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Shoji S, Mentz RJ. Beyond quadruple therapy: the potential roles for ivabradine, vericiguat, and omecamtiv mecarbil in the therapeutic armamentarium. Heart Fail Rev 2024; 29:949-955. [PMID: 38951303 DOI: 10.1007/s10741-024-10412-y] [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: 07/03/2024]
Abstract
Quadruple therapy is effective for patients with heart failure with reduced ejection fraction, providing significant clinical benefits, including reduced mortality. Clinicians are now in an era focused on how to initiate and titrate quadrable therapy in the early phase of the disease trajectory, including during heart failure hospitalization. However, patients with heart failure with reduced ejection fraction still face a significant "residual risk" of mortality and heart failure hospitalization. Despite the effective implementation of quadruple therapy, high mortality and rehospitalization rates persist in heart failure with reduced ejection fraction, and many patients cannot maximize therapy due to side effects such as hypotension and renal dysfunction. In this context, ivabradine, vericiguat, and omecamtiv mecarbil may have adjunct roles in addition to quadruple therapy (note that omecamtiv mecarbil is not currently approved for clinical use). However, the contemporary use of ivabradine and vericiguat is relatively low globally, likely due in part to the under-recognition of the role of these therapies as well as costs. This review offers clinicians a straightforward guide for bedside evaluation of potential candidates for these medications. Quadruple therapy, with strong evidence to reduce mortality, should always be prioritized for implementation. As second-line therapies, ivabradine could be considered for patients who cannot achieve optimal heart rate control (≥ 70 bpm at rest) despite maximally tolerated beta-blocker dosing. Vericiguat could be considered for high-risk patients who have recently experienced worsening heart failure events despite being on quadrable therapy, but they should not have N-terminal pro-B-type natriuretic peptide levels exceeding 8000 pg/mL. In the future, omecamtiv mecarbil may be considered for severe heart failure (New York Heart Association class III to IV, ejection fraction ≤ 30%, and heart failure hospitalization within 6 months) when current quadrable therapy is limited, although this is still hypothesis-generating and requires further investigation before its approval.
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Affiliation(s)
- Satoshi Shoji
- Duke Clinical Research Institute, 300 W Morgan St, Durham, NC, 27701, USA.
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
| | - Robert J Mentz
- Duke Clinical Research Institute, 300 W Morgan St, Durham, NC, 27701, USA
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
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Mack M, Frishman WH. Cardiac Myosin Activator Omecamtiv Mecarbil: Novel Treatment for Systolic Heart Failure. Cardiol Rev 2024; 32:378-383. [PMID: 36946979 DOI: 10.1097/crd.0000000000000530] [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: 03/23/2023]
Abstract
Systolic Heart failure is a complex clinical syndrome characterized by a decrease in cardiac contractility and a reduction in organ perfusion. Current pharmacologic inotropes attempt to improve contractility via indirect mechanisms but are limited in terms of safety and effectiveness. Omecamtiv mecarbil is a novel agent in a new class of drugs known as cardiac myosin activators; their unique mechanism of action involves directly activating the enzymatic pathway in the cardiac myocyte as a way to improve ventricular contraction. Preclinical and clinical trials have found that omecamtiv mecarbil improves cardiac contractility without increasing the risk of any of the harmful effects that are associated with the currently available inotropic agents. Omecamtiv mecarbil is a worthwhile advance and patients with systolic heart failure would benefit from pharmacological use of this drug.
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Affiliation(s)
- Maat Mack
- From the Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY
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Felker GM, Solomon SD, Metra M, Mcmurray JJV, Diaz R, Claggett B, Lanfear DE, Vandekerckhove H, Biering-Sørensen T, Lopes RD, Arias-Mendoza A, Momomura SI, Corbalan R, Ramires FJA, Zannad F, Heitner SB, Divanji PH, Kupfer S, Malik FI, Teerlink JR. Cardiac Troponin and Treatment Effects of Omecamtiv Mecarbil: Results From the GALACTIC-HF Study. J Card Fail 2024; 30:755-763. [PMID: 38215932 DOI: 10.1016/j.cardfail.2023.11.021] [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: 04/20/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Omecamtiv mecarbil improves outcomes in patients with heart failure and reduced ejection fraction (HFrEF). We examined the relationship between baseline troponin levels, change in troponin levels over time and the treatment effect of omecamtiv mecarbil in patients enrolled in the Global Approach to Lowering Adverse Cardiac Outcomes through Improving Contractility in Heart Failure (GALACTIC-HF) trial (NCT02929329). METHODS GALACTIC-HF was a double-blind, placebo-controlled trial that randomized 8256 patients with symptomatic HFrEF to omecamtiv mecarbil or placebo. High-sensitivity troponin I (cTnI) was measured serially at a core laboratory. We analyzed the relationship between both baseline cTnI and change in cTnI concentrations with clinical outcomes and the treatment effect of omecamtiv mecarbil. RESULTS Higher baseline cTnI concentrations were associated with a risk of adverse outcomes (hazard ratio for the primary endpoint of time to first HF event or CV death = 1.30; 95% CI 1.28, 1.33; P < 0.001 per doubling of baseline cTnI). Although the incidence of safety outcomes was higher in patients with higher baseline cTnI, there was no difference between treatment groups. Treatment with omecamtiv mecarbil led to a modest increase in cTnI that was related to plasma concentrations of omecamtiv mecarbil, and it peaked at 6 weeks. An increase in troponin from baseline to week 6 was associated with an increased risk of the primary endpoint (P < 0.001), which was similar, regardless of treatment assignment (P value for interaction = 0.2). CONCLUSIONS In a cohort of patients with HFrEF, baseline cTnI concentrations were strongly associated with adverse clinical outcomes. Although cTnI concentrations were higher in patients treated with omecamtiv mecarbil, we did not find a differential effect of omecamtiv mecarbil on either safety or efficacy based on baseline cTnI status or change in cTnI.
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Affiliation(s)
- G Michael Felker
- Division of Cardiology, Duke University and Duke Clinical Research Institute, Durham NC, USA.
| | - Scott D Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Marco Metra
- Division of Cardiovascular Medicine Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - John J V Mcmurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Rafael Diaz
- Estudios Clínicos Latino América (ECLA), Rosario, Argentina
| | - Brian Claggett
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - David E Lanfear
- Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI, USA
| | | | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Renato D Lopes
- Division of Cardiology, Duke University and Duke Clinical Research Institute, Durham NC, USA
| | | | | | - Ramon Corbalan
- Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Felix J A Ramires
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Faiez Zannad
- Université de Lorraine, Inserm INI CRCT, CHRU Nancy, France
| | | | | | | | | | - John R Teerlink
- San Francisco Veterans Affairs Medical Center and School of Medicine, University of California-San Francisco, San Francisco, CA, USA
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Lindberg F, Øigaard N, Metra M, Rosano GMC, Dahlström U, Mol P, Hage C, Lund LH, Savarese G. Eligibility for omecamtiv mecarbil in a real-world heart failure population: Data from the Swedish Heart Failure Registry. PLoS One 2024; 19:e0303348. [PMID: 38787867 PMCID: PMC11125482 DOI: 10.1371/journal.pone.0303348] [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: 02/15/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
AIMS We assessed eligibility for omecamtiv mecarbil (OM) in a real-world cohort with heart failure with reduced ejection fraction (HFrEF) according to the selection criteria of the GALACTIC-HF trial (trial scenario) and selected trial´s criteria more likely to impact real-world use (pragmatic scenario). METHODS AND RESULTS We included 31,015 patients with HFrEF lasting ≥3 months and registered in the Swedish HF registry between 2000-2021. Trial eligibility was calculated by applying all the GALACTIC-HF selection criteria. The pragmatic scenario considered only the New York Heart Association class, history of worsening HF, N-terminal pro-B-type natriuretic peptides (NT-proBNP), blood pressure and renal failure criteria defined as in the trial. Eligibility for OM in chronic HFrEF was 21% and 36% in the trial and pragmatic scenarios, respectively. Eligibility was higher in those with EF<30% (trial: 27%, pragmatic: 44%), in-patients (trial:30%, pragmatic:57%), severe HF (trial: 35%, pragmatic: 60%), NYHA class III-IV (trial: 26%, pragmatic: 45%), and NT-proBNP≥5,000pg/mL (trial: 30%, pragmatic: 51%). The criteria that most limited eligibility were history of a recent worsening HF event (60% eligible in chronic HFrEF), elevated NT-proBNP (82% eligible), and deviating blood pressure (82% eligible). Overall, eligible patients were characterized by more severe HF and higher CV event-rates in both scenarios, and higher comorbidity burden in the pragmatic scenario. CONCLUSION Approximately 21% of real-world chronic HFrEF patients would be eligible for OM according to the GALACTIC-HF selection criteria, and 36% according to the criteria more likely to affect OM use in clinical practice. Criteria in both scenarios identified a patient-group with severe HF and high CV event-rates.
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Affiliation(s)
- Felix Lindberg
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Natanael Øigaard
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Cardiothoracic Department, Civil Hospitals, University of Brescia, Brescia, Italy
| | - Giuseppe M. C. Rosano
- Cardiovascular Clinical Academic Group, Molecular and Clinical Research Institute, St George’s University Hospital, London, United Kingdom
- Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Mol
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Camilla Hage
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Lars H. Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
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Zhou S, Liu Y, Huang X, Wu C, Pórszász R. Omecamtiv Mecarbil in the treatment of heart failure: the past, the present, and the future. Front Cardiovasc Med 2024; 11:1337154. [PMID: 38566963 PMCID: PMC10985333 DOI: 10.3389/fcvm.2024.1337154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Heart failure, a prevailing global health issue, imposes a substantial burden on both healthcare systems and patients worldwide. With an escalating prevalence of heart failure, prolonged survival rates, and an aging demographic, an increasing number of individuals are progressing to more advanced phases of this incapacitating ailment. Against this backdrop, the quest for pharmacological agents capable of addressing the diverse subtypes of heart failure becomes a paramount pursuit. From this viewpoint, the present article focuses on Omecamtiv Mecarbil (OM), an emerging chemical compound said to exert inotropic effects without altering calcium homeostasis. For the first time, as a review, the present article uniquely started from the very basic pathophysiology of heart failure, its classification, and the strategies underpinning drug design, to on-going debates of OM's underlying mechanism of action and the latest large-scale clinical trials. Furthermore, we not only saw the advantages of OM, but also exhaustively summarized the concerns in sense of its effects. These of no doubt make the present article the most systemic and informative one among the existing literature. Overall, by offering new mechanistic insights and therapeutic possibilities, OM has carved a significant niche in the treatment of heart failure, making it a compelling subject of study.
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Affiliation(s)
- Shujing Zhou
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ying Liu
- Department of Cardiology, Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xufeng Huang
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Chuhan Wu
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Róbert Pórszász
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Vader JM, Yang BQ. Tricuspid Regurgitation: A Driver or Bystander in Heart Failure? JACC. HEART FAILURE 2024; 12:564-566. [PMID: 38448151 DOI: 10.1016/j.jchf.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 03/08/2024]
Affiliation(s)
- Justin M Vader
- Division of Cardiology, Washington University in St. Louis, Barnes-Jewish Hospital, St. Louis Missouri, USA.
| | - Bin Q Yang
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Tsukamoto O, Takashima S. Response by Tsukamoto and Takashima to Letter Regarding Article, "Restoration of Cardiac Myosin Light Chain Kinase Ameliorates Systolic Dysfunction by Reducing Super-Relaxed Myosin". Circulation 2023; 148:2074-2075. [PMID: 38109341 DOI: 10.1161/circulationaha.123.066938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Osamu Tsukamoto
- Department of Biochemistry, Hyogo Medical University, Nishinomiya, Japan (O.T.)
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Japan (O.T., S.T.)
| | - Seiji Takashima
- Department of Biochemistry, Hyogo Medical University, Nishinomiya, Japan (O.T.)
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Japan (O.T., S.T.)
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Trujillo ME, Ayalasomayajula S, Blaustein RO, Gheyas F. Vericiguat, a novel sGC stimulator: Mechanism of action, clinical, and translational science. Clin Transl Sci 2023; 16:2458-2466. [PMID: 37997225 PMCID: PMC10719466 DOI: 10.1111/cts.13677] [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: 07/19/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 11/25/2023] Open
Abstract
Vericiguat, a novel soluble guanylate cyclase (sGC) stimulator, is approved for the treatment of heart failure (HF) with reduced ejection fraction (HFrEF). Decreased nitric oxide (NO) availability, sGC desensitization to NO, sGC deficiency, and reduced cyclic guanosine monophosphate (cGMP) signaling are potential contributing factors for HF disease progression. Vericiguat works via stimulation of sGC in the critical NO-sGC-cGMP pathway. Vericiguat is primarily metabolized by glucuronidation via uridine diphosphate-glucuronosyltransferase (UGT) isoforms UGT1A1 and UGT1A9. Urinary excretion and renal clearance of vericiguat are low. No intrinsic factor had a clinically relevant effect on vericiguat exposure. Vericiguat has low drug-drug interaction potential with no clinically relevant pharmacokinetic or pharmacodynamic interactions observed with warfarin, digoxin, aspirin, or sacubitril/valsartan. The global phase III study VICTORIA included patients with HFrEF who had a recent HF hospitalization or intravenous diuretic treatment for HF. Treatment with vericiguat on top of standard of care resulted in a 10% relative reduction in the primary composite outcome of death from cardiovascular causes or first hospitalization for HF. Vericiguat was well-tolerated with low incidence of symptomatic hypotension and syncope compared to placebo. Given its positive benefit-risk profile, vericiguat is an important option for high-risk patients with HFrEF who are already on guideline-directed medical therapy and had recent worsening of HF. Future efforts to develop additional effective therapies are needed to further reduce morbidity and mortality in patients with HF.
