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Tona F, Civieri G, Vadori M, Masiero G, Iop L, Marra MP, Perin V, Cuciz E, Cecere A, Bernava G, Tansella D, Naumova N, Grewal S, Cozzi E, Iliceto S. Association of Angiotensin II Receptor Type 1 and Endothelin-1 Receptor Type A Agonistic Autoantibodies With Adverse Remodeling and Cardiovascular Events After Acute Myocardial Infarction. J Am Heart Assoc 2024; 13:e032672. [PMID: 38348777 PMCID: PMC11010093 DOI: 10.1161/jaha.123.032672] [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: 09/15/2023] [Accepted: 12/27/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND The left ventricular remodeling (LVR) process has limited the effectiveness of therapies after myocardial infarction. The relationship between autoantibodies activating AT1R-AAs (angiotensin II receptor type 1-AAs) and ETAR-AAs (autoantibodies activating endothelin-1 receptor type A) with myocardial infarction has been described. Among patients with ST-segment-elevation myocardial infarction, we investigated the relationship between these autoantibodies with LVR and subsequent major adverse cardiac events. METHODS AND RESULTS In this prospective observational study, we included 131 patients with ST-segment-elevation myocardial infarction (61±11 years of age, 112 men) treated with primary percutaneous coronary intervention. Within 48 hours of admission, 2-dimensional transthoracic echocardiography was performed, and blood samples were obtained. The seropositive threshold for AT1R-AAs and ETAR-AAs was >10 U/mL. Patients were followed up at 6 months, when repeat transthoracic echocardiography was performed. The primary end points were LVR, defined as a 20% increase in left ventricular end-diastolic volume index, and major adverse cardiac event occurrence at follow-up, defined as cardiac death, nonfatal re-myocardial infarction, and hospitalization for heart failure. Forty-one (31%) patients experienced LVR. The prevalence of AT1R-AAs and ETAR-AAs seropositivity was higher in patients with versus without LVR (39% versus 11%, P<0.001 and 37% versus 12%, P=0.001, respectively). In multivariable analysis, AT1R-AAs seropositivity was significantly associated with LVR (odds ratio [OR], 4.66; P=0.002) and represented a risk factor for subsequent major adverse cardiac events (OR, 19.6; P=0.002). CONCLUSIONS AT1R-AAs and ETAR-AAs are associated with LVR in patients with ST-segment-elevation myocardial infarction. AT1R-AAs are also significantly associated with recurrent major adverse cardiac events. These initial observations may set the stage for a better pathophysiological understanding of the mechanisms contributing to LVR and ST-segment-elevation myocardial infarction prognosis.
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Affiliation(s)
- Francesco Tona
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
| | - Giovanni Civieri
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
| | - Marta Vadori
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
| | - Laura Iop
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
| | - Valentina Perin
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
| | - Elisa Cuciz
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
| | - Annagrazia Cecere
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
| | - Giacomo Bernava
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
| | - Donatella Tansella
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
| | - Nataliia Naumova
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
| | | | - Emanuele Cozzi
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences, and Public HealthUniversity of PaduaPaduaItaly
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Hsiao CS, Hsiao SH, Chiou FR, Chiou KR. Early predicting improvement of severe systolic heart failure by left atrial volume. Heart Vessels 2023; 38:523-534. [PMID: 36409354 DOI: 10.1007/s00380-022-02199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
Abstract
Left atrium (LA) modulates left ventricle (LV) filling and cardiac performance. We aimed to assess the effect of heart failure (HF) therapy on LA and LV function, and the relationship between LA/LV improvement and clinical outcome in acute HF with reduced LV ejection fraction (LVEF). Totally, 224 hospitalized patients with acute HF and LVEF < 35% were enrolled and underwent echocardiography. They all received maximal tolerable doses of evidence-based medications. Patients received echocardiographic measurements at each visit including stroke volume, LVEF, LA minimal/maximal volume (LAVmin/LAVmax), LA expansion index, and tissue Doppler parameters. The threshold of LV functional improvement was LVEF > 45% ever occurred before study end. During the mean follow-up of 6.3 years, 62 cases improved well, mean LVEF 49 ± 5% at study end. The reduction of LV filling pressure occurring as early as 2 weeks later, LV systolic function improvement took longer (> 1 month). The reductions in LAVmin and LAVmax between initial stabilization and 2 weeks after HF treatment (Initial-2 W) and the increase of LA expansion index (Initial-2 W) were associated independently with LVEF improvement (p 0.002, 0.006, and 0.007, respectively). The best predictor of LVEF improvement was LAVmin reduction (Initial-2 W) > 5 ml with 77% sensitivity, 76% specificity. Cox proportional hazard regression analyses for cardiovascular events revealed LVEF improvement reduced 74% of events (hazard ratio 0.264, 95% CI 0.192-0.607, p < 0.0001); and LA expansion index (per 1% increase) reduced 14% of events (hazard ratio 0.862, 95% CI 0.771-0.959, p < 0.0001). The early reduction of LAV (Initial-2 W), especially LAVmin, is a powerful early predictor of LVEF improvement. Its occurrence reduces cardiovascular events significantly. ClinicalTrials.gov number: NCT01307722.
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Affiliation(s)
- Chao-Sheng Hsiao
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,Department of Internal Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shih-Hung Hsiao
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Fei-Ran Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuan-Rau Chiou
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. .,School of Medicine, Taipei Medical University, Taipei, Taiwan.
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Nallamshetty S, Castillo A, Nguyen A, Haddad F, Heidenreich P. Clinical predictors of improvement in left ventricular ejection fraction in U.S. veterans with heart failure. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 19:100183. [PMID: 38558863 PMCID: PMC10978352 DOI: 10.1016/j.ahjo.2022.100183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/09/2022] [Accepted: 07/14/2022] [Indexed: 04/04/2024]
Abstract
Background Our understanding of the factors associated with improvement of LVEF and a heart failure with improved EF (HFimpEF) phenotype remains incomplete. Methods We conducted a retrospective study using a national database of patients followed in the Veterans Affairs (VA) health system with serial assessment of left ventricular ejection fraction (LVEF) by echocardiography. We identified US veterans with a new diagnosis of heart failure with: (i) LVEF of <40 % in the 12 months prior to diagnosis, and (ii) follow-up LVEF assessment at least 6 months after their diagnosis. We defined HFimpEF as a final LVEF of ≥40 %. Results Among the 106,414 US veterans with an initial LVEF of <40 % in this analysis, 39,994 (37.6 %) had a final EF of >40 % after a median follow up of 5 years. Multivariate regression analysis identified several factors that were independently associated with LVEF improvement including female sex, younger age, higher BMI, and a history of specific comorbid conditions such as hypertension, valve disease, atrial fibrillation, connective tissue disease, liver disease, and malignancy (p < 0.001). Conversely, a history of ischemic heart disease and peripheral arterial disease, as well as specific racial backgrounds (Black and Hispanic) were associated with lower rates of LVEF improvement. The model c-statistic for predicting LVEF improvement was 0.70. Conclusions This large, detailed dataset facilitated an analysis of a large number of variables that significantly associated with HFimpEF; however, their combined discriminatory value for LVEF improvement remained modest, underscoring the complexity of the gene-environment-treatment interactions that govern LV function.
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Affiliation(s)
- Shriram Nallamshetty
- Cardiology Section, VA Palo Alto Healthcare Systems, Palo Alto, CA, United States of America
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Adrian Castillo
- Stanford IM Residency Program, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Andrew Nguyen
- Stanford IM Residency Program, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Francois Haddad
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Paul Heidenreich
- Cardiology Section, VA Palo Alto Healthcare Systems, Palo Alto, CA, United States of America
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
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Role of CCR2-Positive Macrophages in Pathological Ventricular Remodelling. Biomedicines 2022; 10:biomedicines10030661. [PMID: 35327464 PMCID: PMC8945438 DOI: 10.3390/biomedicines10030661] [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: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 12/10/2022] Open
Abstract
Even with recent advances in care, heart failure remains a major cause of morbidity and mortality, which urgently needs new treatments. One of the major antecedents of heart failure is pathological ventricular remodelling, the abnormal change in the size, shape, function or composition of the cardiac ventricles in response to load or injury. Accumulating immune cell subpopulations contribute to the change in cardiac cellular composition that occurs during ventricular remodelling, and these immune cells can facilitate heart failure development. Among cardiac immune cell subpopulations, macrophages that are recognized by their transcriptional or cell-surface expression of the chemokine receptor C-C chemokine receptor type 2 (CCR2), have emerged as playing an especially important role in adverse remodelling. Here, we assimilate the literature that has been generated over the past two decades describing the pathological roles that CCR2+ macrophages play in ventricular remodelling. The goal is to facilitate research and innovation efforts in heart failure therapeutics by drawing attention to the importance of studying the manner by which CCR2+ macrophages mediate their deleterious effects.
