diagnostic, therapeutic and prognostic approaches to patients with heart failure with preserved ejection fraction. We hypothesize that novel imaging techniques and biomarkers will aid in describing heart failure with preserved ejection fraction. Furthermore, the development of new diagnostic criteria will allow us to: 1) better define risk factors associated with heart failure with preserved ejection fraction; 2) elucidate clinical, cellular and molecular mechanisms involved with the development and progression of heart failure with preserved ejection fraction; 3) design and test new therapeutic strategies for patients with heart failure with preserved ejection fraction. Additionally, Alberta HEART provides training and education for enhancing translational medicine, knowledge translation and clinical practice in heart failure. This is a prospective observational cohort study of patients with, or at risk for, heart failure. Patients will have sequential testing including quality of life and clinical outcomes over 12 months. After that time, study participants will be passively followed via linkage to external administrative databases. Clinical outcomes of interest include death, hospitalization, emergency department visits, physician resource use and/or heart transplant. Patients will be followed for a total of 5 years. Discussion Alberta HEART has the primary objective to define new diagnostic criteria for patients with heart failure with preserved ejection fraction. New criteria will allow for targeted therapies, diagnostic tests and further understanding of the patients, both at-risk for and with heart failure. Trial registration ClinicalTrials.gov NCT02052804.
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Affiliation(s)
- Justin A Ezekowitz
- Mazankowski Alberta Heart Institute, 2C2 WMC, 8440-112 Street, Edmonton, AB, Canada.
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Abstract
Left ventricular assist devices (LVADs) are an effective therapy for patients with advanced heart failure, increasing patient survival and quality of life. Left ventricular assist devices are associated with the risks of bleeding and thrombosis. We used lactate dehydrogenase (LDH) and brain natriuretic peptide (BNP) as biomarkers for developing a thrombosis risk index. Data from a single center was retrospectively queried between January 1, 2008, and 10/15, 2011, to identify LVAD patients and related complications. Of 75 consecutive patients implanted with an LVAD, nine had device thrombosis. Analysis of the relationship among international normalized ratio (INR), BNP, LDH, and device thrombosis was performed. Of nine patients with thrombosis, seven had at least 30% of INR readings below 1.5 and two had at least 22% below the therapeutic range from the time of LVAD implant to date of thrombosis. Timeline variability in INR, BNP, and LDH were used to calculate thrombosis risk index (TRI). The TRI retrospectively was able to accurately predict patients with impending device thrombosis. Indexed rise in BNP and LDH in LVAD patients may be useful to identify early device dysfunction and possible future thrombosis. Fibrinogen and D-dimer assays are currently being evaluated in these patients for their possible inclusion and added value to the TRI.
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Abstract
The prevalence of heart failure (HF) is increasing. A distinction is made between diastolic HF (preserved left ventricular ejection fraction (LVEF)) and systolic HF (reduced LVEF). Advanced glycation end-products (AGEs) are crystallized proteins that accumulate during ageing, but are particularly increased in patients with diabetes mellitus and in patients with renal failure. Through the formation of collagen crosslinks, and by interaction with the AGE-receptor, which impairs calcium handling and increases fibrosis, AGE-accumulation has pathophysiologically been associated with the development of diastolic and renal dysfunction. Interestingly, diastolic dysfunction is a frequent finding in elderly patients, diabetic patients and in patients with renal failure. Taken together, this suggests that AGEs are related to the development and progression of diastolic HF and renal failure. In this review, the role of AGEs as a possible pathophysiological factor that link the development and progression of heart and renal failure, is discussed. Finally, the role of AGE intervention as a possible treatment in HF patients will be discussed.
