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Rosano GM, Vitale C, Spoletini I. Precision Cardiology: Phenotype-targeted Therapies for HFmrEF and HFpEF. INTERNATIONAL JOURNAL OF HEART FAILURE 2024; 6:47-55. [PMID: 38694928 PMCID: PMC11058434 DOI: 10.36628/ijhf.2023.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/01/2024] [Accepted: 03/08/2024] [Indexed: 05/04/2024]
Abstract
Heart failure with mid-range ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) represent over half of heart failure cases but lack proven effective therapies beyond sodium-glucose cotransporter 2 inhibitor and diuretics. HFmrEF and HFpEF are heterogeneous conditions requiring precision phenotyping to enable tailored therapies. This review covers concepts on precision medicine approaches for HFmrEF and HFpEF. Areas discussed include HFmrEF mechanisms, anti-inflammatory and antifibrotic treatments for obesity-related HFpEF, If inhibition for HFpEF with atrial fibrillation, and mineralocorticoid receptor antagonism for chronic kidney disease-HFpEF. Incorporating precision phenotyping and matched interventions in HFmrEF and HFpEF trials will further advance therapy compared to blanket approaches.
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Affiliation(s)
- Giuseppe M.C. Rosano
- Department of Human Sciences and Promotion of Quality of Life, Chair of Pharmacology, San Raffaele University of Rome, Rome, Italy
- Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
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Litwin SE, East CA. Assessing clinical and biomarker characteristics to optimize the benefits of sacubitril/valsartan in heart failure. Front Cardiovasc Med 2022; 9:1058998. [PMID: 36620638 PMCID: PMC9815716 DOI: 10.3389/fcvm.2022.1058998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Of the various medical therapies for heart failure (HF), sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor that combines sacubitril, a pro-drug that is further metabolized to the neprilysin inhibitor sacubitrilat, and the angiotensin II type 1 receptor blocker valsartan. Inhibition of neprilysin and blockade of the angiotensin II type 1 receptor with sacubitril/valsartan increases vasoactive peptide levels, increasing vasodilation, natriuresis, and diuresis. Left ventricular ejection fraction (LVEF) is widely used to classify HF, to assist with clinical decision-making, for patient selection in HF clinical trials, and to optimize the benefits of sacubitril/valsartan in HF. However, as HF is a complex syndrome that occurs on a continuum of overlapping and changing phenotypes, patient classification based solely on LVEF becomes problematic. LVEF measurement can be imprecise, have low reproducibility, and often changes over time. LVEF may not accurately reflect inherent disease heterogeneity and complexity, and the addition of alternate criteria to LVEF may improve phenotyping of HF and help guide treatment choices. Sacubitril/valsartan may work, in part, by mechanisms that are not directly related to the LVEF. For example, this drug may exert antifibrotic and neurohumoral modulatory effects through inhibition or activation of several signaling pathways. In this review, we discuss markers of cardiac remodeling, fibrosis, systemic inflammation; activation of neurohormonal pathways, including the natriuretic system and the sympathetic nervous system; the presence of comorbidities; patient characteristics; hemodynamics; and HF signs and symptoms that may all be used to (1) better understand the mechanisms of action of sacubitril/valsartan and (2) help to identify subsets of patients who might benefit from treatment, regardless of LVEF.