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Taylor P, Berg C, Thompson J, Dean K, Yuan T, Nallamshetty S, Tong I. Effective Access to Care in a Crisis Period: Hypertension Control During the COVID-19 Pandemic by Telemedicine. Mayo Clin Proc Innov Qual Outcomes 2021; 6:19-26. [PMID: 34805763 PMCID: PMC8590930 DOI: 10.1016/j.mayocpiqo.2021.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective To assess the effectiveness of telemedicine video visits in the management of hypertensive patients at home during the first year of the COVID-19 pandemic. Methods A quantitative analysis was performed of all home video visits coded with a diagnosis of essential hypertension during the first 12 months of the COVID-19 pandemic (March 2020 through February 2021). A total of 10,634 patients with 16,194 hypertension visits were present in our national telemedicine practice database during this time. Among this population, a total of 569 patients who had 1785 hypertension visits met the criteria of having 2 or more blood pressure (BP) readings, with the last BP reading occurring in the report period. We analyzed baseline characteristics and BP trends of these 569 patients during the study period. Voluntarily submitted patient satisfaction ratings, which were systematically requested at the end of each visit, were also analyzed. Results The mean age of the patients in this study cohort of 569 patients was 43.9 years, and 48.3% (275) were women. More than 62% (355) of the patients had an initial systolic BP (SBP) above 140 mm Hg, and 25.3% (144) had an initial SBP of greater than 160 mm Hg. The average number of visits during the study period was 3.1 visits per patient; an average of 6.4 BP measurements per patient were available. During the study period, 77% (438) of the patients experienced an improvement in either SBP or diastolic BP (DBP), with mean reductions of −9.7 mm Hg and −6.8 mm Hg in SBP and DBP, respectively. A total of 416 patients in the cohort started with a BP above 140/90 mm Hg. For this subset of patients, 55.7% (232) achieved a BP of 140/90 mm Hg or lower by the end of the study period, and the average reductions in SBP and DBP were −17.9 mm Hg and −12.8 mm Hg, respectively, which corresponded to improvements of 11.2% and 12.4%. These improvements did not vary significantly when patients were stratified by age, sex, or geographic region of residence (rural vs urban/suburban). Voluntarily submitted patient surveys indicated a high degree of patient satisfaction, with a mean satisfaction score of 4.94 (5-point scale). Conclusion Clinician-patient relationships established in a video-first telemedicine model were broadly effective for addressing suboptimally controlled hypertension. Patient satisfaction with these visits was high.
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Affiliation(s)
| | | | | | | | | | - Shriram Nallamshetty
- Cardiology Section, Veterans Administration Palo Alto Healthcare System, Palo Alto, CA
- Division of Cardiovascular Medicine, Stanford Medicine, Stanford, CA
| | - Ian Tong
- Doctor on Demand, San Francisco, CA
- Department of Medicine, Stanford Medicine, Stanford, CA
- Correspondence: Address to Ian Tong, MD, Doctor on Demand/Grand Rounds Health, 1 California St, Ste 2300, San Francisco, CA 94111.
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Haji K, Marwick TH, Stewart S, Carrington M, Chan YK, Chan W, Huynh Q, Neil C, Wong C. Incremental Value of Global Longitudinal Strain in the Long-Term Prediction of Heart Failure among Patients with Coronary Artery Disease. J Am Soc Echocardiogr 2021; 35:187-195. [PMID: 34508839 DOI: 10.1016/j.echo.2021.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heart failure (HF) remains a common complication for patients with coronary artery disease (CAD), especially after acute myocardial infarction. Although left ventricular ejection fraction (LVEF) is conventionally used to assess cardiac function for risk stratification, it has been shown in other settings to underestimate the risk of HF compared with global longitudinal strain (GLS). Moreover, most evidence pertains to early-onset HF. We sought the clinical and myocardial predictors for late-onset HF in patients with CAD. METHODS We analyzed echocardiograms (including GLS) in 334 patients with CAD (ages 65 ± 11 years, 77% male) who were enrolled in the Nurse-Led Intervention for Less Chronic Heart Failure trial, a prospective, randomized controlled trial that compared standard care with nurse-led intervention to prevent HF in individuals at risk of incident HF. Long-term (9 years) follow-up was obtained via data linkage. Analysis was performed using a competing-risk model. RESULTS Baseline LVEF values were normal or mildly impaired (LVEF ≥ 40%) in all subjects. After a median of 9 years of follow-up, 50 (15%) of the 334 patients had new HF admissions, and 68 (20%) died. In a competing-risk model, HF was associated with GLS (hazard ratio = 1.15 [1.05-1.25], P = .001), independent of estimated glomerular filtration rate (hazard ratio = 0.98 [0.97-0.99], P = .045), Charlson comorbidity score (hazard ratio = 1.64 [1.25-2.15], P < .001), or E/e' (hazard ratio = 1.08 [1.02-1.14], P = .01). Global longitudinal strain-but not conventional echocardiographic measures-added incremental value to a clinical model based on age, gender, and Charlson score (area under the curve, 0.78-0.83, P = .01). Global longitudinal strain was still associated with HF development in patients taking baseline angiotensin convertase enzyme inhibitors (hazard ratio = 1.21 [1.11-1.31], P < .01) and baseline beta-blockers (1.17 [1.09, 1.26]; P < .01). Mortality was associated with older men, risk factors (hypertension or diabetes), and comorbidities (AF and chronic kidney disease). CONCLUSIONS Global longitudinal strain is independently associated with risk of incident HF in patients admitted with CAD and provides incremental prognostic value to standard markers. Identifying an at-risk subgroup using GLS may be the focus of future randomized controlled trails to enable targeted therapeutic intervention.
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Affiliation(s)
- Kawa Haji
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, Western Health, Melbourne, Australia; Department of Medicine; and University of Melbourne, Melbourne, Australia.
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, Western Health, Melbourne, Australia; Department of Medicine; and University of Melbourne, Melbourne, Australia
| | - Simon Stewart
- Torrens University Australia, Adelaide, Australia; University of Glasgow, Glasgow, Scotland
| | | | - Yih-Kai Chan
- Australian Catholic University, Melbourne, Australia
| | - William Chan
- Cardiology Department, Western Health, Melbourne, Australia; Department of Medicine; and University of Melbourne, Melbourne, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Christopher Neil
- Cardiology Department, Western Health, Melbourne, Australia; Department of Medicine; and University of Melbourne, Melbourne, Australia
| | - Chiew Wong
- Department of Medicine; and University of Melbourne, Melbourne, Australia; Cardiology Department, Northern Health, Melbourne, Australia
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Tsutsui H, Isobe M, Ito H, Ito H, Okumura K, Ono M, Kitakaze M, Kinugawa K, Kihara Y, Goto Y, Komuro I, Saiki Y, Saito Y, Sakata Y, Sato N, Sawa Y, Shiose A, Shimizu W, Shimokawa H, Seino Y, Node K, Higo T, Hirayama A, Makaya M, Masuyama T, Murohara T, Momomura SI, Yano M, Yamazaki K, Yamamoto K, Yoshikawa T, Yoshimura M, Akiyama M, Anzai T, Ishihara S, Inomata T, Imamura T, Iwasaki YK, Ohtani T, Onishi K, Kasai T, Kato M, Kawai M, Kinugasa Y, Kinugawa S, Kuratani T, Kobayashi S, Sakata Y, Tanaka A, Toda K, Noda T, Nochioka K, Hatano M, Hidaka T, Fujino T, Makita S, Yamaguchi O, Ikeda U, Kimura T, Kohsaka S, Kosuge M, Yamagishi M, Yamashina A. JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure ― Digest Version ―. Circ J 2019; 83:2084-2184. [DOI: 10.1253/circj.cj-19-0342] [Citation(s) in RCA: 276] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | | | - Hiroshi Ito
- Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Division of Biophysiological Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Atsushi Hirayama
- The Division of Cardiology, Department of Medicine, Nihon University Graduate School of Medicine
| | | | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Masafumi Yano
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Kenji Yamazaki
- Department of Cardiology Surgery, Tokyo Women’s Medical University
| | - Kazuhiro Yamamoto
- Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
| | | | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shiro Ishihara
- Department of Cardiology, Nippon Medical School Musashi-Kosugi Hospital
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital
| | | | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takatoshi Kasai
- Cardiovascular Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Mahoto Kato
- Department of Cardiovascular Medicine, Nihon University Graduate School of Medicine
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shigeki Kobayashi
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masaru Hatano
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | | | - Takeo Fujino
- Department of Advanced Cardiopulmonary Failure, Kyushu University Graduate School of Medical Sciences
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
| | - Osamu Yamaguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Akira Yamashina
- Medical Education Promotion Center, Tokyo Medical University
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8
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Sharifov OF, Denney TS, Prabhu SD, Lloyd SG, Gupta H. Impact of medical therapy for cardiovascular disease on left ventricular diastolic properties and remodeling. IJC HEART & VASCULATURE 2019; 23:100365. [PMID: 31111086 PMCID: PMC6510698 DOI: 10.1016/j.ijcha.2019.100365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/02/2019] [Accepted: 04/15/2019] [Indexed: 01/08/2023]
Abstract
Background Left ventricular (LV) remodeling and diastolic properties are affected by both underlying cardiovascular disease/cardiovascular disease risk factors (CVDRFs) and corresponding medication therapy. However, these effects may not be apparent in patients with multiple CVDRFs. We evaluated the effect of medication classes on hemodynamics in a patient cohort with normal LV dimensions and systolic function. Methods In 38 participants (61 ± 7 years, 64 ± 9% LV ejection fraction) undergoing coronary angiography, LV pressure measurement and cardiac magnetic resonance imaging was performed. The effects of coronary artery disease (CAD), CVDRFs and their corresponding medication therapy on LV parameters were analyzed considering the number of CAD/CVDRFs and ‘adequacy’ of medication therapy to address each existing condition with specific indication-based medication classes. Results Of the patients studied, 68% had CAD, 87% had hypertension, 87% had dyslipidemia, and 45% had diabetes. Neither individual or total number of CAD/CVDRFs were associated with overall differences in LV diastolic parameters. However, those without (n = 20) and with (n = 18) ‘adequate’ medication therapy for underlying CAD/CVDRFs differed in values of LV end diastolic pressure (17 ± 4 vs. 11 ± 5 mm Hg, P < 0.001), wall stress (3.9 ± 1.6 vs. 2.2 ± 1.2 x1000 N/m2, P < 0.001), pressure/volume ratio (0.13 ± 0.04 vs. 0.08 ± 0.03 mm Hg/ml, P < 0.01), and mass/volume ratio (0.77 ± 0.20 vs. 0.92 ± 0.24 g/ml, P < 0.05), but not in systolic blood pressure or LV mass index. Conclusions Our results suggest an association between the degree of LV diastolic impairment and LV remodeling with the intensity of treatment for CAD/CVDRFs. Comprehensive treatment of all identified CAD/CVDRFs may be an important factor for the preservation of diastolic function.