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Patel K, Fonarow GC, Kitzman DW, Aban IB, Love TE, Allman RM, Gheorghiade M, Ahmed A. Aldosterone antagonists and outcomes in real-world older patients with heart failure and preserved ejection fraction. JACC. HEART FAILURE 2013; 1:40-7. [PMID: 23814702 PMCID: PMC3694622 DOI: 10.1016/j.jchf.2012.08.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the clinical effectiveness of aldosterone antagonists in older patients with heart failure and preserved ejection fraction (HF-PEF). BACKGROUND Aldosterone antagonists improve outcomes in HF and reduced EF. However, their role in HF-PEF remains unclear. METHODS Of the 10,570 hospitalized older (65 years of age) HF-PEF (EF 40%) patients in the Medicare-linked OPTIMIZE-HF(Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) trial, 8,013 patients had no prior aldosterone antagonist use and no current contraindications; 492 (6% of these 8,013) patients received new prescriptions for aldosterone antagonists. We assembled a matched cohort of 487 pairs of patients receiving and not receiving aldosterone antagonists, who had a similar propensity to receive these drugs and were balanced on 116 baseline characteristics. RESULTS Patients had a mean age of 80 years old, a mean EF of 54%, 59% were women, and 8% were African American. During 2.4 year of mean follow-up (through December 2008), the primary composite endpoint of all-cause mortality or HF hospitalization occurred in 392 (81%) and 393 (81%) patients receiving and not receiving aldosterone antagonists, respectively (hazard ratio [HR]: 0.97; 95% confidence interval [CI]: 0.84 to 1.11; p = 0.628). Aldosterone antagonists had no association with all-cause mortality (HR: 1.03; 95% CI: 0.89 to 1.20; p = 0.693) or HF hospitalization (HR: 0.88; 95% CI: 0.73 to 1.07; p = 0.188). Among 8013 prematched patients, multivariable-adjusted HR for the primary composite endpoint associated with aldosterone antagonist use was 0.93 (95% CI: 0.83 to 1.03; p = 0.144). CONCLUSIONS In older HF-PEF patients, aldosterone antagonists had no association with clinical outcomes. Findings from the ongoing randomized controlled TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial will provide further insights into their effect in HF-PEF.
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Affiliation(s)
- Kanan Patel
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | - Richard M. Allman
- University of Alabama at Birmingham, Birmingham, AL, USA
- Veterans Affairs Medical Center, Birmingham, AL, USA
| | | | - Ali Ahmed
- University of Alabama at Birmingham, Birmingham, AL, USA
- Veterans Affairs Medical Center, Birmingham, AL, USA
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McSweeney J, Pettey C, Lefler LL, Heo S. Disparities in heart failure and other cardiovascular diseases among women. WOMEN'S HEALTH (LONDON, ENGLAND) 2012; 8:473-85. [PMID: 22757737 PMCID: PMC3459240 DOI: 10.2217/whe.12.22] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article reviews literature pertinent to cardiovascular disparities in women, focusing primarily on heart failure (HF). It provides an in-depth look at causes, biological influences, self-management and lack of adherence to HF-treatment guidelines in women. Disparities in treatment of causative factors of HF, such as myocardial infarction and hypertension, contribute to women having poorer HF outcomes than men. This article discusses major contributing reasons for nonadherence to medication regimes for HF in women, including advanced age at time of diagnosis, likelihood of multiple comorbidities, lack of social support and low socioeconomic status. Limited inclusion of women in clinical trials and the scarcity of gender analyses for HF and other cardiovascular diseases continues to limit the applicability of research findings to women.
