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Butt JH, Jering K, DE Boer RA, Claggett BL, Desai AS, Hernandez AF, Inzucchi SE, Jhund PS, Køber L, Kosiborod MN, Lam CSP, Martinez FA, Ponikowski P, Sabatine MS, Shah SJ, Vaduganathan M, Langkilde AM, Bengtsson O, Petersson M, Sjöstrand M, Wilderäng U, Solomon SD, McMurray JJV. Heart Failure, Investigator-Reported Sleep Apnea and Dapagliflozin: A Patient-Level Pooled Meta-Analysis of DAPA-HF and DELIVER. J Card Fail 2024; 30:436-448. [PMID: 38104937 DOI: 10.1016/j.cardfail.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Sleep apnea is more common in patients with heart failure (HF) than in the general population, but little is known about its association with clinical outcomes in various HF phenotypes or how it might modify the effect of HF therapy. OBJECTIVES To examine the prevalence of sleep apnea, its association with outcomes and the effects of dapagliflozin in patients with HF with and without sleep apnea in a pooled analysis of 2 trials comparing dapagliflozin to placebo in HFrEF (DAPA-HF trial) and HFmrEF/HFpEF (DELIVER trial). METHODS A history of sleep apnea was investigator-reported. The primary outcome was a composite of worsening HF or cardiovascular death. RESULTS The prevalence of sleep apnea was 5.7% and 7.8% in patients with HFrEF and HFmrEF/HFpEF, respectively. The primary outcome occurred at a rate of 16.0 in participants with sleep apnea compared to 10.6 per 100 person-years in those without (adjusted HR 1.29 [95%CI, 1.10-1.52]). Compared with placebo, dapagliflozin reduced the risk of the primary endpoint to the same extent in patients with (HR 0.78 [95% CI, 0.59-1.03]) and without sleep apnea (HR 0.79 [0.72-0.87]) [Pinteraction = 0.93]. The beneficial effects of dapagliflozin on other clinical outcomes and symptom burden, physical function, and quality of life were consistent in participants with and without sleep apnea. CONCLUSIONS In DAPA-HF and DELIVER, the true prevalence of sleep apnea was likely underestimated. An investigator-reported history of sleep apnea was associated with higher rates of worsening HF events. The benefits of dapagliflozin on clinical outcomes were consistent in patients with and without sleep apnea. CLINICAL TRIAL REGISTRATION Unique identifiers: NCT01920711 CONDENSED ABSTRACT: In a pooled analysis of the DAPA-HF and DELIVER trials of more than 11,000 patients with heart failure (HF) across the range of ejection fractions, an investigator-reported history of sleep apnea was associated with higher rates of worsening HF events but not mortality. The beneficial effects of dapagliflozin on clinical outcomes were consistent in patients with and without sleep apnea. These findings provide further evidence for dapagliflozin as a new treatment option for patients with heart failure across the range of ejection fractions.