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Bui QM, Ding J, Hong KN, Adler EA. The Genetic Evaluation of Dilated Cardiomyopathy. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100200. [PMID: 37745678 PMCID: PMC10512006 DOI: 10.1016/j.shj.2023.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 09/26/2023]
Abstract
Dilated cardiomyopathy (DCM) is a common cause of heart failure and is the primary indication for heart transplantation. A genetic etiology can be found in 20-35% of patients with DCM, especially in those with a family history of cardiomyopathy or sudden cardiac death at an early age. With advancements in genome sequencing, the understanding of genotype-phenotype relationships in DCM has expanded with over 60 genes implicated in the disease. Subsequently, these findings have increased adoption of genetic testing in the management of DCM, which has allowed for improved risk stratification and identification of at risk family members. In this review, we discuss the genetic evaluation of DCM with a focus on practical genetic testing considerations, genotype-phenotype associations, and insights into upcoming personalized therapies.
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Affiliation(s)
- Quan M. Bui
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Jeffrey Ding
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Kimberly N. Hong
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Eric A. Adler
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USA
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RabieeRad M, GhasempourDabaghi G, Zare MM, Amani-Beni R. Novel Treatments of Hypertrophic Cardiomyopathy in GDMT for Heart Failure: A State-of-art Review. Curr Probl Cardiol 2023; 48:101740. [PMID: 37054829 DOI: 10.1016/j.cpcardiol.2023.101740] [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: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
This state-of-the-art review discuss the available evidence on the use of novel treatments of hypertrophic cardiomyopathy such as omecamtiv mecarbil, EMD-57033, levosimendan, pimobendan, and mavacamten for the treatment of heart failure (HF) in the context of guideline-directed medical therapy (GDMT). The paper provides a detailed overview of these agents' mechanisms of action, potential benefits and limitations, and their effects on clinical outcomes. The review also evaluates the efficacy of the novel treatments in comparison to traditional medications such as digoxin. Finally, we seek to provide insight and guidance to clinicians and researchers in the management of HF patients.
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Affiliation(s)
- Mehrdad RabieeRad
- School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | | | - Mohammad M Zare
- School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Reza Amani-Beni
- School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
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Morbach C, Simon I, Danner E, Gelbrich G, Stefenelli U, Sahiti F, Scholz N, Cejka V, Albert J, Ertl G, Angermann CE, Güder G, Frantz S, Heuschmann PU, Maack C, Störk S. Heart rate-corrected systolic ejection time: population-based reference values and differential prognostic utility in acute heart failure. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad020. [PMID: 39045077 PMCID: PMC11195710 DOI: 10.1093/ehjimp/qyad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/12/2023] [Indexed: 07/25/2024]
Abstract
Aims Systolic ejection time (SET) is discussed as a treatment target in patients with heart failure (HF) and a reduced left ventricular (LV) ejection fraction (EF). We derived reference values for SET correcting for its dependence on heart rate (SETc), and explored its prognostic utility in patients admitted with decompensated HF. Methods and results SETc was derived in 4836 participants of the population-based STAAB study (mean age 55 ± 12 years, 52% women). There, mean SETc was 328 ± 18 ms, increased with age (+4.7 ms per decade), was shorter in men than women (-14.9 ms), and correlated with arterial elastance (r = 0.30; all P < 0.001). In 134 patients hospitalized with acute HF, SETc at admission was shorter when compared with the general population and differed between patients with HF with reduced EF (HFrEF; LVEF ≤40%; 269 ± 35 ms), HF with mildly reduced EF (HFmrEF; LVEF 41-49%; 294 ± 27 ms), and HF with preserved EF (HFpEF; LVEF ≥50%; 317 ± 35 ms; P < 0.001). In proportional hazard regression, an in-hospital increase in SETc was associated with an age- and sex-adjusted hazard ratio of 0.38 (95% confidence interval 0.18-0.79) in patients with HFrEF, but a hazard ratio of 2.39 (95% confidence interval 1.24-4.64) in patients with HFpEF. Conclusion In the general population, SETc increased with age and an elevated afterload. SETc was mildly reduced in patients hospitalized with HFpEF, but markedly reduced in patients with HFrEF. In-hospital prolongation of SETc predicted a favourable outcome in HFrEF, but an adverse outcome in HFpEF. Our results support the concept of a U-shaped relationship between cardiac systolic function and risk, providing a rationale for a more individualized treatment approach in patients with HF.
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Affiliation(s)
- Caroline Morbach
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany
| | - Isabelle Simon
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Elisabeth Danner
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Götz Gelbrich
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Joseph-Schneider-Str. 2, 97080 Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Joseph-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Ulrich Stefenelli
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Floran Sahiti
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany
| | - Nina Scholz
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Vladimir Cejka
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Judith Albert
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany
| | - Georg Ertl
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany
| | - Christiane E Angermann
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany
| | - Gülmisal Güder
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany
| | - Stefan Frantz
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany
| | - Peter U Heuschmann
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Joseph-Schneider-Str. 2, 97080 Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Joseph-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Christoph Maack
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany
| | - Stefan Störk
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080 Würzburg, Germany
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Kooiker KB, Mohran S, Turner KL, Ma W, Martinson A, Flint G, Qi L, Gao C, Zheng Y, McMillen TS, Mandrycky C, Mahoney-Schaefer M, Freeman JC, Costales Arenas EG, Tu AY, Irving TC, Geeves MA, Tanner BC, Regnier M, Davis J, Moussavi-Harami F. Danicamtiv Increases Myosin Recruitment and Alters Cross-Bridge Cycling in Cardiac Muscle. Circ Res 2023; 133:430-443. [PMID: 37470183 PMCID: PMC10434831 DOI: 10.1161/circresaha.123.322629] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Modulating myosin function is a novel therapeutic approach in patients with cardiomyopathy. Danicamtiv is a novel myosin activator with promising preclinical data that is currently in clinical trials. While it is known that danicamtiv increases force and cardiomyocyte contractility without affecting calcium levels, detailed mechanistic studies regarding its mode of action are lacking. METHODS Permeabilized porcine cardiac tissue and myofibrils were used for X-ray diffraction and mechanical measurements. A mouse model of genetic dilated cardiomyopathy was used to evaluate the ability of danicamtiv to correct the contractile deficit. RESULTS Danicamtiv increased force and calcium sensitivity via increasing the number of myosins in the ON state and slowing cross-bridge turnover. Our detailed analysis showed that inhibition of ADP release results in decreased cross-bridge turnover with cross bridges staying attached longer and prolonging myofibril relaxation. Danicamtiv corrected decreased calcium sensitivity in demembranated tissue, abnormal twitch magnitude and kinetics in intact cardiac tissue, and reduced ejection fraction in the whole organ. CONCLUSIONS As demonstrated by the detailed studies of Danicamtiv, increasing myosin recruitment and altering cross-bridge cycling are 2 mechanisms to increase force and calcium sensitivity in cardiac muscle. Myosin activators such as Danicamtiv can treat the causative hypocontractile phenotype in genetic dilated cardiomyopathy.
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Affiliation(s)
- Kristina B. Kooiker
- Division of Cardiology, Medicine (K.B.K., M.M.-S., J.C.F., E.G.C.A., F.M.-H.), University of Washington
- Center of Translational Muscle Research (K.B.K., S.M., G.F., T.S.M., C.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Center for Cardiovascular Biology (K.B.K., A.M., M.R., J.D., F.M.-H.), University of Washington
- Institute for Stem Cell & Regenerative Medicine (K.B.K., S.M., A.M., T.S.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
| | - Saffie Mohran
- Center of Translational Muscle Research (K.B.K., S.M., G.F., T.S.M., C.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Institute for Stem Cell & Regenerative Medicine (K.B.K., S.M., A.M., T.S.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Department of Bioengineering (S.M., A.M., G.F., C.M., A.-Y.T., M.R., J.D.), University of Washington
| | - Kyrah L. Turner
- School of Molecular Biosciences, Washington State University (K.L.T.)
| | - Weikang Ma
- Department of Biology, Illinois Institute of Technology, Chicago (W.M., L.Q., T.C.I.)
| | - Amy Martinson
- Center for Cardiovascular Biology (K.B.K., A.M., M.R., J.D., F.M.-H.), University of Washington
- Department of Laboratory Medicine and Pathology (A.M., J.D., F.M.-H.), University of Washington
- Institute for Stem Cell & Regenerative Medicine (K.B.K., S.M., A.M., T.S.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Department of Bioengineering (S.M., A.M., G.F., C.M., A.-Y.T., M.R., J.D.), University of Washington
| | - Galina Flint
- Center of Translational Muscle Research (K.B.K., S.M., G.F., T.S.M., C.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Department of Bioengineering (S.M., A.M., G.F., C.M., A.-Y.T., M.R., J.D.), University of Washington
| | - Lin Qi
- Department of Biology, Illinois Institute of Technology, Chicago (W.M., L.Q., T.C.I.)
| | - Chengqian Gao
- College of Basic Medical Sciences, Dalian Medical University, Liaoning, China (C.G., Y.Z.)
| | - Yahan Zheng
- College of Basic Medical Sciences, Dalian Medical University, Liaoning, China (C.G., Y.Z.)
| | - Timothy S. McMillen
- Center of Translational Muscle Research (K.B.K., S.M., G.F., T.S.M., C.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Institute for Stem Cell & Regenerative Medicine (K.B.K., S.M., A.M., T.S.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Department of Anesthesiology and Pain Medicine (T.S.M.), University of Washington
| | - Christian Mandrycky
- Center of Translational Muscle Research (K.B.K., S.M., G.F., T.S.M., C.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Department of Bioengineering (S.M., A.M., G.F., C.M., A.-Y.T., M.R., J.D.), University of Washington
| | - Max Mahoney-Schaefer
- Division of Cardiology, Medicine (K.B.K., M.M.-S., J.C.F., E.G.C.A., F.M.-H.), University of Washington
| | - Jeremy C. Freeman
- Division of Cardiology, Medicine (K.B.K., M.M.-S., J.C.F., E.G.C.A., F.M.-H.), University of Washington
| | | | - An-Yu Tu
- Center of Translational Muscle Research (K.B.K., S.M., G.F., T.S.M., C.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Institute for Stem Cell & Regenerative Medicine (K.B.K., S.M., A.M., T.S.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Department of Bioengineering (S.M., A.M., G.F., C.M., A.-Y.T., M.R., J.D.), University of Washington
| | - Thomas C. Irving
- Department of Biology, Illinois Institute of Technology, Chicago (W.M., L.Q., T.C.I.)
| | - Michael A. Geeves
- School of Biosciences, Division of Natural Sciences, University of Kent, Canterbury, United Kingdom (M.A.G.)
| | - Bertrand C.W. Tanner
- Department of Integrative Physiology and Neuroscience, Washington State University (B.C.W.T.)
| | - Michael Regnier
- Center of Translational Muscle Research (K.B.K., S.M., G.F., T.S.M., C.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Center for Cardiovascular Biology (K.B.K., A.M., M.R., J.D., F.M.-H.), University of Washington
- Institute for Stem Cell & Regenerative Medicine (K.B.K., S.M., A.M., T.S.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Department of Bioengineering (S.M., A.M., G.F., C.M., A.-Y.T., M.R., J.D.), University of Washington
| | - Jennifer Davis
- Center of Translational Muscle Research (K.B.K., S.M., G.F., T.S.M., C.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Center for Cardiovascular Biology (K.B.K., A.M., M.R., J.D., F.M.-H.), University of Washington
- Department of Laboratory Medicine and Pathology (A.M., J.D., F.M.-H.), University of Washington
- Institute for Stem Cell & Regenerative Medicine (K.B.K., S.M., A.M., T.S.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Department of Bioengineering (S.M., A.M., G.F., C.M., A.-Y.T., M.R., J.D.), University of Washington
| | - Farid Moussavi-Harami
- Division of Cardiology, Medicine (K.B.K., M.M.-S., J.C.F., E.G.C.A., F.M.-H.), University of Washington
- Center of Translational Muscle Research (K.B.K., S.M., G.F., T.S.M., C.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
- Center for Cardiovascular Biology (K.B.K., A.M., M.R., J.D., F.M.-H.), University of Washington
- Department of Laboratory Medicine and Pathology (A.M., J.D., F.M.-H.), University of Washington
- Institute for Stem Cell & Regenerative Medicine (K.B.K., S.M., A.M., T.S.M., A.-Y.T., M.R., J.D., F.M.-H.), University of Washington
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Mangmool S, Duangrat R, Parichatikanond W, Kurose H. New Therapeutics for Heart Failure: Focusing on cGMP Signaling. Int J Mol Sci 2023; 24:12866. [PMID: 37629047 PMCID: PMC10454066 DOI: 10.3390/ijms241612866] [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: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Current drugs for treating heart failure (HF), for example, angiotensin II receptor blockers and β-blockers, possess specific target molecules involved in the regulation of the cardiac circulatory system. However, most clinically approved drugs are effective in the treatment of HF with reduced ejection fraction (HFrEF). Novel drug classes, including angiotensin receptor blocker/neprilysin inhibitor (ARNI), sodium-glucose co-transporter-2 (SGLT2) inhibitor, hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blocker, soluble guanylyl cyclase (sGC) stimulator/activator, and cardiac myosin activator, have recently been introduced for HF intervention based on their proposed novel mechanisms. SGLT2 inhibitors have been shown to be effective not only for HFrEF but also for HF with preserved ejection fraction (HFpEF). In the myocardium, excess cyclic adenosine monophosphate (cAMP) stimulation has detrimental effects on HFrEF, whereas cyclic guanosine monophosphate (cGMP) signaling inhibits cAMP-mediated responses. Thus, molecules participating in cGMP signaling are promising targets of novel drugs for HF. In this review, we summarize molecular pathways of cGMP signaling and clinical trials of emerging drug classes targeting cGMP signaling in the treatment of HF.