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Affiliation(s)
- Jean McSweeney
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Negi SI, Jeong EM, Shukrullah I, Raicu M, Dudley SC. Association of low plasma adiponectin with early diastolic dysfunction. ACTA ACUST UNITED AC 2012; 18:187-91. [PMID: 22809257 DOI: 10.1111/j.1751-7133.2011.00276.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Diastolic dysfunction (DD) with preserved left ventricular (LV) ejection fraction (EF) has been linked to obesity. Adiponectin is a cytokine related to obesity and obesity-linked cardiovascular complications. The authors aimed to determine the independent association of DD with adiponectin. Fifty patients with impaired relaxation DD and a normal EF and age-matched normal controls were recruited. Plasma levels of total and high molecular weight (HMW) adiponectin were measured. Mid and low molecular weight (MMW+LMW) fractions of adiponectin were calculated by subtracting HMW fraction from total adiponectin. The DD group had significantly lower total (median, 4.4 vs 12.7 μg/mL; P=.001), HMW fraction (median, 1.3 vs 3.4 μg/mL; P=.02), and MMW+LMW fraction of adiponectin (median, 3.8 vs 7.2 μg/mL; P=.01). Body mass index (BMI) negatively correlated with total (r:-0.46, P=.003), HMW (r:-0.32, P=.038), and MMW+LMW (r:-0.40, P=.006) fractions of adiponectin. DD had an independent association with both BMI (P<.05) and total adiponectin (P<.001) in linear regression model using sex, BMI, blood pressure, and total adiponectin as covariates. DD was associated with BMI (P=.02), HMW fraction (P=.03), and MMW+LMW fraction (P=.004) in similar linear regression analyses. Adiponectin deficiency may be one explanation for the adiposity-related cardiac oxidation known to be involved in the pathogenesis of DD.
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Affiliation(s)
- Smita I Negi
- Section of Cardiology, University of Illinois at Chicago, Chicago, IL 60612, USA
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Bahrainy S, Vo M, Gill EA. Increased mortality in patients with conflicting diastolic parameters. Int J Cardiovasc Imaging 2011; 28:735-41. [PMID: 21626045 DOI: 10.1007/s10554-011-9891-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 05/12/2011] [Indexed: 01/19/2023]
Abstract
The aim of this study was to describe the clinical characteristics and mortality of patients with conflicting diastolic function during follow-up. Up to 30% of patients have conflicting diastolic function by echo Doppler and therefore cannot be classified into a distinct diastolic dysfunction category of stage 1, 2 or 3. Using our established echocardiography data base, we studied a cohort of 250 subjects with conflicting diastolic function. Each individual was compared to two controls with normal diastolic and systolic function. The pre-specified goal of the analysis was a 6-year follow-up. Patients with conflicting diastolic function were more likely to have diabetes, hypertension, and established coronary artery disease. The Cox proportional hazards model determined that the risk of death was significantly higher for conflicting patients compared to patients with normal diastolic parameters (HR: 1.83; 95% CI: 1.32-2.53), P < 0.001. After adjustment for covariates, the risk of death remained elevated for the conflicting group (HR: 1.56; 95% CI: 1.11-2.18), P = 0.009. Conflicting diastolic dysfunction is associated with an increased risk of death compared to individuals with normal function. In conclusion, this emphasizes the need to attain a more precise characterization and categorization for patients with diastolic dysfunction.
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Affiliation(s)
- Samira Bahrainy
- Division of Cardiology, University of Washington, Harborview Medical Center, Seattle, WA 98104, USA.
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Rogowski O, Shnizer S, Wolff R, Lewis BS, Amir O. Increased serum levels of oxidative stress are associated with hospital readmissions due to acute heart failure. Cardiology 2011; 118:33-7. [PMID: 21411994 DOI: 10.1159/000324192] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 01/04/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Inflammation and serum oxidative stress (OS) are important components in heart failure (HF) deterioration. In this study we tested the hypothesis that an increase in patients' sera OS levels is associated with acute HF (AHF) readmissions. METHODS Thirty consecutive patients (mean age 71 ± 10 years) admitted with AHF were included in the study. Serum OS in these patients was measured in-hospital and repeatedly after discharge over a period of 8 weeks of follow-up in which we reordered patients' HF readmissions. Of the 30 patients, 13 (43%) were readmitted (RAD group) and 17 (57%) did not require readmission (NRAD group). RESULTS OS levels before discharge from the first hospital admission in the 2 groups were similar (p = 0.84 and p = 0.56, respectively). However, using repeated measures ANOVA, we found that the interaction between the time points and the 2 groups of patients (RAD and NRAD) was statistically significant (p = 0.037). It is important to note that OS serum levels were more predictive of HF readmissions than were repeated simultaneous serum measurements of NT-proBNP (p = 0.97). CONCLUSIONS Increased OS levels in AHF patients, after they have been discharged from the hospital, are associated with higher HF readmission rates. In AHF, OS is a dynamic parameter associated with HF deterioration.
