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Harrington J. Anti-obesity medications in the management of heart failure with preserved ejection fraction: available evidence and next STEPS. Heart Fail Rev 2024; 29:939-944. [PMID: 38965119 DOI: 10.1007/s10741-024-10410-0] [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] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
Obesity is associated with an increased risk of incident heart failure with preserved ejection fraction (HFpEF) and, among patients with existing heart failure, is associated with worse quality of life, higher symptom burden, and more HF hospitalizations. Anti-obesity medication (AOM) semaglutide has been shown to be efficacious at both causing intentional weight loss and improving HF symptom burden, with some evidence to suggest that HF clinical events may also be reduced. Additional ongoing trials of AOM in patients with cardiovascular disease, including HFpEF, will further improve insight into the potential role of managing obesity to improve HF status among patients with HFpEF and obesity.
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Affiliation(s)
- Josephine Harrington
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.
- Duke Clinical Research Institute, 300 W. Morris St, Durham, NC, 27701, USA.
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Kao G, Xu G, Zhang Y, Li C, Xiao J. Predictive value of quality of life as measured by KCCQ in heart failure patients: A meta-analysis. Eur J Clin Invest 2024; 54:e14233. [PMID: 38666585 DOI: 10.1111/eci.14233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/07/2024] [Accepted: 04/06/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Studies on the predictive ability of disease-specific health quality of life (QoL) in patients with heart failure (HF) have produced conflicting results. To address these gaps in knowledge, we conducted a meta-analysis to evaluate the predictive value of QoL measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with HF. MATERIALS AND METHODS We searched PubMed, and Embase databases to identify studies investigating the predictive utility of baseline QoL measured by the KCCQ in HF patients. The outcome measures were all-cause mortality and HF hospitalisation. The predictive value of QoL was expressed by pooling the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the bottom versus the top category of KCCQ score or for per 10-point KCCQ score decrease. RESULTS Twelve studies reporting on 11 articles with a total of 34,927 HF patients were identified. Comparison of the bottom with the top KCCQ score, the pooled adjusted HR was 2.34 (95% CI 2.10-2.60) and 2.53 (95% CI 2.23-2.88) for all-cause mortality and HF hospitalisation, respectively. Additionally, a 10-point decrease in KCCQ score was associated with a 12% (95% CI 7%-16%) increased risk of all-cause mortality and a 14% (95% CI 13%-15%) increased risk of HF hospitalisation. CONCLUSIONS Poor health-related QoL as determined by the lower KCCQ score, was associated with an increased risk of all-cause mortality and HF hospitalisation in patients with HF. Measuring disease-specific health-related QoL using the KCCQ score may provide valuable predictive information for HF patients.
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Affiliation(s)
- Guoying Kao
- Department of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Gang Xu
- Department of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Ying Zhang
- Department of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Chuanwei Li
- Department of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Jun Xiao
- Department of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
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Ibrahim R, Pham HN, Ganatra S, Javed Z, Nasir K, Al-Kindi S. Social Phenotyping for Cardiovascular Risk Stratification in Electronic Health Registries. Curr Atheroscler Rep 2024; 26:485-497. [PMID: 38976220 DOI: 10.1007/s11883-024-01222-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE OF REVIEW Evaluation of social influences on cardiovascular care requires a comprehensive analysis encompassing economic, societal, and environmental factors. The increased utilization of electronic health registries provides a foundation for social phenotyping, yet standardization in methodology remains lacking. This review aimed to elucidate the primary approaches to social phenotyping for cardiovascular risk stratification through electronic health registries. RECENT FINDINGS Social phenotyping in the context of cardiovascular risk stratification within electronic health registries can be separated into four principal approaches: place-based metrics, questionnaires, ICD Z-coding, and natural language processing. These methodologies vary in their complexity, advantages and limitations, and intended outcomes. Place-based metrics often rely on geospatial data to infer socioeconomic influences, while questionnaires may directly gather individual-level behavioral and social factors. Z-coding, a relatively new approach, can capture data directly related to social determinant of health domains in the clinical context. Natural language processing has been increasingly utilized to extract social influences from unstructured clinical narratives-offering nuanced insights for risk prediction models. Each method plays an important role in our understanding and approach to using social determinants data for improving population cardiovascular health. These four principal approaches to social phenotyping contribute to a more structured approach to social determinant of health research via electronic health registries, with a focus on cardiovascular risk stratification. Social phenotyping related research should prioritize refining predictive models for cardiovascular diseases and advancing health equity by integrating applied implementation science into public health strategies.
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Affiliation(s)
- Ramzi Ibrahim
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, USA
| | - Hoang Nhat Pham
- Department of Medicine, University of Arizona Tucson, Tucson, AZ, USA
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Zulqarnain Javed
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Khurram Nasir
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Sadeer Al-Kindi
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA.
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Miyama H, Ikemura N, Kimura T, Katsumata Y, Yamashita S, Yamaoka K, Ibe S, Sekine O, Ueda I, Nakamura I, Negishi K, Kohsaka S, Takatsuki S, Ieda M. Predictors and incidence of health status deterioration in patients with early atrial fibrillation. Heart Rhythm 2024; 21:1469-1476. [PMID: 38599472 DOI: 10.1016/j.hrthm.2024.04.014] [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: 11/26/2023] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Various treatment approaches for atrial fibrillation (AF) have demonstrated improved health status, yet the significance of these therapeutic interventions in individual patients remains unclear. OBJECTIVE This study aimed to evaluate health status changes in patients with early AF, focusing on those who experience clinically significant deterioration after treatment initiation. METHODS We analyzed data from a multicenter, prospective registry of newly diagnosed patients with AF. One-year changes in health status across different treatment strategies were assessed by the Atrial Fibrillation Effect on QualiTy-of-life Overall Summary (AFEQT-OS) score. Clinically relevant deterioration and improvement in health status were defined as ≥5-point decrease and increase in AFEQT-OS score, respectively; no change was -5 to 5 points. RESULTS Overall, 1960 patients with AF were evaluated. Mean AFEQT-OS scores at baseline and 1-year follow-up were 76.7 ± 17.7 and 85.4 ± 14.8, respectively. Although most patients (53.9%) experienced clinically important improvement, a considerable proportion had no change (28.7%) or deterioration (17.4%) in their health status. Proportions of patients with no change or deterioration varied by treatment strategy: 59.9%, 53.9%, and 32.0% in rate control, antiarrhythmic drug, and catheter ablation groups, respectively. The multivariable model identified older age, female sex, heart failure, coronary artery disease, and higher baseline AFEQT-OS score as independent predictors of worsening health status, regardless of treatment strategy. CONCLUSION Many patients with early AF experience worsening or no change in health status irrespective of treatment strategy. Standardizing patients' health status assessment, especially for patients with comorbidities, may aid in patients' selection and their outcomes.
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Affiliation(s)
- Hiroshi Miyama
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan; Healthcare Institute for Innovations in Quality, University of Missouri, and Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yoshinori Katsumata
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shuhei Yamashita
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Koki Yamaoka
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Susumu Ibe
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Otoya Sekine
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Iwao Nakamura
- Department of Cardiology, Hino Municipal Hospital, Hino, Tokyo, Japan
| | - Koji Negishi
- Department of Cardiology, Yokohama Municipal Citizen's Hospital, Kanagawa-ku, Yokohama, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
| | - Masaki Ieda
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Fontana M, Berk JL, Gillmore JD, Witteles RM, Grogan M, Drachman B, Damy T, Garcia-Pavia P, Taubel J, Solomon SD, Sheikh FH, Tahara N, González-Costello J, Tsujita K, Morbach C, Pozsonyi Z, Petrie MC, Delgado D, Van der Meer P, Jabbour A, Bondue A, Kim D, Azevedo O, Hvitfeldt Poulsen S, Yilmaz A, Jankowska EA, Algalarrondo V, Slugg A, Garg PP, Boyle KL, Yureneva E, Silliman N, Yang L, Chen J, Eraly SA, Vest J, Maurer MS. Vutrisiran in Patients with Transthyretin Amyloidosis with Cardiomyopathy. N Engl J Med 2024. [PMID: 39213194 DOI: 10.1056/nejmoa2409134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Transthyretin amyloidosis with cardiomyopathy (ATTR-CM) is a progressive, fatal disease. Vutrisiran, a subcutaneously administered RNA interference therapeutic agent, inhibits the production of hepatic transthyretin. METHODS In this double-blind, randomized trial, we assigned patients with ATTR-CM in a 1:1 ratio to receive vutrisiran (25 mg) or placebo every 12 weeks for up to 36 months. The primary end point was a composite of death from any cause and recurrent cardiovascular events. Secondary end points included death from any cause, the change from baseline in the distance covered on the 6-minute walk test, and the change from baseline in the Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS) score. The efficacy end points were assessed in the overall population and in the monotherapy population (the patients who were not receiving tafamidis at baseline) and were tested hierarchically. RESULTS A total of 655 patients underwent randomization; 326 were assigned to receive vutrisiran and 329 to receive placebo. Vutrisiran treatment led to a lower risk of death from any cause and recurrent cardiovascular events than placebo (hazard ratio in the overall population, 0.72; 95% confidence interval [CI], 0.56 to 0.93; P = 0.01; hazard ratio in the monotherapy population, 0.67; 95% CI, 0.49 to 0.93; P = 0.02) and a lower risk of death from any cause through 42 months (hazard ratio, 0.65; 95% CI, 0.46 to 0.90; P = 0.01). A primary end-point event occurred in 163 patients in the vutrisiran group and in 202 in the placebo group. In the overall population, treatment with vutrisiran resulted in less of a decline in the distance covered on the 6-minute walk test than placebo (least-squares mean difference, 26.5 m; 95% CI, 13.4 to 39.6; P<0.001) and less of a decline in the KCCQ-OS score (least-squares mean difference, 5.8 points; 95% CI, 2.4 to 9.2; P<0.001). Similar benefits were observed in the monotherapy population. The incidence of adverse events was similar in the two groups (99% in the vutrisiran group and 98% in the placebo group); serious adverse events occurred in 62% of the patients in the vutrisiran group and in 67% of those in the placebo group. CONCLUSIONS Among patients with ATTR-CM, treatment with vutrisiran led to a lower risk of death from any cause and cardiovascular events than placebo and preserved functional capacity and quality of life. (Funded by Alnylam Pharmaceuticals; HELIOS-B ClinicalTrials.gov number, NCT04153149.).
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Affiliation(s)
- Marianna Fontana
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - John L Berk
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Julian D Gillmore
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Ronald M Witteles
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Martha Grogan
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Brian Drachman
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Thibaud Damy
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Pablo Garcia-Pavia
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Jorg Taubel
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Scott D Solomon
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Farooq H Sheikh
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Nobuhiro Tahara
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - José González-Costello
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Kenichi Tsujita
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Caroline Morbach
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Zoltán Pozsonyi
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Mark C Petrie
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Diego Delgado
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Peter Van der Meer
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Andrew Jabbour
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Antoine Bondue
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Darae Kim
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Olga Azevedo
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Steen Hvitfeldt Poulsen
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Ali Yilmaz
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Ewa A Jankowska
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Vincent Algalarrondo
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Andrew Slugg
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Pushkal P Garg
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Katherine L Boyle
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Elena Yureneva
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Nancy Silliman
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Lilli Yang
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Jihong Chen
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Satish A Eraly
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - John Vest
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
| | - Mathew S Maurer
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital (M.F., J.D.G.), and Richmond Pharmacology (J.T.), London, and the Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow (M.C.P.) - all in the United Kingdom; Boston University School of Medicine (J.L.B.) and the Cardiovascular Division, Brigham and Women's Hospital (S.D.S.) - both in Boston; the Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA (R.M.W.); the Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (M.G.); the Division of Cardiology, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia (B.D.); the Cardiology Department and French National Reference Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute and Clinical Investigation Centre 1430 at Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Creteil, Creteil (T.D.), and the Department of Cardiology, French National Reference Center for Cardiac Amyloidosis, Bichat University Hospital, AP-HP, Paris (V.A.) - all in France; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Health Research Institute of the Puerta de Hierro Majadahonda-Segovia, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER-CV), and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.), and CIBER-CV (J.G.-C.), Madrid, and the Department of Cardiology, Hospital Universitari de Bellvitge, Instituto de Investigación Biomédica de Bellvitge, and Universitat de Barcelona, Barcelona (J.G.-C.) - all in Spain; MedStar Heart and Vascular Institute, MedStar Health, and Georgetown University School of Medicine - both in Washington, DC (F.H.S.); the Division of Cardiovascular Medicine, Department of Medicine, Kurume University School of Medicine, Kurume (N.T.), and the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto (K.T.) - both in Japan; the Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, and the Department of Medicine I, University Hospital Würzburg, Würzburg (C.M.), and the Division of Cardiovascular Imaging, University Hospital Münster, Münster (A.Y.) - both in Germany; the Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary (Z.P.); the Department of Cardiology, University Health Network of Toronto, Toronto (D.D.); University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.V.M.); the Victor Chang Cardiac Research Institute, the Cardiology Department, St. Vincent's Hospital, and the School of Clinical Medicine, University of New South Wales - all in Sydney (A.J.); the Department of Cardiology, Hôpital Universitaire de Bruxelles-Hôpital Erasme, Université Libre de Bruxelles, Brussels (A.B.); the Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (D.K.); the Cardiology Department, Hospital Senhora da Oliveira-Guimarães, Guimarães, and the School of Medicine, University of Minho, Braga - both in Portugal (O.A.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); the Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland (E.A.J.); Alnylam Pharmaceuticals, Cambridge, MA (A.S., P.P.G., K.L.B., E.Y., N.S., L.Y., J.C., S.A.E., J.V.); and Columbia University Irving Medical Center, New York (M.S.M.)
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Sherrod CF, Saberi S, Nassif ME, Claggett BL, Coats CJ, Garcia-Pavia P, Januzzi JL, Lewis GD, Ma C, Maron MS, Miao ZM, Olivotto I, Veselka J, Butzner M, Jacoby DL, Heitner SB, Kupfer S, Malik FI, Meng L, Wohltman A, Spertus JA. Effect of Aficamten on Health Status Outcomes in Obstructive Hypertrophic Cardiomyopathy: Results from SEQUOIA-HCM. J Am Coll Cardiol 2024:S0735-1097(24)08166-X. [PMID: 39217569 DOI: 10.1016/j.jacc.2024.08.014] [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: 07/18/2024] [Revised: 08/07/2024] [Accepted: 08/10/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND A primary goal in treating obstructive hypertrophic cardiomyopathy (oHCM) is to improve patients' health status: their symptoms, function, and quality of life. The health status benefits of aficamten, a novel cardiac myosin inhibitor, have not been comprehensively described. OBJECTIVES This study sought to determine the effect of aficamten on patient-reported health status, including symptoms of fatigue, shortness of breath, chest pain, physical and social limitations, and quality of life. METHODS SEQUOIA-HCM (Phase 3 Trial to Evaluate the Efficacy and Safety of Aficamten Compared to Placebo in Adults With Symptomatic oHCM) randomized symptomatic adults with oHCM to 24 weeks of aficamten (n = 142) or placebo (n = 140), followed by a 4-week washout. The Kansas City Cardiomyopathy Questionnaire (KCCQ) and Seattle Angina Questionnaire 7-item (SAQ7) were serially administered. Changes in mean KCCQ-Overall Summary Score (KCCQ-OSS) and SAQ7-Summary Score (SAQ7-SS) from baseline to 24 weeks and following treatment withdrawal were compared using linear regression adjusted for baseline scores and randomization strata. Proportions of patients with clinically important changes were compared. RESULTS Among 282 participants, the mean age was 59 ± 13 years, 115 (41%) were female, and 223 (79%) were White. Baseline KCCQ-OSS (69.3 ± 20.1 vs 67.3 ± 18.8) and SAQ7-SS (72.0 ± 21.0 vs 72.4 ± 18.3) were similar between aficamten and placebo groups. Treatment with aficamten, compared with placebo, improved both the mean KCCQ-OSS (13.3 ± 16.3 vs 6.1 ± 12.6; mean difference: 7.9; 95% CI: 4.8-11.0; P < 0.001) and SAQ7-SS (11.6 ± 17.4 vs 3.8 ± 14.4; mean difference: 7.8; 95% CI: 4.7-11.0; P < 0.001) at 24 weeks, with benefits emerging within 4 weeks. No heterogeneity in treatment effect was found across subgroups. A much larger proportion of participants experienced a very large health status improvement (≥20 points) with aficamten vs placebo (KCCQ-OSS: 29.7% vs 12.4%, number needed to treat: 5.8; SAQ7-SS: 31.2% vs 13.9%, number needed to treat: 5.8). Participants' health status worsened significantly more after withdrawal from aficamten than placebo (KCCQ-OSS: -16.2 ± 19.0 vs -3.0 ± 9.6; P < 0.001; SAQ7-SS: -17.4 ± 21.4 vs -2.5 ± 13.3), further confirming a causal effect of aficamten. CONCLUSIONS In patients with symptomatic oHCM, treatment with aficamten resulted in markedly improved health status, including significant improvement in chest pain-related health status, than placebo. (Phase 3 Trial to Evaluate the Efficacy and Safety of Aficamten Compared to Placebo in Adults With Symptomatic oHCM [SEQUOIA-HCM]; NCT05186818).