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Affiliation(s)
- Supachoke Mangmool
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand; (S.M.); (R.D.)
| | - Ratchanee Duangrat
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand; (S.M.); (R.D.)
| | | | - Hitoshi Kurose
- Pharmacology for Life Sciences, Graduate School of Pharmaceutical Sciences, Tokushima University, Tokushima 770-8505, Japan
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14
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Hitsumoto T, Tsukamoto O, Matsuoka K, Li J, Liu L, Kuramoto Y, Higo S, Ogawa S, Fujino N, Yoshida S, Kioka H, Kato H, Hakui H, Saito Y, Okamoto C, Inoue H, Hyejin J, Ueda K, Segawa T, Nishimura S, Asano Y, Asanuma H, Tani A, Imamura R, Komagawa S, Kanai T, Takamura M, Sakata Y, Kitakaze M, Haruta JI, Takashima S. Restoration of Cardiac Myosin Light Chain Kinase Ameliorates Systolic Dysfunction by Reducing Superrelaxed Myosin. Circulation 2023; 147:1902-1918. [PMID: 37128901 PMCID: PMC10270284 DOI: 10.1161/circulationaha.122.062885] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Cardiac-specific myosin light chain kinase (cMLCK), encoded by MYLK3, regulates cardiac contractility through phosphorylation of ventricular myosin regulatory light chain. However, the pathophysiological and therapeutic implications of cMLCK in human heart failure remain unclear. We aimed to investigate whether cMLCK dysregulation causes cardiac dysfunction and whether the restoration of cMLCK could be a novel myotropic therapy for systolic heart failure. METHODS We generated the knock-in mice (Mylk3+/fs and Mylk3fs/fs) with a familial dilated cardiomyopathy-associated MYLK3 frameshift mutation (MYLK3+/fs) that had been identified previously by us (c.1951-1G>T; p.P639Vfs*15) and the human induced pluripotent stem cell-derived cardiomyocytes from the carrier of the mutation. We also developed a new small-molecule activator of cMLCK (LEUO-1154). RESULTS Both mice (Mylk3+/fs and Mylk3fs/fs) showed reduced cMLCK expression due to nonsense-mediated messenger RNA decay, reduced MLC2v (ventricular myosin regulatory light chain) phosphorylation in the myocardium, and systolic dysfunction in a cMLCK dose-dependent manner. Consistent with this result, myocardium from the mutant mice showed an increased ratio of cardiac superrelaxation/disordered relaxation states that may contribute to impaired cardiac contractility. The phenotypes observed in the knock-in mice were rescued by cMLCK replenishment through the AAV9_MYLK3 vector. Human induced pluripotent stem cell-derived cardiomyocytes with MYLK3+/fs mutation reduced cMLCK expression by 50% and contractile dysfunction, accompanied by an increased superrelaxation/disordered relaxation ratio. CRISPR-mediated gene correction, or cMLCK replenishment by AAV9_MYLK3 vector, successfully recovered cMLCK expression, the superrelaxation/disordered relaxation ratio, and contractile dysfunction. LEUO-1154 increased human cMLCK activity ≈2-fold in the Vmax for ventricular myosin regulatory light chain phosphorylation without affecting the Km. LEUO-1154 treatment of human induced pluripotent stem cell-derived cardiomyocytes with MYLK3+/fs mutation restored the ventricular myosin regulatory light chain phosphorylation level and superrelaxation/disordered relaxation ratio and improved cardiac contractility without affecting calcium transients, indicating that the cMLCK activator acts as a myotrope. Finally, human myocardium from advanced heart failure with a wide variety of causes had a significantly lower MYLK3/PPP1R12B messenger RNA expression ratio than control hearts, suggesting an altered balance between myosin regulatory light chain kinase and phosphatase in the failing myocardium, irrespective of the causes. CONCLUSIONS cMLCK dysregulation contributes to the development of cardiac systolic dysfunction in humans. Our strategy to restore cMLCK activity could form the basis of a novel myotropic therapy for advanced systolic heart failure.
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Affiliation(s)
- Tatsuro Hitsumoto
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Osamu Tsukamoto
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Ken Matsuoka
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Junjun Li
- Department of Cardiovascular Surgery (J.L., L.L.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Li Liu
- Department of Cardiovascular Surgery (J.L., L.L.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Yuki Kuramoto
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Shuichiro Higo
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Shou Ogawa
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Noboru Fujino
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University. Kanazawa, Ishikawa, Japan (N.F., S.Y., M.T.)
| | - Shohei Yoshida
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University. Kanazawa, Ishikawa, Japan (N.F., S.Y., M.T.)
| | - Hidetaka Kioka
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Hisakazu Kato
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Hideyuki Hakui
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Yuki Saito
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Chisato Okamoto
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Hijiri Inoue
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Jo Hyejin
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Kyoko Ueda
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Takatsugu Segawa
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Shunsuke Nishimura
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Yoshihiro Asano
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
- Department of Genomic Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (Y.A.)
| | - Hiroshi Asanuma
- Department of Internal Medicine, Meiji University of Integrative Medicine, Nantan, Kyoto, Japan (H.A.)
| | - Akiyoshi Tani
- Compound Library Screening Center (A.T.), Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
| | - Riyo Imamura
- Drug Discovery Initiative, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan (R.I.)
| | - Shinsuke Komagawa
- Lead Explorating Units (S.K., T.K., J.-i.H.), Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
| | - Toshio Kanai
- Lead Explorating Units (S.K., T.K., J.-i.H.), Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University. Kanazawa, Ishikawa, Japan (N.F., S.Y., M.T.)
| | - Yasushi Sakata
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | | | - Jun-ichi Haruta
- Lead Explorating Units (S.K., T.K., J.-i.H.), Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
| | - Seiji Takashima
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
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15
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Jani V, Aslam MI, Fenwick AJ, Ma W, Gong H, Milburn G, Nissen D, Cubero Salazar IM, Hanselman O, Mukherjee M, Halushka MK, Margulies KB, Campbell KS, Irving TC, Kass DA, Hsu S. Right Ventricular Sarcomere Contractile Depression and the Role of Thick Filament Activation in Human Heart Failure With Pulmonary Hypertension. Circulation 2023; 147:1919-1932. [PMID: 37194598 PMCID: PMC10270283 DOI: 10.1161/circulationaha.123.064717] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/17/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Right ventricular (RV) contractile dysfunction commonly occurs and worsens outcomes in patients with heart failure with reduced ejection fraction and pulmonary hypertension (HFrEF-PH). However, such dysfunction often goes undetected by standard clinical RV indices, raising concerns that they may not reflect aspects of underlying myocyte dysfunction. We thus sought to characterize RV myocyte contractile depression in HFrEF-PH, identify those components reflected by clinical RV indices, and uncover underlying biophysical mechanisms. METHODS Resting, calcium-, and load-dependent mechanics were prospectively studied in permeabilized RV cardiomyocytes isolated from explanted hearts from 23 patients with HFrEF-PH undergoing cardiac transplantation and 9 organ donor controls. RESULTS Unsupervised machine learning using myocyte mechanical data with the highest variance yielded 2 HFrEF-PH subgroups that in turn mapped to patients with decompensated or compensated clinical RV function. This correspondence was driven by reduced calcium-activated isometric tension in decompensated clinical RV function, whereas surprisingly, many other major myocyte contractile measures including peak power and myocyte active stiffness were similarly depressed in both groups. Similar results were obtained when subgroups were first defined by clinical indices, and then myocyte mechanical properties in each group compared. To test the role of thick filament defects, myofibrillar structure was assessed by x-ray diffraction of muscle fibers. This revealed more myosin heads associated with the thick filament backbone in decompensated clinical RV function, but not compensated clinical RV function, as compared with controls. This corresponded to reduced myosin ATP turnover in decompensated clinical RV function myocytes, indicating less myosin in a crossbridge-ready disordered-relaxed (DRX) state. Altering DRX proportion (%DRX) affected peak calcium-activated tension in the patient groups differently, depending on their basal %DRX, highlighting potential roles for precision-guided therapeutics. Last, increasing myocyte preload (sarcomere length) increased %DRX 1.5-fold in controls but only 1.2-fold in both HFrEF-PH groups, revealing a novel mechanism for reduced myocyte active stiffness and by extension Frank-Starling reserve in human heart failure. CONCLUSIONS Although there are many RV myocyte contractile deficits in HFrEF-PH, commonly used clinical indices only detect reduced isometric calcium-stimulated force, which is related to deficits in basal and recruitable %DRX myosin. Our results support use of therapies to increase %DRX and enhance length-dependent recruitment of DRX myosin heads in such patients.
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Affiliation(s)
- Vivek Jani
- Department of Biomedical Engineering (V.J., O.H., D.A.K.), Johns Hopkins School of Medicine, Baltimore, MD
- Division of Cardiology, Department of Medicine (V.J., A.J.F., I.M.C.S., M.M., D.A.K., S.H.), Johns Hopkins School of Medicine, Baltimore, MD
| | - M. Imran Aslam
- Division of Cardiology, Department of Medicine, University of Texas San Antonio School of Medicine (M.I.A.)
| | - Axel J. Fenwick
- Division of Cardiology, Department of Medicine (V.J., A.J.F., I.M.C.S., M.M., D.A.K., S.H.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Weikang Ma
- Biophysics Collaborative Access Team (BioCAT), Department of Biology, Illinois Institute of Technology, Chicago (W.M., H.G., D.N., T.C.I.)
| | - Henry Gong
- Biophysics Collaborative Access Team (BioCAT), Department of Biology, Illinois Institute of Technology, Chicago (W.M., H.G., D.N., T.C.I.)
| | - Gregory Milburn
- Division of Cardiovascular Medicine, Department of Medicine, University of Kentucky, Lexington (G.M., K.S.C.)
| | - Devin Nissen
- Biophysics Collaborative Access Team (BioCAT), Department of Biology, Illinois Institute of Technology, Chicago (W.M., H.G., D.N., T.C.I.)
| | - Ilton M. Cubero Salazar
- Division of Cardiology, Department of Medicine (V.J., A.J.F., I.M.C.S., M.M., D.A.K., S.H.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Olivia Hanselman
- Department of Biomedical Engineering (V.J., O.H., D.A.K.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine (V.J., A.J.F., I.M.C.S., M.M., D.A.K., S.H.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Marc K. Halushka
- Division of Cardiovascular Pathology, Department of Pathology (M.K.H.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Kenneth B. Margulies
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia (K.B.M.)
| | - Kenneth S. Campbell
- Division of Cardiovascular Medicine, Department of Medicine, University of Kentucky, Lexington (G.M., K.S.C.)
| | - Thomas C. Irving
- Biophysics Collaborative Access Team (BioCAT), Department of Biology, Illinois Institute of Technology, Chicago (W.M., H.G., D.N., T.C.I.)
| | - David A. Kass
- Department of Biomedical Engineering (V.J., O.H., D.A.K.), Johns Hopkins School of Medicine, Baltimore, MD
- Division of Cardiology, Department of Medicine (V.J., A.J.F., I.M.C.S., M.M., D.A.K., S.H.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Steven Hsu
- Division of Cardiology, Department of Medicine (V.J., A.J.F., I.M.C.S., M.M., D.A.K., S.H.), Johns Hopkins School of Medicine, Baltimore, MD
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16
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Stevenson LW, Ross HJ, Rathman LD, Boehmer JP. Remote Monitoring for Heart Failure Management at Home. J Am Coll Cardiol 2023; 81:2272-2291. [PMID: 37286258 DOI: 10.1016/j.jacc.2023.04.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 06/09/2023]
Abstract
Early telemonitoring of weights and symptoms did not decrease heart failure hospitalizations but helped identify steps toward effective monitoring programs. A signal that is accurate and actionable with response kinetics for early re-assessment is required for the treatment of patients at high risk, while signal specifications differ for surveillance of low-risk patients. Tracking of congestion with cardiac filling pressures or lung water content has shown most impact to decrease hospitalizations, while multiparameter scores from implanted rhythm devices have identified patients at increased risk. Algorithms require better personalization of signal thresholds and interventions. The COVID-19 epidemic accelerated transition to remote care away from clinics, preparing for new digital health care platforms to accommodate multiple technologies and empower patients. Addressing inequities will require bridging the digital divide and the deep gap in access to HF care teams, who will not be replaced by technology but by care teams who can embrace it.
