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Sahin E, Gökçay Bek S, Eren N, Karauzum I, Ergul M, Yildiz N, Sahin T, Dervisoglu E, Kalender B. Usefulness of Peritoneal Ultrafiltration in Patients with Diuretic Resistant Heart Failure without End-Stage Renal Disease. Cardiorenal Med 2020; 10:429-439. [PMID: 33022682 DOI: 10.1159/000510249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/11/2020] [Indexed: 11/19/2022] Open
Abstract
AIM This study aimed to explore the role of peritoneal ultrafiltration (UF) in cardiorenal syndrome (CRS) patients for fluid and metabolic control. BACKGROUND Peritoneal UF is safely and efficiently used for the management of CRS. It has been shown to provide efficient UF in hypervolemic patients. METHODS Thirty (20 males and 10 females) CRS patients were treated by peritoneal dialysis (PD) and UF. The baseline data of the patients (demographics, causes of heart failure, the presence of pacemaker or implantable cardioverter-defibrillator, the need for extracorporeal UF or paracentesis or thoracentesis, comorbidity, drugs, left ventricular ejection fraction [LVEF] and pulmonary artery systolic pressure [PAPs], pericardial effusion, physical examination, body weight, NYHA class, dialysis regime, urine output, N-terminal pro-B-type natriuretic peptide [NT-proBNP] level, hemoglobin, estimated glomerular filtration rate [eGFR], and other routine biochemical determinations) were recorded at the onset, every 6 months, and then annually. Echocardiograms were performed at baseline and after 6 and 12 months. The time points of complications associated with PD, the need for hemodialysis, the day of death, and causes of death were documented. RESULTS Mean age was 69 ± 8 years (range 49-84 years). The average PD duration was 18.25 ± 14.87 months. According to the CKD-EPI, initial mean GFR was 34.34 ± 11.9 mL/min/1.73 m2 (range 16.57-59.0), and this increased to 45.48 ± 26.04, 45.10 ± 28.58, and 41.10 ± 25.68 mL/min/1.73 m2 in the third, sixth, and twelfth months, respectively. There was a significant increase in the first 3 months and a significant decrease between the third and twelfth months (respectively, p = 0.018 and p = 0.043). There was no difference in eGFR levels between baseline and the end of the first year (p = 0.217). In the first 3 months, there was a significant decline in urea levels to 79.38 ± 36.65 from 109.92 ± 42.44 mg/dL and this was maintained until the end of the first year of PD therapy (after 3 months, p = 0.002; after 1 year, p = 0.024). However, there was no significant change in creatinine levels within the first year (p = 0.312). There was a significant increase in hemoglobin level up to the end of the first year of PD (after 3 months, p = 0.000; after 12 months, p = 0.013). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). Functional capacity (according to NYHA classification) improved in all patients by the third month of PD treatment (p < 0.001). This early improvement was maintained in many patients during the following 12 months (p < 0.001). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). At the end of the first year, there was an approximate 15% reduction in NT-proBNP levels (p = 0.647). Hospitalizations decreased to 6 ± 15 days/patient-year (range 18-122 days) from 62 ± 24 days/patient-year (p = 0.000). CONCLUSION Peritoneal UF is a treatment method that maintains renal function and electrolyte balance, improves cardiac function, and reduces hospitalizations in CRS patients. We observed that this treatment significantly increased functional capacity and quality of life and significantly reduced hospital admissions.