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Affiliation(s)
- Charles F Sherrod
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality, Kansas City, Missouri, USA; Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
| | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael E Nassif
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality, Kansas City, Missouri, USA; Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Caroline J Coats
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Gregory D Lewis
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Changsheng Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Martin S Maron
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Zi Michael Miao
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Iacopo Olivotto
- Meyer Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Florence, Italy
| | - Josef Veselka
- Department of Cardiology, Angiology and Intensive Care, Klinikum Chemnitz gGmbH, Medical Campus Chemnitz of the Technische Universität Dresden, Dresden, Germany
| | - Michael Butzner
- Cytokinetics, Incorporated, South San Francisco, California, USA
| | - Daniel L Jacoby
- Cytokinetics, Incorporated, South San Francisco, California, USA
| | | | - Stuart Kupfer
- Cytokinetics, Incorporated, South San Francisco, California, USA
| | - Fady I Malik
- Cytokinetics, Incorporated, South San Francisco, California, USA
| | - Lisa Meng
- Cytokinetics, Incorporated, South San Francisco, California, USA
| | - Amy Wohltman
- Cytokinetics, Incorporated, South San Francisco, California, USA
| | - John A Spertus
- University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality, Kansas City, Missouri, USA; Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
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Feldman JM, Frishman WH, Aronow WS. Ninerafaxstat in the Treatment of Diabetic Cardiomyopathy and Nonobstructive Hypertrophic Cardiomyopathy. Cardiol Rev 2024:00045415-990000000-00318. [PMID: 39194232 DOI: 10.1097/crd.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Ninerafaxstat is a novel mitotrope under investigation in 2 large clinical trials: IMPROVE-DiCE (a phase IIa trial investigating ninerafaxstat) and IMPROVE-hypertrophic cardiomyopathy (HCM). IMPROVE-DiCE is a single-center, open-label, phase 2a trial investigating the effectiveness of ninerafaxstat in diabetic cardiomyopathy. Ninerafaxstat significantly improved phosphocreatine/adenosine triphosphate median by 32% (P < 0.01) and reduced myocardial triglyceride content by 34% (P = 0.026). Magnetic resonance imaging (MRI) analysis showed improved left ventricular peak circumferential diastolic strain rate by 15% (P < 0.047) and peak left ventricular filling rate by 11% (P < 0.05). Pyruvate dehydrogenase flux was increased in 7 of 9 patients (P = 0.08), consistent with improved glucose utilization. IMPROVE-HCM (ninerafaxstat safe, effective for nonobstructive hypertrophic cardiomyopathy patients) is a phase 2, multicenter, randomized controlled and double-blinded study. From baseline to 12 weeks, ninerafaxstat was associated with a significantly improved ventilatory efficiency slope compared with placebo (P = 0.006). In a post hoc analysis with 35 patients with baseline Kansas City Cardiomyopathy Questionnaire score ≤80, changes in ventilatory efficiency slope favored ninerafaxstat versus placebo (P = 0.02). Left atrial size, a surrogate marker of diastolic dysfunction, was significantly decreased in patients on ninerafaxstat versus placebo (P = 0.01). These findings support a larger phase 3 study in symptomatic nonobstructive HCM patients to further investigate ninerafaxstat. Several drugs that also improve glucose utilization including fatty acid oxidation inhibitors, carnitine palmitoyltransferase I inhibitors, and glucagon-like peptide-1 receptor agonists are presently under investigation in clinical trials.
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Affiliation(s)
- Jared M Feldman
- From the Department of Medicine, Long Island Jewish Medical Center and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | | | - Wilbert S Aronow
- Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
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8
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Andersen CF, Omar M, Larsen JH, Kistorp C, Tuxen C, Gustafsson F, Køber L, Poulsen MK, Brønd JC, Møller JE, Schou M, Jensen J. Accelerometer-Measured Physical Activity in Patients with Heart Failure and Reduced Ejection Fraction: Determinants and Relationship with Patient-Reported Health Status. Am Heart J 2024:S0002-8703(24)00220-5. [PMID: 39209211 DOI: 10.1016/j.ahj.2024.08.017] [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: 04/11/2024] [Revised: 08/22/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Accelerometer-measured physical activity is an increasingly used endpoint in heart failure (HF) trials. We investigated the determinants of accelerometer-measured physical activity and the relationship with patient-reported health status. METHODS Post-hoc analysis of the Empire HF trial, including outpatients with HF with reduced ejection fraction (HFrEF). Physical activity was quantified as average accelerometer counts per minute (CPM) with higher values representing higher activity. We investigated associations between activity level and clinical variables, including age, sex, and body mass index, as well as patient-reported health status assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ). RESULTS Complete data were available in 180 (95%) patients (86% male, mean age 65 year). Baseline median physical activity level was 1318 CPM (Q1-Q3 1111-1585). Age and anemia were independently associated with activity level (β-coefficients: -10 CPM per year age increase [95% CI -16 to -5.1], p=0.00015, and -126 CPM for anemia [95% CI -9.1 to -244], p=0.035). Significant independent associations were observed between activity level and all KCCQ summary scores (β-coefficient point estimates of 3.7, 4.6, and 4.9 CPM, all p<0.02). For 12-week changes in KCCQ-summary scores, only the KCCQ-CSS was associated with activity level; mean increase of 17.5 CPM [95% CI 1.5 to 34.0], p=0.032, per 5-point increase in KCCQ-CSS. Associations were not modified by treatment allocation (interaction p-values>0.05). CONCLUSIONS In patients with HFrEF, older age and anemia were independently associated with lower activity. Moreover, physical activity only weakly increased with better health status, suggesting that changes in physical activity reflect improvements in patients' health status to a limited degree. This highlights the need to better understand the endpoint with regards to all other health parameters to ease interpretation in future HF trials.
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Affiliation(s)
- Camilla Fuchs Andersen
- Department of Cardiology, Herlev-Gentofte Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
| | - Massar Omar
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.
| | - Julie Hempel Larsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.
| | - Caroline Kistorp
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark.
| | - Christian Tuxen
- Department of Cardiology, Frederiksberg-Bispebjerg Hospital, Copenhagen, Denmark.
| | - Finn Gustafsson
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
| | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
| | | | - Jan Christian Brønd
- Center for Research in Childhood Health/Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
| | - Jesper Jensen
- Department of Cardiology, Herlev-Gentofte Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
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9
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Sammour YM, Cohen DJ, Arnold S, Spertus JA, Stebbins A, Vekstein A, Kosinski AS, Goel SS, Kleiman NS, Vemulapalli S, Kapadia SR. Association of Baseline Tricuspid Regurgitation With Health Status and Clinical Outcomes After TAVR and Mitral TEER. JACC Cardiovasc Interv 2024; 17:1905-1915. [PMID: 39197989 DOI: 10.1016/j.jcin.2024.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is associated with worse clinical outcomes after transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (M-TEER), but little is known about its association with health status outcomes. OBJECTIVES The aims of this study were to explore, using the Society of Thoracic Surgeons and American College of Cardiology TVT (Transcatheter Valve Therapy) Registry, the association between baseline TR and health status after TAVR and M-TEER and to determine if baseline TR was associated with clinical endpoints. METHODS Health status was assessed using Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS) score in patients enrolled in the TVT Registry who underwent isolated TAVR or M-TEER between January 2019 and June 2021. The association among baseline TR and KCCQ-OS score, being alive and well, and clinical outcomes was examined. RESULTS In total, 130,097 TAVR patients (13.1% with moderate TR, 2.3% with severe TR) and 19,593 M-TEER patients (33.2% with moderate TR, 14.7% with severe TR) were included. Mean KCCQ-OS scores were lower with severe vs moderate vs none to mild TR at baseline prior to TAVR (39.4 ± 24.2 vs 45.2 ± 24.7 vs 51.3 ± 25.3; P < 0.01) or M-TEER (38.1 ± 23.9 vs 41.9 ± 24.7 vs 45.4 ± 25.2; P < 0.01) and similarly at 30 days and 1 year. The odds of being alive and well at 1 year were lower with moderate or severe TR before TAVR (adjusted OR: 0.79 [95% CI: 0.74-0.85] and adjusted OR: 0.81 [95% CI: 0.70-0.94], respectively) and severe TR before M-TEER (adjusted OR: 0.53; 95% CI: 0.40-0.71). Furthermore, moderate or severe TR before TAVR was associated with higher 1-year mortality and readmission, whereas moderate or severe TR before M-TEER was associated with higher 1-year mortality. CONCLUSIONS In a large cohort of U.S. patients who underwent TAVR or M-TEER, greater baseline TR was associated with worse health status and clinical outcomes. Understanding adverse outcomes of TR in patients with coexisting valvular abnormalities is important, especially with rapidly evolving transcatheter tricuspid valve interventions.
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Affiliation(s)
- Yasser M Sammour
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Suzanne Arnold
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Amanda Stebbins
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Andrew Vekstein
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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10
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Tan YJ, Linden S, Ong SC. Cost-effectiveness of empagliflozin in the treatment of Malaysian patients with chronic heart failure and preserved or mildly reduced ejection fraction. PLoS One 2024; 19:e0305257. [PMID: 39178204 PMCID: PMC11343421 DOI: 10.1371/journal.pone.0305257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 05/28/2024] [Indexed: 08/25/2024] Open
Abstract
INTRODUCTION Empagliflozin demonstrates promising clinical benefits in patients with heart failure (HF). While an early study demonstrates that empagliflozin is cost-effective for treating HF patients with reduced ejection fraction (HFrEF) in Malaysia, its cost-effectiveness for HF with ejection fraction (EF)>40% remains unclear. Therefore, the current study aimed to assess the cost-effectiveness of adding empagliflozin to the standard of care (SoC) for HF patients with EF>40% from the perspective of Malaysian healthcare system. Subsequently, the results were consolidated with the findings for HFrEF to evaluate the cost-effectiveness of empagliflozin when used for all HF patients in Malaysia, irrespective of EF. METHODS A cost-utility analysis was performed using a validated Markov model, which modelled a cohort of adult patients through health states related to symptom severity and functional impairment, to estimate costs and quality-adjusted life-years (QALYs). The influence of model inputs and assumptions, sensitivity, scenario, and subgroup analyses were explored. All costs were expressed in 2022 Malaysian ringgits (RM). Costs and QALYs were discounted at an annual rate of 3.0% as per local pharmacoeconomic guideline. RESULTS The base-case incremental cost-effectiveness ratio (ICER) for HF patients with EF>40% was RM 40,454 per QALY gained. At a cost-effectiveness threshold of RM 47,439/QALY gained, empagliflozin was cost-effective in 57% of replications. The model outcomes were sensitive to inputs related to the treatment effect of empagliflozin in reducing HF-related hospitalisation and cardiovascular mortality, and empagliflozin cost. For the overall HF population, the ICER was RM 29,463/QALY gained. CONCLUSION The findings suggest that empagliflozin is a cost-effective treatment option for the Malaysian HF population, including those with EF>40%. As such, the intervention warrants consideration by the Malaysian healthcare provider to mitigate the burden of HF and address the unmet needs of the EF>40% population.
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Affiliation(s)
- Yi Jing Tan
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Hospital Seri Manjung, Ministry of Health Malaysia, Seri Manjung, Perak, Malaysia
| | - Stephan Linden
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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11
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Yang M, Kondo T, Anand IS, de Boer RA, Campbell RT, Køber L, Lam CSP, Maggioni AP, Martinez FA, O'Meara E, Packer M, Sabatine MS, Kerr Saraiva JF, Shah SJ, Zannad F, Zile MR, Jhund PS, Solomon SD, McMurray JJV. Clinical characteristics and outcomes of patients aged 80 years and over with heart failure: Need for better treatment. Eur J Heart Fail 2024. [PMID: 39169481 DOI: 10.1002/ejhf.3417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/28/2024] [Accepted: 07/21/2024] [Indexed: 08/23/2024] Open
Abstract
AIMS Although the prevalence of heart failure (HF) increases markedly with advancing age, surprisingly little is known about HF in the very elderly. The aim of this study was to describe the clinical characteristics and outcomes of octogenarians with HF. METHODS AND RESULTS Individual participant meta-analysis of patients with HF and reduced, mildly reduced, and preserved ejection fraction (HFrEF, HFmrEF, and HFpEF, respectively) enrolled in eight large randomized trials. Overall, the proportion of octogenarians was 1518 of 20 168 patients (7.5%) with HFrEF, 610 of 4609 (13.2%) with HFmrEF, and 3130 of 15 354 (20.4%) with HFpEF. Regardless of HF phenotype, octogenarian patients were more often female and had more comorbidities, more symptoms and signs of congestion, and worse health status (but not quality of life), in comparison to patients aged <80 years. The incidence (per 100 person-years) of the composite of cardiovascular death or HF hospitalization was 13.3 (95% confidence interval [CI] 12.7-14.0) in octogenarians versus 9.5 (95% CI 9.3-9.7) in non-octogenarians (adjusted hazard ratio [aHR] 1.40, 95% CI 1.32-1.48). Each component of the composite was more frequent in octogenarians with rates of cardiovascular mortality of 7.0 (95% CI 6.5-7.4) per 100 person-years versus 4.9 (95% CI 4.8-5.1) in non-octogenarians (aHR 1.60, 95% CI 1.48-1.72, p < 0.001). Octogenarians received less evidence-based therapy, especially mineralocorticoid receptor antagonists, than younger patients. CONCLUSION Despite worse health status and higher hospitalization and mortality rates, octogenarians were undertreated compared to younger patients.
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Affiliation(s)
- Mingming Yang
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Toru Kondo
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Inder S Anand
- Department of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ross T Campbell
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore, Singapore, Singapore
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | | | - Eileen O'Meara
- Montreal Heart Institute Department of Medicine (Cardiology) and Research Centre, Université de Montréal, Montreal, QC, Canada
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jose F Kerr Saraiva
- Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Faiez Zannad
- Inserm CIC 1433 and Université de Lorraine, Centre Hospitalier Régional Universitaire, Nancy, France
| | - Michael R Zile
- RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston, SC, USA
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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12
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Grayburn PA, Kodali SK, Hahn RT, Lurz P, Thourani VH, Kozorovitsky ER, Gilmore SY, Vinekar C, Zhang B, Boulware K, Krzmarzick AM, Nguyen D, Vu MT, Feldman T, Mack MJ, Leon MB. TRISCEND II: Novel Randomized Trial Design for Transcatheter Tricuspid Valve Replacement. Am J Cardiol 2024; 225:171-177. [PMID: 38897265 DOI: 10.1016/j.amjcard.2024.06.009] [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: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024]
Abstract
Severe tricuspid regurgitation remains largely undertreated given limited treatment options. Transcatheter tricuspid valve interventions have emerged as a promising therapy for these patients, and the TRISCEND II pivotal trial is the first randomized controlled trial to evaluate transcatheter tricuspid valve replacement (TTVR). The TRISCEND II pivotal trial studies the transcatheter EVOQUE (Edwards Lifesciences, Irvine, California) tricuspid valve replacement system using a United States Food and Drug Administration Breakthrough Device Designation-a program intended to provide timely access to medical devices by speeding up development, assessment, and review. The TRISCEND II trial is a prospective, multicenter trial that randomizes patients with symptomatic severe tricuspid regurgitation to treatment with either TTVR in conjunction with optimal medical therapy or optimal medical therapy alone. The trial's novel 2-phase design evaluates 30-day safety and 6-month effectiveness end points for the first 150 patients in the initial phase and a 1-year safety and effectiveness end point for the full cohort of 400 patients in the second phase. The TRISCEND II trial's 2-phase trial design provided an opportunity for early review and led to the first commercial approval of a TTVR system. In conclusion, the design of the TRISCEND II trial will likely inform future transcatheter tricuspid device trials.
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Affiliation(s)
- Paul A Grayburn
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas; Baylor Scott and White Research Institute Cardiac Imaging Core Laboratory, Plano, Texas.
| | | | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York
| | | | | | | | | | | | | | | | | | - Don Nguyen
- Edwards Lifesciences, Irvine, California
| | - Minh T Vu
- Edwards Lifesciences, Irvine, California
| | | | - Michael J Mack
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York
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13
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Hamo CE, DeJong C, Hartshorne-Evans N, Lund LH, Shah SJ, Solomon S, Lam CSP. Heart failure with preserved ejection fraction. Nat Rev Dis Primers 2024; 10:55. [PMID: 39143132 DOI: 10.1038/s41572-024-00540-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 08/16/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure cases and has a prevalence that is expected to rise with the growing ageing population. HFpEF is associated with significant morbidity and mortality. Specific HFpEF risk factors include age, diabetes, hypertension, obesity and atrial fibrillation. Haemodynamic contributions to HFpEF include changes in left ventricular structure, diastolic and systolic dysfunction, left atrial myopathy, pulmonary hypertension, right ventricular dysfunction, chronotropic incompetence, and vascular dysfunction. Inflammation, fibrosis, impaired nitric oxide signalling, sarcomere dysfunction, and mitochondrial and metabolic defects contribute to the cellular and molecular changes observed in HFpEF. HFpEF impacts multiple organ systems beyond the heart, including the skeletal muscle, peripheral vasculature, lungs, kidneys and brain. The diagnosis of HFpEF can be made in individuals with signs and symptoms of heart failure with abnormality in natriuretic peptide levels or evidence of cardiopulmonary congestion, facilitated by the use of HFpEF risk scores and additional imaging and testing with the exclusion of HFpEF mimics. Management includes initiation of guideline-directed medical therapy and management of comorbidities. Given the significant impact of HFpEF on quality of life, future research efforts should include a particular focus on how patients can live better with this disease.