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Affiliation(s)
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, Peter Munk Centre, Toronto, Ontario, Canada
| | - Lisa D Rathman
- PENN Medicine Lancaster General Health, Lancaster, Pennsylvania, USA
| | - John P Boehmer
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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17
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Leancă SA, Afrăsânie I, Crișu D, Matei IT, Duca ȘT, Costache AD, Onofrei V, Tudorancea I, Mitu O, Bădescu MC, Șerban LI, Costache II. Cardiac Reverse Remodeling in Ischemic Heart Disease with Novel Therapies for Heart Failure with Reduced Ejection Fraction. Life (Basel) 2023; 13:1000. [PMID: 37109529 PMCID: PMC10143569 DOI: 10.3390/life13041000] [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: 03/07/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Despite the improvements in the treatment of coronary artery disease (CAD) and acute myocardial infarction (MI) over the past 20 years, ischemic heart disease (IHD) continues to be the most common cause of heart failure (HF). In clinical trials, over 70% of patients diagnosed with HF had IHD as the underlying cause. Furthermore, IHD predicts a worse outcome for patients with HF, leading to a substantial increase in late morbidity, mortality, and healthcare costs. In recent years, new pharmacological therapies have emerged for the treatment of HF, such as sodium-glucose cotransporter-2 inhibitors, angiotensin receptor-neprilysin inhibitors, selective cardiac myosin activators, and oral soluble guanylate cyclase stimulators, demonstrating clear or potential benefits in patients with HF with reduced ejection fraction. Interventional strategies such as cardiac resynchronization therapy, cardiac contractility modulation, or baroreflex activation therapy might provide additional therapeutic benefits by improving symptoms and promoting reverse remodeling. Furthermore, cardiac regenerative therapies such as stem cell transplantation could become a new therapeutic resource in the management of HF. By analyzing the existing data from the literature, this review aims to evaluate the impact of new HF therapies in patients with IHD in order to gain further insight into the best form of therapeutic management for this large proportion of HF patients.
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Affiliation(s)
- Sabina Andreea Leancă
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Irina Afrăsânie
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Daniela Crișu
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Iulian Theodor Matei
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ștefania Teodora Duca
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Alexandru Dan Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iași, Romania
| | - Viviana Onofrei
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ionuţ Tudorancea
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ovidiu Mitu
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Minerva Codruța Bădescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Lăcrămioara Ionela Șerban
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Irina Iuliana Costache
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
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18
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Castaldi B, Cuppini E, Fumanelli J, Di Candia A, Sabatino J, Sirico D, Vida V, Padalino M, Di Salvo G. Chronic Heart Failure in Children: State of the Art and New Perspectives. J Clin Med 2023; 12:2611. [PMID: 37048694 PMCID: PMC10095364 DOI: 10.3390/jcm12072611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
Pediatric heart failure (HF) is an important clinical condition with high morbidity and mortality. Compared to adults, pediatric HF shows different etiologies characterized by different physiology, a different clinical course, and deeply different therapeutic approaches. In the last few years, new drugs have been developed and new therapeutic strategies have been proposed with the goal of identifying an individualized treatment regimen. The aim of this article is to review the new potential drugs and non-pharmacological therapies for pediatric heart failure in children.
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Affiliation(s)
- Biagio Castaldi
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
| | - Elena Cuppini
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
| | - Jennifer Fumanelli
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
| | - Angela Di Candia
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
- Pediatric Research Institute (IRP) Città della Speranza, University of Padua, 35122 Padova, Italy
| | - Jolanda Sabatino
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
- Pediatric Research Institute (IRP) Città della Speranza, University of Padua, 35122 Padova, Italy
| | - Domenico Sirico
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
| | - Vladimiro Vida
- Pediatric Cardiac Surgery Unit, Department of Cardio Thoracic Sciences, University of Padua, 35122 Padova, Italy
| | - Massimo Padalino
- Pediatric Research Institute (IRP) Città della Speranza, University of Padua, 35122 Padova, Italy
- Pediatric Cardiac Surgery Unit, Department of Cardio Thoracic Sciences, University of Padua, 35122 Padova, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
- Pediatric Research Institute (IRP) Città della Speranza, University of Padua, 35122 Padova, Italy
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19
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Jani V, Aslam MI, Fenwick AJ, Ma W, Gong H, Milburn G, Nissen D, Salazar IC, Hanselman O, Mukherjee M, Halushka MK, Margulies KB, Campbell K, Irving TC, Kass DA, Hsu S. Right Ventricular Sarcomere Contractile Depression and the Role of Thick Filament Activation in Human Heart Failure with Pulmonary Hypertension. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.09.531988. [PMID: 36945606 PMCID: PMC10029011 DOI: 10.1101/2023.03.09.531988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Rationale Right ventricular (RV) contractile dysfunction commonly occurs and worsens outcomes in heart failure patients with reduced ejection fraction and pulmonary hypertension (HFrEF-PH). However, such dysfunction often goes undetected by standard clinical RV indices, raising concerns that they may not reflect aspects of underlying myocyte dysfunction. Objective To determine components of myocyte contractile depression in HFrEF-PH, identify those reflected by clinical RV indices, and elucidate their underlying biophysical mechanisms. Methods and Results Resting, calcium- and load-dependent mechanics were measured in permeabilized RV cardiomyocytes isolated from explanted hearts from 23 HFrEF-PH patients undergoing cardiac transplantation and 9 organ-donor controls. Unsupervised machine learning using myocyte mechanical data with the highest variance yielded two HFrEF-PH subgroups that in turn mapped to patients with depressed (RVd) or compensated (RVc) clinical RV function. This correspondence was driven by reduced calcium-activated isometric tension in RVd, while surprisingly, many other major myocyte contractile measures including peak power, maximum unloaded shortening velocity, and myocyte active stiffness were similarly depressed in both groups. Similar results were obtained when subgroups were first defined by clinical indices, and then myocyte mechanical properties in each group compared. To test the role of thick-filament defects, myofibrillar structure was assessed by X-ray diffraction of muscle fibers. This revealed more myosin heads associated with the thick filament backbone in RVd but not RVc, as compared to controls. This corresponded to reduced myosin ATP turnover in RVd myocytes, indicating less myosin in a cross-bridge ready disordered-relaxed (DRX) state. Altering DRX proportion (%DRX) affected peak calcium-activated tension in the patient groups differently, depending on their basal %DRX, highlighting potential roles for precision-guided therapeutics. Lastly, increasing myocyte preload (sarcomere length) increased %DRX 1.5-fold in controls but only 1.2-fold in both HFrEF-PH groups, revealing a novel mechanism for reduced myocyte active stiffness and by extension Frank-Starling reserve in human HF. Conclusions While there are multiple RV myocyte contractile deficits In HFrEF-PH, clinical indices primarily detect reduced isometric calcium-stimulated force related to deficits in basal and recruitable %DRX myosin. Our results support use of therapies to increase %DRX and enhance length-dependent recruitment of DRX myosin heads in such patients.
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20
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[Mechano-energetic defects in heart failure]. Herz 2023; 48:123-133. [PMID: 36700949 DOI: 10.1007/s00059-022-05161-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/27/2023]
Abstract
Heart failure is characterized by defects in excitation-contraction coupling, energetic deficit and oxidative stress. The energy for cardiac contraction and relaxation is provided in mitochondria, whose function is tightly regulated by excitation-contraction coupling in cardiac myocytes. In heart failure with reduced ejection fraction (HFrEF), alterations in the ion balance in cardiac myocytes impair mitochondrial Ca2+ uptake, which is required for activation of the Krebs cycle, causing an energetic deficit and oxidative stress in mitochondria. Recent clinical studies suggest that in heart failure with preserved ejection fraction (HFpEF), in stark contrast to HFrEF, hypercontractility often occurs as an attempt to compensate for a pathological increase in systemic and pulmonary vascular resistance. This hypercontractility increases cardiac energy and oxygen demands at rest and reduces the contractile, diastolic and coronary reserves, preventing an adequate increase in cardiac output during exercise. Moreover, increased contractility causes long-term maladaptive remodeling processes due to oxidative stress and redox-sensitive prohypertrophic signaling pathways. As overweight and diabetes, particularly in the interplay with hemodynamic stress, are important risk factors for the development of HFpEF, interventions targeting metabolism in particular could ameliorate the development and progression of HFpEF.
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21
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Kooiker KB, Mohran S, Turner KL, Ma W, Flint G, Qi L, Gao C, Zheng Y, McMillen TS, Mandrycky C, Martinson A, Mahoney-Schaefer M, Freeman JC, Costales Arenas EG, Tu AY, Irving TC, Geeves MA, Tanner BCW, Regnier M, Davis J, Moussavi-Harami F. Danicamtiv increases myosin recruitment and alters the chemomechanical cross bridge cycle in cardiac muscle. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.31.526380. [PMID: 36778318 PMCID: PMC9915609 DOI: 10.1101/2023.01.31.526380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Modulating myosin function is a novel therapeutic approach in patients with cardiomyopathy. Detailed mechanism of action of these agents can help predict potential unwanted affects and identify patient populations that can benefit most from them. Danicamtiv is a novel myosin activator with promising preclinical data that is currently in clinical trials. While it is known danicamtiv increases force and cardiomyocyte contractility without affecting calcium levels, detailed mechanistic studies regarding its mode of action are lacking. Using porcine cardiac tissue and myofibrils we demonstrate that Danicamtiv increases force and calcium sensitivity via increasing the number of myosin in the "on" state and slowing cross bridge turnover. Our detailed analysis shows that inhibition of ADP release results in decreased cross bridge turnover with cross bridges staying on longer and prolonging myofibril relaxation. Using a mouse model of genetic dilated cardiomyopathy, we demonstrated that Danicamtiv corrected calcium sensitivity in demembranated and abnormal twitch magnitude and kinetics in intact cardiac tissue. Significance Statement Directly augmenting sarcomere function has potential to overcome limitations of currently used inotropic agents to improve cardiac contractility. Myosin modulation is a novel mechanism for increased contraction in cardiomyopathies. Danicamtiv is a myosin activator that is currently under investigation for use in cardiomyopathy patients. Our study is the first detailed mechanism of how Danicamtiv increases force and alters kinetics of cardiac activation and relaxation. This new understanding of the mechanism of action of Danicamtiv can be used to help identify patients that could benefit most from this treatment.
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22
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Docherty KF, McMurray JJV, Claggett BL, Miao ZM, Adams KF, Arias-Mendoza A, Cleland JGF, Diaz R, Echeverria Correa LE, Felker GM, Fonseca C, Li J, Metra M, Sliwa-Hahnle K, Solomon SD, Vandekerckhove HJ, Vinereanu D, Voors AA, Heitner SB, Kupfer S, Malik FI, Meng L, Teerlink JR. Efficacy of omecamtiv mecarbil in heart failure with reduced ejection fraction according to N-terminal pro-B-type natriuretic peptide level: insights from the GALACTIC-HF trial. Eur J Heart Fail 2023; 25:248-259. [PMID: 36597719 DOI: 10.1002/ejhf.2763] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/01/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023] Open
Abstract
AIM N-terminal pro-B-type natriuretic peptide (NT-proBNP) is predictive of both outcomes and response to treatment in patients with heart failure with reduced ejection fraction (HFrEF). The aim of this study was to examine the effect of the cardiac myosin activator omecamtiv mecarbil according to baseline NT-proBNP level in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure trial (GALACTIC-HF). METHODS AND RESULTS The primary outcome was the composite of a worsening heart failure event (urgent clinic visit, emergency department visit, or hospitalization) or cardiovascular death. We prespecified analysis of the effect of treatment according to baseline NT-proBNP (≤ median, > median), excluding individuals with atrial fibrillation/flutter (AF/AFL). Of the 8232 patients analysed, 8206 had an available baseline NT-proBNP measurement. Among the 5971 patients not in AF/AFL, the median (Q1-Q3) NT-proBNP level was 1675 (812-3579) pg/ml. Hazard ratios (HR) for the effect of omecamtiv mecarbil, compared with placebo, for the primary endpoint in patients without AF/AFL were: ≤ median 0.94 (95% confidence interval [CI] 0.80-1.09), > median 0.81 (0.73-0.90) (p-interaction = 0.095); for the overall population (including patients with AF/AFL) the HRs were ≤ median 1.01 (0.90-1.15) and > median 0.88 (0.80-0.96) (p-interaction = 0.035). There was an interaction between treatment and NT-proBNP, examined as a continuous variable, with greater effect of omecamtiv mecarbil on the primary outcome in patients with a higher baseline NT-proBNP (p-interaction = 0.086). CONCLUSIONS In GALACTIC-HF, the benefit of omecamtiv mecarbil appeared to be larger in patients with higher baseline NT-proBNP levels, especially in patients without AF/AFL. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02929329; EudraCT number, 2016-002299-28.