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Affiliation(s)
- Ori Rogowski
- Department of Internal Medicine E, Tel Aviv Sourasky Medical Center affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Immune-inflammatory dysregulation modulates the incidence of progressive fibrosis and diastolic stiffness in the aging heart. J Mol Cell Cardiol 2010; 50:248-56. [PMID: 20974150 DOI: 10.1016/j.yjmcc.2010.10.019] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 10/15/2010] [Indexed: 12/16/2022]
Abstract
Diastolic dysfunction in the aging heart is a grave condition that challenges the life and lifestyle of a growing segment of our population. This report seeks to examine the role and interrelationship of inflammatory dysregulation in interstitial myocardial fibrosis and progressive diastolic dysfunction in aging mice. We studied a population of C57BL/6 mice that developed progressive diastolic dysfunction over 30 months of life. This progressive dysfunction was associated with increasing infiltration of CD45(+) fibroblasts of myeloid origin. In addition, increased rates of collagen expression as measured by cellular procollagen were apparent in the heart as a function of age. These cellular and functional changes were associated with progressive increases in mRNA for MCP-1 and IL-13, which correlated both temporally and quantitatively with changes in fibrosis and cellular procollagen levels. MCP-1 protein was also increased and found to be primarily in the venular endothelium. Protein assays also demonstrated elevation of IL-4 and IL-13 suggesting a shift to a Th2 phenotype in the aging heart. In vitro studies demonstrated that IL-13 markedly enhanced monocyte-fibroblast transformation. Our results indicate that immunoinflammatory dysregulation in the aging heart induces progressive MCP-1 production and an increased shift to a Th2 phenotype paralleled by an associated increase in myocardial interstitial fibrosis, cellular collagen synthesis, and increased numbers of CD45(+) myeloid-derived fibroblasts that contain procollagen. The temporal association and functional correlations suggest a causative relationship between age-dependent immunoinflammatory dysfunction, fibrosis and diastolic dysfunction.
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Boyle AJ, Russell SD, Teuteberg JJ, Slaughter MS, Moazami N, Pagani FD, Frazier OH, Heatley G, Farrar DJ, John R. Low thromboembolism and pump thrombosis with the HeartMate II left ventricular assist device: analysis of outpatient anti-coagulation. J Heart Lung Transplant 2010; 28:881-7. [PMID: 19716039 DOI: 10.1016/j.healun.2009.05.018] [Citation(s) in RCA: 262] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 05/08/2009] [Accepted: 05/09/2009] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The HeartMate II (Thoratec, Pleasanton, CA) is an effective bridge to transplantation (BTT) but requires anti-coagulation with warfarin and aspirin. We evaluated the risk of thromboembolism and hemorrhage related to the degree of anti-coagulation as reflected by the international normalized ratio (INR). METHODS INRs were measured monthly for 6 months in all discharged HeartMate II BTT patients and at an event. Each INR was assigned to ranges of INRs. Adverse events analyzed were ischemic and hemorrhagic stroke, pump thrombosis, and bleeding requiring surgery or transfusion. Events were correlated to the INR during the event and at the start of the month. RESULTS In 331 patients discharged on support, 10 had thrombotic events (9 ischemic strokes, 3 pump thromboses), and 58 had hemorrhagic events (7 strokes, 4 hemorrhages requiring surgery, and 102 requiring transfusions). The median INR was 2.1 at discharge and 1.90 at 6 months. Although the incidence of stroke was low, 40% of ischemic strokes occurred in patients with INRs < 1.5 and 33% of hemorrhagic strokes were in patients with INRs > 3.0. The highest incidence of bleeding was at INRs > 2.5. CONCLUSIONS The rate of thromboembolism during long-term outpatient support with the HeartMate II is low. The low number of thrombotic events appears to be offset by a greater number of hemorrhagic events. An appropriate target INR is 1.5 to 2.5 in addition to aspirin therapy. In patients having recurrent episodes of bleeding, the risk of lowering the target INR appears to be small.