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Affiliation(s)
- Carine E Hamo
- New York University School of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Colette DeJong
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Nick Hartshorne-Evans
- CEO and Founder of the Pumping Marvellous Foundation (Patient-Led Heart Failure Charity), Preston, UK
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine and Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA
| | - Scott Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore, Singapore, Singapore.
- Baim Institute for Clinical Research, Boston, MA, USA.
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14
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Iyengar A, Weingarten N, Song C, Rekhtman D, Shin M, Helmers MR, Wald J, Cevasco M, Atluri P. Outcomes and quality of life in patients receiving durable left ventricular assist device with biventricular support. Artif Organs 2024. [PMID: 39118457 DOI: 10.1111/aor.14835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 05/25/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Patients requiring biventricular support (BIVAD) face higher morbidity than those undergoing durable left ventricular assist device (LVAD) implantation alone. The goal of the current study was to evaluate quality of life (QOL) of patients with LVAD therapy in the modern era, stratified by use of biventricular support. METHODS All patients undergoing LVAD at our center were reviewed between October 2017 and September 2021. Patients were stratified by perioperative use of BIVAD. Patients were administered a telephone survey consisting of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) as well as free-responses regarding satisfaction surrounding their operation. Outcomes included survival, KCCQ-12 metrics, and thematic analysis of free response questions. RESULTS 92 patients were identified, of whom 26 (28%) received BIVAD support. BIVAD patients had more preoperative ECMO use (54% vs. 12%, p < 0.001) and lower INTERMACS scores (Category 1: 46% vs. 14%, p = 0.001). Three-year survival was 73.8% among LVAD-alone patients and 50.1% among BIVAD patients (log-rank p = 0.022). Median composite KCCQ-12 score was 78 (57-88). No differences in composite or any component scores were noted between groups. 76% of patients report they would be moderately or extremely like to go through surgery again if given repeat choice. The most common themes expressed were overall gratitude (24%) and disappointment with device-related restrictions (20%). CONCLUSIONS Patients requiring BIVAD therapy have more advanced shock, longer associated hospital courses, and lower long-term survival. However, those that survive enjoy similar overall quality of life, and many endorse positive outlooks on their surgical course. Continued assessments of quality of life are important in providing patient-centered LVAD care.
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Affiliation(s)
- Amit Iyengar
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Noah Weingarten
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cindy Song
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Rekhtman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Max Shin
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark R Helmers
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joyce Wald
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marisa Cevasco
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Yang M, Kondo T, Jhund PS, Alcocer-Gamba MA, Borleffs CJW, Chiang CE, Comin-Colet J, Desai AS, Dobreanu D, Drożdż J, Han Y, Janssens SP, Katova T, Kosiborod MN, Lam CSP, Merkely B, Pham VN, Thierer J, Vaduganathan M, Verma S, Solomon SD, McMurray JJV. Geographical variation in patient characteristics and outcomes in heart failure with mildly reduced and preserved ejection fraction. Eur J Heart Fail 2024; 26:1788-1803. [PMID: 38923118 DOI: 10.1002/ejhf.3352] [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: 03/13/2024] [Revised: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
AIMS Compared to heart failure (HF) with reduced ejection fraction, HF with preserved ejection fraction (HFpEF), and HF with mildly reduced ejection fraction (HFmrEF) are increasing in prevalence, yet little is known about the geographic variation in patient characteristics, treatments and outcomes among these two HF phenotypes. The aim of this study was to investigate geographic differences in HFpEF and HFmrEF. METHODS AND RESULTS We conducted an individual patient analysis of five clinical trials enrolling patients with HFpEF or HFmrEF from North America (NA), Latin America (LA), Western Europe (WE), Central/Eastern Europe and Russia (CEER), and Asia-Pacific (AP). We compared regions using descriptive statistics and multivariable regression models. Among the 19 959 patients included, 4066 (23.1%) had HFmrEF and 15 353 (76.9%) HFpEF. Regardless of HF phenotype, patients from WE were oldest, and those in CEER youngest. LA had the largest portion of females and NA most black patients. Obesity and diabetes were most prevalent in NA and hypertension and coronary heart disease most common in CEER. Self-reported health status varied strikingly and was the worst in NA and best in AP. Among patients with HFmrEF, rates of the primary composite endpoint (cardiovascular death or HF hospitalization) were: NA 12.56 per 100 patient-years (/100py), AP 11.67/100py, CEER 10.12/100py, LA 8.90/100py, and WE 8.43/100py, driven by differences in the rate of HF hospitalization. The corresponding values in HFpEF were 11.47/100py, 7.80/100py, 5.47/100py, 5.92/100py, and 7.80/100py, respectively. CONCLUSIONS There is substantial geographic variation in patient characteristics, treatment and outcomes among patients with HFpEF and HFmrEF. These findings have implications for interpretation and generalizability of trial results, design and conduct of future trials, and optimization of care for these patients.
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Affiliation(s)
- Mingming Yang
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Toru Kondo
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Marco Antonio Alcocer-Gamba
- Centro de Estudios Clínicos de Querétaro (CECLIQ), School of Medicine, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Chern-En Chiang
- General Clinical Research Center and Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Josep Comin-Colet
- Hospital Universitari de Bellvitge, The Institute of Biomedical Research of Bellvitge (IDIBELL), Barcelona, Spain
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dan Dobreanu
- University of Medicine, Pharmacy, Science and Technology 'G.E. Palade', Târgu Mureş, Romania
| | - Jarosław Drożdż
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Yaling Han
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Stefan P Janssens
- Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium
| | - Tzvetana Katova
- Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Carolyn S P Lam
- National Heart Center Singapore and Duke-National University of Singapore, Singapore, Singapore
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Vinh Nguyen Pham
- Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam
| | - Jorge Thierer
- Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educatión Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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Senanayake S, Uchil R, Sharma P, Parsonage W, Kularatna S. Mapping Kansas City cardiomyopathy, Seattle Angina, and minnesota living with heart failure to the MacNew-7D in patients with heart disease. Qual Life Res 2024; 33:2151-2163. [PMID: 38839680 PMCID: PMC11286692 DOI: 10.1007/s11136-024-03676-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION The Kansas City Cardiomyopathy Questionnaire (KCCQ), Seattle Angina Questionnaire (SAQ), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) are widely used non-preference-based instruments that measure health-related quality of life (QOL) in people with heart disease. However, currently it is not possible to estimate quality-adjusted life-years (QALYs) for economic evaluation using these instruments as the summary scores produced are not preference-based. The MacNew-7D is a heart disease-specific preference-based instrument. This study provides different mapping algorithms for allocating utility scores to KCCQ, MLHFQ, and SAQ from MacNew-7D to calculate QALYs for economic evaluations. METHODS The study included 493 participants with heart failure or angina who completed the KCCQ, MLHFQ, SAQ, and MacNew-7D questionnaires. Regression techniques, namely, Gamma Generalized Linear Model (GLM), Bayesian GLM, Linear regression with stepwise selection and Random Forest were used to develop direct mapping algorithms. Cross-validation was employed due to the absence of an external validation dataset. The study followed the Mapping onto Preference-based measures reporting Standards checklist. RESULTS The best models to predict MacNew-7D utility scores were determined using KCCQ, MLHFQ, and SAQ item and domain scores. Random Forest performed well for item scores for all questionnaires and domain score for KCCQ, while Bayesian GLM and Linear Regression were best for MLHFQ and SAQ domain scores. However, models tended to over-predict severe health states. CONCLUSION The three cardiac-specific non-preference-based QOL instruments can be mapped onto MacNew-7D utilities with good predictive accuracy using both direct response mapping techniques. The reported mapping algorithms may facilitate estimation of health utility for economic evaluations that have used these QOL instruments.
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Affiliation(s)
- Sameera Senanayake
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4059, Australia
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Rithika Uchil
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4059, Australia
| | - Pakhi Sharma
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4059, Australia.
| | - William Parsonage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4059, Australia
- Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, QLD, Australia
| | - Sanjeewa Kularatna
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4059, Australia
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
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17
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Schou M, Petrie MC, Borlaug BA, Butler J, Davies MJ, Kitzman DW, Shah SJ, Verma S, Patel S, Chinnakondepalli KM, Harring S, Abildstrøm SZ, Liisberg K, Kosiborod MN. Semaglutide and NYHA Functional Class in Obesity-Related Heart Failure With Preserved Ejection Fraction: The STEP-HFpEF Program. J Am Coll Cardiol 2024; 84:247-257. [PMID: 38913004 DOI: 10.1016/j.jacc.2024.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND In the Semaglutide Treatment Effect in People with obesity and HFpEF (STEP-HFpEF) program, semaglutide improved heart failure (HF)-related symptoms, physical limitations, and exercise function, and reduced bodyweight in patients with obesity-related heart failure with preserved ejection fraction (HFpEF). Whether semaglutide improves functional status, as assessed by NYHA functional class, is unknown. OBJECTIVES The goal of this study was to examine the effects of semaglutide on change in NYHA functional class over time. We also investigated the effects of semaglutide on HF-related symptoms, physical limitations, and bodyweight and other trial endpoints across baseline NYHA functional class categories. METHODS This was a prespecified analysis of pooled data from 2 international, double-blind, randomized trials (STEP-HFpEF and STEP-HFpEF type 2 diabetes [STEP-HFpEF DM], comprising the STEP-HFpEF program), which collectively randomized 1,145 participants with obesity-related HFpEF to once-weekly semaglutide 2.4 mg or placebo for 52 weeks. The outcome of interest for this analysis was the change in NYHA functional class (baseline to 52 weeks). We also investigated the effects of semaglutide on the dual primary, confirmatory secondary, and selected exploratory endpoints according to baseline NYHA functional class. RESULTS More semaglutide-treated than placebo-treated patients had an improvement in NYHA functional class (32.6% vs 21.5%, respectively; OR: 2.20 [95% CI: 1.62-2.99; P < 0.001]) and fewer semaglutide-treated patients experienced deterioration in NYHA functional class (2.09% vs 5.24%, respectively; OR: 0.36 [95% CI: 0.19-0.70; P = 0.003]) at 52 weeks. Semaglutide (vs placebo) improved the Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CCS) across NYHA functional class categories; this was especially pronounced in those in NYHA functional classes III/IV (10.5 points [95% CI: 6.6-14.4 points]) vs NYHA functional class II (6.0 points [95% CI: 3.4-8.6 points]) (P interaction = 0.06). By contrast, the degree of reduction in bodyweight was similar with semaglutide vs placebo regardless of baseline NYHA functional class category (NYHA functional class II, -8.4% [95% CI: -9.4% to -7.3%]; NYHA functional classes III/IV, -8.3% [95% CI: -9.9% to -6.8%]; P interaction = 0.96). Semaglutide consistently improved 6-minute walking distance (6MWD), the hierarchical composite endpoint (death, HF events, differences in KCCQ-CSS, and 6MWD changes), and reduced C-reactive protein and N-terminal prohormone of brain natriuretic peptide across NYHA functional class categories (all P interactions = NS). CONCLUSIONS In patients with obesity-related HFpEF, fewer semaglutide-treated than placebo-treated patients had a deterioration, and more had an improvement, in NYHA functional class at 52 weeks. Semaglutide consistently improved HF-related symptoms, physical limitations, and exercise function, and reduced bodyweight and biomarkers of inflammation and congestion in all NYHA functional class categories. Semaglutide-mediated improvements in health status were especially large in patients with NYHA functional classes III/IV. (Research Study to Look at How Well Semaglutide Works in People Living With Heart Failure and Obesity; NCT04788511) (Research Study to Look at How Well Semaglutide Works in People Living With Heart Failure, Obesity and Type 2 Diabetes; NCT04916470).
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Affiliation(s)
- Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom. https://twitter.com/markcpetrie20
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Dalane W Kitzman
- Section of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Shachi Patel
- Health Economics and Technology Assessment Group, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Khaja M Chinnakondepalli
- Health Economics and Technology Assessment Group, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | | | | | - Mikhail N Kosiborod
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
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18
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de Almeida Pinho I, Pimentel MJ, Oliveira C, Matos MI, Vale C, Matias P, Pereira J, Marques P, Leite-Moreira A, Friões F, Vasques-Nóvoa F, Ferreira JP. Office- versus home-based evaluation of quality of life in heart failure with reduced ejection fraction: A randomized study. Int J Cardiol 2024; 413:132341. [PMID: 38971536 DOI: 10.1016/j.ijcard.2024.132341] [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: 05/10/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Heart failure (HF) patients often experience poor health-related quality-of-life (HR-QoL). The Kansas City Cardiomyopathy Questionnaire (KCCQ) is frequently used for assessing HR-QoL in HF. Whether KCCQ scores vary in a clinical meaningful manner according to the setting (home vs office) where patients respond to the questionnaire is currently unknown. AIMS Assess the differences in the responses to KCCQ-23 questionnaire when completed at home or office. METHODS Randomized parallel-group study, including patients with HF with reduced ejection fraction (HFrEF). Primary outcome was home vs office comparison of overall summary score (KCCQ-OSS). Main secondary outcomes were clinical summary score (KCCQ-CSS) and total symptom score (KCCQ-TSS). RESULTS A total of 100 patients were included in the study: 50 home vs 50 office. Mean age was 71 yrs. Most baseline characteristics were well balanced between groups, except male sex, MRA use, and prior HF hospitalizations which were more frequent in the home group. No statistically-significant between-group differences were found regarding KCCQ-OSS (median [percentile25-75]) scores: home 69.1 (42.0-86.5) vs office 63.1 (44.3-82.3) points, P-value = 0.59, or main secondary outcomes: KCCQ-CSS home 62.2 (46.5-79.9) vs office 68.1 (51.9-79.2) points, P-value = 0.69, and KCCQ-TSS home 84.7 (59.7-97.2) vs office 76.4 (66.7-94.4) points, P-value = 0.85. Results remained similar after adjustment for differences in baseline characteristics and using non-parametric regressions. CONCLUSIONS No major differences were found in KCCQ-23 scores regardless of whether the questionnaire was completed at home or office. These findings can be useful to make HR-QoL more accessible, allowing patients to respond at home using email or cell-phone applications.
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Affiliation(s)
- Inês de Almeida Pinho
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Maria João Pimentel
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Cristina Oliveira
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Maria Inês Matos
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Vale
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paula Matias
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Joana Pereira
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Marques
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fernando Friões
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Francisco Vasques-Nóvoa
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Pedro Ferreira
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Internal Medicine Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Institut National de la Santé et de la Recherche Médicale U1116, Centre Hospitalier Régional Universitaire, French Clinical Research Infrastructure Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Nancy, France.
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19
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Nativi-Nicolau J, Yilmaz A, Dasgupta N, Macey R, Cochrane J, Peatman J, Summers C, Luth J, Zolty R. Six-minute walk test as clinical end point in cardiomyopathy clinical trials, including ATTR-CM: a systematic literature review. J Comp Eff Res 2024; 13:e230158. [PMID: 38869839 PMCID: PMC11234454 DOI: 10.57264/cer-2023-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
Aim: The six-minute walk test (6MWT) is a common measure of functional capacity in patients with heart failure (HF). Primary clinical study end points in cardiomyopathy (CM) trials, including transthyretin-mediated amyloidosis with CM (ATTR-CM), are often limited to hospitalization and mortality. Objective: To investigate the relationship between the 6MWT and hospitalization or mortality in CM, including ATTR-CM. Method: A PRISMA-guided systematic literature review was conducted using search terms for CM, 6MWT, hospitalization and mortality. Results: Forty-one studies were identified that reported 6MWT data and hospitalization or mortality data for patients with CM. The data suggest that a greater 6MWT distance is associated with a reduced risk of hospitalization or mortality in CM. Conclusion: The 6MWT is an accepted alternative end point in CM trials, including ATTR-CM.