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Affiliation(s)
- Sheldon E. Litwin
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, United States,Ralph H. Johnson Veterans Affairs Health Network, Charleston, SC, United States,*Correspondence: Sheldon E. Litwin,
| | - Cara A. East
- Baylor Soltero Cardiovascular Research Center, Baylor Scott and White Research Institute, Dallas, TX, United States
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Effects of a multidisciplinary management program on symptom burden and medication adherence in heart failure patients with comorbidities: A randomized controlled trial. BMC Nurs 2022; 21:346. [PMID: 36476375 PMCID: PMC9727875 DOI: 10.1186/s12912-022-01130-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Comorbidities in heart failure (HF) are a complex clinical challenge. There is little data on the benefits of multidisciplinary postdischarge management programs in such patients. This study aimed to examine the effects of a multidisciplinary management program (MMP) on symptom burden and medication adherence in HF patients with comorbidities. METHODS In this clinical trial study, 94 HF patients with comorbidities were assigned to intervention (n = 47) and control (n = 47) groups by the stratified-random method. The intervention group underwent MMP supervised by a nurse for two months after discharge, including multi-professional visits, telephone follow-ups, and an educational booklet. Medication adherence and symptom burden were assessed using Morisky Medication Adherence Scale (MMAS) and Edmonton Symptom Assessment Scale (ESAS), respectively, on three occasions: Before discharge, six weeks, and eight weeks after discharge. RESULTS Both groups almost matched at the baseline, and the most frequent comorbidities included myocardial infarction (MI), hypertension, peptic ulcer, and depression, respectively. The interactive effect of time in groups showed that mean changes in total scores of symptom burden and medication adherence were significantly different (P < 0.001) at other time points. A significant increase in medication adherence (P < 0.001) and a significant reduction in the burden of all symptoms were observed in the intervention group compared to the control group from Time 1 to Time 3. CONCLUSIONS The MMP (targeting comorbidity) is a promising strategy for managing symptoms and medication adherence in HF patients with comorbidities.
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Hormonal characteristics of androgen status and their relationship with the anthropometric and metabolic parameter in men depending on the severity of hypertension. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.4.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. According to the literature data, long-term and poorly controlled hypertension (HTN) leads to target organs damage, and in some cases, to the development of associated diseases, the severity of which in men may be partly due to the characteristics of the androgenic status.The aim: to reveal the features of hormonal indicators of androgen status and their relationship with the anthropometric and metabolic characteristics of the therapeutic clinic male patients, depending on the severity of HTN.Materials and methods. 296 men aged 59,0 [54,0; 65,0] years with confirmed HTN were examined. All study participants in the morning on an empty stomach underwent anthropometry, determination of metabolic and androgenic status, and assessment of comorbid burden. Depending on the severity of hypertension, all patients were divided into two groups (G): G1 (n = 134) – patients with hypertension without a history of coronary artery disease or stroke; G2 (n = 162) – patients with hypertension with a history of ischemic heart disease (IHD) and/or stroke.Results. In male patients of G2 with severe HTN, a decrease in the levels of free testosterone (FT) and, to a greater extent, dehydroepiandrosterone sulfate (DHEA-S), as well as total cholesterol, high and low density lipoproteins, was revealed. The correlation analysis performed revealed statistically significant negative correlations between the levels of total testosterone (TT) and FT with body mass index, the value of the ratio of waist circumference to hips, only the level of FT – with the presence of IHD, chronic heart failure (CHF), disorders of carbohydrate metabolism and abdominal type of fat distribution, and the level of DHEA-S – with the presence of IHD and CHF.Conclusion. A decrease in FT and DHEA-S is associated with early progression of atherosclerosis and the risk of developing HTN-associated cardiovascular events, which can aggravate the course of HTN.