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Affiliation(s)
- Kieran F Docherty
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Brian L Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Zi Michael Miao
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rafael Diaz
- Estudios Clinicos Latino America, Rosario, Argentina
| | | | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC, USA
| | - Candida Fonseca
- Department of Internal Medicine, Hospital São Francisco Xavier, Lisbon, Portugal
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Marco Metra
- Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania
| | | | | | | | - Fady I Malik
- Cytokinetics, Inc., South San Francisco, CA, USA
| | - Lisa Meng
- Cytokinetics, Inc., South San Francisco, CA, USA
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
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23
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Tomasoni D, Adamo M, Metra M. February 2023 at a glance: focus on pathophysiology and treatment. Eur J Heart Fail 2023; 25:135-138. [PMID: 36823990 DOI: 10.1002/ejhf.2806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/22/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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24
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Martens P, Dauw J, Verbrugge FH, Nijst P, Meekers E, Augusto SN, Ter Maaten JM, Damman K, Mebazaa A, Filippatos G, Ruschitzka F, Tang WHW, Dupont M, Mullens W. Decongestion With Acetazolamide in Acute Decompensated Heart Failure Across the Spectrum of Left Ventricular Ejection Fraction: A Prespecified Analysis From the ADVOR Trial. Circulation 2023; 147:201-211. [PMID: 36335479 DOI: 10.1161/circulationaha.122.062486] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acetazolamide inhibits proximal tubular sodium reabsorption and improved decongestion in the ADVOR (Acetazolamide in Decompensated Heart Failure with Volume Overload) trial. It remains unclear whether the decongestive effects of acetazolamide differ across the spectrum of left ventricular ejection fraction (LVEF). METHODS This is a prespecified analysis of the randomized, double-blind, placebo-controlled ADVOR trial that enrolled 519 patients with acute heart failure (HF), clinical signs of volume overload (eg, edema, pleural effusion, or ascites), NTproBNP (N-terminal pro-B-type natriuretic peptide) >1000 ng/L, or BNP (B-type natriuretic peptide) >250 ng/mL to receive intravenous acetazolamide (500 mg once daily) or placebo in addition to standardized intravenous loop diuretics (twice that of the oral home maintenance dose). Randomization was stratified according to LVEF (≤40% or >40%). The primary end point was successful decongestion, defined as the absence of signs of volume overload within 3 days from randomization without the need for mandatory escalation of decongestive therapy because of poor urine output. RESULTS Median LVEF was 45% (25th to 75th percentile; 30% to 55%), and 43% had an LVEF ≤40%. Patients with lower LVEF were younger and more likely to be male with a higher prevalence of ischemic heart disease, higher NTproBNP, less atrial fibrillation, and lower estimated glomerular filtration rate. No interaction on the overall beneficial treatment effect of acetazolamide to the primary end point of successful decongestion (OR, 1.77 [95% CI, 1.18-2.63]; P=0.005; all P values for interaction >0.401) was found when LVEF was assessed per randomization stratum (≤40% or >40%), or as HF with reduced ejection fraction, HF with mildly reduced ejection fraction, and HF with preserved ejection fraction, or on a continuous scale. Acetazolamide resulted in improved diuretic response measured by higher cumulative diuresis and natriuresis and shortened length of stay without treatment effect modification by baseline LVEF (all P values for interaction >0.160). CONCLUSIONS When added to treatment with loop diuretics in patients with acute decompensated HF, acetazolamide improves the incidence of successful decongestion and diuretic response, and shortens length of stay without treatment effect modification by baseline LVEF. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03505788.
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Affiliation(s)
- Pieter Martens
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (P.M., W.H.W.T.), Cleveland Clinic, Cleveland, OH.,Ziekenhuis Oost-Limburg A.V., Genk, Belgium (P.M., J.D., P.N., E.M., M.D., W.M.)
| | - Jeroen Dauw
- Ziekenhuis Oost-Limburg A.V., Genk, Belgium (P.M., J.D., P.N., E.M., M.D., W.M.).,Hasselt University, Diepenbeek/Hasselt, Belgium (J.D., E.M., W.M.)
| | - Frederik H Verbrugge
- Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium (F.H.V.).,Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium (F.H.V.)
| | - Petra Nijst
- Ziekenhuis Oost-Limburg A.V., Genk, Belgium (P.M., J.D., P.N., E.M., M.D., W.M.)
| | - Evelyne Meekers
- Ziekenhuis Oost-Limburg A.V., Genk, Belgium (P.M., J.D., P.N., E.M., M.D., W.M.).,Hasselt University, Diepenbeek/Hasselt, Belgium (J.D., E.M., W.M.)
| | - Silvio Nunes Augusto
- Cardiovascular and Metabolic Sciences, Lerner Research Institute (S.N.A.), Cleveland Clinic, Cleveland, OH
| | - Jozine M Ter Maaten
- University of Groningen, Department of Cardiology, University Medical Center Groningen, The Netherlands (J.M.T.M. K.D.)
| | - Kevin Damman
- University of Groningen, Department of Cardiology, University Medical Center Groningen, The Netherlands (J.M.T.M. K.D.)
| | - Alexandre Mebazaa
- Université Paris Cité, Inserm MASCOT, Assistance Publique Hopitaux de Paris' France (A.M.)
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, Athens University Hospital Attikon, Greece (G.F.)
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, University of Zurich, Switzerland (F.R.)
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute (P.M., W.H.W.T.), Cleveland Clinic, Cleveland, OH
| | - Matthias Dupont
- Ziekenhuis Oost-Limburg A.V., Genk, Belgium (P.M., J.D., P.N., E.M., M.D., W.M.)
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg A.V., Genk, Belgium (P.M., J.D., P.N., E.M., M.D., W.M.).,Hasselt University, Diepenbeek/Hasselt, Belgium (J.D., E.M., W.M.)
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25
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Lanfear DE, Njoroge JN, Adams KF, Anand I, Fang JC, Ramires F, Sliwa-Hahnle K, Badat A, Burgess L, Gorodeski EZ, Williams C, Diaz R, Felker GM, McMurray JJV, Metra M, Solomon S, Miao ZM, Claggett BL, Heitner SB, Kupfer S, Malik FI, Teerlink JR. Omecamtiv Mecarbil in Black Patients With Heart Failure and Reduced Ejection Fraction: Insights From GALACTIC-HF. JACC. HEART FAILURE 2023; 11:569-579. [PMID: 36881396 DOI: 10.1016/j.jchf.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Omecamtiv mecarbil improves cardiovascular outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). Consistency of drug benefit across race is a key public health topic. OBJECTIVES The purpose of this study was to evaluate the effect of omecamtiv mecarbil among self-identified Black patients. METHODS In GALACTIC-HF (Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure) patients with symptomatic HF, elevated natriuretic peptides, and left ventricular ejection fraction (LVEF) ≤35% were randomized to omecamtiv mecarbil or placebo. The primary outcome was a composite of time to first event of HF or cardiovascular death. The authors analyzed treatment effects in Black vs White patients in countries contributing at least 10 Black participants. RESULTS Black patients accounted for 6.8% (n = 562) of overall enrollment and 29% of U.S. enrollment. Most Black patients enrolled in the United States, South Africa, and Brazil (n = 535, 95%). Compared with White patients enrolled from these countries (n = 1,129), Black patients differed in demographics, comorbid conditions, received higher rates of medical therapy and lower rates of device therapies, and experienced higher overall event rates. The effect of omecamtiv mecarbil was consistent in Black vs White patients, with no difference in the primary endpoint (HR = 0.83 vs 0.88, P-interaction = 0.66), similar improvements in heart rate and N-terminal pro-B-type natriuretic peptide, and no significant safety signals. Among endpoints, the only nominally significant treatment-by-race interaction was the placebo-corrected change in blood pressure from baseline in Black vs White patients (+3.4 vs -0.7 mm Hg, P-interaction = 0.02). CONCLUSIONS GALACTIC-HF enrolled more Black patients than other recent HF trials. Black patients treated with omecamtiv mecarbil had similar benefit and safety compared with White counterparts.
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Affiliation(s)
| | - Joyce N Njoroge
- University of California San Francisco, San Francisco, California, USA
| | | | - Inder Anand
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Felix Ramires
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Aysha Badat
- Wits Clinical Research, Johannesburg, South Africa
| | - Lesley Burgess
- TREAD Research, Cardiology Unit, Department of Internal Medicine, Tygerberg Hospital and Stellenbosch University, Parow, South Africa
| | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Rafael Diaz
- Estudios Clínicos Latino América, Rosario, Argentina
| | - Gary M Felker
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, Glasgow, United Kingdom
| | | | - Scott Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Brian L Claggett
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Stuart Kupfer
- Cytokinetics Inc, South San Francisco, California, USA
| | - Fady I Malik
- Cytokinetics Inc, South San Francisco, California, USA
| | - John R Teerlink
- San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California, USA
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The Future for Inotropes in Heart Failure. Do Not Throw the Baby Out With the Bathwater! J Cardiovasc Pharmacol 2023; 81:1-3. [PMID: 36383059 DOI: 10.1097/fjc.0000000000001377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Crespo-Leiro MG, McDonagh TA, Barge-Caballero E. Omecamtiv mecarbil for patients with severe systolic dysfunction and hypotension. Eur Heart J 2022; 43:5017-5019. [PMID: 36367733 DOI: 10.1093/eurheartj/ehac552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Eduardo Barge-Caballero
- Cardiology Department, Complexo Hospitalario Universitario A Coruña, CIBERCV. INIBIC, UDC, A Coruña, Spain
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Titin-truncating variants in hiPSC cardiomyocytes induce pathogenic proteinopathy and sarcomere defects with preserved core contractile machinery. Stem Cell Reports 2022; 18:220-236. [PMID: 36525964 PMCID: PMC9860080 DOI: 10.1016/j.stemcr.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022] Open
Abstract
Titin-truncating variants (TTNtv) are the single largest genetic cause of dilated cardiomyopathy (DCM). In this study we modeled disease phenotypes of A-band TTNtv-induced DCM in human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) using genome editing and tissue engineering technologies. Transcriptomic, cellular, and micro-tissue studies revealed that A-band TTNtv hiPSC-CMs exhibit pathogenic proteinopathy, sarcomere defects, aberrant Na+ channel activities, and contractile dysfunction. These phenotypes establish a dual mechanism of poison peptide effect and haploinsufficiency that collectively contribute to DCM pathogenesis. However, TTNtv cellular defects did not interfere with the function of the core contractile machinery, the actin-myosin-troponin-Ca2+ complex, and preserved the therapeutic mechanism of sarcomere modulators. Treatment of TTNtv cardiac micro-tissues with investigational sarcomere modulators augmented contractility and resulted in sustained transcriptomic changes that promote reversal of DCM disease signatures. Together, our findings elucidate the underlying pathogenic mechanisms of A-band TTNtv-induced DCM and demonstrate the validity of sarcomere modulators as potential therapeutics.
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29
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Ameri P, De Marzo V, Zoccai GB, Tricarico L, Correale M, Brunetti ND, Canepa M, De Ferrari GM, Castagno D, Porto I. Efficacy of new medical therapies in patients with heart failure, reduced ejection fraction, and chronic kidney disease already receiving neurohormonal inhibitors: a network meta-analysis. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:768-776. [PMID: 34928347 DOI: 10.1093/ehjcvp/pvab088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/20/2021] [Accepted: 12/16/2021] [Indexed: 12/29/2022]
Abstract
AIMS We assessed the efficacy of the drugs developed after neurohormonal inhibition (NEUi) in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and concomitant chronic kidney disease (CKD). METHODS AND RESULTS The literature was systematically searched for phase 3 randomized controlled trials (RCTs) involving ≥90% patients with left ventricular ejection fraction <45%, of whom <30% were acutely decompensated, and with published information about the subgroup of estimated glomerular filtration rate <60 mL/min/1.73 m2. Six RCTs were included in a study-level network meta-analysis evaluating the effect of NEUi, ivabradine, angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter-2 inhibitors (SGLT2i), vericiguat, and omecamtiv mecarbil (OM) on a composite outcome of cardiovascular death or hospitalization for HF. In a fixed-effects model, SGLT2i [hazard ratio (HR) 0.78, 95% credible interval (CrI) 0.69-0.89], ARNI (HR 0.79, 95% CrI 0.69-0.90), and ivabradine (HR 0.82, 95% CrI 0.69-0.98) decreased the risk of the composite outcome vs. NEUi, whereas OM did not (HR 0.98, 95% CrI 0.89-1.10). A trend for improved outcome was also found for vericiguat (HR 0.90, 95% CrI 0.80-1.00). In indirect comparisons, both SLGT2i (HR 0.80, 95% CrI 0.68-0.94) and ARNI (HR 0.80, 95% CrI 0.68-0.95) reduced the risk vs. OM; furthermore, there was a trend for a greater benefit of SGLT2i vs. vericiguat (HR 0.88, 95% CrI 0.73-1.00) and ivabradine vs. OM (HR 0.84, 95% CrI 0.68-1.00). Results were comparable in a random-effects model and in sensitivity analyses. Surface under the cumulative ranking area scores were 81.8%, 80.8%, 68.9%, 44.2%, 16.6%, and 7.8% for SGLT2i, ARNI, ivabradine, vericiguat, OM, and NEUi, respectively. CONCLUSION Expanding pharmacotherapy beyond NEUi improves outcomes in HFrEF with CKD.