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Affiliation(s)
- Jawad H Butt
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK; Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Karola Jering
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Pardeep S Jhund
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Lars Køber
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore, Singapore
| | | | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland
| | - Marc S Sabatine
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Olof Bengtsson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Mikaela Sjöstrand
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Ulrica Wilderäng
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
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Kato ET, Lewis BS, Ono K. GLP-1 receptor agonists: new game changing drugs in patients with heart failure with preserved ejection fraction and obesity. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2023; 9:679-680. [PMID: 37777847 DOI: 10.1093/ehjcvp/pvad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Eri Toda Kato
- Department of Cardiovascular Medicine and Department of Clinical Laboratory Department, Kyoto University Hospital, 6068507 Kyoto, Japan
| | - Basil S Lewis
- Ruth and Bruce Rappaport School of Medicine of the Technion-Israel Institute of Technology, 3525433 Haifa, Israel
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Hospital, 6068507 Kyoto, Japan
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Marques P, Matias P, Packer M, Vieira JT, Vasques-Nóvoa F, Sharma A, Mavrakanas TA, Friões F, Ferreira JP. Erythropoietic response after intravenous iron in patients with heart failure and reduced ejection fraction with and without background treatment with sodium-glucose cotransporter 2 inhibitors. Eur J Heart Fail 2023; 25:2191-2198. [PMID: 37559543 DOI: 10.1002/ejhf.2992] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
AIMS Intravenous (IV) iron increases haemoglobin/haematocrit and improves outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) also increase haemoglobin/haematocrit and improve outcomes in heart failure by mechanisms linked to nutrient deprivation signalling and reduction of inflammation and oxidative stress. The effect of IV iron among patients using SGLT2i has not yet been studied. The aim of this study was to evaluate the changes in haemoglobin, haematocrit, and iron biomarkers in HFrEF patients treated with IV iron with and without background SGLT2i treatment. Secondary outcomes included changes in natriuretic peptides, kidney function and heart failure-associated outcomes. METHODS AND RESULTS Retrospective, single-centre analysis of HFrEF patients with iron deficiency treated with IV iron using (n = 60) and not using (n = 60) SGLT2i, matched for age and sex. Mean age was 73 ± 12 years, 48% were men, with more than 65% of patients having chronic kidney disease and anaemia. After adjustment for all baseline differences, SGLT2i users experienced a greater increase in haemoglobin and haematocrit compared to SGLT2i non-users: haemoglobin +0.57 g/dl (95% confidence interval [CI] 0.04-1.10, p = 0.036) and haematocrit +1.64% (95% CI 0.18-3.11, p = 0.029). No significant differences were noted for iron biomarkers or any of the secondary outcomes. CONCLUSION Combined treatment with IV iron and background SGLT2i was associated with a greater increase in haemoglobin and haematocrit than IV iron without background SGLT2i. These results suggest that in HFrEF patients treated with IV iron, SGLT2i may increase the erythropoietic response. Further studies are needed to ascertain the potential benefit or harm of combining these two treatments in heart failure patients.
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Affiliation(s)
- Pedro Marques
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Cardiovascular Research and Development Center (UnIC@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
- Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada
| | - Paula Matias
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Milton Packer
- Baylor Heart and Vascular Institute, Dallas, TX, USA
- Imperial College, London, UK
| | - Joana T Vieira
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Francisco Vasques-Nóvoa
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Cardiovascular Research and Development Center (UnIC@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Abhinav Sharma
- Division of Cardiology, DREAM-CV Lab, McGill University Health Centre, Montreal, QC, Canada
| | - Thomas A Mavrakanas
- Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada
| | - Fernando Friões
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Cardiovascular Research and Development Center (UnIC@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Medicine, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Pedro Ferreira
- Department of Surgery and Physiology, Cardiovascular Research and Development Center (UnIC@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal
- Inserm, Centre d'Investigations Cliniques, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France
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Sabouret P, Ecarnot F, De Rosa S, Ray KK. What about glucagon-like peptide-1 receptor agonist for all? Recent data and perspectives. Eur Heart J 2023; 44:4499-4502. [PMID: 37793139 DOI: 10.1093/eurheartj/ehad632] [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: 10/06/2023] Open
Affiliation(s)
- Pierre Sabouret
- Heart Institute and Action Group, Pitié-Salpétrière, Sorbonne University, Paris, France
- National College of French Cardiologists, 13 rue Niepce, 75014 Paris, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besancon, Boulevard Fleming, 25000 Besançon, France
- EA3920, Université de Franche-Comté, 1 Rue Claude Goudimel, 25000 Besançon, France
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College, London, UK
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5
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Galati G, Germanova O, Pedretti RFE, Ambrosio G. Hypotension and optimization of heart failure therapy after a recent hospitalization for heart failure: When the going gets tough, the tough get going. Int J Cardiol 2023; 388:131118. [PMID: 37321330 DOI: 10.1016/j.ijcard.2023.131118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Giuseppe Galati
- Unit of Cardiology, Cardiovascular Department, I.R.C.C.S. Multimedica, Milan, Italy; International Centre for Education and Research in Cardiovascular pathology and Cardiovisualization, Samara state medical university, Samara, Russia.