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Affiliation(s)
- Oleg F Sharifov
- Departments of Medicine, University of Alabama at Birmingham, AL, USA
| | - Thomas S Denney
- Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA
| | - Sumanth D Prabhu
- Departments of Medicine, University of Alabama at Birmingham, AL, USA.,Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Steven G Lloyd
- Departments of Medicine, University of Alabama at Birmingham, AL, USA.,Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Himanshu Gupta
- Departments of Medicine, University of Alabama at Birmingham, AL, USA.,Veterans Affairs Medical Center, Birmingham, AL, USA.,Valley Medical Group, Paramus, NJ, USA
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9
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Cardiooncology. Basic principles of prevention and treatment of cardiotoxicity in cancer patients. КЛИНИЧЕСКАЯ ПРАКТИКА 2019. [DOI: 10.17816/clinpract10130-40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Advances in the diagnostics and treatment of cancer have led to improved survival of patients and decreased mortality. Cardiovascular complications (CVC) however, are among the most frequent side effects of anticancer treatment, which can have an adverse effect on the prognosis. This may be the result of cardiotoxicity, which involves direct effects of the radiation therapy and /or chemotherapy on the heart function and structure. Heart failure with cancer therapy was associated with a 3.5-fold increase in the risk of mortality compared with idiopathic cardiomyopathy. The cardiotoxicity risk assessment is often difficult, due to the different susceptibility of patients to drugs and their combinations, and coadministration of radiation therapy. Therefore, the likelihood of development and the time of occurrence of cardiotoxicity may vary and not always depend on the initial risk. Strategies for managing such patients are in most cases based on the expert opinion. This article provides recommendations for the prevention and therapy of cardiotoxicity, set out in the consensus of the European Society of Cardiology 2016.
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Katsi V, Georgiopoulos G, Laina A, Koutli E, Parissis J, Tsioufis C, Nihoyannopoulos P, Tousoulis D. Left ventricular ejection fraction as therapeutic target: is it the ideal marker? Heart Fail Rev 2018; 22:641-655. [PMID: 28601914 DOI: 10.1007/s10741-017-9624-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) consists the fastest growing clinical cardiac disease. HF patients are categorized on the basis of underlying left ventricular ejection fraction (LVEF) into HF with preserved EF (HFpEF), reduced LVEF (HFrEF), and mid-range LVEF (HFmrEF). While LVEF is the most commonly used surrogate marker of left ventricular (LV) systolic function, the implementation of two-dimensional echocardiography in estimating this parameter imposes certain caveats on current HF classification. Most importantly, LVEF could fluctuate in repeated measurements or even recover after treatment, thus blunting the borders between proposed categories of HF and enabling upward classification of patients. Under this prism, we sought to summarize possible procedures to improve systolic function in patients with HFrEF either naturally or by the means of pharmacologic and non-pharmacologic treatment and devices. Therefore, we reviewed established pharmacotherapy, including beta-blockers, inhibitors of renin-angiotensin-aldosterone axis, statins, and digoxin as well as novel treatments like sacubitril-valsartan, ranolazine, and ivabradine. In addition, we assessed evidence in favor of cardiac resynchronization therapy and exercise training programs. Finally, innovative therapeutic strategies, including stem cells, xanthine oxidase inhibitors, antibiotic regimens, and omega-3 polyunsaturated fatty acids, were also taken into consideration. We concluded that LVEF is subject to changes in HF after intervention and besides the aforementioned HFrEF, HFpEF, and HFmrEF categories, a new entity of HF patients with recovered LVEF should be acknowledged. An improved global and refined LV function assessment by sophisticated imaging modalities and circulating biomarkers is expected to render HF classification more accurate and indicate patients with viable-yet dysfunctional-myocardium and favorable characteristics as the ideal candidates for LVEF recovery by individualized HF therapy.
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Affiliation(s)
- V Katsi
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - G Georgiopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece.
| | - A Laina
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - E Koutli
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - J Parissis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - C Tsioufis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - P Nihoyannopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - D Tousoulis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
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11
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Bjerre J, Kyhl K, Gustafsson F, Kelbaek H, Engstrøm T, Olsen PS, Hasbak P, Vejlstrup N, Madsen PL. Longitudinal shortening of sub-epicardial myocytes in severe ischaemic cardiomyopathy: insights from gadolinium contrast cardiac magnetic resonance imaging. ESC Heart Fail 2017; 4:670-674. [PMID: 29030924 PMCID: PMC5695176 DOI: 10.1002/ehf2.12187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 04/11/2017] [Accepted: 04/27/2017] [Indexed: 11/11/2022] Open
Abstract
We present two patients with three‐vessel disease and severely depressed left ventricular (LV) systolic function where viability analysis by cardiac magnetic resonance imaging demonstrated areas of near‐transmural sub‐endocardial fibrosis and hence little chance of regaining systolic function as judged by conventional analysis from radial function. Despite the pessimistic cardiac magnetic resonance imaging analysis, however, the patients underwent full revascularization and regained impressive increases in LV systolic function mainly based on improved longitudinal systolic segment function. The cases highlight that sub‐epicardial, longitudinally oriented myocytes can contribute to overall LV systolic function and suggest taking their ‘piston‐function’ into consideration when analysing viability.
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Affiliation(s)
- Jenny Bjerre
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Kasper Kyhl
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Henning Kelbaek
- Department of Cardiology, Copenhagen University Hospital, Roskilde, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Skov Olsen
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Rigshospitalet, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Per Lav Madsen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
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12
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Hemingway H, Feder GS, Fitzpatrick NK, Denaxas S, Shah AD, Timmis AD. Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases: 33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BackgroundElectronic health records (EHRs), when linked across primary and secondary care and curated for research use, have the potential to improve our understanding of care quality and outcomes.ObjectiveTo evaluate new opportunities arising from linked EHRs for improving quality of care and outcomes for patients at risk of or with coronary disease across the patient journey.DesignEpidemiological cohort, health informatics, health economics and ethnographic approaches were used.Setting230 NHS hospitals and 226 general practices in England and Wales.ParticipantsUp to 2 million initially healthy adults, 100,000 people with stable coronary artery disease (SCAD) and up to 300,000 patients with acute coronary syndrome.Main outcome measuresQuality of care, fatal and non-fatal cardiovascular disease (CVD) events.Data platform and methodsWe created a novel research platform [ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER)] based on linkage of four major sources of EHR data in primary care and national registries. We carried out 33 complementary studies within the CALIBER framework. We developed a web-based clinical decision support system (CDSS) in hospital chest pain clinics. We established a novel consented prognostic clinical cohort of SCAD patients.ResultsCALIBER was successfully established as a valid research platform based on linked EHR data in nearly 2 million adults with > 600 EHR phenotypes implemented on the web portal (seehttps://caliberresearch.org/portal). Despite national guidance, key opportunities for investigation and treatment were missed across the patient journey, resulting in a worse prognosis for patients in the UK compared with patients in health systems in other countries. Our novel, contemporary, high-resolution studies showed heterogeneous associations for CVD risk factors across CVDs. The CDSS did not alter the decision-making behaviour of clinicians in chest pain clinics. Prognostic models using real-world data validly discriminated risk of death and events, and were used in cost-effectiveness decision models.ConclusionsEmerging ‘big data’ opportunities arising from the linkage of records at different stages of a patient’s journey are vital to the generation of actionable insights into the diagnosis, risk stratification and cost-effective treatment of people at risk of, or with, CVD.Future workThe vast majority of NHS data remain inaccessible to research and this hampers efforts to improve efficiency and quality of care and to drive innovation. We propose three priority directions for further research. First, there is an urgent need to ‘unlock’ more detailed data within hospitals for the scale of the UK’s 65 million population. Second, there is a need for scaled approaches to using EHRs to design and carry out trials, and interpret the implementation of trial results. Third, large-scale, disease agnostic genetic and biological collections linked to such EHRs are required in order to deliver precision medicine and to innovate discovery.Study registrationCALIBER studies are registered as follows: study 2 – NCT01569139, study 4 – NCT02176174 and NCT01164371, study 5 – NCT01163513, studies 6 and 7 – NCT01804439, study 8 – NCT02285322, and studies 26–29 – NCT01162187. Optimising the Management of Angina is registered as Current Controlled Trials ISRCTN54381840.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (RP-PG-0407-10314) (all 33 studies) and additional funding from the Wellcome Trust (study 1), Medical Research Council Partnership grant (study 3), Servier (study 16), NIHR Research Methods Fellowship funding (study 19) and NIHR Research for Patient Benefit (study 33).