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Affiliation(s)
| | - Ali Yilmaz
- Division of Cardiovascular Imaging, University Hospital Münster, 48149, Münster, Germany
| | - Noel Dasgupta
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Richard Macey
- Adelphi Values PROVETM, Bollington, Cheshire, UK, SK10 5JB
| | - James Cochrane
- Adelphi Values PROVETM, Bollington, Cheshire, UK, SK10 5JB
| | - Judith Peatman
- Adelphi Values PROVETM, Bollington, Cheshire, UK, SK10 5JB
| | - Catherine Summers
- Medical Affairs Department, Alnylam Pharmaceuticals, Cambridge, MA 02142, USA
| | - Jennifer Luth
- Medical Affairs Department, Alnylam Pharmaceuticals, Cambridge, MA 02142, USA
| | - Ronald Zolty
- Division of Cardiovascular Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE 68198 USA
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20
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Jani VP, Strom JB, Gami A, Beussink-Nelson L, Patel R, Michos ED, Shah SJ, Freed BH, Mukherjee M. Optimal Method for Assessing Right Ventricular to Pulmonary Arterial Coupling in Older Healthy Adults: The Multi-Ethnic Study of Atherosclerosis. Am J Cardiol 2024; 222:11-19. [PMID: 38643925 PMCID: PMC11175998 DOI: 10.1016/j.amjcard.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/09/2024] [Accepted: 03/11/2024] [Indexed: 04/23/2024]
Abstract
Right ventricular (RV) to pulmonary arterial (PA) coupling describes the ability of the RV to augment contractility in response to increased afterload. Several echocardiographic indexes of RV-PA coupling have been defined; however, the optimal numerator in the coupling ratio is unclear. We sought to establish which of these ratios is best for assessing RV-PA coupling based on their relations with 6-minute walk distance (6MWD), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and the Kansas City Cardiomyopathy Questionnaire (KCCQ) in aging adults. In this study of 1,611 Multi-Ethnic Study of Atherosclerosis participants who underwent echocardiography at Exam 6, we evaluated the association between different numerators, including tricuspid annular planar systolic excursion (TAPSE), fractional area change (FAC), RV free wall strain, and tissue Doppler imaging S' velocity to pulmonary artery systolic pressure (PASP) with 6MWD, NT-proBNP, and KCCQ score, adjusted for socioeconomic and cardiovascular disease risk factors. Our cohort had a mean age of 73 ± 8 years, 54% female, 17% Chinese American, 22% African American, 22% Hispanic, and 39% White participants. The mean ( ± SD) TAPSE/PASP, FAC/PASP, tissue Doppler imaging S' velocity/PASP, and RV free wall strain:PASP ratios were 0.7 ± 0.2, 1.3 ± 0.3, 0.5 ± 0.1, and 0.8 ± 0.2, respectively. All RV-PA coupling indices decreased with age (p <0.0001 for all). TAPSE:PASP ratio was lower in older (³85 years) female (0.59 ± 0.14) versus male (0.65 ± 0.17) participants (p = 0.01), whereas FAC/PASP ratio was higher in the same female versus male participants (p <0.01). TAPSE/PASP and FAC/PASP ratios were significantly and strongly associated with all NT-proBNP, 6MWD, and KCCQ scores in fully adjusted and receiver operating characteristic analysis. In older community-dwelling adults free of heart failure and pulmonary hypertension, both FAC/PASP and TAPSE:PASP ratios are optimal for assessment of RV-PA coupling based on its association with 6MWD, NT-proBNP, and KCCQ score. FAC/PASP ratio has the additional benefit of reflecting age and gender-related geometric and functional changes.
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Affiliation(s)
- Vivek P Jani
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jordan B Strom
- Division of Cardiology, Beth Israel Deaconess, Harvard Medical School, Boston, Massachusetts
| | - Abhishek Gami
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lauren Beussink-Nelson
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ravi Patel
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Benjamin H Freed
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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21
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Gard EK, Noaman S, Stub D, Vriesendorp P, Htun N, Johnston R, Gartner E, Dick R, Walton A, Kaye D, Nanayakkara S. The Role of Comorbidities in Predicting Functional Improvement After Transcatheter Aortic Valve Implantation. Heart Lung Circ 2024; 33:1018-1026. [PMID: 38582702 DOI: 10.1016/j.hlc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/05/2024] [Accepted: 02/04/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Patients undergoing transcatheter aortic valve implantation (TAVI) have a high comorbidity burden. We sought to stratify patients into functional outcomes using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12), a patient-reported outcome with benefits over both the New York Heart Association (NYHA) classification and the original 23-item KCCQ, and to evaluate the importance of comorbidities in predicting failure of functional improvement post-TAVI in a contemporary cohort. METHODS In total, 366 patients with severe aortic stenosis undergoing TAVI with baseline KCCQ-12 were retrospectively analysed and divided into two groups. Failure to improve was defined as a score <60 and a change in score <10 at 1 year in either overall score (KCCQ-OS) or clinical summary score (KCCQ-CSS). RESULTS Failure to improve was noted in 13% of patients, who were more likely to have lower KCCQ-OS at baseline (47 [35-59] vs 56 [42-74]), chronic obstructive pulmonary disease (COPD) (19% vs 8%), severe chronic kidney disease (CKD) (13% vs 2%), a clinical frailty score (CFS) ≥5 (41% vs 14%), and lower serum albumin (36 g/L [34-38] vs 38 g/L [35-40]). On multivariate analysis, with an area under the curve of 0.71 (0.63-0.78), baseline KCCQ-OS (adjusted odds ratio [aOR] 0.3 [0.1-0.6], p=0.04), COPD (aOR 2.8 [1.2-6.5], p=0.02), and severe CKD (aOR 5.7 [1.7-18.5], p=0.004) remained independent predictors. CFS alone had a similar predictive value as the multivariable model (OR 2.0 [1.3-3.4], area under the curve 0.69 [0.59-0.80], p<0.001). CONCLUSIONS KCCQ scores were effective in delineating functional outcomes, with most patients in our relatively lower surgical risk cohort showing significant functional improvements post-TAVI. Low baseline KCCQ, moderate or worse COPD, and severe CKD were associated with failure of improvement post-TAVI. Baseline CFS appears to be a good screening tool to predict poor improvement. These factors should be evaluated and weighted accordingly in pre-TAVI assessments and decision-making.
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Affiliation(s)
- Emma K Gard
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Samer Noaman
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia
| | - Pieter Vriesendorp
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - Nay Htun
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia
| | - Rozanne Johnston
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Elisha Gartner
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Ronald Dick
- Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - David Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Vic, Australia
| | - Shane Nanayakkara
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia; Baker Heart & Diabetes Institute, Melbourne, Vic, Australia.
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22
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Yang M, Kondo T, Talebi A, Jhund PS, Docherty KF, Claggett BL, Vaduganathan M, Bachus E, Hernandez AF, Lam CSP, Inzucchi SE, Martinez FA, de Boer RA, Kosiborod MN, Desai AS, Køber L, Ponikowski P, Sabatine MS, Solomon SD, McMurray JJV. Dapagliflozin and quality of life measured using the EuroQol 5-dimension questionnaire in patients with heart failure with reduced and mildly reduced/preserved ejection fraction. Eur J Heart Fail 2024; 26:1524-1538. [PMID: 38700986 DOI: 10.1002/ejhf.3263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/13/2024] [Accepted: 04/13/2024] [Indexed: 05/05/2024] Open
Abstract
AIMS Although much is known about the usefulness of heart failure (HF)-specific instruments for assessing patient well-being, less is known about the value of generic instruments for the measurement of health-related quality of life (HRQL) in HF. The aim of this study was to assess the relationship between the EuroQol 5-dimension 5-level (EQ-5D-5L) visual analogue scale (VAS) and index scores, clinical characteristics, and outcomes in patients with HF and the effect of dapagliflozin on these scores. METHODS AND RESULTS We performed a patient-level pooled analysis of the DAPA-HF and DELIVER trials, which investigated the effectiveness and safety of dapagliflozin in patients with HF and reduced ejection fraction (HFrEF) and mildly reduced/preserved ejection fraction (HFmrEF/HFpEF), respectively. Patients reporting higher (better) EQ-5D-5L VAS and index scores had a lower prevalence of comorbidities, including atrial fibrillation and hypertension, than patients with a worse score. They were also more likely to have better investigator-reported (New York Heart Association class) and patient-self-reported (Kansas City Cardiomyopathy Questionnaire) health status and lower median N-terminal pro-B-type natriuretic peptide levels. Compared to patients with the lowest scores (Q1), those with higher EQ-5D-5L VAS scores had better outcomes: the hazard ratio for the composite of cardiovascular death or worsening HF was 0.81 (95% confidence interval 0.72-0.91) in Q2, 0.74 (0.65-0.84) in Q3, and 0.62 (0.54-0.72) in Q4. The risk of each component of the composite outcome, and all-cause death, was also lower in patients with better scores. Similar findings were observed for the index score. Treatment with dapagliflozin improved both EQ-5D-5L VAS and index scores across the range of ejection fraction. CONCLUSIONS Both higher (better) EQ-5D-5L VAS and index scores were associated with better outcomes. Dapagliflozin treatment improved EQ-5D-5L VAS and index scores, irrespective of ejection fraction.
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Affiliation(s)
- Mingming Yang
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Toru Kondo
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atefeh Talebi
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Kieran F Docherty
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Erasmus Bachus
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, Biopharmaceuticals R&D AstraZeneca, Gothenburg, Sweden
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | | | | | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Marc S Sabatine
- TIMI (Thrombolysis in Myocardial Infarction) Study Group, Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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23
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Kherallah RY, Suffredini JM, Rahman F, Eng MH, Kleiman N, Manandhar P, Kosinski A, Silva G, Kamat I, Kapadia S, Vemulapalli S, Jneid H. Impact of Elevated Gradients After Transcatheter Aortic Valve Implantation for Degenerated Surgical Aortic Valve Bioprostheses. Circ Cardiovasc Interv 2024; 17:e013558. [PMID: 38785079 DOI: 10.1161/circinterventions.123.013558] [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: 08/26/2023] [Accepted: 03/18/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Elevated aortic valve gradients are common after transcatheter aortic valve implantation for degenerated surgical aortic valve replacement bioprostheses, but their clinical impact is uncertain. METHODS A total of 12 122 patients who underwent transcatheter aortic valve implantation-in-surgical aortic valve replacement from November 2011 to December 2019 in the Society of Thoracic Surgery/American College of Cardiology Transvalvular Therapeutics Registry were included. The primary outcome was a composite of 1-year all-cause mortality, stroke, myocardial infarction, or valve reintervention. Secondary outcomes included 1-year all-cause mortality, readmission, and change from baseline 12-question self-administered Kansas City Cardiomyopathy Questionnaire-Overall Summary Score. Due to nonlinearity observed with restricted cubic splines analysis, a Cox regression analysis with aortic valve mean gradient modeled as a spline-continuous variable (with 20 mm Hg as a cutoff) was used to study the 1-year composite outcome and mortality. RESULTS The composite outcome occurred most frequently in patients with aortic valve mean gradient ≥30 and <10 mm Hg, as compared with those with 10 to 20 and 20 to 30 mm Hg ranges (unadjusted rates, 13.9%, 12.1%, 7.5%, and 6.5%, respectively; P=0.002). When the mean aortic valve gradient was ≥20 mm Hg, higher gradients were associated with greater risk of the 1-year composite outcome (adjusted hazard ratio, 1.02 [1.02-1.03] per mm Hg; P<0.001) and 1-year mortality (adjusted hazard ratio, 1.02 [1.00-1.03] per mm Hg; P=0.007). Whereas when the mean aortic valve gradient was <20 mm Hg, higher gradients were not significantly associated with the composite outcome (adjusted hazard ratio, 0.99 [0.98-1.003] per mm Hg; P=0.12) but were associated with lower 1-year mortality (adjusted hazard ratio, 0.98 [0.97-0.99] per mm Hg; P=0.007). CONCLUSIONS The relationship between postprocedural aortic valve mean gradient after transcatheter aortic valve implantation-in-surgical aortic valve replacement and clinical outcomes is complex and nonlinear, with relatively greater adverse events occurring at low and high gradient extremes. Further study of factors mediating the relationship between postprocedural gradients and clinical outcomes, including low-flow states, is necessary.
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Affiliation(s)
- Riyad Yazan Kherallah
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (R.Y.K., J.M.S., G.S.)
| | - John M Suffredini
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (R.Y.K., J.M.S., G.S.)
| | - Faisal Rahman
- Division of Cardiology, Department of Medicine, John Hopkins School of Medicine, Baltimore, MD (F.R.)
| | - Marvin H Eng
- Division of Cardiology, Department of Internal Medicine, University of Arizona Banner University Heart Institute, Phoenix (M.H.E.)
| | - Neal Kleiman
- Department of Cardiology, Houston Methodist Hospital, TX (N.K.)
| | | | | | - Guilherme Silva
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (R.Y.K., J.M.S., G.S.)
| | - Ishan Kamat
- Division of Cardiology, Department of Internal Medicine, University of California San Francisco (I.K.)
| | - Samir Kapadia
- Department of Internal Medicine, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (S.K.)
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, NC (P.M., A.K., S.V.)
- Division of Cardiology, Department of Internal Medicine, Duke Department of Medicine, Durham, NC (S.V.)
| | - Hani Jneid
- Division of Cardiology, Department of Internal Medicine, University of Texas Medical Branch, Galveston (H.J.)
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24
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Nguyen DD, Spertus JA, Benton MC, Thomas M, Jones PG, Andrei AC, Wu T, Baldridge AS, Grady KL. Association of Patient Reported Outcomes With Caregiver Burden in Older Patients With Advanced Heart Failure: Insights From the SUSTAIN-IT Study. Circ Heart Fail 2024; 17:e011705. [PMID: 38910557 DOI: 10.1161/circheartfailure.124.011705] [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: 02/13/2024] [Accepted: 04/03/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Caregivers of patients with advanced heart failure may experience burden in providing care, but whether changes in patient health status are associated with caregiver burden is unknown. METHODS This observational study included older patients (60-80 years old) receiving advanced surgical heart failure therapies and their caregivers at 13 US sites. Patient health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire (range, 0-100; higher scores are better). Caregiver burden was assessed using the Oberst Caregiving Burden Scale, which measures time on task (OCBS-time) and task difficulty (OCBS-difficulty; range, 1-5; lower scores are better). Measurements occurred before surgery and 12 months after in 3 advanced heart failure cohorts: patients receiving long-term left ventricular assist device support; heart transplantation with pretransplant left ventricular assist device support; and heart transplantation without pretransplant left ventricular assist device support. Multivariable linear regression was used to identify predictors of change in OCBS-time and OCBS-difficulty at 12 months. RESULTS Of 162 caregivers, the mean age was 61.0±9.4 years, 139 (86%) were female, and 140 (86%) were the patient's spouse. At 12 months, 99 (61.1%) caregivers experienced improved OCBS-time, and 61 (37.7%) experienced improved OCBS-difficulty (versus no change or worse OCBS). A 10-point higher baseline 12-item Kansas City Cardiomyopathy Questionnaire predicted lower 12-month OCBS-time (β=-0.09 [95% CI, -0.14 to -0.03]; P<0.001) and OCBS-difficulty (β=-0.08 [95% CI, -0.12 to -0.05]; P<0.001). Each 10-point improvement in the 12-item Kansas City Cardiomyopathy Questionnaire predicted lower 12-month OCBS-time (β=-0.07 [95% CI, -0.12 to -0.03]; P=0.002) and OCBS-difficulty (β=-0.09 [95% CI, -0.12 to -0.06]; P<0.001). CONCLUSIONS Among survivors at 12 months, baseline and change in patient health status were associated with subsequent caregiver time on task and task difficulty in dyads receiving advanced heart failure surgical therapies, highlighting the potential for serial 12-item Kansas City Cardiomyopathy Questionnaire assessments to identify caregivers at risk of increased burden. REGISTRATION URL: https://www.clinicaltrials.gov; unique identifier: NCT02568930.
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Affiliation(s)
- Dan D Nguyen
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - John A Spertus
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Mary C Benton
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Merrill Thomas
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Philip G Jones
- University of Missouri, Kansas City (D.D.N., J.A.S., M.C.B., M.T., P.G.J.)
- Saint Luke's Mid America Heart Institute, Kansas City, MO (D.D.N., J.A.S., M.C.B., M.T., P.J.)
| | - Adin-Cristian Andrei
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Tingqing Wu
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Abigail S Baldridge
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
| | - Kathleen L Grady
- Feinberg School of Medicine at Northwestern University, Chicago, IL (A.-C.A., T.W., A.S.B., K.L.G.)
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25
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Shen Q, Cintron SA, Pierce JD. Platelet and Leukocyte Mitochondrial Function With Cardiac Function and Self-Reported Health Status Among Obese Patients With Heart Failure. Nurs Res 2024; 73:294-303. [PMID: 38905622 DOI: 10.1097/nnr.0000000000000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
BACKGROUND Mitochondrial dysfunction plays a key role in the development of heart failure (HF), including HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Impaired mitochondrial function negatively affects cardiac function and, subsequently, the health status of patients. However, measuring mitochondrial function in human myocytes is difficult because of the high risk associated with myocardial biopsy. Platelets and leukocytes have functional mitochondria and can potentially serve as a surrogate for myocardial mitochondria. Roles of platelet and leukocyte mitochondrial function in HF have not yet been fully explored. OBJECTIVE We aimed to explore the relationships of platelet and leukocyte mitochondrial function with cardiac function and self-reported health status among obese patients with HF and examine if the relationships vary between HFrEF and HFpEF. METHODS Forty-five obese patients with HF were recruited. Maximal enzymatic activities (Vmax) of platelet cytochrome c oxidase (COX) and citrate synthase (CS) were assessed. Leukocyte mitochondrial mass, membrane potential, superoxide production, and apoptosis were measured in a subset of the sample. Data on cardiac function were retrieved from electronic health records. Self-reported health status was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Pearson correlations were performed. RESULTS Platelet COX Vmax was negatively correlated with left ventricular end-systolic diameter. Positive correlations of leukocyte mitochondrial mass and superoxide production with left ventricular mass and mass index were observed, respectively. Leukocyte mitochondrial mass and superoxide production also negatively correlated with KCCQ summary scores. These relationships varied between HFrEF and HFpEF. DISCUSSION Platelet and leukocyte mitochondrial function was found to significantly correlate with some echocardiographic parameters and KCCQ scores. These findings provided preliminary data to support future research to further explore the potential of using platelets and leukocytes as surrogate biomarkers. Identifying easy-accessible mitochondrial biomarkers will be useful for assessing mitochondrial function to assist with early diagnosis and monitoring the effectiveness of mitochondrial-targeted therapy in HF patients.