| | - Olga Germanova
- International Centre for Education and Research in Cardiovascular pathology and Cardiovisualization, Samara state medical university, Samara, Russia
| | | | - Giuseppe Ambrosio
- Division of Cardiology, and Center for Clinical and Translational Research (CERICLET), University of Perugia School of Medicine, Perugia, Italy
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Håkansson E, Brunström M, Norberg H, Själander S, Lindmark K. Prevalence and treatment of diabetes and pre-diabetes in a real-world heart failure population: a single-centre cross-sectional study. Open Heart 2022; 9:openhrt-2022-002133. [PMID: 36600650 PMCID: PMC9748948 DOI: 10.1136/openhrt-2022-002133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS The aim of this study was to investigate a real-world heart failure (HF) cohort regarding (1) prevalence of known diabetes mellitus (DM), undiagnosed DM and pre-diabetes, (2) if hf treatment differs depending on glycaemic status and (3) if treatment of DM differs depending on HF phenotype. METHODS All patients who had received a diagnosis of HF at Umeå University Hospital between 2010 and 2019 were identified and data were extracted from patient files according to a prespecified protocol containing parameters for clinical characteristics, including echocardiogram results, comorbidities, fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) values. Patients' HF phenotype was determined using the latest available echocardiogram. The number of patients with previous DM diagnosis was assessed. Patients without a previous diagnosis of DM were classified as non-DM, pre-diabetes or probable DM according to FPG and HbA1c levels using WHO criteria. RESULTS In total, 2326 patients (59% male, mean age 76±13 years) with HF and at least one echocardiogram were assessed. Of these, 617 (27%) patients had a previous diagnosis of DM. Of the 1709 patients without a previous diagnosis of DM, 1092 (67%) patients had either an FPG or HbA1c recorded, of which 441 (41%) met criteria for pre-diabetes and 97 (9%) met criteria for probable diabetes, corresponding to 19% and 4% of the entire cohort, respectively. Patients with HF and diabetes were more often treated with diuretics and beta blockers compared with non-DM patients (64% vs 42%, p<0.001 and 88% vs 83%, p<0.001, respectively). There was no difference in DM treatment between HF phenotypes. CONCLUSIONS DM and pre-diabetes are common in this HF population with 50% of patients having either known DM, probable DM or pre-diabetes. Patients with HF and DM are more often treated with common HF medications. HF phenotype did not affect choice of DM therapy.
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Affiliation(s)
- Erik Håkansson
- Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Helena Norberg
- Department of Integrative Medical Biology, Umeå universitet Medicinska fakulteten, Umea, Sweden
| | - Sara Själander
- Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Krister Lindmark
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institute, Danderyd, Sweden
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7
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Charaya K, Shchekochikhin D, Andreev D, Dyachuk I, Tarasenko S, Poltavskaya M, Mesitskaya D, Bogdanova A, Ananicheva N, Kuzub A. Impact of dapagliflozin treatment on renal function and diuretics use in acute heart failure: a pilot study. Open Heart 2022; 9:openhrt-2021-001936. [PMID: 35609943 PMCID: PMC9131063 DOI: 10.1136/openhrt-2021-001936] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/02/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the impact of sodium-dependent glucose type 2 cotransporter inhibitors on the renal function in acute heart failure. METHODS In a single-centre, controlled, randomised study, patients were prescribed dapagliflozin in addition to standard therapy, or were in receipt of standard therapy. The prespecified outcome was renal function deterioration; the secondary outcomes were the development of resistance to diuretics, weight loss, death during hospitalisation and the rehospitalisation or death for any reason within 30 days following discharge. RESULTS 102 patients were included (73.4±11.7 years, 57.8% men). The average left ventricular ejection fraction was 44.9%±14.7%, the