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Affiliation(s)
- Pietro Ameri
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.,Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Vincenzo De Marzo
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.,Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Lucia Tricarico
- Cardiology Unit, Ospedali Riuniti di Foggia, Foggia, Italy.,University of Foggia, Foggia, Italy
| | | | - Natale Daniele Brunetti
- Cardiology Unit, Ospedali Riuniti di Foggia, Foggia, Italy.,University of Foggia, Foggia, Italy
| | - Marco Canepa
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.,Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Davide Castagno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Italo Porto
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.,Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
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Cimino G, Pancaldi E, Tomasoni D, Lombardi CM, Metra M, Adamo M. Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming. J Cardiovasc Med (Hagerstown) 2022; 23:761-769. [PMID: 36349941 DOI: 10.2459/jcm.0000000000001409] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Prevalence of heart failure is increasing worldwide mainly due to the ageing of the population and the improvement in diagnosis and treatment. In recent years, huge progress has been made in the management of heart failure patients. A new definition of chronic heart failure based on left ventricular ejection fraction and its possible trajectories has been reported. New drug classes have been introduced for the treatment of chronic heart failure. In particular, the prognostic benefit of sodium glucose co-transporter 2 inhibitors was demonstrated across all the heart failure phenotypes. Therapies for patients with advanced heart failure (long-term mechanical circulatory supports and heart transplantation) are now indicated also in the case of mild-to-moderate symptoms but with high risk of progression. In patients with acute heart failure, monitoring of urinary sodium and the use of acetazolamide may lead to better decongestion. Importantly, pre- and postdischarge assessment should lead to optimal treatment. Devices and telemonitoring can also be of help. Cardiovascular and noncardiovascular comorbidities are major determinants of the clinical course and need proper management. This review will summarize these important advances.
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31
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Riccardi M, Sammartino AM, Piepoli M, Adamo M, Pagnesi M, Rosano G, Metra M, von Haehling S, Tomasoni D. Heart failure: an update from the last years and a look at the near future. ESC Heart Fail 2022; 9:3667-3693. [PMID: 36546712 PMCID: PMC9773737 DOI: 10.1002/ehf2.14257] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
In the last years, major progress occurred in heart failure (HF) management. Quadruple therapy is now mandatory for all the patients with HF with reduced ejection fraction. Whilst verciguat is becoming available across several countries, omecamtiv mecarbil is waiting to be released for clinical use. Concurrent use of potassium-lowering agents may counteract hyperkalaemia and facilitate renin-angiotensin-aldosterone system inhibitor implementations. The results of the EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trial were confirmed by the Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER) trial, and we now have, for the first time, evidence for treatment of also patients with HF with preserved ejection fraction. In a pre-specified meta-analysis of major randomized controlled trials, sodium-glucose co-transporter-2 inhibitors reduced all-cause mortality, cardiovascular (CV) mortality, and HF hospitalization in the patients with HF regardless of left ventricular ejection fraction. Other steps forward have occurred in the treatment of decompensated HF. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload (ADVOR) trial showed that the addition of intravenous acetazolamide to loop diuretics leads to greater decongestion vs. placebo. The addition of hydrochlorothiazide to loop diuretics was evaluated in the CLOROTIC trial. Torasemide did not change outcomes, compared with furosemide, in TRANSFORM-HF. Ferric derisomaltose had an effect on the primary outcome of CV mortality or HF rehospitalizations in IRONMAN (rate ratio 0.82; 95% confidence interval 0.66-1.02; P = 0.070). Further options for the treatment of HF, including device therapies, cardiac contractility modulation, and percutaneous treatment of valvulopathies, are summarized in this article.
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Affiliation(s)
- Mauro Riccardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Antonio Maria Sammartino
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San DonatoUniversity of MilanMilanItaly
- Department of Preventive CardiologyUniversity of WrocławWrocławPoland
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | | | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Goettingen Medical CenterGottingenGermany
- German Center for Cardiovascular Research (DZHK), Partner Site GöttingenGottingenGermany
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
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Herting J, Fischer TH, Maack C. Herzinsuffizienz. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00544-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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33
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Heart Failure Medical Therapy: A Review for Structural/Interventional Cardiologists. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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34
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Popa IP, Haba MȘC, Mărănducă MA, Tănase DM, Șerban DN, Șerban LI, Iliescu R, Tudorancea I. Modern Approaches for the Treatment of Heart Failure: Recent Advances and Future Perspectives. Pharmaceutics 2022; 14:pharmaceutics14091964. [PMID: 36145711 PMCID: PMC9503448 DOI: 10.3390/pharmaceutics14091964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Heart failure (HF) is a progressively deteriorating medical condition that significantly reduces both the patients’ life expectancy and quality of life. Even though real progress was made in the past decades in the discovery of novel pharmacological treatments for HF, the prevention of premature deaths has only been marginally alleviated. Despite the availability of a plethora of pharmaceutical approaches, proper management of HF is still challenging. Thus, a myriad of experimental and clinical studies focusing on the discovery of new and provocative underlying mechanisms of HF physiopathology pave the way for the development of novel HF therapeutic approaches. Furthermore, recent technological advances made possible the development of various interventional techniques and device-based approaches for the treatment of HF. Since many of these modern approaches interfere with various well-known pathological mechanisms in HF, they have a real ability to complement and or increase the efficiency of existing medications and thus improve the prognosis and survival rate of HF patients. Their promising and encouraging results reported to date compel the extension of heart failure treatment beyond the classical view. The aim of this review was to summarize modern approaches, new perspectives, and future directions for the treatment of HF.
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Affiliation(s)
- Irene Paula Popa
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Mihai Ștefan Cristian Haba
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Minela Aida Mărănducă
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Daniela Maria Tănase
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700115 Iași, Romania
| | - Dragomir N. Șerban
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Lăcrămioara Ionela Șerban
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Radu Iliescu
- Department of Pharmacology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ionuț Tudorancea
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Correspondence:
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35
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Yang Y, Fu Z, Zhu W, Hu H, Wang J. Application of optical tweezers in cardiovascular research: More than just a measuring tool. Front Bioeng Biotechnol 2022; 10:947918. [PMID: 36147537 PMCID: PMC9486066 DOI: 10.3389/fbioe.2022.947918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/12/2022] [Indexed: 12/04/2022] Open
Abstract
Recent advances in the field of optical tweezer technology have shown intriguing potential for applications in cardiovascular medicine, bringing this laboratory nanomechanical instrument into the spotlight of translational medicine. This article summarizes cardiovascular system findings generated using optical tweezers, including not only rigorous nanomechanical measurements but also multifunctional manipulation of biologically active molecules such as myosin and actin, of cells such as red blood cells and cardiomyocytes, of subcellular organelles, and of microvessels in vivo. The implications of these findings in the diagnosis and treatment of diseases, as well as potential perspectives that could also benefit from this tool, are also discussed.
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Affiliation(s)
- Yi Yang
- Department of Cardiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China
| | - Zhenhai Fu
- Quantum Sensing Center, Zhejiang Lab, Hangzhou, China
| | - Wei Zhu
- Department of Cardiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China
- *Correspondence: Wei Zhu, ; Huizhu Hu, ; Jian’an Wang,
| | - Huizhu Hu
- Quantum Sensing Center, Zhejiang Lab, Hangzhou, China
- State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering, Zhejiang University, Hangzhou, China
- *Correspondence: Wei Zhu, ; Huizhu Hu, ; Jian’an Wang,
| | - Jian’an Wang
- Department of Cardiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China
- *Correspondence: Wei Zhu, ; Huizhu Hu, ; Jian’an Wang,
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36
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Sindone AP, De Pasquale C, Amerena J, Burdeniuk C, Chan A, Coats A, Hare D, Macdonald P, Sverdlov A, Atherton JJ. Consensus statement on the current pharmacological prevention and management of heart failure. Med J Aust 2022; 217:212-217. [PMID: 35908234 PMCID: PMC9545515 DOI: 10.5694/mja2.51656] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 12/11/2022]
Abstract
Introduction: This consensus statement of Australian clinicians provides new recommendations for the pharmacological management of heart failure based on studies reported since the publication of the 2018 Australian heart failure guidelines. Main recommendations:Use of sodium–glucose cotransporter 2 (SGLT2) inhibitors to prevent hospitalisation for heart failure in type 2 diabetes mellitus can be extended to patients with multiple cardiovascular risk factors, albuminuric chronic kidney disease, or atherosclerotic cardiovascular disease. New evidence supports the use of a mineralocorticoid receptor antagonist (finerenone) to prevent heart failure in type 2 diabetes mellitus associated with albuminuric chronic kidney disease. In addition to renin angiotensin system inhibitors (angiotensin receptor neprilysin inhibitor preferred), beta blockers and mineralocorticoid receptor antagonists, an SGLT2 inhibitor (dapagliflozin or empagliflozin) is recommended in all patients with heart failure with reduced left ventricular ejection fraction (LVEF ≤ 40%) (HFrEF). Lower quality evidence supports these therapies in patients with heart failure with mildly reduced LVEF (41‐49%) (HFmrEF). A soluble guanylate cyclase stimulator (vericiguat), selective cardiac myosin activator (omecamtiv mecarbil) and, if iron deficient, intravenous iron (ferric carboxymaltose) provide additional benefits in persistent HFrEF. An SGLT2 inhibitor (empagliflozin) should be considered in patients with heart failure with preserved LVEF (≥ 50%) (HFpEF).
Key changes in management from this statement: This document broadens the scope of angiotensin receptor neprilysin inhibitor use in patients with HFrEF and HFmrEF. SGLT2 inhibitor use expands to become a cornerstone therapy in HFrEF, with increasing evidence to support its use in HFmrEF and HFpEF.
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Affiliation(s)
| | | | - John Amerena
- University Hospital Geelong Geelong VIC
- Deakin University Melbourne VIC
| | | | - Alicia Chan
- Royal Adelaide Hospital Adelaide SA
- University of Adelaide Adelaide SA
| | | | | | - Peter Macdonald
- St Vincent's Hospital Sydney NSW
- Victor Chang Cardiac Research Institute Sydney NSW
| | - Aaron Sverdlov
- Hunter Medical Research Institute University of Newcastle Sydney NSW
- John Hunter Hospital Sydney NSW
| | - John J Atherton
- Royal Brisbane and Women's Hospital Brisbane QLD
- University of Queensland Brisbane QLD
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37
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Lennon KM, Saftics A, Abuelreich S, Sahu P, Lehmann HI, Maddox AL, Bagabas R, Januzzi JL, Van Keuren-Jensen K, Shah R, Das S, Jovanovic-Talisman T. Cardiac troponin T in extracellular vesicles as a novel biomarker in human cardiovascular disease. Clin Transl Med 2022; 12:e979. [PMID: 35988159 PMCID: PMC9393073 DOI: 10.1002/ctm2.979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/23/2022] [Accepted: 06/30/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Kathleen M Lennon
- Department of Molecular Medicine, Beckman Research Institute of the City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Andras Saftics
- Department of Molecular Medicine, Beckman Research Institute of the City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sarah Abuelreich
- Department of Molecular Medicine, Beckman Research Institute of the City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Parul Sahu
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - H Immo Lehmann
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Adam L Maddox
- Department of Molecular Medicine, Beckman Research Institute of the City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Reem Bagabas
- Department of Molecular Medicine, Beckman Research Institute of the City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - James L Januzzi
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kendall Van Keuren-Jensen
- Neurogenomics Division, Center for Noninvasive Diagnostics, Translational Genomics Research Institute, Phoenix, AZ, USA.,Department of Molecular and Cellular Biology, Beckman Research Institute of the City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ravi Shah
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Saumya Das
- Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tijana Jovanovic-Talisman
- Department of Molecular Medicine, Beckman Research Institute of the City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Pharmacological Targets in Chronic Heart Failure with Reduced Ejection Fraction. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081112. [PMID: 35892914 PMCID: PMC9394280 DOI: 10.3390/life12081112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022]
Abstract
Heart failure management has been repeatedly reviewed over time. This strategy has resulted in improved quality of life, especially in patients with heart failure with reduced ejection fraction (HFrEF). It is for this reason that new mechanisms involved in the development and progression of heart failure, along with specific therapies, have been identified. This review focuses on the most recent guidelines of therapeutic interventions, trials that explore novel therapies, and also new molecules that could improve prognosis of different HFrEF phenotypes.