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Rubino D, Bjorner JB, Rathor N, Sharma AM, von Huth Smith L, Wharton S, Wadden T, Zeuthen N, Kolotkin RL. Effect of semaglutide 2.4 mg on physical functioning and weight- and health-related quality of life in adults with overweight or obesity: Patient-reported outcomes from the STEP 1-4 trials. Diabetes Obes Metab 2024; 26:2945-2955. [PMID: 38698650 DOI: 10.1111/dom.15620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Abstract
AIMS To summarize the effects of semaglutide 2.4 mg on weight-related quality of life (WRQOL) and health-related quality of life (HRQOL), focusing on the confirmatory secondary endpoint of physical functioning. MATERIALS AND METHODS The STEP 1-4 Phase 3a, 68-week, double-blind, randomized controlled trials assessed the efficacy and safety of semaglutide 2.4 mg versus placebo in individuals with overweight/obesity. WRQOL and HRQOL were assessed by change from baseline to Week 68 in two different but complementary measures, the Impact of Weight on Quality of Life-Lite Clinical Trials Version (IWQOL-Lite-CT; STEP 1 and 2) and the SF-36v2 Health Survey Acute (SF-36v2; STEP 1-4). RESULTS Superiority for semaglutide 2.4 mg over placebo based on IWQOL-Lite-CT and SF-36v2 physical functioning scores was confirmed in STEP 1 and 2 and in STEP 1, 2 and 4, respectively. At Week 68, a greater proportion of participants treated with semaglutide 2.4 mg than with placebo reached meaningful within-person change (MWPC) thresholds for IWQOL-Lite-CT Physical Function scores in STEP 1 (51.8% vs. 28.3%; p < 0.0001) and STEP 2 (39.6% vs. 29.5%; p = 0.0083) and the MWPC threshold for SF-36v2 Physical Functioning in STEP 1 (39.8% vs. 24.1%; p < 0.0001), STEP 2 (41.0% vs. 27.3%; p = 0.0001) and STEP 4 (18.0% vs. 6.6%; p < 0.0001). All other IWQOL-Lite-CT and SF-36v2 scale scores in STEP 1-4 were numerically improved with semaglutide 2.4 mg versus placebo, except for SF-36v2 Role Emotional in STEP 2. CONCLUSIONS Semaglutide 2.4 mg significantly improved physical functioning, with greater proportions of participants achieving MWPC compared with placebo, and showed beneficial effects on WRQOL and HRQOL beyond physical functioning.
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Affiliation(s)
- Domenica Rubino
- Washington Center for Weight Management and Research, Arlington, Virginia, USA
| | - Jakob B Bjorner
- QualityMetric Inc., LLC, Johnston, Rhode Island, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Arya M Sharma
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sean Wharton
- York University, McMaster University and Wharton Weight Management Clinic, Toronto, Ontario, Canada
| | - Thomas Wadden
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Ronette L Kolotkin
- Quality of Life Consulting, Durham, North Carolina, USA
- Duke Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Centre of Health Research, Helse Førde Hospital Trust, Førde, Norway
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
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27
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Uchijima D, Kano S. International Comparison of Qualification Process for Medical Product Development Tools. Ther Innov Regul Sci 2024; 58:663-677. [PMID: 38538949 PMCID: PMC11169009 DOI: 10.1007/s43441-024-00630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/09/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Qualification of medical product evaluation tools is underway in the United States, Europe, and Japan to reflect the advancements in the basic science of medical products. In Europe and the U.S., Guidance of Guidances (GoG) policies that clarify regulators'processes, tasks, and methods of sponsor involvement are adopted to issue tool guidance. However, in Japan, a non-GoG type policy focusing on supporting the research and development for tools without defining a tool guidance-making process has been adopted. METHODS In this study, an analytical framework for the lifecycle of development tools was constructed, including pre- and post-tool qualification processes, to compare the two above-mentioned approaches. For this study, Japanese cases were selected as experimental cases, whereas Western cases served as controls. The progress of tool qualification and composition of deliverables were analyzed. RESULTS AND CONCLUSIONS It was indicated that in the GoG type policy, in which processes are defined, and involvement methods are clarified, tool qualification can progress more smoothly than in a non-GoG type policy. This policy indicates that deliverables may have a consistent composition. Contrastingly, GoG-type policies alone present challenges in connecting upstream tools for R&D support.
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Affiliation(s)
- Daichi Uchijima
- Bio-Innovation Policy Unit, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, University of Tokyo, Bioscience Bldg B1-17, 5-1-5, Kashiwanoha, Kashiwa City, Chiba, 8562, Japan.
| | - Shingo Kano
- Bio-Innovation Policy Unit, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, University of Tokyo, Bioscience Bldg B1-17, 5-1-5, Kashiwanoha, Kashiwa City, Chiba, 8562, Japan
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28
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Kitzman DW, Lewis GD, Pandey A, Borlaug BA, Sauer AJ, Litwin SE, Sharma K, Jorkasky DK, Khan S, Shah SJ. A novel controlled metabolic accelerator for the treatment of obesity-related heart failure with preserved ejection fraction: Rationale and design of the Phase 2a HuMAIN trial. Eur J Heart Fail 2024. [PMID: 38924328 DOI: 10.1002/ejhf.3305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/18/2024] [Accepted: 05/09/2024] [Indexed: 06/28/2024] Open
Abstract
AIMS Compared with those without obesity, patients with obesity-related heart failure with preserved ejection fraction (HFpEF) have worse symptoms, haemodynamics, and outcomes. Current weight loss strategies (diet, drug, and surgical) work through decreased energy intake rather than increased expenditure and cause significant loss of skeletal muscle mass in addition to adipose tissue. This may have adverse implications for patients with HFpEF, who already have reduced skeletal muscle mass and function and high rates of physical frailty. Mitochondrial uncoupling agents may have unique beneficial effects by producing weight loss via increased catabolism rather than reduced caloric intake, thereby causing loss of adipose tissue while sparing skeletal muscle. HU6 is a controlled metabolic accelerator that is metabolized to the mitochondrial uncoupling agent 2,4-dinotrophenol. HU6 selectively increases carbon oxidation from fat and glucose while also decreasing toxic reactive oxygen species (ROS) production. In addition to sparing skeletal muscle loss, HU6 may have other benefits relevant to obesity-related HFpEF, including reduced specific tissue depots contributing to HFpEF; improved glucose utilization; and reduction in systemic inflammation via both decreased ROS production from mitochondria and decreased cytokine elaboration from excess, dysfunctional adipose. METHODS We describe the rationale and design of HuMAIN-HFpEF, a Phase 2a randomized, double-blind, placebo-controlled, dose-titration, parallel-group trial in patients with obesity-related HFpEF to evaluate the effects of HU6 on weight loss, body composition, exercise capacity, cardiac structure and function, metabolism, and inflammation, and identify optimal dosage for future Phase 3 trials. CONCLUSIONS HuMAIN will test a promising novel agent for obesity-related HFpEF.
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Affiliation(s)
- Dalane W Kitzman
- Section on Geriatrics and Gerontology, Department of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Gregory D Lewis
- Department of Medicine, Massachusetts General Brigham, Boston, MA, USA
| | - Ambarish Pandey
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrew J Sauer
- Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Sheldon E Litwin
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
- Division of Cardiology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Kavita Sharma
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | | | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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29
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Palmiero G, Monda E, Verrillo F, Dongiglio F, Cirillo C, Caiazza M, Rubino M, Cirillo A, Fusco A, Diana G, Ciccarelli G, Dellegrottaglie S, Calabrò P, Golino P, Limongelli G. Impact of Tafamidis on Delaying Clinical, Functional, and Structural Cardiac Changes in Patients with Wild-Type Transthyretin Amyloid Cardiomyopathy. J Clin Med 2024; 13:3730. [PMID: 38999296 PMCID: PMC11242185 DOI: 10.3390/jcm13133730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/24/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Background: This study aimed to evaluate the effect of treatment with tafamidis on clinical, laboratory, functional, and structural cardiovascular imaging parameters at the 12-month follow-up timepoint in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) and to assess the response to treatment in terms of disease progression. Methods: Patients with ATTRwt-CM undergoing treatment with tafamidis for >12 months were included. The patients underwent a comprehensive evaluation (including echocardiography, cardiac magnetic resonance imaging, six-minute walking test, assessment of quality of life, and laboratory tests) at baseline and the 12-month follow-up timepoint. Disease progression was assessed using a set of tools proposed by an international panel of experts, evaluating three main domains (clinical, biochemical, and structural). Results: The study cohort consisted of 25 patients (mean age of 75.9 ± 6.1 years, with 92% males). At the 12-month follow-up timepoint, an improvement in quality of life calculated with the KCCQ overall score (64 ± 20 vs. 75 ± 20, p = 0.002) and a reduction in pulmonary artery pressure (34 ± 10 mmHg vs. 30 ± 5 mmHg, p-value = 0.008) and in native T1 time were observed (1162 ± 66 ms vs. 1116 ± 52 ms, p-value = 0.001). Clinical, biochemical, and structural disease progression was observed in 6 (24%), 13 (52%), and 7 (28%) patients, respectively. Overall disease progression was observed in two patients (8%). Conclusions: This study described the impact of tafamidis treatment on clinical, laboratory, and functional parameters. Disease progression, assessed using a multiparametric tool recommended by a recent position paper of experts, was observed in a minority of patients.
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Affiliation(s)
- Giuseppe Palmiero
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Diseases, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Emanuele Monda
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Diseases, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Federica Verrillo
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Diseases, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Francesca Dongiglio
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Diseases, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Chiara Cirillo
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Diseases, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Diseases, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Marta Rubino
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Diseases, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Annapaola Cirillo
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Diseases, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Adelaide Fusco
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Diseases, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Gaetano Diana
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Diseases, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Giovanni Ciccarelli
- Vanvitelli Cardiology Unit, Department of Translational Medical Sciences, Monaldi Hospital, 80131 Naples, Italy
- Sbarro Institute for Cancer Research and Molecular Medicine, Center of Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
| | - Santo Dellegrottaglie
- Advanced Cardiovascular Imaging Unit, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, 80131 Naples, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Diseases, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Paolo Golino
- Vanvitelli Cardiology Unit, Department of Translational Medical Sciences, Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Diseases, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
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Sandhu AT, Calma J, Skye M, Kalwani N, Zheng J, Schirmer J, Din N, Brown Johnson C, Gupta A, Lan R, Yu B, Spertus JA, Heidenreich PA. Clinical Impact of Routine Assessment of Patient-Reported Health Status in Heart Failure Clinic: The PRO-HF Trial. Circulation 2024; 149:1717-1728. [PMID: 38583147 DOI: 10.1161/circulationaha.124.069624] [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: 03/13/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The impact of routine clinic use of patient-reported outcome (PRO) measures on clinical outcomes in patients with heart failure (HF) has not been well-characterized. We tested if clinic-based use of a disease-specific PRO improves patient-reported quality of life at 1 year. METHODS The PRO-HF trial (Patient-Reported Outcome Measurement in Heart Failure Clinic) was an open-label, parallel, patient-level randomized clinical trial of routine PRO assessment or usual care at an academic HF clinic between August 30, 2021, and June 30, 2022, with 1 year of follow-up. In the PRO assessment arm, participants completed the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) at each HF clinic visit, and results were shared with their treating clinician. The usual care arm completed the KCCQ-12 at randomization and 1 year later, which was not shared with the treating clinician. The primary outcome was the KCCQ-12 overall summary score (OSS) between 12 and 15 months after randomization. Secondary outcomes included domains of the KCCQ-12, hospitalization and emergency department visit rates, HF medication therapy, clinic visit frequency, and testing rates. RESULTS Across 17 clinicians, 1248 participants were enrolled and randomized to PRO assessment (n=624) or usual care (n=624). The median age was 63.9 years (interquartile range [IQR], 51.8-72.8), 38.9% were women, and the median baseline KCCQ-12 OSS was 82.3 (IQR, 58.3-94.8). Final KCCQ-12 (available in 87.9% of the PRO arm and 85.1% in usual care; P=0.16) median OSS were 87.5 (IQR, 68.8-96.9) in the PRO arm and 87.6 (IQR, 69.7-96.9) in the usual care arm with a baseline-adjusted mean difference of 0.2 ([95% CI, -1.7 to 2.0]; P=0.85). The results were consistent across prespecified subgroups. A post hoc analysis demonstrated a significant interaction with greater benefit among participants with a baseline KCCQ-12 OSS of 60 to 80 but not in less or more symptomatic participants. No significant differences were found in 1-year mortality, hospitalizations, emergency department visits, medication therapy, clinic follow-up, or testing rates between arms. CONCLUSIONS Routine PRO assessment in HF clinic visits did not impact patient-reported quality of life or other clinical outcomes. Alternate strategies and settings for embedding PROs into routine clinical care should be tested. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04164004.
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Affiliation(s)
- Alexander T Sandhu
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Stanford Prevention Research Center (A.T.S.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Jamie Calma
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
| | - Megan Skye
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Neil Kalwani
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Jimmy Zheng
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Jessica Schirmer
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
| | - Natasha Din
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
| | - Cati Brown Johnson
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Anshal Gupta
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Roy Lan
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - Brian Yu
- Department of Medicine (J.Z., C.B.J., A.G., R.L., B.Y.), Stanford University, CA
| | - John A Spertus
- University of Missouri-Kansas City Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.)
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine (A.T.S., J.C., M.S., N.K., J.S., P.A.H.), Stanford University, CA
- Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., M.S., N.K., N.D., P.A.H.)
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Maron MS, Mahmod M, Abd Samat AH, Choudhury L, Massera D, Phelan DMJ, Cresci S, Martinez MW, Masri A, Abraham TP, Adler E, Wever-Pinzon O, Nagueh SF, Lewis GD, Chamberlin P, Patel J, Yavari A, Dehbi HM, Sarwar R, Raman B, Valkovič L, Neubauer S, Udelson JE, Watkins H. Safety and Efficacy of Metabolic Modulation With Ninerafaxstat in Patients With Nonobstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2024; 83:2037-2048. [PMID: 38599256 DOI: 10.1016/j.jacc.2024.03.387] [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: 02/22/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND In nonobstructive hypertrophic cardiomyopathy (nHCM), there are no approved medical therapies. Impaired myocardial energetics is a potential cause of symptoms and exercise limitation. Ninerafaxstat, a novel cardiac mitotrope, enhances cardiac energetics. OBJECTIVES This study sought to evaluate the safety and efficacy of ninerafaxstat in nHCM. METHODS Patients with hypertrophic cardiomyopathy and left ventricular outflow tract gradient <30 mm Hg, ejection fraction ≥50%, and peak oxygen consumption <80% predicted were randomized to ninerafaxstat 200 mg twice daily or placebo (1:1) for 12 weeks. The primary endpoint was safety and tolerability, with efficacy outcomes also assessed as secondary endpoints. RESULTS A total of 67 patients with nHCM were enrolled at 12 centers (57 ± 11.8 years of age; 55% women). Serious adverse events occurred in 11.8% (n = 4 of 34) in the ninerafaxstat group and 6.1% (n = 2 of 33) of patients in the placebo group. From baseline to 12 weeks, ninerafaxstat was associated with significantly better VE/Vco2 (ventilatory efficiency) slope compared with placebo with a least-squares (LS) mean difference between the groups of -2.1 (95% CI: -3.6 to -0.6; P = 0.006), with no significant difference in peak VO2 (P = 0.90). The Kansas City Cardiomyopathy Questionnaire Clinical Summary Score was directionally, though not significantly, improved with ninerafaxstat vs placebo (LS mean 3.2; 95% CI: -2.9 to 9.2; P = 0.30); however, it was statistically significant when analyzed post hoc in the 35 patients with baseline Kansas City Cardiomyopathy Questionnaire Clinical Summary Score ≤80 (LS mean 9.4; 95% CI: 0.3-18.5; P = 0.04). CONCLUSIONS In symptomatic nHCM, novel drug therapy targeting myocardial energetics was safe and well tolerated and associated with better exercise performance and health status among those most symptomatically limited. The findings support assessing ninerafaxstat in a phase 3 study.