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Moyehodie YA, Muluneh MW, Belay AT, Fenta SM. Time to Death and Its Determinant Factors Among Patients With Chronic Heart Failure in Northwest Ethiopia: A Retrospective Study at Selected Referral Hospitals. Front Cardiovasc Med 2022; 9:817074. [PMID: 35600464 PMCID: PMC9120604 DOI: 10.3389/fcvm.2022.817074] [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: 11/19/2021] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Heart failure (HF) is a major health problem that affects patients and healthcare systems worldwide. It is the leading cause of morbidity and death and negatively impacts the quality of life, healthcare costs, and longevity. However, the causes of death were not well defined. This study aimed to identify the determinants of death among patients with HF in the Amhara Region, Northwest Ethiopia. Methods A multicenter retrospective cohort study was conducted on 285 patients in the age group 15 years or older under follow-up from 1 January 2015 to 31 December 2019. Descriptive analyses were summarized using the Kaplan–Meier survival curve and the log-rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to 5 years after they were admitted to the HF department to follow up on their treatment. Results Out of 285 patients with HF, 93(32.6%) of the respondents were dying within 5 years of follow-up. Anemia was the common comorbid disease (30.5%), and valvular heart disease was the most common etiology (33.7%) of chronic heart failure in this study. This study showed a significant mortality difference between hospitals. HF patients with hypertension [adjusted hazard ratio (AHR): 3.5076, 95% confidence interval (CI): 1.43, 8.60], anemia (AHR: 2.85, 95% 1.61, 5.03), pneumonia (AHR: 2.02, 95% 1.20, 3.39), chronic kidney disease (2.23, CI: 1.31, 3.77), and diabetes mellitus (AHR: 2.42, 95% CI: 1.43, 4.09) were at a higher risk of death. Moreover, patients with symptoms listed in the New York Heart Association Class (III and IV), Ischemic Heart Disease and unknown etiologies, men (AHR: 2.76, 95%:1.59, 4.78), and those with a high pulse rate (AHR: 1.02, 95%:1.00, 1.04) were at a higher risk of death. Conclusion There was a mortality difference between hospitals. This study has revealed that HF patients with anemia, diabetes mellitus, pneumonia, hypertension, chronic kidney disease, HF etiologies, severe New York Heart Association Class (III and IV), men, and high pulse rate were the main factors associated with death. Health professionals could give more attention to patients whose pulse rate is high, men, and a patient who had comorbidities in the ward.
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Doğanözü E, Ersoy O, Sezgin A, Ozin B. A Case Report of Ventricular Fibrillation Survival by Left Ventricular Assist Device for Hours. EXP CLIN TRANSPLANT 2022. [PMID: 35037608 DOI: 10.6002/ect.2021.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In recent years, the population of patients implanted with a left ventricular assist device has been increasing. Ventricular arrhythmias are the most interesting and most deadly complications among patients with these implants. Ventricular arrhythmias may cause cardiovascular collapse and death in some cases, whereas they may be asymptomatic or less symptomatic in others. In the case described here, we present the therapeutic approach to a patient with a left ventricular assist device who had ventricular fibrillation and the pathophysiology of his clinical condition.
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Affiliation(s)
- Ersin Doğanözü
- From the Department of Cardiology, 29 Mayis State Hospital, Ankara, Turkey
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Sokolski M, Reszka K, Suchocki T, Adamik B, Doroszko A, Drobnik J, Gorka-Dynysiewicz J, Jedrzejczyk M, Kaliszewski K, Kilis-Pstrusinska K, Konopska B, Kopec A, Larysz A, Lis W, Matera-Witkiewicz A, Pawlik-Sobecka L, Rosiek-Biegus M, Sokolska JM, Sokolowski J, Zapolska-Tomasiewicz A, Protasiewicz M, Madziarska K, Jankowska EA. History of Heart Failure in Patients Hospitalized Due to COVID-19: Relevant Factor of In-Hospital Complications and All-Cause Mortality up to Six Months. J Clin Med 2022; 11:jcm11010241. [PMID: 35011982 PMCID: PMC8746048 DOI: 10.3390/jcm11010241] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 02/04/2023] Open
Abstract
Background: Patients with heart failure (HF) are at high risk of unfavorable courses of COVID-19. The aim of this study was to evaluate characteristics and outcomes of COVID-19 patients with HF. Methods: Data of patients hospitalized in a tertiary hospital in Poland between March 2020 and May 2021 with laboratory-confirmed COVID-19 were analyzed. The study population was divided into a HF group (patients with a history of HF) and a non-HF group. Results: Out of 2184 patients (65 ± 13 years old, 50% male), 12% had a history of HF. Patients from the HF group were older, more often males, had more comorbidities, more often dyspnea, pulmonary and peripheral congestion, inflammation, and end-organ damage biomarkers. HF patients had longer and more complicated hospital stay, with more frequent acute HF development as compared with non-HF. They had significantly higher mortality assessed in hospital (35% vs. 12%) at three (53% vs. 22%) and six months (72% vs. 47%). Of 76 (4%) patients who developed acute HF, 71% died during hospitalization, 79% at three, and 87% at six months. Conclusions: The history of HF identifies patients with COVID-19 who are at high risk of in-hospital complications and mortality up to six months of follow-up.