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Affiliation(s)
- Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Gene S Feder
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Natalie K Fitzpatrick
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Anoop D Shah
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Adam D Timmis
- Farr Institute of Health Informatics Research, University College London, London, UK
- Barts Health NHS Trust, London, UK
- Farr Institute of Health Informatics Research, Queen Mary University of London, London, UK
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13
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Pituskin E, Mackey JR, Koshman S, Jassal D, Pitz M, Haykowsky MJ, Pagano JJ, Chow K, Thompson RB, Vos LJ, Ghosh S, Oudit GY, Ezekowitz JA, Paterson DI. Multidisciplinary Approach to Novel Therapies in Cardio-Oncology Research (MANTICORE 101-Breast): A Randomized Trial for the Prevention of Trastuzumab-Associated Cardiotoxicity. J Clin Oncol 2016; 35:870-877. [PMID: 27893331 DOI: 10.1200/jco.2016.68.7830] [Citation(s) in RCA: 261] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The primary toxicity of trastuzumab therapy for human epidermal growth factor receptor 2-overexpressing (HER2-positive) breast cancer is dose-independent cardiac dysfunction. Angiotensin-converting enzyme inhibitors and β-blockers are recommended first-line agents for heart failure. We hypothesized that angiotensin-converting enzyme inhibitors and β-blockers could prevent trastuzumab-related cardiotoxicity. Patients and Methods In this double-blinded, placebo-controlled trial, patients with HER2-positive early breast cancer were randomly assigned to receive treatment with perindopril, bisoprolol, or placebo (1:1:1) for the duration of trastuzumab adjuvant therapy. Patients underwent cardiac magnetic resonance imaging at baseline and post-cycle 17 for the determination of left ventricular volumes and left ventricular ejection fraction (LVEF). Cardiotoxicity was evaluated as the change in indexed left ventricular end diastolic volume and LVEF. Results Thirty-three patients received perindopril, 31 received bisoprolol, and 30 received placebo. Baseline demographic, cancer, and cardiovascular profiles were similar between groups. Study drugs were well tolerated with no serious adverse events. After 17 cycles of trastuzumab, indexed left ventricular end diastolic volume increased in patients treated with perindopril (+7 ± 14 mL/m2), bisoprolol (+8 mL ± 9 mL/m2), and placebo (+4 ± 11 mL/m2; P = .36). In secondary analyses, trastuzumab-mediated decline in LVEF was attenuated in bisoprolol-treated patients (-1 ± 5%) relative to the perindopril (-3 ± 4%) and placebo (-5 ± 5%) groups ( P = .001). Perindopril and bisoprolol use were independent predictors of maintained LVEF on multivariable analysis. Conclusion Perindopril and bisoprolol were well tolerated in patients with HER2-positive early breast cancer who received trastuzumab and protected against cancer therapy-related declines in LVEF; however, trastuzumab-mediated left ventricular remodeling-the primary outcome-was not prevented by these pharmacotherapies.
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Affiliation(s)
- Edith Pituskin
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John R Mackey
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheri Koshman
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Davinder Jassal
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marshall Pitz
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark J Haykowsky
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph J Pagano
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelvin Chow
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard B Thompson
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Larissa J Vos
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sunita Ghosh
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gavin Y Oudit
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Justin A Ezekowitz
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
| | - D Ian Paterson
- Edith Pituskin John R. Mackey, Sheri Koshman, Mark J. Haykowsky, Joseph J. Pagano, Kelvin Chow, Richard B. Thompson, Larissa J. Vos, Sunita Ghosh, Gavin Y. Oudit, Justin A. Ezekowitz, and D. Ian Paterson, University of Alberta, Edmonton, Alberta; and Davinder Jassal and Marshall Pitz, University of Manitoba, Winnipeg, Manitoba, Canada
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14
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Ferrari R, Malagù M, Biscaglia S, Fucili A, Rizzo P. Remodelling after an Infarct: Crosstalk between Life and Death. Cardiology 2016; 135:68-76. [DOI: 10.1159/000445882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 11/19/2022]
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15
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Witte KK, Byrom R, Gierula J, Paton MF, Jamil HA, Lowry JE, Gillott RG, Barnes SA, Chumun H, Kearney LC, Greenwood JP, Plein S, Law GR, Pavitt S, Barth JH, Cubbon RM, Kearney MT. Effects of Vitamin D on Cardiac Function in Patients With Chronic HF: The VINDICATE Study. J Am Coll Cardiol 2016; 67:2593-603. [PMID: 27058906 PMCID: PMC4893154 DOI: 10.1016/j.jacc.2016.03.508] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 12/31/2022]
Abstract
Background Patients with chronic heart failure (HF) secondary to left ventricular systolic dysfunction (LVSD) are frequently deficient in vitamin D. Low vitamin D levels are associated with a worse prognosis. Objectives The VINDICATE (VitamIN D treatIng patients with Chronic heArT failurE) study was undertaken to establish safety and efficacy of high-dose 25 (OH) vitamin D3 (cholecalciferol) supplementation in patients with chronic HF due to LVSD. Methods We enrolled 229 patients (179 men) with chronic HF due to LVSD and vitamin D deficiency (cholecalciferol <50 nmol/l [<20 ng/ml]). Participants were allocated to 1 year of vitamin D3 supplementation (4,000 IU [100 μg] daily) or matching non−calcium-based placebo. The primary endpoint was change in 6-minute walk distance between baseline and 12 months. Secondary endpoints included change in LV ejection fraction at 1 year, and safety measures of renal function and serum calcium concentration assessed every 3 months. Results One year of high-dose vitamin D3 supplementation did not improve 6-min walk distance at 1 year, but was associated with a significant improvement in cardiac function (LV ejection fraction +6.07% [95% confidence interval (CI): 3.20 to 8.95; p < 0.0001]); and a reversal of LV remodeling (LV end diastolic diameter -2.49 mm [95% CI: -4.09 to -0.90; p = 0.002] and LV end systolic diameter -2.09 mm [95% CI: -4.11 to -0.06 p = 0.043]). Conclusions One year of 100 μg daily vitamin D3 supplementation does not improve 6-min walk distance but has beneficial effects on LV structure and function in patients on contemporary optimal medical therapy. Further studies are necessary to determine whether these translate to improvements in outcomes. (VitamIN D Treating patIents With Chronic heArT failurE [VINDICATE]; NCT01619891)
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Affiliation(s)
- Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom.
| | - Rowena Byrom
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Maria F Paton
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Haqeel A Jamil
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Judith E Lowry
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Richard G Gillott
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, United Kingdom
| | - Sally A Barnes
- Leeds Teaching Hospitals NHS Trust, Department of Cardiology, Leeds, United Kingdom
| | - Hemant Chumun
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Lorraine C Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Graham R Law
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Sue Pavitt
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - Julian H Barth
- Leeds Teaching Hospitals NHS Trust, Department of Clinical Biochemistry, Leeds, United Kingdom
| | - Richard M Cubbon
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Mark T Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
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16
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Maranta F, Spoladore R, Fragasso G. Pathophysiological Mechanisms and Correlates of Therapeutic Pharmacological Interventions in Essential Arterial Hypertension. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:37-59. [PMID: 27864806 DOI: 10.1007/5584_2016_169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Treating arterial hypertension (HT) remains a hard task. The hypertensive patient is often a subject with several comorbidities and metabolic abnormalities. Clinicians everyday have to choose the right drug for the single patient among the different classes of antihypertensives. Apart from lowering blood pressure, a main therapeutic target should be that of counteracting all the possible pathophysiological mechanisms involved in HT itself and in existing/potential comorbidities. All the ancillary positive and negative effects of the administered drugs should be considered: in particular, since hypertensive patients are often glucose intolerant/diabetic, carrier of serum lipids disorder, have already developed atherosclerotic diseases and endothelial dysfunction, they should not be treated with drugs negatively interfering with these conditions but with molecules that, if possible, improve them. The main pathophysiological mechanisms and correlates of therapeutic pharmacological interventions in essential HT are reviewed here.
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Affiliation(s)
- Francesco Maranta
- Clinical Cardiology, Heart Failure Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Spoladore
- Clinical Cardiology, Heart Failure Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Fragasso
- Clinical Cardiology, Heart Failure Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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17
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Mao S, Li X, Wang L, Yang PC, Zhang M. Rationale and Design of Sodium Tanshinone IIA Sulfonate in Left Ventricular Remodeling Secondary to Acute Myocardial Infarction (STAMP-REMODELING) Trial: A Randomized Controlled Study. Cardiovasc Drugs Ther 2015; 29:535-542. [PMID: 26482376 DOI: 10.1007/s10557-015-6625-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Left ventricular (LV) remodeling in ischemic cardiomyopathy is the leading cause of heart failure and is an established prognostic factor for adverse cardiovascular events. Experimental studies suggest that sodium tanshinone IIA sulfonate attenuates cardiac remodeling in animal models of acute myocardial infarction (AMI). However, the effects of this drug in the clinical setting remain unclear. Therefore, the STAMP-REMODELING trial is set up to investigate whether treatment with sodium tanshinone IIA sulfonate would prevent the maladaptive progression to adverse LV remodeling in patients following ST-segment elevation myocardial infarction (STEMI). METHODS Approximately 80 patients with STEMI successfully treated with primary percutaneous coronary intervention (PCI) will be enrolled and randomized to receive sodium tanshinone IIA sulfonate (80 mg q.d. for 7 days) in addition to standard therapy or the same volume of hydration per day. The primary endpoint is the variation in LV end-diastolic volume index (LVEDVi) assessed with cardiac magnetic resonance imaging (CMR) at baseline and 6 months. CONCLUSION This study will provide important clinical evidence on the efficacy of sodium tanshinone IIA sulfonate treatment in patients with STEMI when used in combination with current therapies that may significantly reduce adverse LV remodeling and potentially improve clinical outcomes. TRIAL REGISTRATION Clinical Trials.gov: NCT02524964.