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Drazner MH. Omecamtiv Mecarbil as a Therapy for Heart Failure With Low Ejection Fraction. JAMA 2022; 328:249-250. [PMID: 35852543 DOI: 10.1001/jama.2022.6805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mark H Drazner
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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Lewis GD, Voors AA, Cohen-Solal A, Metra M, Whellan DJ, Ezekowitz JA, Böhm M, Teerlink JR, Docherty KF, Lopes RD, Divanji PH, Heitner SB, Kupfer S, Malik FI, Meng L, Wohltman A, Felker GM. Effect of Omecamtiv Mecarbil on Exercise Capacity in Chronic Heart Failure With Reduced Ejection Fraction: The METEORIC-HF Randomized Clinical Trial. JAMA 2022; 328:259-269. [PMID: 35852527 PMCID: PMC9297119 DOI: 10.1001/jama.2022.11016] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Exercise limitation is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF) but is not consistently improved by any of the current guideline-directed medical therapies. OBJECTIVE To determine whether omecamtiv mecarbil, a novel direct myosin activator that improves cardiac performance and reduces the risk for cardiovascular death or first HF event in HFrEF, can improve peak exercise capacity in patients with chronic HFrEF. DESIGN, SETTING, AND PARTICIPANTS Phase 3, double-blind, placebo-controlled randomized trial of patients with HFrEF (left ventricular ejection fraction ≤35%), New York Heart Association class II-III symptoms, N-terminal pro-B-type natriuretic peptide level of 200 pg/mL or greater, and baseline peak oxygen uptake (V̇o2) of 75% or less of predicted. Patients were randomized in a 2:1 ratio (omecamtiv mecarbil to placebo) between March 2019 and May 2021 at 63 sites in North America and Europe, with the last patient visit occurring on November 29, 2021. INTERVENTIONS Omecamtiv mecarbil (n = 185) or matching placebo (n = 91), given orally twice daily at a dose of 25 mg, 37.5 mg, or 50 mg based on target plasma levels, for 20 weeks. MAIN OUTCOMES AND MEASURES The primary end point was a change in exercise capacity (peak V̇o2) from baseline to week 20. Secondary end points included total workload, ventilatory efficiency, and daily physical activity as determined by accelerometry. RESULTS Among 276 patients who were randomized (median age, 64 years; IQR, 55-70 years; 42 women [15%]), 249 (90%) completed the trial. The median left ventricular ejection fraction was 28% (IQR, 21-33) and the median baseline peak V̇o2 was 14.2 mL/kg/min (IQR, 11.6-17.4) in the omecamtiv mecarbil group and 15.0 mL/kg/min (IQR, 12.0-17.2) in the placebo group. Mean change in peak V̇o2 did not differ significantly between the omecamtiv mecarbil and placebo groups (mean, -0.24 mL/kg/min vs 0.21 mL/kg/min; least square mean difference, -0.45 mL/kg/min [95% CI, -1.02 to 0.13]; P = .13). Adverse events included dizziness (omecamtiv mecarbil: 4.9%, placebo: 5.5%), fatigue (omecamtiv mecarbil: 4.9%, placebo: 4.4%), heart failure events (omecamtiv mecarbil: 4.9%, placebo: 4.4%), death (omecamtiv mecarbil: 1.6%, placebo: 1.1%), stroke (omecamtiv mecarbil: 0.5%, placebo: 1.1%), and myocardial infarction (omecamtiv mecarbil: 0%, placebo: 1.1%). CONCLUSIONS AND RELEVANCE In patients with chronic HFrEF, omecamtiv mecarbil did not significantly improve exercise capacity over 20 weeks compared with placebo. These findings do not support the use of omecamtiv mecarbil for treatment of HFrEF for improvement of exercise capacity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03759392.
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Affiliation(s)
| | - Adriaan A. Voors
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Alain Cohen-Solal
- Paris University, UMR-S 942, Department of Cardiology, Lariboisiere Hospital, Assistance Publique Hopitaux de Paris, Paris, France
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - David J. Whellan
- Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Michael Böhm
- Department of Internal Medicine, Saarland University, Homburg, Saarland, Germany
- Department of Cardiology, Saarland University, Homburg, Saarland, Germany
| | - John R. Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and University of California, San Francisco
| | - Kieran F. Docherty
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Renato D. Lopes
- Division of Cardiology, School of Medicine, Duke University Medical Center, Durham, North Carolina
| | | | | | - Stuart Kupfer
- Cytokinetics, Incorporated, South San Francisco, California
| | - Fady I. Malik
- Cytokinetics, Incorporated, South San Francisco, California
| | - Lisa Meng
- Cytokinetics, Incorporated, South San Francisco, California
| | - Amy Wohltman
- Cytokinetics, Incorporated, South San Francisco, California
| | - G. Michael Felker
- Division of Cardiology, School of Medicine, Duke University Medical Center, Durham, North Carolina
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Mareev VY, Mareev YV, Begrambekova YL. [Coenzyme Q-10 in the treatment of patients with chronic heart failure and reduced left ventricular ejection fraction: systematic review and meta-analysis]. KARDIOLOGIIA 2022; 62:3-14. [PMID: 35834336 DOI: 10.18087/cardio.2022.6.n2050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/28/2022] [Indexed: 06/15/2023]
Abstract
Aim The aim of the study was evaluation of the effect of the coenzyme Q10 (Q10) treatment on all-cause and cardiovascular mortality of patients with chronic heart failure (CHF). Q-10 increases the electron transfer in the mitochondrial respiratory chain and exerts anti-inflammatory and antioxidant effects. These effects improve the endothelial function and reduce afterload, which facilitates the heart pumping function. Patients with reduced left ventricular (LV) ejection fraction (EF) (CHFrEF) have low Q10.Material and methods Criteria of inclusion in the meta-analysis: 1) placebo-controlled studies; 2) enrollment of at least 100 patients; 3) publications after 2010, which implies an optimal basic therapy for CHF; 4) duration of at least 6 months; 5) reported cardiovascular and/or all-cause mortality; 6) using sufficient doses of Q10 (>100 mg/day). The search was performed in CENTRAL, MEDLINE, Embase, Web of Science, E-library, and ClinicalTrials.gov databases. All-cause mortality was the primary efficacy endpoint in this systematic review and the meta-analysis. The secondary endpoint was cardiovascular mortality. Meta-analysis was performed according to the Mantel-Haenszel methods. The Cochrane criterion (I2) was used for evaluation of statistical heterogeneity. The random effects model was used at I2≥50 %, whereas the fixed effects model was used at I2<50.Results Analysis of studies published from 01.01.2011 to 01.12.2021 identified 357 publications, 23 of which corresponded to the study topic, but only 6 (providing results of four randomized clinical trials, RCT) completely met the predefined criteria. The final analysis included results of managing 1139 patients (586 received Q10 and 553 received placebo). Risk of all-cause death was analyzed by data of four RCTs (1139 patients). The decrease in the risk associated with the Q10 treatment was 36 % (OR=0.64, 95 % CI 0.48-0.87, р=0.004). The heterogeneity of studies was low (Chi2=0.84; p=0.84; I2=0 %). Risk of cardiovascular mortality was analyzed by data of two RCTs (863 patients). The decrease in the risk associated with the Q10 treatment was significant, 55% (OR=0.45, 95 % CI: 0.32-0.64, р=0.00001). In this case, the data heterogeneity was also low (Chi2=0.41; p=0.52; I2=0 %).Conclusion The meta-analysis confirmed the beneficial effect of coenzyme Q10 on the prognosis of patients with CHFrEF receiving the recommended basic therapy.
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Affiliation(s)
- V Yu Mareev
- Medical Research and Educational Center, Lomonosov Moscow State University; School of Fundamental Medicine, Lomonosov Moscow State University
| | - Yu V Mareev
- Medical Research and Educational Center, Lomonosov Moscow State University; National Medical Research Center for Therapy and Preventive Medicine
| | - Yu L Begrambekova
- Medical Research and Educational Center, Lomonosov Moscow State University; School of Fundamental Medicine, Lomonosov Moscow State University
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Advances in Clinical Cardiology 2021: A Summary of Key Clinical Trials. Adv Ther 2022; 39:2398-2437. [PMID: 35482250 PMCID: PMC9047629 DOI: 10.1007/s12325-022-02136-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 12/22/2022]
Abstract
Introduction Over the course of 2021, numerous key clinical trials with valuable contributions to clinical cardiology were published or presented at major international conferences. This review seeks to summarise these trials and reflect on their clinical context. Methods The authors reviewed clinical trials presented at major cardiology conferences during 2021 including the American College of Cardiology (ACC), European Association for Percutaneous Cardiovascular Interventions (EuroPCR), European Society of Cardiology (ESC), Transcatheter Cardiovascular Therapeutics (TCT), American Heart Association (AHA), European Heart Rhythm Association (EHRA), Society for Cardiovascular Angiography and Interventions (SCAI), TVT-The Heart Summit (TVT) and Cardiovascular Research Technologies (CRT). Trials with a broad relevance to the cardiology community and those with potential to change current practice were included. Results A total of 150 key cardiology clinical trials were identified for inclusion. Interventional cardiology data included trials evaluating the use of new generation novel stent technology and new intravascular physiology strategies such as quantitative flow ratio (QFR) to guide revascularisation in stable and unstable coronary artery disease. New trials in acute coronary syndromes focused on shock, out of hospital cardiac arrest (OOHCA), the impact of COVID-19 on ST-elevation myocardial infarction (STEMI) networks and optimal duration/type of antiplatelet treatment. Structural intervention trials included latest data on transcatheter aortic valve replacement (TAVR) and mitral, tricuspid and pulmonary valve interventions. Heart failure data included trials with sodium-glucose cotransporter 2 (SGLT2) inhibitors, sacubitril/valsartan and novel drugs such as mavacamten for hypertrophic cardiomyopathy (HCM). Prevention trials included new data on proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. In electrophysiology, new data regarding atrial fibrillation (AF) screening and new evidence for rhythm vs. rate control strategies were evaluated. Conclusion This article presents a summary of key clinical cardiology trials published and presented during the past year and should be of interest to both practising clinicians and researchers.
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Metra M, Pagnesi M, Claggett BL, Díaz R, Felker GM, McMurray JJV, Solomon SD, Bonderman D, Fang JC, Fonseca C, Goncalvesova E, Howlett JG, Li J, O’Meara E, Miao ZM, Abbasi SA, Heitner SB, Kupfer S, Malik FI, Teerlink JR. Effects of omecamtiv mecarbil in heart failure with reduced ejection fraction according to blood pressure: the GALACTIC-HF trial. Eur Heart J 2022; 43:5006-5016. [PMID: 35675469 PMCID: PMC9769958 DOI: 10.1093/eurheartj/ehac293] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 01/26/2023] Open
Abstract
AIM Patients with heart failure with reduced ejection fraction and low systolic blood pressure (SBP) have high mortality, hospitalizations, and poorly tolerate evidence-based medical treatment. Omecamtiv mecarbil may be particularly helpful in such patients. This study examined its efficacy and tolerability in patients with SBP ≤100 mmHg enrolled in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF). METHODS AND RESULTS The GALACTIC-HF enrolled patients with baseline SBP ≥85 mmHg with a primary outcome of time to cardiovascular death or first heart failure event. In this analysis, patients were divided according to their baseline SBP (≤100 vs. >100 mmHg). Among the 8232 analysed patients, 1473 (17.9%) had baseline SBP ≤100 mmHg and 6759 (82.1%) had SBP >100 mmHg. The primary outcome occurred in 715 (48.5%) and 2415 (35.7%) patients with SBP ≤100 and >100 mmHg, respectively. Patients with lower SBP were at higher risk of adverse outcomes. Omecamtiv mecarbil, compared with placebo, appeared to be more effective in reducing the primary composite endpoint in patients with SBP ≤100 mmHg [hazard ratio (HR), 0.81; 95% confidence interval (CI), 0.70-0.94] compared with those with SBP >100 mmHg (HR, 0.95; 95% CI, 0.88-1.03; P-value for interaction = 0.051). In both groups, omecamtiv mecarbil did not change SBP values over time and did not increase the risk of adverse events, when compared with placebo. CONCLUSION In GALACTIC-HF, risk reduction of heart failure outcomes with omecamtiv mecarbil compared with placebo was large and significant in patients with low SBP. Omecamtiv mecarbil did not affect SBP and was well tolerated independent of SBP values.
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Affiliation(s)
- Marco Metra
- Corresponding author. Tel: +39 33 5646 0581,
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Brian L Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Rafael Díaz
- Estudios Clinicos Latino America (ECLA), Rosario, Argentina
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Cândida Fonseca
- Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Jonathan G Howlett
- Division of Cardiology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Eileen O’Meara
- Montreal Heart Institute and Université de Montréal, Montreal, QC, Canada
| | - Zi Michael Miao
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | - Fady I Malik
- Cytokinetics, Inc., South San Francisco, CA, USA
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Tomasoni D, Vishram-Nielsen JKK, Pagnesi M, Adamo M, Lombardi CM, Gustafsson F, Metra M. Advanced heart failure: guideline-directed medical therapy, diuretics, inotropes, and palliative care. ESC Heart Fail 2022; 9:1507-1523. [PMID: 35352499 PMCID: PMC9065830 DOI: 10.1002/ehf2.13859] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/16/2022] [Accepted: 02/09/2022] [Indexed: 01/10/2023] Open
Abstract
Heart failure (HF) is a major cause of mortality, hospitalizations, and reduced quality of life and a major burden for the healthcare system. The number of patients that progress to an advanced stage of HF is growing. Only a limited proportion of these patients can undergo heart transplantation or mechanical circulatory support. The purpose of this review is to summarize medical management of patients with advanced HF. First, evidence-based oral treatment must be implemented although it is often not tolerated. New therapeutic options may soon become possible for these patients. The second goal is to lessen the symptomatic burden through both decongestion and haemodynamic improvement. Some new treatments acting on cardiac function may fulfil both these needs. Inotropic agents acting through an increase in intracellular calcium have often increased risk of death. However, in the recent Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial, omecamtiv mecarbil was safe and effective in the reduction of the primary outcome of cardiovascular death or HF event compared with placebo (hazard ratio, 0.92; 95% confidence interval, 0.86-0.99; P = 0.03) and its effects were larger in those patients with more severe left ventricular dysfunction. Patients with severe HF who received omecamtiv mecarbil experienced a significant treatment benefit, whereas patients without severe HF did not (P = 0.005 for interaction). Lastly, clinicians should take care of the end of life with an appropriate multidisciplinary approach. Medical treatment of advanced HF therefore remains a major challenge and a wide open area for further research.