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Affiliation(s)
- Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
| | - Masliza Mahmod
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Azlan Helmy Abd Samat
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Lubna Choudhury
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniele Massera
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York, USA
| | - Dermot M J Phelan
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Sharon Cresci
- Center for Cardiovascular Research, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Matthew W Martinez
- Division of Cardiology, Atlantic Health System, Morristown, New Jersey, USA
| | - Ahmad Masri
- Hypertrophic Cardiomyopathy Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Theodore P Abraham
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Eric Adler
- Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego, La Jolla, California, USA
| | - Omar Wever-Pinzon
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah and Salt Lake Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Gregory D Lewis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jai Patel
- Imbria Pharmaceuticals, Boston, Massachusetts, USA
| | - Arash Yavari
- Imbria Pharmaceuticals, Boston, Massachusetts, USA
| | | | | | - Betty Raman
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Ladislav Valkovič
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - James E Udelson
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Ambardekar AV, Kopecky BJ, Raymer DS. Finding an Unobstructed View Toward the Treatment of Nonobstructive Hypertrophic Cardiomyopathy: Lifting the Hunger Fog. J Am Coll Cardiol 2024; 83:2049-2051. [PMID: 38777508 DOI: 10.1016/j.jacc.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Amrut V Ambardekar
- Department of Medicine, Division of Cardiology, Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
| | - Benjamin J Kopecky
- Department of Medicine, Division of Cardiology, Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. https://twitter.com/BKopeckyMDPhD
| | - David S Raymer
- Department of Medicine, Division of Cardiology, Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. https://twitter.com/dsraymer
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Kondo T, Mogensen UM, Talebi A, Gasparyan SB, Campbell RT, Docherty KF, de Boer RA, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, Sabatine MS, Bengtsson O, Sjöstrand M, Vaduganathan M, Solomon SD, Jhund PS, McMurray JJV. Dapagliflozin and Days of Full Health Lost in the DAPA-HF Trial. J Am Coll Cardiol 2024; 83:1973-1986. [PMID: 38537918 DOI: 10.1016/j.jacc.2024.03.385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Conventional time-to-first-event analyses cannot incorporate recurrent hospitalizations and patient well-being in a single outcome. OBJECTIVES To overcome this limitation, we tested an integrated measure that includes days lost from death and hospitalization, and additional days of full health lost through diminished well-being. METHODS The effect of dapagliflozin on this integrated measure was assessed in the DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) trial, which examined the efficacy of dapagliflozin, compared with placebo, in patients with NYHA functional class II to IV heart failure and a left ventricular ejection fraction ≤40%. RESULTS Over 360 days, patients in the dapagliflozin group (n = 2,127) lost 10.6 ± 1.0 (2.9%) of potential follow-up days through cardiovascular death and heart failure hospitalization, compared with 14.4 ± 1.0 days (4.0%) in the placebo group (n = 2,108), and this component of all measures of days lost accounted for the greatest between-treatment difference (-3.8 days [95% CI: -6.6 to -1.0 days]). Patients receiving dapagliflozin also had fewer days lost to death and hospitalization from all causes vs placebo (15.5 ± 1.1 days [4.3%] vs 20.3 ± 1.1 days [5.6%]). When additional days of full health lost (ie, adjusted for Kansas City Cardiomyopathy Questionnaire-overall summary score) were added, total days lost were 110.6 ± 1.6 days (30.7%) with dapagliflozin vs 116.9 ± 1.6 days (32.5%) with placebo. The difference in all measures between the 2 groups increased over time (ie, days lost by death and hospitalization -0.9 days [-0.7%] at 120 days, -2.3 days [-1.0%] at 240 days, and -4.8 days [-1.3%] at 360 days). CONCLUSIONS Dapagliflozin reduced the total days of potential full health lost due to death, hospitalizations, and impaired well-being, and this benefit increased over time during the first year. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure; NCT03036124).
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Affiliation(s)
- Toru Kondo
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ulrik M Mogensen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Atefeh Talebi
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Samvel B Gasparyan
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Ross T Campbell
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Kieran F Docherty
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | | | | | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Olof Bengtsson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Mikaela Sjöstrand
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
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Kusayev J, Levy Y, Weininger D, Frishman WH, Aronow WS. Semaglutide in Heart Failure With Preserved Ejection Fraction: Exploring Recent Evidence in Therapeutic Potential for the Obese Population. Cardiol Rev 2024:00045415-990000000-00269. [PMID: 38757954 DOI: 10.1097/crd.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent condition, particularly among the aging population in the United States, and is associated with significant challenges due to its complex pathophysiology and limited therapeutic options. Historically, few pharmacological therapies have successfully mitigated HFpEF, making the emergence of effective treatments particularly significant. This review evaluates recent evidence on the therapeutic potential of semaglutide for managing HFpEF, especially in the obese population. Results from the STEP-HFpEF and STEP-HFpEF DM trials demonstrate that semaglutide, a glucagon-like peptide-1 receptor agonist originally developed for type 2 diabetes but now also approved for obesity treatment, significantly improves clinical outcomes such as symptom scores, body weight, exercise capacity, and inflammation markers in the obese population suffering from HFpEF. These improvements are attributed to both the weight loss induced by semaglutide and its direct effects on the congestive pathophysiology of HFpEF. The efficacy of semaglutide offers new hope for addressing a condition that has long lacked effective pharmacological interventions.
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Affiliation(s)
- Josef Kusayev
- From the Department of Medicine, New York Medical College, Valhalla, NY
| | - Yisrael Levy
- From the Department of Medicine, New York Medical College, Valhalla, NY
| | - David Weininger
- Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | | | - Wilbert S Aronow
- Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
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Lee SY. Using Bayesian statistics in confirmatory clinical trials in the regulatory setting: a tutorial review. BMC Med Res Methodol 2024; 24:110. [PMID: 38714936 PMCID: PMC11077897 DOI: 10.1186/s12874-024-02235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
Bayesian statistics plays a pivotal role in advancing medical science by enabling healthcare companies, regulators, and stakeholders to assess the safety and efficacy of new treatments, interventions, and medical procedures. The Bayesian framework offers a unique advantage over the classical framework, especially when incorporating prior information into a new trial with quality external data, such as historical data or another source of co-data. In recent years, there has been a significant increase in regulatory submissions using Bayesian statistics due to its flexibility and ability to provide valuable insights for decision-making, addressing the modern complexity of clinical trials where frequentist trials are inadequate. For regulatory submissions, companies often need to consider the frequentist operating characteristics of the Bayesian analysis strategy, regardless of the design complexity. In particular, the focus is on the frequentist type I error rate and power for all realistic alternatives. This tutorial review aims to provide a comprehensive overview of the use of Bayesian statistics in sample size determination, control of type I error rate, multiplicity adjustments, external data borrowing, etc., in the regulatory environment of clinical trials. Fundamental concepts of Bayesian sample size determination and illustrative examples are provided to serve as a valuable resource for researchers, clinicians, and statisticians seeking to develop more complex and innovative designs.
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Affiliation(s)
- Se Yoon Lee
- Department of Statistics, Texas A &M University, 3143 TAMU, College Station, TX, 77843, USA.
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36
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Mukherjee M, Strom JB, Afilalo J, Hu M, Beussink-Nelson L, Kim J, Addetia K, Bertoni A, Gottdiener J, Michos ED, Gardin JM, Shah SJ, Freed BH. Normative Values of Echocardiographic Chamber Size and Function in Older Healthy Adults: The Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2024; 17:e016420. [PMID: 38716661 PMCID: PMC11108741 DOI: 10.1161/circimaging.123.016420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/26/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND Echocardiographic (2-dimensional echocardiography) thresholds indicating disease or impaired functional status compared with normal physiological aging in individuals aged ≥65 years are not clearly defined. In the present study, we sought to establish standard values for 2-dimensional echocardiography parameters related to chamber size and function in older adults without cardiopulmonary or cardiometabolic conditions. METHODS In this cross-sectional study of 3032 individuals who underwent 2-dimensional echocardiography at exam 6 in the MESA (Multi-Ethnic Study of Atherosclerosis), 608 participants fulfilled our inclusion criteria of healthy aging, with normative values defined as the mean ± 1.96 standard deviation and compared across sex and race and ethnicity. Functional status measures included NT-proBNP (N-terminal pro-B-type natriuretic peptide), 6-minute walk distance, and Kansas City Cardiomyopathy Questionnaire. Prognostic performance using MESA cutoffs was compared with established guideline cutoffs using time-to-event analysis. RESULTS The normative aging cohort (69.5±7.0 years, 46.2% male, 47.5% White) had lower NT-proBNP, higher 6-minute walk distance, and higher (better) Kansas City Cardiomyopathy Questionnaire summary values. Women had significantly smaller chamber sizes and better biventricular systolic function. White participants had the largest chamber dimensions, whereas Chinese participants had the smallest, even after adjustment for body size. Current guidelines identified 81.6% of healthy older adults in MESA as having cardiac abnormalities. CONCLUSIONS Among a large, diverse group of healthy older adults, we found significant differences in cardiac structure and function by sex and race/ethnicity, which may signal sex-specific cardiac remodeling with advancing age. It is crucial for existing guidelines to consider the observed and clinically significant differences in cardiac structure and function associated with healthy aging. Our study highlights that existing guidelines, which grade abnormalities in echocardiographic cardiac chamber size and function based on younger individuals, may not adequately address the anticipated changes associated with normal aging.
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Affiliation(s)
| | | | | | - Mo Hu
- Northwestern University Feinberg School of Medicine,
Chicago, IL
| | | | - Jiwon Kim
- Weill Cornell Medicine, New York, NY
| | - Karima Addetia
- University of Chicago Pritzker School of Medicine, Chicago,
IL
| | | | | | - Erin D. Michos
- Johns Hopkins University School of Medicine, Baltimore,
MD
| | | | - Sanjiv J. Shah
- Northwestern University Feinberg School of Medicine,
Chicago, IL
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Capone F, Nambiar N, Schiattarella GG. Beyond Weight Loss: the Emerging Role of Incretin-Based Treatments in Cardiometabolic HFpEF. Curr Opin Cardiol 2024; 39:148-153. [PMID: 38294187 DOI: 10.1097/hco.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW Incretin-based drugs are potent weight-lowering agents, emerging as potential breakthrough therapy for the treatment of obesity-related phenotype of heart failure with preserved ejection fraction (HFpEF). In this review article, we will discuss the contribution of weight loss as part of the benefits of incretin-based medications in obese patients with HFpEF. Furthermore, we will describe the potential effects of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists on the heart, particularly in relation to HFpEF pathophysiology. RECENT FINDINGS In the STEP-HFpEF trial, the GLP-1 receptor agonist semaglutide significantly improved quality of life outcomes in obese HFpEF patients. Whether the beneficial effects of semaglutide in obese patients with HFpEF are merely a consequence of body weight reduction is unclear. Considering the availability of other weight loss strategies (e.g., caloric restriction, exercise training, bariatric surgery) to be used in obese HFpEF patients, answering this question is crucial to provide tailored therapeutic options in these subjects. SUMMARY Incretin-based drugs may represent a milestone in the treatment of obesity in HFpEF. Elucidating the contribution of weight loss in the overall benefit observed with these drugs is critical in the management of obese HFpEF patients, considering that other weight-lowering strategies are available and might represent potential alternative options for these patients.
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Affiliation(s)
- Federico Capone
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Division of Internal Medicine, Department of Medicine, University of Padua, Padua, Italy
| | - Natasha Nambiar
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Gabriele G Schiattarella
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC), Deutsches Herzzentrum der Charité (DHZC), Charité -Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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Gouda P, Rathwell S, Colin-Ramirez E, Felker GM, Ross H, Escobedo J, Macdonald P, Troughton RW, O'Connor CM, Ezekowitz JA. Utilizing Quality of Life Adjusted Days Alive and Out of Hospital in Heart Failure Clinical Trials. Circ Cardiovasc Qual Outcomes 2024; 17:e010560. [PMID: 38567506 DOI: 10.1161/circoutcomes.123.010560] [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: 09/19/2023] [Accepted: 02/15/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND In heart failure (HF) trials, there has been an emphasis on utilizing more patient-centered outcomes, including quality of life (QoL) and days alive and out of hospital. We aimed to explore the impact of QoL adjusted days alive and out of hospital as an outcome in 2 HF clinical trials. METHODS Using data from 2 trials in HF (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure [GUIDE-IT] and Study of Dietary Intervention under 100 mmol in Heart Failure [SODIUM-HF]), we determined treatment differences using percentage days alive and out of hospital (%DAOH) adjusted for QoL at 18 months as the primary outcome. For each participant, %DAOH was calculated as a ratio between days alive and out of hospital/total follow-up. Using a regression model, %DAOH was subsequently adjusted for QoL measured by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score. RESULTS In the GUIDE-IT trial, 847 participants had a median baseline Kansas City Cardiomyopathy Questionnaire Overall Summary Score of 59.0 (interquartile range, 40.8-74.3), which did not change over 18 months. %DAOH was 90.76%±22.09% in the biomarker-guided arm and 88.56%±25.27% in the usual care arm. No significant difference in QoL adjusted %DAOH was observed (1.09% [95% CI, -1.57% to 3.97%]). In the SODIUM-HF trial, 796 participants had a median baseline Kansas City Cardiomyopathy Questionnaire Overall Summary Score of 69.8 (interquartile range, 49.3-84.3), which did not change over 18 months. %DAOH was 95.69%±16.31% in the low-sodium arm and 95.95%±14.76% in the usual care arm. No significant difference was observed (1.91% [95% CI, -0.85% to 4.77%]). CONCLUSIONS In 2 large HF clinical trials, adjusting %DAOH for QoL was feasible and may provide complementary information on treatment effects in clinical trials.
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Affiliation(s)
- Pishoy Gouda
- University of Alberta, Edmonton, Canada (P.G., J.A.E.)
| | - Sarah Rathwell
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (S.R., J.A.E.)
| | - Eloisa Colin-Ramirez
- Universidad Anáhuac México, Huixquilucan, Estado de México, Naucalpan, Mexico (E.C.-R.)
| | | | | | - Jorge Escobedo
- Instituto Mexicano del Seguro Social, Mexico City, Mexico (J.E.)
| | - Peter Macdonald
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.)
| | - Richard W Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.)
| | - Christopher M O'Connor
- Duke Clinical Research Institute, Durham, NC (G.M.F., C.M.O.)
- Inova Heart and Vascular Center, Falls Church, VA (C.M.O.)
| | - Justin A Ezekowitz
- University of Alberta, Edmonton, Canada (P.G., J.A.E.)
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (S.R., J.A.E.)
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Desai N, Olewinska E, Famulska A, Remuzat C, Francois C, Folkerts K. Heart failure with mildly reduced and preserved ejection fraction: A review of disease burden and remaining unmet medical needs within a new treatment landscape. Heart Fail Rev 2024; 29:631-662. [PMID: 38411769 PMCID: PMC11035416 DOI: 10.1007/s10741-024-10385-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/28/2024]
Abstract
This review provides a comprehensive overview of heart failure with mildly reduced and preserved ejection fraction (HFmrEF/HFpEF), including its definition, diagnosis, and epidemiology; clinical, humanistic, and economic burdens; current pharmacologic landscape in key pharmaceutical markets; and unmet needs to identify key knowledge gaps. We conducted a targeted literature review in electronic databases and prioritized articles with valuable insights into HFmrEF/HFpEF. Overall, 27 randomized controlled trials (RCTs), 66 real-world evidence studies, 18 clinical practice guidelines, and 25 additional publications were included. Although recent heart failure (HF) guidelines set left ventricular ejection fraction thresholds to differentiate categories, characterization and diagnosis criteria vary because of the incomplete disease understanding. Recent epidemiological data are limited and diverse. Approximately 50% of symptomatic HF patients have HFpEF, more common than HFmrEF. Prevalence varies with country because of differing definitions and study characteristics, making prevalence interpretation challenging. HFmrEF/HFpEF has considerable mortality risk, and the mortality rate varies with study and patient characteristics and treatments. HFmrEF/HFpEF is associated with considerable morbidity, poor patient outcomes, and common comorbidities. Patients require frequent hospitalizations; therefore, early intervention is crucial to prevent disease burden. Recent RCTs show promising results like risk reduction of composite cardiovascular death or HF hospitalization. Costs data are scarce, but the economic burden is increasing. Despite new drugs, unmet medical needs requiring new treatments remain. Thus, HFmrEF/HFpEF is a growing global healthcare concern. With improving yet incomplete understanding of this disease and its promising treatments, further research is required for better patient outcomes.