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Affiliation(s)
- Shuai Mao
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Xiaotong Li
- School of Chemistry & Molecular Biosciences, The University of Queensland, Brisbane, 4072, Australia
| | - Lei Wang
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China
| | - Phillip C Yang
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Minzhou Zhang
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China. .,Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
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18
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Meijers WC, van der Velde AR, Pascual-Figal DA, de Boer RA. Galectin-3 and post-myocardial infarction cardiac remodeling. Eur J Pharmacol 2015; 763:115-21. [PMID: 26101067 DOI: 10.1016/j.ejphar.2015.06.025] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/01/2015] [Accepted: 06/15/2015] [Indexed: 01/13/2023]
Abstract
This review summarizes the current literature regarding the involvement and the putative role(s) of galectin-3 in post-myocardial infarction cardiac remodeling. Post-myocardial infarction remodeling is characterized by acute loss of myocardium, which leads to structural and biomechanical changes in order to preserve cardiac function. A hallmark herein is fibrosis formation, both in the early and late phase following acute myocardial infarction. Galectin-3, a β-galactoside-binding lectin, which is a shared factor in fibrosis formation in multiple organs, has an established role in cardiac fibrosis in the setting of pressure overload, neuro-endocrine activation and hypertension, but its role in post- myocardial infarction remodeling has received less attention. However, accumulative experimental studies have shown that myocardial galectin-3 expression is upregulated after myocardial infarction, both on mRNA and protein level. This already occurs shortly after myocardial infarction in the infarcted and border zone area, and also at a later stage in the spared myocardium, contributing to tissue repair and fibrosis. This is associated with typical aspects of fibrosis formation, such as apposition of matricellular proteins and increased factors of collagen turnover. Interestingly, myocardial fibrosis in experimental post-myocardial infarction cardiac remodeling could be attenuated by galectin-3 inhibition. In clinical studies, circulating galectin-3 levels have been shown to identify patients at risk for new-onset heart failure and atrial fibrillation. Circulating galectin-3 levels also predict progressive left ventricular dilatation after myocardial infarction. From literature we conclude that galectin-3 is an active player in cardiac remodeling after myocardial infarction. Future studies should focus on the dynamics of galectin-3 activation after myocardial infarction, and study the possibilities to target galectin-3.
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Affiliation(s)
- Wouter C Meijers
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - A Rogier van der Velde
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Domingo A Pascual-Figal
- University of Murcia, University Hospital Virgen de la Arrixaca, Department of Cardiology, Spain
| | - Rudolf A de Boer
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands.
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Huang CH, Chang CC, Kuo CL, Huang CS, Lin CS, Liu CS. Decrease in plasma cyclophilin A concentration at 1 month after myocardial infarction predicts better left ventricular performance and synchronicity at 6 months: a pilot study in patients with ST elevation myocardial infarction. Int J Biol Sci 2015; 11:38-47. [PMID: 25552928 PMCID: PMC4278253 DOI: 10.7150/ijbs.10271] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/05/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cyclophilin A (CyPA) concentration increases in acute coronary syndrome. In an animal model of acute myocardial infarction, administration of angiotensin-converting-enzyme inhibitor was associated with lower left ventricular (LV) CyPA concentration and improved LV performance. This study investigated the relationships between changes in plasma CyPA concentrations and LV remodeling in patients with ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS We enrolled 55 patients who underwent percutaneous coronary intervention for acute STEMI. Plasma CyPA, matrix metalloproteinase (MMP), interleukin-6 and high-sensitivity C-reactive protein concentrations were measured at baseline and at one-month follow-up. Echocardiography was performed at baseline and at one-, three-, and six-month follow-up. Patients with a decrease in baseline CyPA concentration at one-month follow-up (n = 28) had a significant increase in LV ejection fraction (LVEF) (from 60.2 ± 11.5% to 64.6 ± 9.9%, p < 0. 001) and preserved LV synchrony at six months. Patients without a decrease in CyPA concentration at one month (n = 27) did not show improvement in LVEF and had a significantly increased systolic dyssynchrony index (SDI) (from 1.170 ± 0.510% to 1.637 ± 1.299%, p = 0.042) at six months. Multiple linear regression analysis showed a significant association between one-month CyPA concentration and six-month LVEF. The one-month MMP-2 concentration was positively correlated with one-month CyPA concentration and LV SDI. Conclusions : Decreased CyPA concentration at one-month follow-up after STEMI was associated with better LVEF and SDI at six months. Changes in CyPA, therefore, may be a prognosticator of patient outcome.
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Affiliation(s)
- Ching-Hui Huang
- 1. Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan ; 2. Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan
| | - Chia-Chu Chang
- 3. Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan ; 4. School of Medicine, Chung Shan Medical University, Taichung 404, Taiwan
| | - Chen-Ling Kuo
- 5. Vascular and Genomic Research Center, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Ching-Shan Huang
- 5. Vascular and Genomic Research Center, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Chih-Sheng Lin
- 2. Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan
| | - Chin-San Liu
- 5. Vascular and Genomic Research Center, Changhua Christian Hospital, Changhua 500, Taiwan ; 6. Department of Neurology, Changhua Christian Hospital, Changhua 500, Taiwan ; 7. Graduate Institute of Integrative Medicine, China Medical University, Taichung 404, Taiwan
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Hartley LC, Girling AJ, Bowater RJ, Lilford RJ. A multistudy analysis investigating systematic differences in cardiovascular trial results between Europe and Asia. J Epidemiol Community Health 2014; 69:397-404. [PMID: 25480408 DOI: 10.1136/jech-2013-203646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess whether there are differences in the results of cardiovascular trials between Europe and Asia using data from an extensive collection of randomised controlled trials. STUDY DESIGN AND SETTING All meta-analyses containing randomised controlled trials (RCT's) for the treatment or prevention of cardiovascular diseases were searched for in The Cochrane Library (2000-2008) and MEDLINE (2005-2008). Analysis was then conducted within and over each meta-analysis which satisfied given criteria. Separate estimates of treatment effect were calculated for Europe and Asia in each meta-analysis and then compared. Estimates of a common inter-continental difference over all meta-analyses were also calculated and meta-regression was performed. This was performed for both fatal and non-fatal end points. RESULTS The literature search identified 59 meta-analyses that satisfied the inclusion criteria. After exclusion, the number of meta-analyses reporting greater effect sizes in Asia than in Europe was significantly more than would be expected by chance (fatal 12/14, p=0.013; non-fatal 23/32, p=0.020). CONCLUSIONS This study provides some evidence that for cardiovascular interventions treatment effect estimation differs between Europe and Asia, with respect to both fatal and non-fatal end points.
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Affiliation(s)
- Louise C Hartley
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Alan J Girling
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Russell J Bowater
- Faculty of Engineering, Universidad Autónoma de Querétaro, Cerro de las Campanas, Santiago de Querétaro, Qro, Mexico
| | - Richard J Lilford
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
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Serial dual single-photon emission computed tomography of thallium-201 and iodine-123 beta-methyliodophenyl pentadecanoic acid scintigraphy can predict functional recovery of patients with coronary artery disease after coronary artery bypass graft surgery. Nucl Med Commun 2014; 36:148-55. [PMID: 25321160 DOI: 10.1097/mnm.0000000000000228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND A mismatch between thallium-201 ((201)Tl) and iodine-123 ((123)I)-beta-methyl iodophenyl pentadecanoic acid (BMIPP) dual single-photon emission computed tomography (SPECT) reflects a dysfunctional but viable myocardium, such as stunned or hibernating myocardium, in patients with coronary artery disease (CAD). However, the cardiac function does not always improve after revascularization. The present study aimed to determine whether serial (201)Tl and (123)I-BMIPP dual SPECT can predict improvements in cardiac function after coronary artery bypass graft surgery (CABG) in patients with CAD. MATERIALS AND METHODS The study included 98 patients with CAD requiring CABG and having a left ventricular ejection fraction (LVEF) less than 50%. The total defect score (TDS) was calculated from (201)Tl and (123)I-BMIPP dual-SPECT images acquired before and 3 weeks after CABG. The LVEF, left ventricular end-diastolic volume index, and end-systolic volume index were determined by means of contrast left ventriculography before and 6 months after CABG. RESULTS After 6 months, LVEF improved by 5% or more in 62 patients (group A) but did not improve in the remaining 36 patients (group B). Baseline Tl-TDS was significantly lower (9.1±4.6 vs. 14.6±6.5, P<0.001), and the mismatch score (BMIPP-TDS-Tl-TDS) was significantly higher (6.9±4.2 vs. 4.2±3.9, P=0.002) in group A than in group B. The extent of change in BMIPP-TDS 3 weeks after CABG compared with that before (delta-BMIPP-TDS) was significantly greater in group A than in group B (-5.9±3.0 vs. 2.8±4.3, P<0.001). Stepwise multivariate analysis selected delta-BMIPP-TDS as a significant independent predictor of improvement in LVEF at 6 months after CABG (multivariate β-coefficient=-0.718, P<0.001). The degree of change in LVEF 6 months after CABG compared with that before significantly and negatively correlated with delta-BMIPP-TDS (r=-0.631, P<0.001). CONCLUSION The delta-BMIPP-TDS evaluated by serial (201)Tl and (123)I-BMIPP dual SPECT can predict improvements in cardiac function during the chronic phase of CAD.