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Affiliation(s)
- Elif Sahin
- Internal Medicine, Kocaeli University Hospital, Kocaeli, Turkey
| | | | - Necmi Eren
- Nephrology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Irem Karauzum
- Cardiology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Metin Ergul
- Nephrology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Nuriye Yildiz
- Nephrology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Tayfun Sahin
- Cardiology, Kocaeli University Hospital, Kocaeli, Turkey
| | | | - Betul Kalender
- Nephrology, Kocaeli University Hospital, Kocaeli, Turkey
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Onyemelukwe OU, Oyati AI, Danbauchi SS, Obasohan A. B-Type Natriuretic Peptides (BNP) and Tissue Doppler E/e´ Before and After 4 Weeks Standard Treatment of African Heart Failure Subjects: The ABU-BNP Longitudinal Survey. Vasc Health Risk Manag 2019; 15:559-569. [PMID: 31908467 PMCID: PMC6929926 DOI: 10.2147/vhrm.s211498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/20/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The study aimed at determining the response of BNP and tissue Doppler (TD) E/e´ to standard heart failure (HF) therapy in an African black population as data on these are lacking in Africa. BNP assessment in relation to HF severity and its association with its predictors were also determined. METHODS It was a longitudinal-analytical study with a one month follow-up among 100 HF patients seen at Ahmadu Bello University Teaching Hospital, Zaria-Nigeria. Two-way Repeated Measures ANOVA determined BNP levels before and after treatment according to the HF severity. Wilcoxon-Signed Ranks test determined the difference in BNP and TD E/e´ before and after treatment. Pearson's correlation assessed log-transformed BNP's association with its predictors. RESULTS BNP significantly (p<0.001) rose with increasing severity of HF from 386.6 ± 186.5 pg/mL to 581.7 ± 299.0 pg/mL to 805.0 ± 484.0 pg/mL in the NYHA II-IV HF, respectively, with consequent fall in a similar fashion following treatment. The Median (IQR) BNP levels reduced significantly (p<0.001) from 450 (362.5, 712.5) to 275.0 (225, 375.2) pg/mL with a 38.9% reduction over 4 weeks associated with significant improvement in TD E/e´, structural and functional parameters. Ln10BNP was significantly (p<0.001) positively correlated to TD E/e´ before (r=0.51) and after treatment (r=0.43). Likewise, Ln10BNP was significantly (p<0.05) negatively correlated to ejection fraction & fractional shortening before and after treatment. CONCLUSION BNP and tissue Doppler can serve as useful tools in the assessment of the effectiveness of African HF treatment and functional capacity over 4 weeks. TD E/e´ may be a reliable non-invasive estimate of left ventricular filling pressures and diastolic dysfunction.
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Affiliation(s)
| | | | | | - Austine Obasohan
- Department of Medicine, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
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Jan MI, Khan RA, Sultan A, Ullah A, Ishtiaq A, Murtaza I. Analysis of NT-proBNP and uric acid due to left ventricle hypertrophy in the patients of aortic valve disease. Pak J Med Sci 2018; 35:183-188. [PMID: 30881420 PMCID: PMC6408659 DOI: 10.12669/pjms.35.1.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: To evaluate the concentration of N terminal proBNP (NT-proBNP) and partially the serum uric acid in the severe condition of aortic valve dysfunction for assessment of left ventricle hypertrophy. Methods: The study was conducted in the signal transduction lab department of biochemistry Quaid-I-Azam University, Islamabad from September 2013 to February 2017. NT-proBNP and serum uric acid were measured in one hundred patients of aortic valve dysfunction. The patients were divided into three main groups: 1) Aortic stenosis, 2) Aortic regurgitation, and 3) Aortic stenosis with Aortic regurgitation. The results were compared between disease and controls groups. Results: High level of plasma NT-proBNP was detected in all the three disease groups of aortic valve (stenosis, p<0.001), (regurgitation, p<0.001) and (stenosis with regurgitation, p<0.001). In addition, non-significantly increased level of serum uric acid was also observed in left ventricle hypertrophy in all the three respective disease groups of aortic valve. Conclusion: Increased secretion of NT-proBNP during cardiac remodeling can be related to the severity of left ventricle hypertrophy due to aortic valve abnormality in all the disease groups of severe stenosis, severe regurgitation, and combine disease condition of severe stenosis and severe regurgitation. However, non-significant increase in uric acid concentration is also identified which may be due to one of the factors involved in left ventricle hypertrophy in all the three disease groups of aortic valve. The interaction of uric acid with NT-proBNP during cardiac remolding due to aortic valve dysfunction is still not clear.