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Affiliation(s)
- Nihar Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
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40
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Butler J, Shah SJ, Petrie MC, Borlaug BA, Abildstrøm SZ, Davies MJ, Hovingh GK, Kitzman DW, Møller DV, Verma S, Einfeldt MN, Lindegaard ML, Rasmussen S, Abhayaratna W, Ahmed FZ, Ben-Gal T, Chopra V, Ezekowitz JA, Fu M, Ito H, Lelonek M, Melenovský V, Merkely B, Núñez J, Perna E, Schou M, Senni M, Sharma K, van der Meer P, Von Lewinski D, Wolf D, Kosiborod MN. Semaglutide versus placebo in people with obesity-related heart failure with preserved ejection fraction: a pooled analysis of the STEP-HFpEF and STEP-HFpEF DM randomised trials. Lancet 2024; 403:1635-1648. [PMID: 38599221 PMCID: PMC11317105 DOI: 10.1016/s0140-6736(24)00469-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND In the STEP-HFpEF (NCT04788511) and STEP-HFpEF DM (NCT04916470) trials, the GLP-1 receptor agonist semaglutide improved symptoms, physical limitations, bodyweight, and exercise function in people with obesity-related heart failure with preserved ejection fraction. In this prespecified pooled analysis of the STEP-HFpEF and STEP-HFpEF DM trials, we aimed to provide a more definitive assessment of the effects of semaglutide across a range of outcomes and to test whether these effects were consistent across key patient subgroups. METHODS We conducted a prespecified pooled analysis of individual patient data from STEP-HFpEF and STEP-HFpEF DM, randomised, double-blind, placebo-controlled trials at 129 clinical research sites in 18 countries. In both trials, eligible participants were aged 18 years or older, had heart failure with a left ventricular ejection fraction of at least 45%, a BMI of at least 30 kg/m2, New York Heart Association class II-IV symptoms, and a Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS; a measure of heart failure-related symptoms and physical limitations) of less than 90 points. In STEP-HFpEF, people with diabetes or glycated haemoglobin A1c concentrations of at least 6·5% were excluded, whereas for inclusion in STEP-HFpEF DM participants had to have been diagnosed with type 2 diabetes at least 90 days before screening and to have an HbA1c of 10% or lower. In both trials, participants were randomly assigned to either 2·4 mg semaglutide once weekly or matched placebo for 52 weeks. The dual primary endpoints were change from baseline to week 52 in KCCQ-CSS and bodyweight in all randomly assigned participants. Confirmatory secondary endpoints included change from baseline to week 52 in 6-min walk distance, a hierarchical composite endpoint (all-cause death, heart failure events, and differences in changes in KCCQ-CSS and 6-min walk distance); and C-reactive protein (CRP) concentrations. Heterogeneity in treatment effects was assessed across subgroups of interest. We assessed safety in all participants who received at least one dose of study drug. FINDINGS Between March 19, 2021 and March 9, 2022, 529 people were randomly assigned in STEP-HFpEF, and between June 27, 2021 and Sept 2, 2022, 616 were randomly assigned in STEP-HFpEF DM. Overall, 1145 were included in our pooled analysis, 573 in the semaglutide group and 572 in the placebo group. Improvements in KCCQ-CSS and reductions in bodyweight between baseline and week 52 were significantly greater in the semaglutide group than in the placebo group (mean between-group difference for the change from baseline to week 52 in KCCQ-CSS 7·5 points [95% CI 5·3 to 9·8]; p<0·0001; mean between-group difference in bodyweight at week 52 -8·4% [-9·2 to -7·5]; p<0·0001). For the confirmatory secondary endpoints, 6-min walk distance (mean between-group difference at week 52 17·1 metres [9·2 to 25·0]) and the hierarchical composite endpoint (win ratio 1·65 [1·42 to 1·91]) were significantly improved, and CRP concentrations (treatment ratio 0·64 [0·56 to 0·72]) were significantly reduced, in the semaglutide group compared with the placebo group (p<0·0001 for all comparisons). For the dual primary endpoints, the efficacy of semaglutide was largely consistent across multiple subgroups, including those defined by age, race, sex, BMI, systolic blood pressure, baseline CRP, and left ventricular ejection fraction. 161 serious adverse events were reported in the semaglutide group compared with 301 in the placebo group. INTERPRETATION In this prespecified pooled analysis of the STEP-HFpEF and STEP-HFpEF DM trials, semaglutide was superior to placebo in improving heart failure-related symptoms and physical limitations, and reducing bodyweight in participants with obesity-related heart failure with preserved ejection fraction. These effects were largely consistent across patient demographic and clinical characteristics. Semaglutide was well tolerated. FUNDING Novo Nordisk.
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Affiliation(s)
- Javed Butler
- Baylor Scott & White Research Institute, Dallas, TX, USA; Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK; National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | | | - Dalane W Kitzman
- Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Walter Abhayaratna
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Fozia Z Ahmed
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tuvia Ben-Gal
- Heart Failure Unit, Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vijay Chopra
- Max Super Speciality Hospital, Saket, New Delhi, India
| | | | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Ostra, Gothenburg, Sweden
| | - Hiroshi Ito
- Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland
| | - Vojtěch Melenovský
- Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Bela Merkely
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Julio Núñez
- Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red Cardiovascular, Valencia, Spain
| | - Eduardo Perna
- Instituto de Cardiologia J F Cabral, Corrientes, Argentina
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Herlev, Denmark
| | - Michele Senni
- Azienda Socio Sanitaria Territorial Papa Giovanni XXIII, Bergamo, Italy
| | - Kavita Sharma
- Heart Failure & Cardiac Transplantation, Johns Hopkins University Heart Failure with Preserved Ejection Fraction Program, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Dennis Wolf
- Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mikhail N Kosiborod
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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41
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Kosiborod MN, Petrie MC, Borlaug BA, Butler J, Davies MJ, Hovingh GK, Kitzman DW, Møller DV, Treppendahl MB, Verma S, Jensen TJ, Liisberg K, Lindegaard ML, Abhayaratna W, Ahmed FZ, Ben-Gal T, Chopra V, Ezekowitz JA, Fu M, Ito H, Lelonek M, Melenovský V, Merkely B, Núñez J, Perna E, Schou M, Senni M, Sharma K, van der Meer P, Von Lewinski D, Wolf D, Shah SJ. Semaglutide in Patients with Obesity-Related Heart Failure and Type 2 Diabetes. N Engl J Med 2024; 390:1394-1407. [PMID: 38587233 DOI: 10.1056/nejmoa2313917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Obesity and type 2 diabetes are prevalent in patients with heart failure with preserved ejection fraction and are characterized by a high symptom burden. No approved therapies specifically target obesity-related heart failure with preserved ejection fraction in persons with type 2 diabetes. METHODS We randomly assigned patients who had heart failure with preserved ejection fraction, a body-mass index (the weight in kilograms divided by the square of the height in meters) of 30 or more, and type 2 diabetes to receive once-weekly semaglutide (2.4 mg) or placebo for 52 weeks. The primary end points were the change from baseline in the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS; scores range from 0 to 100, with higher scores indicating fewer symptoms and physical limitations) and the change in body weight. Confirmatory secondary end points included the change in 6-minute walk distance; a hierarchical composite end point that included death, heart failure events, and differences in the change in the KCCQ-CSS and 6-minute walk distance; and the change in the C-reactive protein (CRP) level. RESULTS A total of 616 participants underwent randomization. The mean change in the KCCQ-CSS was 13.7 points with semaglutide and 6.4 points with placebo (estimated difference, 7.3 points; 95% confidence interval [CI], 4.1 to 10.4; P<0.001), and the mean percentage change in body weight was -9.8% with semaglutide and -3.4% with placebo (estimated difference, -6.4 percentage points; 95% CI, -7.6 to -5.2; P<0.001). The results for the confirmatory secondary end points favored semaglutide over placebo (estimated between-group difference in change in 6-minute walk distance, 14.3 m [95% CI, 3.7 to 24.9; P = 0.008]; win ratio for hierarchical composite end point, 1.58 [95% CI, 1.29 to 1.94; P<0.001]; and estimated treatment ratio for change in CRP level, 0.67 [95% CI, 0.55 to 0.80; P<0.001]). Serious adverse events were reported in 55 participants (17.7%) in the semaglutide group and 88 (28.8%) in the placebo group. CONCLUSIONS Among patients with obesity-related heart failure with preserved ejection fraction and type 2 diabetes, semaglutide led to larger reductions in heart failure-related symptoms and physical limitations and greater weight loss than placebo at 1 year. (Funded by Novo Nordisk; STEP-HFpEF DM ClinicalTrials.gov number, NCT04916470.).
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Affiliation(s)
- Mikhail N Kosiborod
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Mark C Petrie
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Barry A Borlaug
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Javed Butler
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Melanie J Davies
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - G Kees Hovingh
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Dalane W Kitzman
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Daniél V Møller
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Marianne B Treppendahl
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Subodh Verma
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Thomas J Jensen
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Karoline Liisberg
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Marie L Lindegaard
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Walter Abhayaratna
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Fozia Z Ahmed
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Tuvia Ben-Gal
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Vijay Chopra
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Justin A Ezekowitz
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Michael Fu
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Hiroshi Ito
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Małgorzata Lelonek
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Vojtěch Melenovský
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Bela Merkely
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Julio Núñez
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Eduardo Perna
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Morten Schou
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Michele Senni
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Kavita Sharma
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Peter van der Meer
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Dirk Von Lewinski
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Dennis Wolf
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
| | - Sanjiv J Shah
- From the Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City (M.N.K.); the School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow (M.C.P.), the Diabetes Research Centre, University of Leicester, and the NIHR Leicester Biomedical Research Centre, Leicester (M.J.D.), and the Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester (F.Z.A.) - all in the United Kingdom; the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.); the Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Novo Nordisk, Søborg (G.K.H., D.V.M., M.B.T., T.J.J., K.L., M.L.L.), and the Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev (M. Schou) - both in Denmark; the Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); the Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto (S.V.), and the University of Alberta, Edmonton (J.A.E.) - both in Canada; the College of Health and Medicine, Australian National University, Canberra, ACT, Australia (W.A.); the Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (T.B.-G.); Max Super Speciality Hospital, Saket, New Delhi, India (V.C.); the Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden (M.F.); the Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.); the Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland (M.L.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (V.M.); the Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER (Centro de Investigación Biomédica en Red) Cardiovascular - both in Valencia, Spain (J.N.); Instituto de Cardiologia J.F. Cabral, Corrientes, Argentina (E.P.); ASST (Azienda Socio Sanitaria Territoriale) Papa Giovanni XXIII, Bergamo, Italy (M. Senni); the Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore (K.S.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); the Medical University of Graz, Graz, Austria (D.V.L.); Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.); and the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago (S.J.S.)
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Vyas R, Panchal V, Jain S, Sondhi M, Singh M, Jaisingh K, Thotamgari SR, Thakre A, Modi K. Evaluating the efficacy and safety of mavacamten in hypertrophic cardiomyopathy: A systematic review and meta-analysis focusing on qualitative assessment, biomarkers, and cardiac imaging. PLoS One 2024; 19:e0301704. [PMID: 38635724 PMCID: PMC11025865 DOI: 10.1371/journal.pone.0301704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Hypertrophic Cardiomyopathy (HCM) is a complex cardiac condition characterized by hypercontractility of cardiac muscle leading to a dynamic obstruction of left ventricular outlet tract (LVOT). Mavacamten, a first-in-class cardiac myosin inhibitor, is increasingly being studied in randomized controlled trials. In this meta-analysis, we aimed to analyse the efficacy and safety profile of Mavacamten compared to placebo in patients of HCM. METHOD We carried out a comprehensive search in PubMed, Cochrane, and clinicaltrials.gov to analyze the efficacy and safety of mavacamten compared to placebo from 2010 to 2023. To calculate pooled odds ratio (OR) or risk ratio (RR) at 95% confidence interval (CI), the Mantel-Haenszel formula with random effect was used and Generic Inverse Variance method assessed pooled mean difference value at a 95% CI. RevMan was used for analysis. P<0.05 was considered significant. RESULTS We analyzed five phase 3 RCTs including 609 patients to compare mavacamten with a placebo. New York Heart Association (NYHA) grade improvement and KCCQ score showed the odds ratio as 4.94 and 7.93 with p<0.00001 at random effect, respectively. Cardiac imaging which included LAVI, LVOT at rest, LVOT post valsalva, LVOT post-exercise, and reduction in LVEF showed the pooled mean differences for change as -5.29, -49.72, -57.45, -36.11, and -3.00 respectively. Changes in LVEDV and LVMI were not statistically significant. The pooled mean difference for change in NT-proBNP and Cardiac troponin-I showed 0.20 and 0.57 with p<0.00001. The efficacy was evaluated in 1) A composite score, which was defined as either 1·5 mL/kg per min or greater increase in peak oxygen consumption (pVO2) and at least one NYHA class reduction, or a 3·0 mL/kg per min or greater pVO2 increase without NYHA class worsening and 2) changes in pVO2, which was not statistically significant. Similarly, any treatment-associated emergent adverse effects (TEAE), treatment-associated serious adverse effects (TSAE), and cardiac-related adverse effects were not statistically significant. CONCLUSION Mavacamten influences diverse facets of HCM comprehensively. Notably, our study delved into the drug's impact on the heart's structural and functional aspects, providing insights that complement prior findings. Further large-scale trials are needed to evaluate the safety profile of Mavacamten.
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Affiliation(s)
- Rahul Vyas
- Department of Internal Medicine, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Viraj Panchal
- Department of Medicine, Smt. NHL Municipal Medical College and SVPISMR, Ahmedabad, Gujarat, India
| | - Shubhika Jain
- Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India
| | - Manush Sondhi
- Department of Internal Medicine, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Mansunderbir Singh
- Department of Internal Medicine, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Keerthish Jaisingh
- Department of Cardiology, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Sahith Reddy Thotamgari
- Department of Cardiology, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Anuj Thakre
- Department of Internal Medicine, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Kalgi Modi
- Department of Cardiology, Louisiana State University, Shreveport, Louisiana, United States of America
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DeGroot L, Pavlovic N, Perrin N, Gilotra NA, Miller H, Denfeld QE, McIlvennan CK, Dy SM, Davidson PM, Szanton SL, Abshire Saylor M. The Association of Unmet Palliative Care Needs and Physical Frailty With Clinical Outcomes: A Prospective Study of Adults With Heart Failure. J Cardiovasc Nurs 2024:00005082-990000000-00185. [PMID: 38635901 DOI: 10.1097/jcn.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND People with heart failure, particularly those who are physically frail, experience complex needs that can be addressed by palliative care (PC). However, we have a limited understanding of how the intersection of unmet PC needs and physical frailty contributes to health-related quality of life (HRQOL) and risk for hospitalization or mortality. OBJECTIVE In this study, we sought to examine the association of unmet PC needs and physical frailty with clinical outcomes (baseline HRQOL and hospitalizations or mortality at 6 months). METHODS We recruited a convenience sample of community-dwelling persons with heart failure from an urban hospital system who were older than 50 years and hospitalized in the last year. We measured physical frailty using the FRAIL scale (nonfrail, 0-2; frail, 3-5), PC needs using the Integrated Palliative Outcome Scale (range, 0-58; higher scores indicating higher needs), and HRQOL using the Kansas City Cardiomyopathy Questionnaire (range, 0-100; higher scores indicate higher HRQOL). We performed multivariable linear regression to test the relationships between physical frailty, PC needs, and HRQOL, and multivariable logistic regression for associations with all-cause 6-month hospitalization or mortality. We also performed an exploratory analysis of 4 PC needs/frailty groups (high PC needs/frail, high PC needs/nonfrail, low PC needs/frail, low PC needs/nonfrail) with outcomes. RESULTS In our overall sample (n = 298), mean (SD) age was 68 (9.8) years, 37% were women (n = 108), 28% identified as Black/African American (n = 84), and 65% had heart failure with preserved ejection fraction (n = 194). Mean PC needs score was 19.7, and frail participants (n = 130, 44%) had a significantly higher mean PC needs score than nonfrail participants (P < .001). Those with higher PC needs (Integrated Palliative Care Outcome Scale ≥ 20) had significantly worse HRQOL (P < .001) and increased odds of hospitalization or mortality (odds ratio, 2.5; P < .01) compared with those with lower PC needs, adjusting for covariates. Physically frail participants had significantly worse HRQOL (P < .001) and higher odds of hospitalization or mortality at 6 months (odds ratio, 2.6; P < .01) than nonfrail participants, adjusting for covariates. In an exploratory analysis, physically frail participants with high PC needs had the lowest HRQOL score, with an average score of 28.6 points lower (P < .001) and 4.6 times higher odds of hospitalization or mortality (95% confidence interval, 2.03-10.43; P < .001) than low-needs/nonfrail participants. CONCLUSION Higher unmet PC needs and physical frailty, separately and in combination, were associated with lower HRQOL and higher odds of hospitalization or mortality. Self-reported PC needs and physical frailty assessment in clinical settings may improve identification of patients at the highest risk for poor HRQOL and hospitalization or mortality amenable to PC intervention.
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Masri A, Lester SJ, Stendahl JC, Hegde SM, Sehnert AJ, Balaratnam G, Shah A, Fox S, Wang A. Long-Term Safety and Efficacy of Mavacamten in Symptomatic Obstructive Hypertrophic Cardiomyopathy: Interim Results of the PIONEER-OLE Study. J Am Heart Assoc 2024; 13:e030607. [PMID: 38591260 PMCID: PMC11262496 DOI: 10.1161/jaha.123.030607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/16/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The phase 2 PIONEER-HCM (Phase 2 Open-label Pilot Study Evaluating Mavacamten in Subjects With Symptomatic Hypertrophic Cardiomyopathy and Left Ventricular Outflow Tract Obstruction) study showed that mavacamten improved left ventricular outflow tract gradients, exercise capacity, and symptoms in patients with obstructive hypertrophic cardiomyopathy (HCM), but the results of longer-term treatment are less well described. We report interim results from the PIONEER-OLE (PIONEER Open-Label Extension) study, the longest-term study of mavacamten in patients with symptomatic obstructive HCM. METHODS AND RESULTS Patients who previously completed PIONEER-HCM (n=20) were eligible to enroll in PIONEER-OLE. Patients received oral mavacamten, 5 mg once daily (starting dose), with individualized dose titration at week 6. Evaluations included serial monitoring of safety, echocardiography, Kansas City Cardiomyopathy Questionnaire-Overall Summary Score, and serum NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels. Thirteen patients enrolled and received mavacamten (median study duration at data cutoff, 201 weeks). Most patients (92.3%) received β-blockers concomitantly. Treatment-emergent adverse events were predominantly mild/moderate. One patient had an isolated reduction in left ventricular ejection fraction to 47%, which recovered and remained normal with continued treatment at a reduced dose. At week 180, mavacamten was associated with New York Heart Association class improvements from baseline (class II to I, n=9; class III to II, n=1; and unchanged, n=2), sustained reductions in left ventricular outflow tract gradients (mean [SD] change from baseline: resting, -50 [55] mm Hg; Valsalva, -70 [41] mm Hg), and serum NT-proBNP levels (median [interquartile range] change from baseline: -498 [-2184 to -76] ng/L), and improved Kansas City Cardiomyopathy Questionnaire-Overall Summary Score (mean [SD] change from baseline: +17 [16]). CONCLUSIONS This long-term analysis supports the continued safety and effectiveness of mavacamten for >3 years in obstructive HCM. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03496168.