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Need and evolution of need for device therapy in a community heart failure population. Eur J Heart Fail 2014; 10:601-7. [DOI: 10.1016/j.ejheart.2008.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 03/11/2008] [Accepted: 04/21/2008] [Indexed: 01/10/2023] Open
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Circulating angiotensin-converting enzyme is associated with left ventricular dysfunction, but not with central aortic hemodynamics. Int J Cardiol 2012; 166:540-1. [PMID: 23084549 DOI: 10.1016/j.ijcard.2012.09.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 09/25/2012] [Indexed: 11/20/2022]
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Patel K, Fonarow GC, Kitzman DW, Aban IB, Love TE, Allman RM, Gheorghiade M, Ahmed A. Angiotensin receptor blockers and outcomes in real-world older patients with heart failure and preserved ejection fraction: a propensity-matched inception cohort clinical effectiveness study. Eur J Heart Fail 2012; 14:1179-88. [PMID: 22759445 DOI: 10.1093/eurjhf/hfs101] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To examine the clinical effectiveness of angiotensin receptor blockers (ARBs) in older patients with heart failure and preserved ejection fraction (HF-PEF). METHODS AND RESULTS Of the 10 570 hospitalized HF-PEF patients, aged ≥ 65 years, EF ≥ 40%, in OPTIMIZE-HF (2003-2004), linked to Medicare data (up to 31 December 2008), 3806 were not receiving angiotensin-converting enzyme inhibitors or prior ARB therapy. Of these, 303 (8%) patients received new discharge prescriptions for ARBs. Propensity scores for the receipt of ARBs, estimated for each of the 3806 patients, were used to assemble a cohort of 296 pairs of patients receiving and not receiving ARBs, who were balanced on 114 baseline characteristics. Patients had a mean age of 80 years, mean EF of 55%, 69% were women, and 12% were African American. During 6 years of follow-up, the primary composite endpoint of all-cause mortality or HF hospitalization occurred in 79% (235/296) and 81% (241/296) of patients receiving and not receiving ARBs, respectively [hazard ratio (HR) associated with ARB use 0.88, 95% confidence interval (CI) 0.74-1.06; P = 0.179]. ARB use had no association with individual endpoints of all-cause mortality (HR 0.93, 95% CI 0.76-1.14; P = 0.509), HF hospitalization (HR 0.90, 95% CI, 0.72-1.14; P = 0.389), or all-cause hospitalization (HR 0.91, 95% CI 0.77-1.08; P = 0.265). These associations remained unchanged when we compared any (prevalent and new prescriptions) ARB use vs. non-use in a separately assembled propensity-matched cohort of 1137 pairs of HF-PEF patients. CONCLUSIONS In real-world older HF-PEF patients, ARB use was not associated with improved clinical outcomes.
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Affiliation(s)
- Kanan Patel
- University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA
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Juillière Y, Cambou JP, Bataille V, Mulak G, Galinier M, Gibelin P, Benamer H, Bouvaist H, Méneveau N, Tabone X, Simon T, Danchin N. Heart failure in acute myocardial infarction: a comparison between patients with or without heart failure criteria from the FAST-MI registry. Rev Esp Cardiol 2012; 65:326-33. [PMID: 22357361 DOI: 10.1016/j.recesp.2011.10.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 10/29/2011] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES To compare acute myocardial infarction patients with or without congestive heart failure in the French FAST-MI registry. METHODS The French FAST-MI registry included 374 centers and 3059 patients over a 1-month period at the end of 2005, with 1-year follow-up. Among this population, patients with at least one congestive heart failure criterion constituted group 1 (n=1149; 37.5%) and were compared to patients without congestive heart failure (group 2, n=1910; 62.5%). The congestive heart failure patients were further divided according to presence of both beta-blockers and antagonists of the renin-angiotensin-aldosterone system at hospital discharge (n=511) or not (n=498), in order to assess the real-world clinical importance of recommended medications. RESULTS Overall in-hospital and 1-year mortality rates were 3.4% and 13.2%, respectively. In hospital survivors, presence of congestive heart failure was associated with increased mortality (adjusted hazard ratio: 1.55; 95% confidence interval, 1.10-2.17; P=.01). Survival was higher in patients without congestive heart failure, compared with congestive heart failure patients receiving or not recommended medications (P<.001). Congestive heart failure patients receiving neither renin-angiotensin-aldosterone system blockers nor beta-blockers (adjusted hazard ratio: 1.66; 95% confidence interval, 1.08-2.55; P=.02) had a significantly higher risk of death than patients receiving both classes of medications (adjusted hazard ratio: 1.16; 95% confidence interval, 0.82-1.64; not statistically significant). Patients receiving only one of the recommended classes had an intermediate risk (adjusted hazard ratio: 1.47; 95% confidence interval, 1.04-2.07; P=.03). CONCLUSIONS Patients admitted for acute myocardial infarction with congestive heart failure criteria are still at very high risk of mortality. When receiving major recommended medications, they presented with significantly reduced mortality rates. Additional efforts should therefore be made to encourage the prescription of recommended medications in acute myocardial infarction patients with congestive heart failure.
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Affiliation(s)
- Yves Juillière
- Département de Cardiologie, Centre Hospitalier Universitaire, Nancy-Brabois-Vandoeuvre-les-Nancy, France.
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Fragasso G, Maranta F, Montanaro C, Salerno A, Torlasco C, Margonato A. Pathophysiologic therapeutic targets in hypertension: a cardiological point of view. Expert Opin Ther Targets 2012; 16:179-93. [DOI: 10.1517/14728222.2012.655724] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Holecki M, Szewieczek J, Chudek J. Effects of angiotensin-converting enzyme inhibitors beyond lowering blood pressure--are they important for doctors? Pharmacol Rep 2011; 63:740-51. [PMID: 21857085 DOI: 10.1016/s1734-1140(11)70586-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 11/18/2010] [Indexed: 01/19/2023]
Abstract
Large clinical trials and experimental studies have indicated that not all of the beneficial properties of angiotensin-converting enzyme inhibitors (ACE-Is) can be attributed to the lowering of blood pressure. The aim of this study was to assess doctors' opinions about the importance of the cardioprotective effects of ACE-Is beyond lowering blood pressure. The study participants (685 physicians) filled in a questionnaire testing doctors' knowledge of all of the therapeutic effects of ACE-Is not directly associated with lowering blood pressure and their clinical importance. In addition, each doctor filled in 20 questionnaires for subsequent patients treated with any ACE-I. Fifty-nine percent of the investigated physicians were aware of most of the therapeutic effects of ACE-Is. The most important therapeutic effects for the respondents were the following: reduction of peripheral resistance, inhibition of left ventricle hypertrophy, inhibition of vascular remodeling and atherosclerotic plaque stabilization. The most commonly prescribed ACE-Is were perindopril, lisinopril and chinalapril for inhibition of left ventricular hypertrophy and perindopril, ramipril and chinalapril for inhibition of arterial wall remodeling. The ACE-Is that were used to reduce peripheral vessel resistance included perindopril, lisinopril and trandolapril. Drugs used to stabilize the plaque included perindopril, lisinopril and cilazapril. The therapeutic effects of ACE-Is beyond lowering blood pressure were considered to be valid and important in daily clinical practice for the prevention of cardiovascular diseases and diabetic complications. The attribution of the effects of a particular ACE-I was not always in accordance with evidence-based medicine. The obtained treatment outcomes were attributed to the entire group of ACE-Is.