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Affiliation(s)
- Mateusz Sokolski
- Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.M.S.); (A.Z.-T.); (M.P.); (E.A.J.)
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
- Correspondence: ; Tel.: +48-717331112
| | - Konrad Reszka
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
| | - Tomasz Suchocki
- Biostatistics Group, Department of Genetics, Wroclaw University of Environmental and Life Sciences, 51-631 Wroclaw, Poland;
| | - Barbara Adamik
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Adrian Doroszko
- Clinical Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Jarosław Drobnik
- Gerontology Unit, Public Health Department, Wroclaw Medical University, 51-618 Wroclaw, Poland;
| | - Joanna Gorka-Dynysiewicz
- Department of Pharmaceutical Biochemistry, Division of Pharmaceutical Biochemistry, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Maria Jedrzejczyk
- Department of Nursing and Obstetrics, Division of Internal Medicine Nursing, Wroclaw Medical University, 51-618 Wroclaw, Poland;
| | - Krzysztof Kaliszewski
- Clinical Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | | | - Bogusława Konopska
- Department of Pharmaceutical Biochemistry, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Agnieszka Kopec
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, 50-369 Wroclaw, Poland; (A.K.); (M.R.-B.)
| | - Anna Larysz
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
- Clinical Department of Heart Transplantation and Mechanical Circulatory Support, Institute of Heart Disease, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Weronika Lis
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
| | | | - Lilla Pawlik-Sobecka
- Division of Basic Sciences, Faculty of Health Sciences, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Marta Rosiek-Biegus
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, 50-369 Wroclaw, Poland; (A.K.); (M.R.-B.)
| | - Justyna M. Sokolska
- Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.M.S.); (A.Z.-T.); (M.P.); (E.A.J.)
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
| | - Janusz Sokolowski
- Clinical Department of Emergency Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Anna Zapolska-Tomasiewicz
- Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.M.S.); (A.Z.-T.); (M.P.); (E.A.J.)
| | - Marcin Protasiewicz
- Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.M.S.); (A.Z.-T.); (M.P.); (E.A.J.)
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
| | - Katarzyna Madziarska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Ewa A. Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.M.S.); (A.Z.-T.); (M.P.); (E.A.J.)
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland; (K.R.); (A.L.); (W.L.)
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Predicting the risk of stroke in patients with late-onset epilepsy: A machine learning approach. Epilepsy Behav 2021; 122:108211. [PMID: 34325155 DOI: 10.1016/j.yebeh.2021.108211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The goal of this cohort study was to estimate the predictors for ischemic stroke in patients with epilepsy in a large database containing data from general practitioners in Germany using machine learning methods. METHODS This retrospective cohort study included 11,466 patients aged ≥ 60 years with an initial diagnosis of epilepsy in 1182 general practices in Germany between January 2010 and December 2018 from the IQVIA Disease Analyzer database. The Sub-Population Optimization and Modeling Solutions (SOMS) tool was used to identify subgroups at a higher risk of stroke than the overall population with epilepsy based on 37 different variables. RESULTS A total of seven variables were considered important. Four co-diagnoses (diabetes, hypertension, heart failure, and alcohol dependence) were by far the strongest predictors with a combined predictive ability of more than 90%, whereby diabetes (41.4%) was the strongest predictor, followed by hypertension (35.0%) and heart failure (11.8%). The predictive importance of male gender was only 1.5%, and age was not recognized as an important predictor. Finally, the prescribed AEDs levetiracetam, with a predictive importance of 5.0%, and valproate, with 2.7%, were found to be weak predictors. CONCLUSION The stroke risk in patients with epilepsy was relatively high and could be predicted based on comorbidities such as diabetes mellitus, hypertension, heart failure, and alcohol dependence. Knowing and addressing these factors may help reduce the risk of stroke in patients with epilepsy.
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Gorcsan J. Can Left Atrial Strain Forecast Future Fibrillation? JACC Cardiovasc Imaging 2021; 14:145-147. [PMID: 33413884 DOI: 10.1016/j.jcmg.2020.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/18/2022]
Affiliation(s)
- John Gorcsan
- Division of Cardiology, Washington University in St. Louis, St. Louis, Missouri, USA.
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