average N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was 4706 (1757; 11 244) pg/mL, the average estimated glomerular filtration rate (eGFR) was 51.6±19.5 mL/min. eGFR decreased 48 hours after randomisation in the dapagliflozin group (-4.2 (-11.03; 2.28) mL/min vs 0.3 (-6; 6) mL/min; p=0.04) but did not differ between the groups on discharge (54.71±19.18 mL/min and 58.92±24.65 mL/min; p=0.36). The incidence of worsening renal function did not differ (34.4% vs 15.2%; p=0.07). In the dapagliflozin group, there was less tendency to increase the dose of loop diuretics (14% vs 30%; p=0.048), lower average doses of loop diuretics (78.46±38.95 mg/day vs 102.82±31.26 mg/day; p=0.001) and more significant weight loss (4100 (2950; 5750) g vs 3000 (1380; 4650) g; p=0.02). In-hospital mortality was 7.8% (4(8%) in the dapagliflozin and 4 (7.7%) in the control group (p=0.95). The number of deaths within 30 days following discharge in the dapagliflozin group and in the control group was 9 (19%) and 12 (25%), p=0.55; the number of rehospitalisations was 14 (29%) and 17 (35%), respectively (p=0.51). CONCLUSION The use of dapagliflozin was associated with a more pronounced weight loss and less need to increase diuretic therapy without significant deterioration of the renal function. Dapagliflozin did not improve the in-hospital and 30-day prognosis after discharge. TRIAL REGISTRATION NUMBER N04778787.
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Affiliation(s)
- Kristina Charaya
- Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov University, Moskva, Moskva, Russian Federation
| | - Dmitry Shchekochikhin
- Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov University, Moskva, Moskva, Russian Federation
| | - Denis Andreev
- Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov University, Moskva, Moskva, Russian Federation
| | - Irina Dyachuk
- Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov University, Moskva, Moskva, Russian Federation
| | - Svetlana Tarasenko
- Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov University, Moskva, Moskva, Russian Federation
| | - Maria Poltavskaya
- Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov University, Moskva, Moskva, Russian Federation
| | - Dinara Mesitskaya
- Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov University, Moskva, Moskva, Russian Federation
| | - Alexandra Bogdanova
- Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov University, Moskva, Moskva, Russian Federation
| | - Natalia Ananicheva
- Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov University, Moskva, Moskva, Russian Federation
| | - Alina Kuzub
- Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov University, Moskva, Moskva, Russian Federation
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Galati G, Sabouret P, Germanova O, Bhatt DL. Women and Diabetes: Preventing Heart Disease in a New Era of Therapies. Eur Cardiol 2021; 16:e40. [PMID: 34777580 PMCID: PMC8576483 DOI: 10.15420/ecr.2021.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Despite major advances in cardiovascular research over the past decade, women with type 2 diabetes have a high risk of cardiovascular events. Several factors contribute to the poor prognosis for women, including higher levels of frailty and comorbidities, but their cardiovascular risk is underestimated and there is suboptimal implementation and uptitration of new evidence-based therapies, leading to high morbidity and mortality. Recent studies highlight the need for better management of diabetes in women that can be pursued and achieved in light of recent results from randomised controlled trials demonstrating evidence of the benefits of new therapeutic strategies in improving cardiovascular outcomes and quality of life of women covering the entire cardiovascular continuum. This review critically discusses the multiple benefits for women of new pharmacological treatments, such as glucagon-like peptide-1 receptor agonists, sodium–glucose cotransporter type 2 inhibitors (SGLT2i), proprotein convertase subtilisin/kexin type 9 inhibitors, inclisiran, icosapent ethyl and bempedoic acid in preventing cardiovascular events, and treatments, such as angiotensin receptor neprilysin inhibitors, SGLT2i, vericiguat and omecamtiv mecarbil, for preventing heart failure.