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Affiliation(s)
- Michał Holecki
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, Ziołowa 45-47, PL 40-635 Katowice, Poland
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Pituskin E, Haykowsky M, Mackey JR, Thompson RB, Ezekowitz J, Koshman S, Oudit G, Chow K, Pagano JJ, Paterson I. Rationale and design of the Multidisciplinary Approach to Novel Therapies in Cardiology Oncology Research Trial (MANTICORE 101--Breast): a randomized, placebo-controlled trial to determine if conventional heart failure pharmacotherapy can prevent trastuzumab-mediated left ventricular remodeling among patients with HER2+ early breast cancer using cardiac MRI. BMC Cancer 2011; 11:318. [PMID: 21794114 PMCID: PMC3171383 DOI: 10.1186/1471-2407-11-318] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/27/2011] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND MANTICORE 101 - Breast (Multidisciplinary Approach to Novel Therapies in Cardiology Oncology Research) is a randomized trial to determine if conventional heart failure pharmacotherapy (angiotensin converting enzyme inhibitor or beta-blocker) can prevent trastuzumab-mediated left ventricular remodeling, measured with cardiac MRI, among patients with HER2+ early breast cancer. METHODS/DESIGN One hundred and fifty-nine patients with histologically confirmed HER2+ breast cancer will be enrolled in a parallel 3-arm, randomized, placebo controlled, double-blind design. After baseline assessments, participants will be randomized in a 1:1:1 ratio to an angiotensin-converting enzyme inhibitor (perindopril), beta-blocker (bisoprolol), or placebo. Participants will receive drug or placebo for 1 year beginning 7 days before trastuzumab therapy. Dosages for all groups will be systematically up-titrated, as tolerated, at 1 week intervals for a total of 3 weeks. The primary objective of this randomized clinical trial is to determine if conventional heart failure pharmacotherapy can prevent trastuzumab-mediated left ventricular remodeling among patients with HER2+ early breast cancer, as measured by 12 month change in left ventricular end-diastolic volume using cardiac MRI. Secondary objectives include 1) determine the evolution of left ventricular remodeling on cardiac MRI in patients with HER2+ early breast cancer, 2) understand the mechanism of trastuzumab mediated cardiac toxicity by assessing for the presence of myocardial injury and apoptosis on serum biomarkers and cardiac MRI, and 3) correlate cardiac biomarkers of myocyte injury and extra-cellular matrix remodeling with left ventricular remodeling on cardiac MRI in patients with HER2+ early breast cancer. DISCUSSION Cardiac toxicity as a result of cancer therapies is now recognized as a significant health problem of increasing prevalence. To our knowledge, MANTICORE will be the first randomized trial testing proven heart failure pharmacotherapy in the prevention of trastuzumab-mediated cardiotoxicity. We expect the findings of this trial to provide important evidence in the development of guidelines for preventive therapy. TRIAL REGISTRATION ClinicalTrials.gov: NCT01016886.
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Transplantation of progenitor cells and regeneration enhancement in acute myocardial infarction (TOPCARE-AMI): final 5-year results suggest long-term safety and efficacy. Clin Res Cardiol 2011; 100:925-34. [PMID: 21633921 DOI: 10.1007/s00392-011-0327-y] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 05/23/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Limited data is available for investigating the long-term safety and effects of intracoronary progenitor cell therapy in patients with acute myocardial infarction (AMI). OBJECTIVE To assess the clinical course, NT-proBNP and MRI data as objective markers of cardiac function of the TOPCARE-AMI patients at 5-year follow-up. DESIGN The TOPCARE-AMI trial was the first randomized study investigating the effects of intracoronary infusion of circulating (CPC) or bone marrow-derived progenitor cells (BMC) in 59 patients with successfully reperfused AMI. RESULTS Five-year follow-up data were completed in 55 patients, 3 patients were lost to follow-up. None of the patients showed any signs of intramyocardial calcification or tumors at 5 years. One patient died during the initial hospitalization, no patient was rehospitalized for heart failure and 16 patients underwent target vessel revascularization (TVR). Only two TVRs occurred later than 1 year after cell administration making it very unlikely that the infused cells accelerate atherosclerotic disease progression. Serum levels of NT-proBNP remained significantly reduced at the 5-year follow-up indicating the absence of heart failure. MRI subgroup analysis in 31 patients documented a persistent improvement of LV ejection fraction (from 46 ± 10% at baseline to 57 ± 10% at 5 years, p < 0.001)). Simultaneously, there was a reduction (p < 0.001) in functional infarct size measured as late enhancement volume normalized to LV mass. However, whereas LV end-systolic volume remained stable, LV end-diastolic volume increased significantly. CONCLUSIONS The 5-year follow-up of the TOPCARE-AMI trial provides reassurance with respect to the long-term safety of intracoronary cell therapy and suggests favorable effects on LV function.
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Context-dependent effects of the angiotensin II type 2 receptor gene on left ventricular remodelling: the story continues. J Hypertens 2010; 28:1124-6. [DOI: 10.1097/hjh.0b013e32833ae553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zellweger MJ, Pfisterer ME. Therapeutic Strategies in Patients with Chronic Stable Coronary Artery Disease. Cardiovasc Ther 2010; 29:e23-30. [DOI: 10.1111/j.1755-5922.2010.00164.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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O'Grady MR, O'Sullivan ML, Minors SL, Horne R. Efficacy of benazepril hydrochloride to delay the progression of occult dilated cardiomyopathy in Doberman Pinschers. J Vet Intern Med 2009; 23:977-83. [PMID: 19572914 DOI: 10.1111/j.1939-1676.2009.0346.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Angiotensin converting enzyme inhibitors (ACEIs) are recommended in people to treat asymptomatic (occult) dilated cardiomyopathy (DCM). Efficacy of therapy in occult DCM in dogs is unknown. HYPOTHESIS ACEIs, specifically benazepril hydrochloride (BH), will delay the onset of overt DCM in Doberman Pinschers. ANIMALS Ninety-one Doberman Pinschers were studied, 57 dogs received BH, and 34 dogs no ACEI. METHODS Retrospective study of the medical records of all Doberman Pinschers with occult DCM that received BH or no ACEI between April 1989 and February 2003. Two criteria of left ventricular enlargement were used for enrollment: one independent of body weight (BW) (C1) and the other indexed to BW (C2). Cox proportional hazards analyses were used to identify variables associated with the onset of overt DCM. RESULTS On univariate analysis the median time to onset of overt DCM was significantly longer for the benazepril group (for C1: 425 days for BH, 95% confidence interval [CI] 264-625 days; 339 days for no ACEI, CI 172-453 days, P= .02; for C2: 454 days for BH, CI 264-628 days; 356 days for no ACEI, CI 181-547 days, P= .02). The hazard ratio (HR) (benazepril/no ACEI) was 0.57, CI 0.35-0.94, P= .03 for C1; HR = 0.56, CI 0.34-0.93, P= .02 for C2. On multivariate analysis, BH significantly delayed onset of overt DCM (HR [benazepril/no ACEI] = 0.45, CI 0.26-0.78, P < .01, for C1; HR = 0.36, CI 0.21-0.63, P < .01, for C2). CONCLUSIONS BH in particular and ACEIs in general might delay the progression of occult DCM. Prospective studies are warranted to test this theory.
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Affiliation(s)
- M R O'Grady
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, ON, Canada NIG 2W1.
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Kjekshus JK, Torp-Pedersen C, Gullestad L, Køber L, Edvardsen T, Olsen IC, Sjaastad I, Qvigstad E, Skomedal T, Osnes JB, Levy FO. Effect of piboserod, a 5-HT4 serotonin receptor antagonist, on left ventricular function in patients with symptomatic heart failure. Eur J Heart Fail 2009; 11:771-8. [PMID: 19567409 DOI: 10.1093/eurjhf/hfp087] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Myocardial 5-HT(4) serotonin (5-HT) receptors are increased and activated in heart failure (HF). Blockade of 5-HT(4) receptors reduced left ventricular (LV) remodelling in HF rats. We evaluated the effect of piboserod, a potent, selective, 5-HT(4) serotonin receptor antagonist, on LV function in patients with HF. METHODS AND RESULTS This was a prospective, double-blind, parallel group trial in patients with NYHA class II-IV HF and LV ejection fraction (EF) < or =0.35. Patients receiving standard HF treatment were randomized to placebo (n = 70) or piboserod 80 mg (n = 67) for 24 weeks including 4 weeks up titration. The primary endpoint was LVEF measured by cardiac magnetic resonance imaging (MRI). Secondary endpoints were LV volumes, N-terminal pro-brain natriuretic peptide, norepinephrine, quality of life, and 6 min walk test. Piboserod significantly increased LVEF by 1.7% vs. placebo (CI 0.3, 3.2, P = 0.020), primarily through reduced end-systolic volume from 165 to 158 mL (P = 0.060). There was a trend for greater increase in LVEF (2.7%, CI -1.1, 6.6, P = 0.15) in a small subset of patients not on chronic beta-blocker therapy. There was no significant effect on neurohormones, quality of life, or exercise tolerance. Patients on piboserod reported more adverse events, but numbers were too small to identify specific safety issues. CONCLUSION Although patients with chronic HF had a small but significant improvement in LVEF when treated with piboserod for 24 weeks, the result was not reflected in significant changes in other efficacy parameters, and its clinical relevance remains uncertain.
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Affiliation(s)
- John K Kjekshus
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.
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Left ventricular remodeling after acute myocardial infarction: does eplerenone have an effect? Am Heart J 2009; 157:1088-96. [PMID: 19464421 DOI: 10.1016/j.ahj.2009.04.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Accepted: 04/02/2009] [Indexed: 11/23/2022]
Abstract
AIMS Aldosterone antagonism reduces cardiovascular morbidity and mortality in patients with left ventricular (LV) systolic dysfunction and heart failure or diabetes after acute myocardial infarction (AMI). The mechanism of this effect is unclear. We performed a contrast-enhanced cardiac magnetic resonance study to assess the effects of eplerenone on LV remodeling after AMI. METHODS One hundred patients (mean age, 58.9 +/- 12 years; 77% male) with LV systolic dysfunction but without heart failure or diabetes were randomized to 24 weeks' double-blind treatment with eplerenone or placebo started 1 to 14 days after AMI. Contrast-enhanced cardiac magnetic resonance was performed, and plasma concentrations of matrix metalloproteinase-2 (MMP-2) and MMP-9 were measured before randomization and at 12 and 24 weeks. RESULTS Baseline LV ejection fraction was, by chance, significantly higher in eplerenone than in placebo-treated patients. Eplerenone had no effect on the primary end point (change in LV end-systolic volume index); after covariate adjustment, the primary end point fell by 6.1 +/- 2.7 mL/m2 with eplerenone compared to placebo (P = .027), and LV end-diastolic volume index fell by 7.5 +/- 3.4 mL/m2 (P = .031); eplerenone did not significantly influence LV ejection fraction. Eplerenone, after covariate adjustment, significantly decreased MMP-2 and increased MMP-9 over 24 weeks relative to placebo. CONCLUSIONS In a population of patients with AMI with high uptake of contemporary antiremodeling therapy, eplerenone provides modest incremental protection against LV remodeling, only after covariate adjustment.