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Affiliation(s)
- Daniela Tomasoni
- Cardiology, Cardio-thoracic Department, Civil Hospitals and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Matteo Pagnesi
- Cardiology, Cardio-thoracic Department, Civil Hospitals and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology, Cardio-thoracic Department, Civil Hospitals and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Mario Lombardi
- Cardiology, Cardio-thoracic Department, Civil Hospitals and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marco Metra
- Cardiology, Cardio-thoracic Department, Civil Hospitals and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Mefford MT, Koyama SY, De Jesus J, Wei R, Fischer H, Harrison TN, Woo P, Reynolds K. Representativeness of the GALACTIC-HF Clinical Trial in Patients Having Heart Failure With Reduced Ejection Fraction. J Am Heart Assoc 2022; 11:e023766. [PMID: 35322672 PMCID: PMC9075481 DOI: 10.1161/jaha.121.023766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Randomized clinical trials in populations with heart failure with reduced ejection fraction may not be reflective of the general population with heart failure with reduced ejection fraction. Our study assessed the representativeness of the GALACTIC‐HF (Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure) patient population in Kaiser Permanente Southern California. Methods and Results We identified 9770 patients with a diagnosis of heart failure with reduced ejection fraction from 2014 to 2018 using electronic health records. Four mutually exclusive cohorts were created, including GALACTIC‐HF–ineligible cohorts: (1) not taking guideline‐directed medical therapy (GDMT) and (2) taking GDMT; and GALACTIC‐HF–eligible cohorts with: (3) ejection fraction (EF) ≤28% and (4) EF 29% to 35%. Patients were followed for 30‐day and 1‐year mortality and 30‐day, 180‐day, and 1‐year hospitalization. Overall, 3626 (37.1%) met GALACTIC‐HF inclusion criteria with EF ≤35%, and 2367 (65.3%) of those individuals had EF ≤28%. The risk of 1‐year mortality was lower among all cohorts versus the GALACTIC‐HF–ineligible cohort not taking GDMT (hazard ratio, 0.80 [95% CI, 0.70–0.91], 0.84 [95% CI, 0.72–0.98], and 0.62 [95% CI, 0.51–0.75] for the GALACTIC‐HF–ineligible cohort taking GDMT and GALACTIC‐HF‐eligible cohorts with EF ≤28% and 29%–35%, respectively). Compared with the GALACTIC‐HF–ineligible cohort not taking GDMT, the short‐term hospitalization risk at 30 and 180 days were similar for both GALACTIC‐HF–eligible cohorts and the hospitalization risk at 1 year was similar for the GALACTIC‐HF–eligible cohort with EF ≤28%. Conclusions A large portion of patients with heart failure with reduced ejection fraction with low EF met inclusion criteria for the GALACTIC‐HF trial and, despite being on GDMT, had hospitalization rates similar to those not taking GDMT, suggesting potential benefits from other innovative treatments.
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Affiliation(s)
- Matthew T Mefford
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Sandra Y Koyama
- Internal Medicine Kaiser Permanente Southern California Baldwin Park CA
| | - Justine De Jesus
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Rong Wei
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Heidi Fischer
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Teresa N Harrison
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Pauline Woo
- Department of Cardiology Kaiser Permanente Southern California Baldwin Park CA
| | - Kristi Reynolds
- Department of Research & Evaluation Kaiser Permanente Southern California Pasadena CA.,Department of Health Systems Science Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena CA
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Solomon SD, Claggett BL, Miao ZM, Diaz R, Felker GM, McMurray JJV, Metra M, Corbalan R, Filippatos G, Goudev AR, Mareev V, Serpytis P, Suter T, Yilmaz MB, Zannad F, Kupfer S, Heitner SB, Malik FI, Teerlink JR. Influence of atrial fibrillation on efficacy and safety of omecamtiv mecarbil in heart failure: the GALACTIC-HF trial. Eur Heart J 2022; 43:2212-2220. [PMID: 35325102 DOI: 10.1093/eurheartj/ehac144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/09/2022] [Accepted: 03/07/2022] [Indexed: 12/11/2022] Open
Abstract
AIMS In GALACTIC-HF, the cardiac myosin activator omecamtiv mecarbil compared with placebo reduced the risk of heart failure events or cardiovascular death in patients with heart failure with reduced ejection fraction. We explored the influence of atrial fibrillation or flutter (AFF) on the effectiveness of omecamtiv mecarbil. METHODS AND RESULTS GALACTIC-HF enrolled patients with New York Heart Association (NYHA) Class II-IV heart failure, left ventricular ejection fraction ≤35%, and elevated natriuretic peptides. We assessed whether the presence or absence of AFF, a pre-specified subgroup, modified the treatment effect for the primary and secondary outcomes, and additionally explored effect modification in patients who were or were not receiving digoxin. Patients with AFF (n = 2245, 27%) were older, more likely to be randomized as an inpatient, less likely to have a history of ischaemic aetiology or myocardial infarction, had a worse NYHA class, worse quality of life, lower estimated glomerular filtration rate, and higher N-terminal pro-B-type natriuretic peptide. The treatment effect of omecamtiv mecarbil was modified by baseline AFF (interaction P = 0.012), with patients without AFF at baseline deriving greater benefit. The worsening of the treatment effect by baseline AFF was significantly more pronounced in digoxin users than in non-users (interaction P = 0.007); there was minimal evidence of effect modification in those patients not using digoxin (P = 0.47) or in digoxin users not in AFF. CONCLUSION Patients in AFF at baseline were less likely to benefit from omecamtiv mecarbil than patients without AFF, although the attenuation of the treatment effect was disproportionally concentrated in patients with AFF who were also receiving digoxin.Clinical Trial Registration: NCT02929329.
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Affiliation(s)
- Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zi Michael Miao
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rafael Diaz
- Estudios Clínicos Latino América (ECLA), Rosario, Argentina
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC, USA
| | - John J V McMurray
- British Heart Foundation, Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Marco Metra
- Division of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ramon Corbalan
- Cardiovascular Division, School of Medicine Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Assen R Goudev
- Department of Cardiology, Queen Giovanna University Hospital, Sofia, Bulgaria
| | - Viatcheslav Mareev
- University Clinic of M.V. Lomonosov Moscow State University, Moscow, Russia
| | | | - Thomas Suter
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mehmet B Yilmaz
- Department of Cardiology, Dokuz Eylul University, Izmir, Turkey
| | - Faiez Zannad
- Université de Lorraine, Centre Hospitalier Régional Universitaire de Nancy, Inserm CIC, Nancy, France
| | | | | | - Fady I Malik
- Cytokinetics, Inc., South San Francisco, CA, USA
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Abstract
Variants in >12 genes encoding sarcomeric proteins can cause various cardiomyopathies. The two most common are hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). Current therapeutics do not target the root causes of these diseases, but attempt to prevent disease progression and/or to manage symptoms. Accordingly, novel approaches are being developed to treat the cardiac muscle dysfunction directly. Challenges to developing therapeutics for these diseases include the diverse mechanisms of pathogenesis, some of which are still being debated and defined. Four small molecules that modulate the myosin motor protein in the cardiac sarcomere have shown great promise in the settings of HCM and DCM, regardless of the underlying genetic pathogenesis, and similar approaches are being developed to target other components of the sarcomere. In the setting of HCM, mavacamten and aficamten bind to the myosin motor and decrease the ATPase activity of myosin. In the setting of DCM, omecamtiv mecarbil and danicamtiv increase myosin activity in cardiac muscle (but omecamtiv mecarbil decreases myosin activity in vitro). In this Review, we discuss the therapeutic strategies to alter sarcomere contractile activity and summarize the data indicating that targeting one protein in the sarcomere can be effective in treating patients with genetic variants in other sarcomeric proteins, as well as in patients with non-sarcomere-based disease.
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Safety and Efficacy of Omecamtiv Mecarbil for Heart Failure: A Systematic Review and Meta-Analysis. Indian Heart J 2022; 74:155-162. [PMID: 35301008 PMCID: PMC9243594 DOI: 10.1016/j.ihj.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/20/2022] [Accepted: 03/12/2022] [Indexed: 01/10/2023] Open
Abstract
Aim To assess the safety and efficacy of omecamtiv mecarbil compared with placebo in heart failure (HF) patients. Methods We searched PubMed, Web of Science, Cochrane Library, and SCOPUS until August 15th, 2021. We included all randomized controlled studies comparing omecamtiv mecarbil with placebo in heart failure patients. The meta-analysis was carried out using Rev Man software V5.4. Results A total of eight studies were included in our systematic review. Pooled analysis showed that omecamtiv mecarbil is not associated with increased incidence of death, any adverse events, hypotension, heart failure, ventricular tachyarrhythmia, dyspnea, dizziness, and serious adverse events. Regarding the efficacy, omecamtiv mecarbil significantly reduced heart rate with some studies demonstrating its significant improvement in left ventricular ejection fraction and systolic function. Conclusion: Omecamtiv mecarbil is a well-tolerated drug in heart failure patients. The limited data regarding the efficacy suggested that it may improve ejection fraction and systolic function.
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Lewis GD, Docherty KF, Voors AA, Cohen-Solal A, Metra M, Whellan DJ, Ezekowitz JA, Ponikowski P, Böhm M, Teerlink JR, Heitner SB, Kupfer S, Malik FI, Meng L, Felker GM. Developments in Exercise Capacity Assessment in Heart Failure Clinical Trials and the Rationale for the Design of METEORIC-HF. Circ Heart Fail 2022; 15:e008970. [PMID: 35236099 DOI: 10.1161/circheartfailure.121.008970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Heart failure with reduced ejection fraction (HFrEF) is a highly morbid condition for which exercise intolerance is a major manifestation. However, methods to assess exercise capacity in HFrEF vary widely in clinical practice and in trials. We describe advances in exercise capacity assessment in HFrEF and a comparative analysis of how various therapies available for HFrEF impact exercise capacity. Current guideline-directed medical therapy has indirect effects on cardiac performance with minimal impact on measured functional capacity. Omecamtiv mecarbil is a novel selective cardiac myosin activator that directly increases cardiac contractility and in a phase 3 cardiovascular outcomes study significantly reduced the primary composite end point of time to first heart failure event or cardiovascular death in patients with HFrEF. The objective of the METEORIC-HF trial (Multicenter Exercise Tolerance Evaluation of Omecamtiv Mecarbil Related to Increased Contractility in Heart Failure) is to assess the effect of omecamtiv mecarbil versus placebo on multiple components of functional capacity in HFrEF. The primary end point is to test the effect of omecamtiv mecarbil compared with placebo on peak oxygen uptake as measured by cardiopulmonary exercise testing after 20 weeks of treatment. METEORIC-HF will provide state-of-the-art assessment of functional capacity by measuring ventilatory efficiency, circulatory power, ventilatory anaerobic threshold, oxygen uptake recovery kinetics, daily activity, and quality-of-life assessment. Thus, the METEORIC-HF trial will evaluate the potential impact of increased myocardial contractility with omecamtiv mecarbil on multiple important measures of functional capacity in ambulatory patients with symptomatic HFrEF. Registration: URL: https://clinicaltrials.gov; Unique identifier: NCT03759392.
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Affiliation(s)
- Gregory D Lewis
- Division of Cardiology, Massachusetts General Hospital, Boston (G.D.L.)
| | - Kieran F Docherty
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (K.F.D.)
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, the Netherlands (A.A.V.)
| | - Alain Cohen-Solal
- Paris University, UMR-S 942, Department of Cardiology, Lariboisiere Hospital, Assistance Publique Hopitaux de Paris, France (A.C.-S.)
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.M.)
| | - David J Whellan
- Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA (D.J.W.)
| | | | - Piotr Ponikowski
- Department of Heart Diseases, Wrocław Medical University, Poland (P.P.)
| | - Michael Böhm
- Department of Internal Medicine, Saarland University, Homburg, Germany. (M.B.).,Department of Cardiology, Saarland University, Homburg, Germany. (M.B.)
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and University of California San Francisco (J.R.T.)
| | - Stephen B Heitner
- Cytokinetics Inc, South San Francisco, CA (S.B.H., S.K., F.I.M., L.M.)
| | - Stuart Kupfer
- Cytokinetics Inc, South San Francisco, CA (S.B.H., S.K., F.I.M., L.M.)
| | - Fady I Malik
- Cytokinetics Inc, South San Francisco, CA (S.B.H., S.K., F.I.M., L.M.)
| | - Lisa Meng
- Cytokinetics Inc, South San Francisco, CA (S.B.H., S.K., F.I.M., L.M.)
| | - G Michael Felker
- Division of Cardiology, School of Medicine, Duke University Medical Center, Durham, NC (G.M.F.)
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50
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Weisert M, Su JA, Menteer J, Shaddy RE, Kantor PF. Drug Treatment of Heart Failure in Children: Gaps and Opportunities. Paediatr Drugs 2022; 24:121-136. [PMID: 35084696 DOI: 10.1007/s40272-021-00485-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/11/2022]
Abstract
Medical therapy for pediatric heart failure is based on a detailed mechanistic understanding of the underlying causes, which are diverse and unlike those encountered in most adult patients. Diuresis and improved perfusion are the immediate goals of care in the child with acute decompensated heart failure. Conversion to maintenance oral therapy for heart failure is based on the results of landmark studies in adults, as well as recent pediatric clinical trials and heart failure guidelines. There will continue to be an important role for newer drugs, some of which are in active trials in adults, and some of which are already approved for use in children. The need to plan for clinical trials in children during drug development for heart failure is emphasized.
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Affiliation(s)
- Molly Weisert
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Cardiology, Heart Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jennifer A Su
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Cardiology, Heart Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jondavid Menteer
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Cardiology, Heart Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Robert E Shaddy
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Cardiology, Heart Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Paul F Kantor
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- Division of Cardiology, Heart Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.
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