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Affiliation(s)
- Andrew J Boyle
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Hsich E, Gorodeski EZ, Starling RC, Blackstone EH, Ishwaran H, Lauer MS. Importance of treadmill exercise time as an initial prognostic screening tool in patients with systolic left ventricular dysfunction. Circulation 2009; 119:3189-97. [PMID: 19528334 PMCID: PMC4205105 DOI: 10.1161/circulationaha.109.848382] [Citation(s) in RCA: 37] [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
BACKGROUND We sought to determine whether treadmill exercise time may be of value as an initial prognostic screening tool in ambulatory patients with impaired systolic function who are referred for cardiopulmonary exercise testing. METHODS AND RESULTS We studied 2231 adult systolic heart failure patients (27% of whom were women) who underwent cardiopulmonary stress testing using a modified Naughton protocol. We assessed the value of treadmill exercise time for prediction of all-cause death and a composite of death or United Network for Organ Sharing status 1 heart transplantation. During a mean follow-up of 5 years, 742 patients (33%) died. There were 249 United Network for Organ Sharing status 1 heart transplants (11%). Treadmill exercise time was predictive of death and the composite outcome in both women and men, even after accounting for peak oxygen consumption and other clinical covariates (adjusted hazard ratio of lowest versus high sex-specific quartile for prediction of death 1.70, 95% confidence interval 1.05 to 2.75, P=0.03; for prediction of the composite outcome, 1.75, 95% confidence interval 1.15 to 2.66, P=0.009). For a 1-minute change in exercise time, there was a 7% increased hazard of death (eg, comparing 480 to 540 seconds, hazard ratio =1.07, 95% confidence interval 1.02 to 1.12, P=0.004). CONCLUSIONS Because cardiopulmonary stress testing is not available in every hospital, treadmill exercise time with a modified Naughton protocol may be of value as an initial prognostic screening tool.
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Affiliation(s)
- Eileen Hsich
- Department of Cardiovascular Medicine, Cleveland Clinic and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Additive prognostic value of cardiopulmonary exercise testing in elderly patients with heart failure. Clin Sci (Lond) 2009; 116:415-22. [DOI: 10.1042/cs20080111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To date, the role of CPET (cardiopulmonary exercise testing) for risk stratification in elderly patients with HF (heart failure) with depressed or preserved ventricular function has not been evaluated. In the present study, we analysed whether CPET is useful in predicting outcome in this population. A total of 220 NYHA (New York Heart Association) class I–III patients with HF ≥70 years of age [median age, 75 years; 23% had NYHA class III; and 59% had preserved ventricular systolic function (left ventricular ejection fraction ≥40%)] performed maximal CPET (peak expiratory exchange ratio >1.00). Median peak oxygen uptake was 11.9 ml·kg−1 of body weight·min−1, median V̇E/V̇CO2 slope (slope of the minute ventilation/carbon dioxide production ratio) was 33.2 and 45% had an EVR (enhanced ventilatory response) to exercise (V̇E/V̇CO2 slope ≥34). During 19 months of follow-up, 94 patients (43%) met the combined end point of death and hospital admission for worsening HF, arrhythmias or acute coronary syndromes. By Cox multivariable analysis, a creatinine clearance of <50 ml/min {HR (hazard ratio), 1.657 [95% CI (confidence interval), 1.055–2.602]} and EVR [HR, 1.965 (95% CI, 1.195–3.231)] were the best predictors of outcome, while ventricular function had no influence on prognosis. In conclusion, in elderly patients with HF, a steeper V̇E/V̇CO2 slope provides additional information for risk stratification across the spectrum of ventricular function and identifies a high-risk population, commonly not considered in exercise testing guidelines.
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