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van de Ven LLM, van Veldhuisen DJ, Goulder M, Zilahi Z, Meyer WR, Willenheimer R. The effect of treatment with bisoprolol-first versus enalapril-first on cardiac structure and function in heart failure. Int J Cardiol 2009; 144:59-63. [PMID: 19481278 DOI: 10.1016/j.ijcard.2009.04.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 01/30/2009] [Accepted: 04/26/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND In CIBIS III, initiating chronic heart failure (CHF) treatment with bisoprolol (target dose 10 mg q.d.) followed by combination therapy with enalapril (target dose 10 mg b.i.d.), compared to the opposite order, showed similar effects on survival and hospitalization. By echocardiography, we evaluated the effects of these treatment strategies on cardiac structure and function. METHODS In a single-centre substudy, we compared the impact on left ventricular (LV) dimensions and ejection fraction (EF) of treatment with bisoprolol-first (n=21) and enalapril-first (n=19) in 40 beta-blocker and angiotensin-converting-enzyme-inhibitor naive patients, with stable, mild or moderate CHF (NYHA II-III) and LVEF ≤35%. Echocardiography was performed at baseline, after the 6-month monotherapy phase and after 12 months, i.e. after 6 months combination therapy. RESULTS Baseline characteristics were similar across treatment groups. After 6 months LVEF increased by 5.1±4.0 EF-% (P<0.0001) with Bisoprolol and 4.0±4.0 EF-% (P=0.0005), with enalapril (between-group P=0.47). LV end-diastolic volume (LVEDV) decreased by 8.1±4.7 ml (P<0.0001) with bisoprolol and by 4.6±8.2 ml (P=0.03) with enalapril (between-group P=0.16). Mean wall thickness (WT) decreased by 0.31±0.43 mm (P=0.004) with bisoprolol and by 0.18±0.48 mm (P=0.11) with enalapril (between-group P=0.29). From baseline to 12 months, LVEF increased by 7.5±4.0 EF-% (P<0.0001) in Bisoprolol first group and 6.0±4.6 EF-% (P<0.0001), in the enalapril first group (between-group P=0.31). LVEDV decreased by 12.9±6.3 ml (P<0.0001) with bisoprolol-first and by 7.9±7.7 ml (P=0.0006) with enalapril-first (between-group P=0.16) and WT decreased by 0.38±0.44 mm (P=0.0008) and 0.59±0.54 mm (P=0.0004), respectively (between-group P=0.10). CONCLUSION During both monotherapy and combined therapy, bisoprolol-first and enalapril-first similarly reversed cardiac remodelling and improved LVEF.
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Hori M, Nishida K. Oxidative stress and left ventricular remodelling after myocardial infarction. Cardiovasc Res 2008; 81:457-64. [PMID: 19047340 DOI: 10.1093/cvr/cvn335] [Citation(s) in RCA: 354] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In acute myocardial infarction (MI), reactive oxygen species (ROS) are generated in the ischaemic myocardium especially after reperfusion. ROS directly injure the cell membrane and cause cell death. However, ROS also stimulate signal transduction to elaborate inflammatory cytokines, e.g. tumour necrosis factor-alpha (TNF-alpha), interleukin (IL)-1beta and -6, in the ischaemic region and surrounding myocardium as a host reaction. Inflammatory cytokines also regulate cell survival and cell death in the chain reaction with ROS. Both ROS and inflammatory cytokines are cardiodepressant mainly due to impairment of intracellular Ca(2+) homeostasis. Inflammatory cytokines stimulate apoptosis through a TNF-alpha receptor/caspase pathway, whereas Ca(2+) overload induced by extensive ROS generation causes necrosis through enhanced permeability of the mitochondrial membrane (mitochondrial permeability transition). Apoptosis signal-regulating kinase-1 (ASK1) is an ROS-sensitive, mitogen-activated protein kinase kinase kinase that is activated by many stress signals and can activate nuclear factor kappaB and other transcription factors. ASK1-deficient mice demonstrate that the ROS/ASK1 pathway is involved in necrotic as well as apoptotic cell death, indicating that ASK1 may be a therapeutic target to reduce left ventricular (LV) remodelling after MI. ROS and inflammatory cytokines activate matrix metalloproteinases which degrade extracellular matrix, causing a slippage of myofibrils and hence LV dilatation. Consequently, collagen deposition is increased and tissue repair is enhanced with myocardial fibrosis and angiogenesis. Since the extent of LV remodelling is a major predictor of prognosis of the patients with MI, the therapeutic approach to attenuating LV remodelling is critically important.
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Affiliation(s)
- Masatsugu Hori
- Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.
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Therrien J, Provost Y, Harrison J, Connelly M, Kaemmerer H, Webb GD. Effect of angiotensin receptor blockade on systemic right ventricular function and size: a small, randomized, placebo-controlled study. Int J Cardiol 2008; 129:187-92. [PMID: 18672299 DOI: 10.1016/j.ijcard.2008.04.056] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 04/25/2008] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The effects of angiotensin converting enzyme inhibitor on systemic right ventricular size and function are unknown. METHODS Prospective, double blind, randomized, placebo-controlled clinical trial of 1-year therapy with Ramipril in adult patients with DTGA status postatrial baffle procedure. Primary endpoints were change in systemic right ventricular ejection fraction (RVEF) and right ventricular size assessed by magnetic resonance imaging (MRI). RESULTS Seventeen patients were enrolled into the study. Mean age at study enrollment was 26.4+/-5.2 years. Mean baseline RVEF was 44+/-6.5%, mean RVEDV was 206.3+/-75.5 ml. Eight patients were randomized to the treatment group and 9 patients were randomized to the placebo group. RVEF did not improve in the Ramipril group from baseline to 1 year (43.8+/-7.1% vs. 40.9+/-13.3%, p=0.52) and remain unchanged in the placebo group (44.3+/-6.3 vs. 46.3+/-9.6%, p=0.42). RVEDV (184.5+/-56.4 ml vs. 179.6+/-66.4 ml, p=0.64) and RVESV (109.5+/-19.4 ml vs. 111.8+/-30.1, p=0.74) remained unchanged in the Ramipril group from baseline to 1 year as well as in the placebo group (228.1+/-89.2 ml vs. 204.5+/-50.4 ml, p=0.42 and 117.5+/-36.9 ml vs. 117.4+/-26.2 ml, p=0.99, respectively). CONCLUSION One-year treatment with Ramipril does not seem to affect right ventricular function or size in adult patients with systemic right ventricles after a Mustard or Senning procedure. CONDENSED ABSTRACT 17 Adult patients (mean age of 26.4 +/- 5.2 years) with systemic right ventricles were blindly randomized to 1-year treatment with Ramipril placebo. Systemic right ventricular function (RVEF) and size (RVEDV) were assessed by magnetic resonance imaging at baseline and 1 year. RVEF failed to improve in the Ramipril group (43.8+/-7.1% vs. 40.9+/-13.3%, p=0.52) and remain unchanged in the placebo group (44.3+/-6.3 vs. 46.3+/-9.6%, p=0.42). RVEDV remained unchanged in the study group (184.5+/-56.4 ml vs. 179.6+/-66.4 ml, p=0.64 as well as in the placebo group (228.1 +/- 89.2 ml vs. 204.5 +/- 50.4 ml, p = 0.42). One-year treatment with Ramipril does not improve right ventricular function or attenuate remodeling in adult patients with systemic right ventricles.
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Affiliation(s)
- Judith Therrien
- MAUDE Unit, Jewish General Hospital and McGill University Health Center, McGill University, Montreal, Quebec, Canada
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Abstract
As part of the recommended modern post-myocardial infarction (MI) management, including reperfusion strategies, antiplatelet therapy, and beta-blockers, we may wonder whether the impact of early inhibition of the renin-angiotensin system (RAS) is as important as it was 20 years ago. This review demonstrates that significant clinical benefit can be derived from angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) even when added to other currently recommended treatment strategies in post-MI patients. Moreover, the effects of RAS inhibition extend far beyond the early post-MI neurohormonal activation and left ventricular remodeling phases. The favorable effects of RAS inhibition on important prognostic markers such as atrial fibrillation, renal function, and diabetes have recently been unraveled. Post-MI RAS inhibition also benefits all age groups, including elderly patients.
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ACE Inhibition in Heart Failure and Ischaemic Heart Disease. FRONTIERS IN RESEARCH OF THE RENIN-ANGIOTENSIN SYSTEM ON HUMAN DISEASE 2007. [PMCID: PMC7122740 DOI: 10.1007/978-1-4020-6372-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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