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Affiliation(s)
- Muhammad Ishtiaq Jan
- Muhammad Ishtiaq Jan, PhD. Signal Transduction Lab, Department of Bio-Chemistry, Faculty of Biological Sciences, Quaid-I-Azam University Islamabad, Islamabad, Pakistan
| | - Riaz Anwar Khan
- Riaz Anwar Khan, MBBS, FCPS, MCPS. Department of Cardiovascular Surgery, Lady Reading Hospital Peshawar, Pakistan
| | - Aneesa Sultan
- Aneesa Sultan, PhD Cancer Genetics Lab, Department of Bio-Chemistry, Faculty of Biological Sciences, Quaid-I-Azam University Islamabad, Islamabad, Pakistan
| | - Anwar Ullah
- Anwar Ullah, PhD. Cancer Genetics Lab, Department of Bio-Chemistry, Faculty of Biological Sciences, Quaid-I-Azam University Islamabad, Islamabad, Pakistan
| | - Ayesha Ishtiaq
- Ayesha Ishtiaq, MS. Signal Transduction Lab, Department of Bio-Chemistry, Faculty of Biological Sciences, Quaid-I-Azam University Islamabad, Islamabad, Pakistan
| | - Iram Murtaza
- Iram Murtaza, PhD. Signal Transduction Lab, Department of Bio-Chemistry, Faculty of Biological Sciences, Quaid-I-Azam University Islamabad, Islamabad, Pakistan
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Inflammatory and Imaging-based Predictors of Atrial Fibrillation Recurrence after Pulmonary Vein Isolation Using Electroanatomical Mapping – the INFLAMAP Study. JOURNAL OF INTERDISCIPLINARY MEDICINE 2018. [DOI: 10.2478/jim-2018-0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Abstract
Atrial fibrillation (AF) is the most frequent form of supraventricular arrhythmia in medical practice. It is characterized by chaotic electrical activity in the atria, which often leads to irregular and fast ventricular contractions. Pulmonary veins (PV) play an essential part in the genesis of AF. There are a series of risk factors that trigger the development and recurrence of AF after PV isolation. Despite advanced medical technology, the success rate of AF ablation is not satisfactory. The purpose of this study is to assess the preprocedural imaging and serum biomarkers linked to an increased recurrence of AF after PV isolation. The primary endpoint is represented by AF recurrence after PV isolation. In addition, the rate of cardiovascular death and the rate of major adverse cardiovascular events will be assessed in relation to the enlargement of the left atrium and the volume of epicardial adipose tissue surrounding the heart.
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Majerczyk M, Choręza P, Mizia-Stec K, Bożentowicz-Wikarek M, Brzozowska A, Arabzada H, Owczarek AJ, Szybalska A, Grodzicki T, Więcek A, Olszanecka-Glinianowicz M, Chudek J. Plasma Level of Retinol-Binding Protein 4, N-Terminal proBNP and Renal Function in Older Patients Hospitalized for Heart Failure. Cardiorenal Med 2018; 8:237-248. [PMID: 29972826 DOI: 10.1159/000489403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/18/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/AIM Elevated plasma concentration of retinol-binding protein 4 (RBP4) has recently emerged as a potential new risk factor for cardiovascular diseases, including hypertension (HT) and coronary artery disease (CAD). Limited data suggest that RBP4 promotes inflammatory damage to cardiomyocytes and participates in the development of heart failure (HF). This study aimed to analyze the relationship between concentrations of plasma RBP4 and serum N-terminal proBNP (NT-proBNP), a powerful biomarker of left ventricle dysfunction, in the older Polish population. METHODS The study sample consisted of 2,826 (1,487 men) participants of the PolSenior study, aged 65 years and older, including a subgroup hospitalized for HF (n = 282). In all subjects, plasma concentrations of RBP4, interleukin-6 (IL-6), serum level of NT-proBNP, and hs-CRP were measured. Additionally, BMI, estimated glomerular filtration rate (eGFR), and HOMA-IR were calculated. The prevalence of HT, CAD, atrial fibrillation (AF), and medication were considered as potential confounders. RESULTS Similar RBP4 levels were found in subjects with NT-proBNP < 125 and ≥125 ng/mL, with and without AF, and in the subgroups hospitalized for HF with and without AF. Regression analysis revealed no association between log10(NT-proBNP) and log10(RBP4). Plasma levels of RBP4 were increased by HT occurrence and diuretic therapy, while diminished with regard to female gender, age, eGFR values, AF, and IL-6 levels. CONCLUSION Our results show that RBP4 is affected by GFR but cannot be considered as an independent biomarker of heart muscle dysfunction.