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Affiliation(s)
- Giuseppe Galati
- Heart Failure Unit and Division of Cardiology, Cardiothoracic and Vascular Department, San Raffaele Hospital and Scientific Institute (IRCCS) Milan, Italy
| | - Pierre Sabouret
- Heart Institute, Cardiology Department, Pitié-Salpétrière, Sorbonne University and Collège National des Cardiologues Français Paris, France
| | - Olga Germanova
- Department of Diagnostic Medicine and Imaging, Samara State Medical University Samara, Russia
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School Boston, MA, US
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Castelletti S, Aguiar C, Delgado V. Cardiology in 280 characters. Eur Heart J 2021; 43:1186-1188. [PMID: 34406375 DOI: 10.1093/eurheartj/ehab558] [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: 11/14/2022] Open
Affiliation(s)
- Silvia Castelletti
- IRCCS Istituto Auxologico Italiano, Cardiomyopathy Unit and Center for the Cardiac Arrhythmias of Genetic Origin, Department of Cardiovascular, Neural and Metabolic Sciences, Piazzale Brescia, 20, Milan 20149, Italy
| | - Carlos Aguiar
- Advanced Heart Failure and Heart Transplantation Unit, Department of Cardiology, Centro Hospitalar Lisboa Ocidental, Avenida Prof Dr Reinaldo dos Santos 2790-134 Carnaxide, Lisbon, Portugal
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC Leiden, The Netherlands
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10
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Galati G, Germanova O, Iozzo RV, Buraschi S, Shchukin YV, Germanov A, Germanov V, Tereshina O, Senni M, Margonato A. Hemodynamic arterial changes in heart failure: a proposed new paradigm of "Heart and Vessels Failure (HVF)". Minerva Cardiol Angiol 2021; 70:310-320. [PMID: 34100570 DOI: 10.23736/s2724-5683.21.05786-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although heart failure (HF) is one of the most common conditions affecting the heart, little attention has been placed on the role of arteries in contributing to the progression of this disease. We sought to determine the hemodynamic change of arteries in HF patients subdivided according to left ventricular ejection fraction. The major goal was to establish the active compensatory role of arteries in HF. METHODS Using sphygmography, we systematically studied a cohort of 228 HF patients and 52 healthy controls. We focused on the common carotid as the main elastic artery and the posterior tibial as the main muscular artery. Moreover, we categorized the three HF groups, HFrEF, HFmrEF, HFpEF, into two subgroups (A and B) according to the presence or absence of HF signs at baseline. RESULTS We discovered that all the parameters of measured arterial kinetics, i.e., work, power, acceleration, and speed, were significantly increased (p<0.001 by one-way ANOVA) in the groups without HF signs. In contrast, all the arterial kinetics parameters were significantly reduced (p<0.001) in the groups exhibiting HF signs. Similar results were obtained in both types of arteries and were consistently observed across all the three different types of HF, although with some differences in magnitude. Finally, we discovered that HFpEF patients exhibited more compromised arterial function vis-à-vis HFrEF patients. CONCLUSIONS We provide the first documentation of an active compensatory role of arteries during HF. Mechanistically, we explain these findings by a dual activity of large arteries accomplished via an active propulsive work and a concurrent hemodynamic suction. These underestimated arterial functions partially compensate for the heart dysfunction in HF, underlining a key interplay between the heart and the vessels. We propose a new paradigm that we define as "heart and vessels failure" that explicitly focuses on both heart and vessels' interaction during the progression of HF.