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Affiliation(s)
- Ahmad Masri
- Division of Cardiology, Hypertrophic Cardiomyopathy Center, School of MedicineOregon Health & Science UniversityPortlandOR
| | - Steven J. Lester
- Department of Cardiovascular DiseasesMayo Clinic ArizonaPhoenixAZ
| | - John C. Stendahl
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCT
| | - Sheila M. Hegde
- Division of Cardiovascular MedicineBrigham and Women’s HospitalBostonMA
| | | | | | | | | | - Andrew Wang
- Duke CardiologyDuke University HospitalDurhamNC
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Wang J, Okoh AK, Chen Y, Steinberg RS, Gangavelli A, Patel KJ, Ko YA, Alexis JD, Patel SA, Vega DJ, Daneshmand M, Defilippis EM, Breathett K, Morris AA. Association of Psychosocial Risk Factors With Quality of Life and Readmissions 1 Year After LVAD Implantation. J Card Fail 2024:S1071-9164(24)00120-9. [PMID: 38621441 DOI: 10.1016/j.cardfail.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Among patients with advanced heart failure (HF), treatment with a left ventricular assist device (LVAD) improves health-related quality of life (HRQOL). We investigated the association between psychosocial risk factors, HRQOL and outcomes after LVAD implantation. METHODS A retrospective cohort (n = 9832) of adults aged ≥ 19 years who received durable LVADs between 2008 and 2017 was identified by using the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Patients were considered to have psychosocial risk factors if ≥ 1 of the following were present: (1) substance abuse; (2) limited social support; (3) limited cognitive understanding; (4) repeated nonadherence; and (5) major psychiatric disease. Multivariable logistic and linear regression models were used to evaluate the association between psychosocial risk factors and change in Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 scores from baseline to 1 year, persistently poor HRQOL (KCCQ-12 score < 45 at baseline and 1 year), and 1-year rehospitalization. RESULTS Among the final analytic cohort, 2024 (20.6%) patients had ≥ 1 psychosocial risk factors. Psychosocial risk factors were associated with a smaller improvement in KCCQ-12 scores from baseline to 1 year (mean ± SD, 29.1 ± 25.9 vs 32.6 ± 26.1; P = 0.015) for a difference of -3.51 (95% confidence interval [CI]: -5.88 to -1.13). Psychosocial risk factors were associated with persistently poor HRQOL (adjusted odds ratio [aOR] 1.35, 95% confidence interval [CI] 1.04-1.74), and 1-year all-cause readmission (adjusted hazard ratio [aHR] 1.11, 95% CI 1.05-1.18). Limited social support, major psychiatric disorder and repeated nonadherence were associated with persistently poor HRQOL, while major psychiatric disorder was associated with 1-year rehospitalization. CONCLUSION The presence of psychosocial risk factors is associated with lower KCCQ-12 scores and higher risk for readmission at 1 year after LVAD implantation. These associations are statistically significant, but further research is needed to determine whether these differences are clinically meaningful.
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Affiliation(s)
- Jeffrey Wang
- Emory University School of Medicine, Division of Cardiology, Atlanta, GA
| | - Alexis K Okoh
- Emory University School of Medicine, Division of Cardiology, Atlanta, GA
| | - Yuxuan Chen
- Emory University Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, GA
| | | | - Apoorva Gangavelli
- Emory University School of Medicine, Division of Cardiology, Atlanta, GA
| | - Krishan J Patel
- Emory University School of Medicine, Division of Cardiology, Atlanta, GA
| | - Yi-An Ko
- Emory University Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, GA
| | - Jeffrey D Alexis
- University of Rochester Medical Center, Division of Cardiology, Rochester, NY
| | - Shivani A Patel
- Emory University Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA
| | - David J Vega
- Emory University School of Medicine, Department of Surgery, Atlanta, GA
| | - Mani Daneshmand
- Emory University School of Medicine, Department of Surgery, Atlanta, GA
| | - Ersilia M Defilippis
- Center for Advanced Cardiac Care, Columbia University Irving Medical Center, Division of Cardiology, New York, NY
| | - Khadijah Breathett
- Indiana University School of Medicine, Division of Cardiology, Indianapolis, IN
| | - Alanna A Morris
- Emory University School of Medicine, Division of Cardiology, Atlanta, GA.
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Derendorf L, Stock S, Simic D, Shukri A, Zelenak C, Nagel J, Friede T, Herbeck Belnap B, Herrmann-Lingen C, Pedersen SS, Sørensen J, Müller And On Behalf Of The Escape Consortium D. Health economic evaluation of blended collaborative care for older multimorbid heart failure patients: study protocol. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:29. [PMID: 38615050 PMCID: PMC11015692 DOI: 10.1186/s12962-024-00535-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/21/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Integrated care, in particular the 'Blended Collaborative Care (BCC)' strategy, may have the potential to improve health-related quality of life (HRQoL) in multimorbid patients with heart failure (HF) and psychosocial burden at no or low additional cost. The ESCAPE trial is a randomised controlled trial for the evaluation of a BCC approach in five European countries. For the economic evaluation of alongside this trial, the four main objectives were: (i) to document the costs of delivering the intervention, (ii) to assess the running costs across study sites, (iii) to evaluate short-term cost-effectiveness and cost-utility compared to providers' usual care, and (iv) to examine the budgetary implications. METHODS The trial-based economic analyses will include cross-country cost-effectiveness and cost-utility assessments from a payer perspective. The cost-utility analysis will calculate quality-adjusted life years (QALYs) using the EQ-5D-5L and national value sets. Cost-effectiveness will include the cost per hospital admission avoided and the cost per depression-free days (DFD). Resource use will be measured from different sources, including electronic medical health records, standardised questionnaires, patient receipts and a care manager survey. Uncertainty will be addressed using bootstrapping. DISCUSSION The various methods and approaches used for data acquisition should provide insights into the potential benefits and cost-effectiveness of a BCC intervention. Providing the economic evaluation of ESCAPE will contribute to a country-based structural and organisational planning of BCC (e.g., the number of patients that may benefit, how many care managers are needed). Improved care is expected to enhance health-related quality of life at little or no extra cost. TRIAL REGISTRATION The study follows CHEERS2022 and is registered at the German Clinical Trials Register (DRKS00025120).
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Affiliation(s)
- Lisa Derendorf
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany.
| | - Stephanie Stock
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Dusan Simic
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Arim Shukri
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Christine Zelenak
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Jonas Nagel
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Tim Friede
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Birgit Herbeck Belnap
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
- Center for Behavioral Health, Media, and Technology, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jan Sørensen
- Healthcare Outcomes Research Centre, Dublin, Ireland
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Rowin EJ, Wadid M, Maron MS, White M, Hook BG, Harnish P, Silver JS, Reynolds MR, Maron BJ. Assessing the impact of atrial fibrillation on symptoms and quality of life in hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 2024; 35:654-663. [PMID: 38288888 DOI: 10.1111/jce.16192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION In hypertrophic cardiomyopathy (HCM), atrial fibrillation (AF) has historically been regarded to have a deleterious impact on clinical course, strongly associated with progressive heart failure (HF) symptoms. However, there is a paucity of information regarding the impact of AF on HCM employing validated quality of life (QoL) surveys. Therefore, we evaluated the impact of AF on QoL utilizing patient reported outcome measures (PROMs). METHODS 218 consecutive HCM patients with or without AF at the Lahey HCM center in 2022 completed PROMs at their most recent visit evaluating HF (Kansas City Cardiomyopathy Questionnaire [KCCQ]) and AF symptoms (AF Effect on QoL [AFEQT]). RESULTS Among the 218 patients, 50 (23%) had a history of AF and comprise the primary study cohort. AF was diagnosed at 55 ± 10 years of age, median of 5.5 years before PROM, with 66% of patients treated with a rhythm control strategy with antiarrhythmic drug and/or AF ablation. AFEQT indicated that 52% of patients experienced no or minimal AF-related disability, mild to moderate in 22%, and severe in 26%. There was no substantial difference in HCM phenotype in patients with no or minimal AF disability compared to those with severe disability. HF symptoms for most HCM patients with prior AF history was consistent with no or minimal (59%) or only mild (27%) disability as measured by KCCQ overall summary scores. In addition, with multivariate analysis, AF history was associated with less HF symptoms and improved QoL (OR 0.4, p = 0.02). CONCLUSION In contrast to prior perceptions, HCM patients with prior AF history were less likely to incur HF symptoms impairing QoL compared to HCM patients without AF. After treatment, prior history of AF did not substantially impact current QoL. These data provide a realistic appraisal for the impact that AF has on HCM patients and also offers a measure of reassurance for this patient subgroup.
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Affiliation(s)
- Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Mark Wadid
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Maggie White
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Bruce G Hook
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Paul Harnish
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Jonathan S Silver
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Matthew R Reynolds
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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Garcia R, Gras D, Mansourati J, Defaye P, Bisson A, Boveda S, Gandjbakhch E, Gras M, Gueffet JP, Himbert C, Jacon P, Khattar P, Lequeux B, Li A, Mansourati V, Minois D, Marijon E, Pierre B, Probst V, Degand B. Pre-emptive treatment of heart failure exacerbations in patients managed with the HeartLogic™ algorithm. ESC Heart Fail 2024; 11:1228-1235. [PMID: 38234123 DOI: 10.1002/ehf2.14624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/21/2023] [Accepted: 11/20/2023] [Indexed: 01/19/2024] Open
Abstract
AIMS Heart failure (HF) is a chronic disease affecting 64 million people worldwide and places a severe burden on society because of its mortality, numerous re-hospitalizations and associated costs. HeartLogic™ is an algorithm programmed into implanted devices incorporating several biometric parameters which aims to predict HF episodes. It provides an index which can be monitored remotely, allowing pre-emptive treatment of congestion to prevent acute decompensation. We aim to assess the impact and security of pre-emptive HF management, guided by the HeartLogic™ index. METHODS AND RESULTS The HeartLogic™ France Cohort Study is an investigator-initiated, prospective, multi-centre, non-randomized study. Three hundred ten patients with a history of HF (left ventricular ejection fraction ≤40%; or at least one episode of clinical HF with elevated NT-proBNP ≥450 ng/L) and implanted with a cardioverter defibrillator enabling HeartLogic™ index calculation will be included across 10 French centres. The HeartLogic™ index will be monitored remotely for 12 months and in the event of a HeartLogic™ index ≥16, the local investigator will contact the patient for assessment and adjust HF treatment as necessary. The primary endpoint is unscheduled hospitalization for HF. Secondary endpoints are all-cause mortality, cardiovascular death, HF-related death, unscheduled hospitalizations for ventricular or atrial arrhythmia and HeartLogic™ index evolution over time. Blood samples will be collected for biobanking, and quality of life will be assessed. Finally, the safety of a HeartLogic™-triggered strategy for initiating or increasing diuretic therapy will be assessed. A blind and independent committee will adjudicate the events. CONCLUSIONS The HeartLogic™ France Cohort Study will provide robust real-world data in a cohort of HF patients managed with the HeartLogic™ algorithm allowing pre-emptive treatment of heart failure exacerbations.
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Affiliation(s)
- Rodrigue Garcia
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
- Centre d'investigation clinique 1402, University Hospital of Poitiers, Poitiers, France
| | - Daniel Gras
- Department of Cardiology, Hôpital privé du Confluent, Nantes, France
| | | | - Pascal Defaye
- Department of Cardiology, University Hospital Grenoble Alpes, Grenoble, France
| | - Arnaud Bisson
- Department of Cardiology, University Hospital of Tours, Chambray-lès-Tours, France
- Department of Cardiology, University Hospital of Orléans, Orléans, France
| | - Serge Boveda
- Department of Cardiology, Clinique Pasteur, Toulouse, France
- Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | | | - Matthieu Gras
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
| | | | - Caroline Himbert
- Department of Cardiology, Hôpital la Pitié Salpétrière, Paris, France
| | - Peggy Jacon
- Department of Cardiology, University Hospital Grenoble Alpes, Grenoble, France
| | - Pierre Khattar
- Department of Cardiology, Hospital of Lorient, Lorient, France
| | - Benoit Lequeux
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
| | - Anthony Li
- Department of Cardiology, St. George's University of London, Cranmer Terrace, London, UK
| | | | - Damien Minois
- Department of Cardiology, University Hospital of Nantes, Nantes Cedex 1, France
| | - Eloi Marijon
- Department of Cardiology, Hôpital Européen Georges Pomipdou, Paris, France
- Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | - Bertrand Pierre
- Department of Cardiology, University Hospital of Tours, Chambray-lès-Tours, France
| | - Vincent Probst
- Department of Cardiology, University Hospital of Nantes, Nantes Cedex 1, France
| | - Bruno Degand
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
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49
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Hoek AG, Dal Canto E, Wenker E, Bindraban N, Handoko ML, Elders PJM, Beulens JWJ. Epidemiology of heart failure in diabetes: a disease in disguise. Diabetologia 2024; 67:574-601. [PMID: 38334818 PMCID: PMC10904471 DOI: 10.1007/s00125-023-06068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/12/2023] [Indexed: 02/10/2024]
Abstract
Left ventricular diastolic dysfunction (LVDD) without symptoms, and heart failure (HF) with preserved ejection fraction (HFpEF) represent the most common phenotypes of HF in individuals with type 2 diabetes mellitus, and are more common than HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF) and left ventricular systolic dysfunction (LVSD) in these individuals. However, diagnostic criteria for HF have changed over the years, resulting in heterogeneity in the prevalence/incidence rates reported in different studies. We aimed to give an overview of the diagnosis and epidemiology of HF in type 2 diabetes, using both a narrative and systematic review approach; we focus narratively on diagnosing (using the 2021 European Society of Cardiology [ESC] guidelines) and screening for HF in type 2 diabetes. We performed an updated (2016-October 2022) systematic review and meta-analysis of studies reporting the prevalence and incidence of HF subtypes in adults ≥18 years with type 2 diabetes, using echocardiographic data. Embase and MEDLINE databases were searched and data were assessed using random-effects meta-analyses, with findings presented as forest plots. From the 5015 studies found, 209 were screened using the full-text article. In total, 57 studies were included, together with 29 studies that were identified in a prior meta-analysis; these studies reported on the prevalence of LVSD (n=25 studies, 24,460 individuals), LVDD (n=65 studies, 25,729 individuals), HFrEF (n=4 studies, 4090 individuals), HFmrEF (n=2 studies, 2442 individuals) and/or HFpEF (n=8 studies, 5292 individuals), and on HF incidence (n=7 studies, 17,935 individuals). Using Hoy et al's risk-of-bias tool, we found that the studies included generally had a high risk of bias. They showed a prevalence of 43% (95% CI 37%, 50%) for LVDD, 17% (95% CI 7%, 35%) for HFpEF, 6% (95% CI 3%, 10%) for LVSD, 7% (95% CI 3%, 15%) for HFrEF, and 12% (95% CI 7%, 22%) for HFmrEF. For LVDD, grade I was found to be most prevalent. Additionally, we reported a higher incidence rate of HFpEF (7% [95% CI 4%, 11%]) than HFrEF 4% [95% CI 3%, 7%]). The evidence is limited by the heterogeneity of the diagnostic criteria over the years. The systematic section of this review provides new insights on the prevalence/incidence of HF in type 2 diabetes, unveiling a large pre-clinical target group with LVDD/HFpEF in which disease progression could be halted by early recognition and treatment.Registration PROSPERO ID CRD42022368035.
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Affiliation(s)
- Anna G Hoek
- Epidemiology and Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Elisa Dal Canto
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Eva Wenker
- Epidemiology and Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Navin Bindraban
- Heartcenter, Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - M Louis Handoko
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
- Heartcenter, Department of Cardiology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Petra J M Elders
- Department of General Practice, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, Amsterdam, the Netherlands
| | - Joline W J Beulens
- Epidemiology and Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, Amsterdam, the Netherlands
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50
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Metra M, Radulescu CI, Cersosimo A, Massussi M, Laurito A, Chioncel O, Adamo M. Quality of life in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: tools and evidence. J Cardiovasc Med (Hagerstown) 2024; 25:259-270. [PMID: 38488063 DOI: 10.2459/jcm.0000000000001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Aortic stenosis is the most prevalent valvular heart disease requiring intervention, especially in the elderly population. Surgical aortic valve replacement and transcatheter aortic valve implantation (TAVI) are well established treatment options for symptomatic patients with severe aortic stenosis, as they provide a significant survival benefit. Aortic stenosis may have an important impact on patients' quality of life (QoL). However, advanced age, comorbidities and frailty may limit the beneficial effect of aortic stenosis interventions in terms of QoL. Current guidelines mention the importance of frailty and avoiding the futility of interventions, but lack specific indications about decision-making. Also, there are limited data on how to specifically assess QoL in aortic stenosis patients since the most used questionnaires are validated in different populations (i.e. heart failure). The aim of this review is to summarize all the available tools for QoL assessment in patients with aortic stenosis; to report current evidence on the impact of TAVI on QoL; and to discuss the role of frailty and comorbidities in this setting.
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Affiliation(s)
- Marco Metra
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Crina-Ioana Radulescu
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- University of Medicine and Pharmacy Carol Davila
| | - Angelica Cersosimo
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Mauro Massussi
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Laurito
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- University of Medicine and Pharmacy Carol Davila
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
| | - Marianna Adamo
- ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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