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Affiliation(s)
- Marcin Majerczyk
- Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.,Department of Cardiology, District Hospital in Zakopane, Zakopane, Poland
| | - Piotr Choręza
- Department of Statistics, Department of Instrumental Analysis, School of Pharmacy and Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Maria Bożentowicz-Wikarek
- Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aniceta Brzozowska
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Habibullah Arabzada
- Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aleksander J Owczarek
- Department of Statistics, Department of Instrumental Analysis, School of Pharmacy and Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | | | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Więcek
- Department of Nephrology, Transplantation and Internal Medicine, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Magdalena Olszanecka-Glinianowicz
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jerzy Chudek
- Pathophysiology Unit, Department of Pathophysiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.,Department of Internal Diseases and Oncological Chemotherapy, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Beltrami M, Ruocco G, Ibrahim A, Lucani B, Franci B, Nuti R, Palazzuoli A. Different trajectories and significance of B-type natriuretic peptide, congestion and acute kidney injury in patients with heart failure. Intern Emerg Med 2017; 12:593-603. [PMID: 28181125 DOI: 10.1007/s11739-017-1620-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/25/2017] [Indexed: 01/29/2023]
Abstract
The exact relationship existing among congestion status, brain natriuretic peptide (BNP) changes and acute kidney injury (AKI) has not been elucidated in patients with acute heart failure (AHF). The aims of this study are: to investigate the relation and prognostic role of BNP, AKI and clinical congestion after discharge; to define the exact BNP cut off value or a BNP in-hospital reduction to identify patients with higher risk during vulnerable post-discharge phase. We consecutively enrolled 157 patients with a diagnosis of AHF. BNP and creatinine were measured in all patients, and degree of failure was assessed. AKI was defined as a creatinine increase ≥0.3 mg/dL or eGFR reduction ≥20% during hospitalization. All patients were followed for 1 and 3 months. Of 146 included patients, 110 patients (75%) displayed effective decongestion, 116 (79%) showed a BNP decrease ≥30%, and 28 (19%) developed in-hospital AKI. BNP in-hospital decrease ≥30% was found more often in patients who showed good decongestion in comparison to patients in persistent failure (63 vs 22%; p < 0.001). The ROC curve analyses at 3 months show that both BNP reduction of 30% between admission and discharge and decongestion at discharge identifies patients with a reduced incidence of cardiovascular events (AUC = 0.79, confidence interval 0.68-0.90, sensibility 90%, sensitivity 50% p < 0.001). Kaplan-Meier survival plots show a better outcome in patients with a BNP decrease ≥30% and good decongestion at discharge (p = 0.03). BNP reduction in AHF is associated with decongestion. BNP reduction associated with decongestion at discharge is a favorable prognostic indicator at 90-day survival irrespective of the AKI occurrence.
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Affiliation(s)
- Matteo Beltrami
- Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Gaetano Ruocco
- Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Aladino Ibrahim
- Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Barbara Lucani
- Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Beatrice Franci
- Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Ranuccio Nuti
- Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy.
- Department of Internal Medicine and Metabolic Diseases, Cardiology, Le Scotte Hospital, Viale Bracci, 53100, Siena, Italy.