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Affiliation(s)
- Giuseppe Galati
- Heart Failure Unit and Division of Cardiology, Cardiothoracic and Vascular Department, San Raffaele Hospital and Scientific Institute (IRCCS), Milan, Italy -
| | - Olga Germanova
- Department of Diagnostic Medicine and Imaging, Samara State Medical University, Samara, Russian Federation
| | - Renato V Iozzo
- Department of Pathology, Anatomy and Cell Biology, Sydney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Simone Buraschi
- Department of Pathology, Anatomy and Cell Biology, Sydney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Yuri V Shchukin
- Department of Propedeutical Therapy, Samara State Medical University, Samara, Russian Federation
| | - Andrey Germanov
- Department of Propedeutical Therapy, Samara State Medical University, Samara, Russian Federation
| | - Vladimir Germanov
- Department of Faculty Surgery, Samara State Medical University, Samara, Russian Federation
| | - Olga Tereshina
- Department of Diagnostic Medicine and Imaging, Samara State Medical University, Samara, Russian Federation
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alberto Margonato
- Heart Failure Unit and Division of Cardiology, Cardiothoracic and Vascular Department, San Raffaele Hospital and Scientific Institute (IRCCS), Milan, Italy
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11
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Atallah B, AlMahmeed W. The Emirates Cardiac Society Congress 2020. Eur Heart J 2020; 42:807-809. [PMID: 33508100 DOI: 10.1093/eurheartj/ehaa981] [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: 11/15/2022] Open
Affiliation(s)
- Bassam Atallah
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, United Arab Emirates, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Wael AlMahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE
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12
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Margonato D, Galati G, Mazzetti S, Cannistraci R, Perseghin G, Margonato A, Mortara A. Renal protection: a leading mechanism for cardiovascular benefit in patients treated with SGLT2 inhibitors. Heart Fail Rev 2020; 26:337-345. [PMID: 32901315 PMCID: PMC7895775 DOI: 10.1007/s10741-020-10024-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 02/06/2023]
Abstract
Initially developed as glucose-lowering drugs, sodium-glucose co-transporter type 2 inhibitors (SGLT2i) have demonstrated to be effective agents for the risk reduction of cardiovascular (CV) events in patients with type 2 diabetes mellitus (T2DM). Subsequently, data has emerged showing a significant CV benefit in patients treated with SGLT2i regardless of diabetes status. Renal protection has been initially evaluated in CV randomized trials only as secondary endpoints; nonetheless, the positive results gained have rapidly led to the evaluation of nephroprotection as primary outcome in the CREDENCE trial. Different renal and vascular mechanisms can account for the CV and renal benefits enlightened in recent literature. As clinical guidelines rapidly evolve and the role of SGLT2i appears to become pivotal for CV, T2DM, and kidney disease management, in this review, we analyze the renal effects of SGLT2, the benefits derived from its inhibition, and how this may result in the multiple CV and renal benefits evidenced in recent clinical trials.
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Affiliation(s)
- Davide Margonato
- Heart Failure Unit and Department of Cardiology, Policlinico di Monza, Via Amati 111, 20900, Monza, Italy. .,Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Giuseppe Galati
- Heart Failure Unit and Department of Cardiology, San Raffaele Hospital and Scientific Institute (IRCCS), Milan, Italy
| | - Simone Mazzetti
- Heart Failure Unit and Department of Cardiology, Policlinico di Monza, Via Amati 111, 20900, Monza, Italy
| | - Rosa Cannistraci
- Department of Medicine and Surgery, Università Degli Studi di Milano Bicocca, & Policlinico di Monza, Monza, Italy
| | - Gianluca Perseghin
- Department of Medicine and Surgery, Università Degli Studi di Milano Bicocca, & Policlinico di Monza, Monza, Italy
| | - Alberto Margonato
- Heart Failure Unit and Department of Cardiology, San Raffaele Hospital and Scientific Institute (IRCCS), Milan, Italy
| | - Andrea Mortara
- Heart Failure Unit and Department of Cardiology, Policlinico di Monza, Via Amati 111, 20900, Monza, Italy
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Agewall S. Antiplatelet treatment in coronary syndrome. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:81-82. [PMID: 33720341 DOI: 10.1093/ehjcvp/pvab015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Stefan Agewall
- Editor-in-Chief, Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
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