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Ruocco G, Pellegrini M, De Gori C, Franci B, Nuti R, Palazzuoli A. The prognostic combined role of B-type natriuretic peptide, blood urea nitrogen and congestion signs persistence in patients with acute heart failure. J Cardiovasc Med (Hagerstown) 2016; 17:818-27. [DOI: 10.2459/jcm.0000000000000350] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Schurgers LJ, Burgmaier M, Ueland T, Schutters K, Aakhus S, Hofstra L, Gullestad L, Aukrust P, Hellmich M, Narula J, Reutelingsperger CP. Circulating annexin A5 predicts mortality in patients with heart failure. J Intern Med 2016. [PMID: 26223343 DOI: 10.1111/joim.12396] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Natriuretic peptides are currently used to predict mortality in patients with heart failure (HF). However, novel independent biomarkers are needed to improve risk stratification in these patients. We hypothesized that annexin A5 (anxA5) would be highly expressed by organs which are generally affected by HF and that circulating anxA5 levels would predict mortality in HF patients. METHODS We prospectively determined the diagnostic value of anxA5, N-terminal pro-B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and estimated glomerular filtration rate (eGFR) to predict mortality in 180 HF patients during a median follow-up of 3.6 years. Studies were conducted with anxA5(-/-) mice to investigate the underlying mechanisms. RESULTS AnxA5 levels were significantly elevated in HF patients compared to healthy control subjects. Cox regression analysis demonstrated that anxA5, NT-proBNP and eGFR all predict mortality independently. AnxA5 significantly improved the diagnostic efficiency of NT-proBNP alone (improvement of c-statistic from 0.662 to 0.705, P < 0.001) and also combined with eGFR and CRP (improvement of c-statistic from 0.675 to 0.738, P < 0.001) to predict mortality in the Cox regression model. Receiver operating characteristic curve analysis showed that anxA5 predicted 3-year survival (area under curve 0.708) with an optimal cut-off value of 2.24 ng mL(-1) . Using anxA5(-/-) mice, we demonstrated that anxA5 is highly expressed in organs that are often affected by HF including lung, kidney, liver and spleen. Lysis of these organs in vitro resulted in a marked and significant increase in anxA5 concentrations. CONCLUSION AnxA5 improves the diagnostic efficiency of conventional biomarkers to predict mortality in HF patients. Whereas natriuretic peptides originate from the myocardium, high circulating anxA5 levels in patients with HF are likely to reflect peripheral organ damage secondary to HF.
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Affiliation(s)
- L J Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - M Burgmaier
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, University Hospital of the RWTH Aachen, Aachen, Germany
| | - T Ueland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - K Schutters
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - S Aakhus
- Department of Cardiology, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - L Hofstra
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - L Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - P Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - M Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - J Narula
- Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, USA
| | - C P Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
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Perez-Lloret S, Rey MV, Crispo J, Krewski D, Lapeyre-Mestre M, Montastruc JL, Rascol O. Risk of heart failure following treatment with dopamine agonists in Parkinson's disease patients. Expert Opin Drug Saf 2014; 13:351-60. [PMID: 24547918 DOI: 10.1517/14740338.2014.888057] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Dopamine agonists (DAs) are frequently used to treat early or advanced Parkinson's disease (PD) patients. They have been shown to be efficacious for the treatment of motor symptoms and for delaying levodopa-induced dyskinesias. However, their utilization is limited by the risk of adverse drug reactions, some of which affect the cardiovascular system. Recently, the US FDA identified a possible association between exposure to pramipexole and the risk of heart failure. AREAS COVERED This article begins by reviewing the pharmacodynamic and cardiovascular effects of DAs on PD patients. Pharmacoepidemiological studies about the association between DAs and heart failure are then evaluated. EXPERT OPINION Four nested case-control studies were reviewed. In general, results showed higher heart failure risk following use of pramipexole or cabergoline. Although the effects of cabergoline may be explained by the induction of cardiac valve fibrosis, the basis for the significantly increased risk associated with pramipexole is unclear. It remains to be determined if these are dose-related effects, at what point they occur during the course of treatment, and if the risk is the same for all patients irrespective of other potential modifying factors, such as age and sex.
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Affiliation(s)
- Santiago Perez-Lloret
- Hospital and University Paul Sabatier of Toulouse, France and INSERM CIC9023 and UMR 825, Department of Clinical Pharmacology and Neurosciences , Toulouse , France
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