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Song S, Xie L, Xu H, Xu K, Fu H, Zhang L, Hou R, Tao Y, Guo Y. Evaluation of cardiac remodeling in pediatric chronic kidney disease by cardiovascular magnetic resonance. BMC Cardiovasc Disord 2024; 24:526. [PMID: 39354376 PMCID: PMC11443670 DOI: 10.1186/s12872-024-04179-1] [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: 07/17/2023] [Accepted: 09/10/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Children with chronic kidney disease (CKD) are at high risk of cardiovascular disease. Cardiovascular magnetic resonance (CMR) is the reference method for assessing cardiac remodeling. To our knowledge, no study has reported a comprehensive analysis of left ventricular(LV) cardiac remodeling using CMR in different stages of pediatric CKD. This prospective case-control study aimed to investigate cardiac remodeling in pediatric CKD, using CMR, and determine its relationship with risk factors. METHOD CMR was performed in 124 children with CKD and 50 controls. The cardiac remodeling parameters included left ventricular mass index (LVMI), LV remodeling index (LVRI), and LV wall thickness. Univariable and multivariable analyses were performed to assess the cardiac remodeling risk factors. RESULTS Cardiac remodeling was observed in 35.5% (44/124) of children with CKD. The LVMI, LVRI, and LV wall thickness were higher in advanced stages of CKD (P < 0.05). In the CKD stage 1-2 group, a lower in the estimated glomerular filtration rate was an independent determinant of impaired LVMI (β = -0.425, P = 0.019) and LVRI (β = -0.319, P = 0.044). A higher protein to creatinine ratio(PCR) was independently associated with impaired LVRI (β = 0.429, P = 0.022). In the CKD stage 3-5 group, higher in systolic blood pressure (SBP) (β = 0.464, P = 0.005) and PCR (β = 0.852, P = 0.031) were independent determinants of impaired LVMI. Additionally, higher SBP was positively correlated with impaired LVRI(r = 0.599, P < 0.001). There was a trend toward more abnormal cardiac remodeling in the CKD stage 3-5 group with hypertension than those without. CONCLUSION Cardiac remodeling is prevalent in children with CKD, from an early stage. kidney markers are independently associated with cardiac remodeling. Hypertension increases the risk of cardiac remodeling in CKD stages 3-5. Strict BP control may help reverse or prevent remodeling.
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Affiliation(s)
- Sisi Song
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
- Department of Radiology, Deyang People's Hospital, Deyang, Sichuan, China
| | - Linjun Xie
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Huayan Xu
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Ke Xu
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Hang Fu
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Lu Zhang
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
| | - Ruilai Hou
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China
- Department of Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuhong Tao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China.
- Division of Nephrology, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
| | - Yingkun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China.
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Zhang TY, An DA, Fang Y, Zhou H, Yan H, Chen B, Lu R, Fang W, Wang Q, Che X, Xu Y, Huang J, Jin H, Shen J, Mou S, Wu LM. Assessment of the Prognostic Value of MRI Left Ventricular Global Function Index (LVGFI) in Patients With End-Stage Renal Disease Under Maintenance Dialysis. J Magn Reson Imaging 2024; 59:2275-2286. [PMID: 37668069 DOI: 10.1002/jmri.28979] [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: 06/20/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Left ventricular global function index (LVGFI) integrates LV volumetric and functional parameters. In patients with end-stage renal disease (ESRD), cardiac injury manifests as LV hypertrophy and dysfunction. However, the prognostic value of LVGFI in this population remains unclear. PURPOSE To investigate the association of LVGFI with major adverse cardiac events (MACE) in patients with ESRD. STUDY TYPE Prospective. POPULATION One hundred fifty-eight ESRD patients (mean age: 54.1 ± 14.4 years; 105 male) on maintenance dialysis. FILED STRENGTH/SEQUENCE 3.0 T, balanced steady-state free precession (bSSFP) cine and modified Look-Locker inversion recovery (MOLLI) sequences. ASSESSMENT LV volumetric and functional parameters were determined from bSSFP images. LVGFI was calculated as the ratio of stroke volume to global volume and native T1 was determined from MOLLI T1 maps. MACE was recorded on follow up. Models were developed to predict MACE from conventional risk factors combined with LVGFI, GLS, native T1, and LV mass index (LVMI), respectively. Subgroup analyses were further performed in participants with LVEF above median. STATISTICAL TESTS Cox proportional hazard regression and log-rank test were used to investigate the association between LVGFI and MACE. The predictive models were evaluated and compared using Harrell's C-statistics and DeLong tests. A P value <0.05 was considered statistically significant. RESULTS Thirty-four MACE occurred during the median follow-up period of 26 months. The hazard of MACE increased by 114% for each 10% decrease in LVGFI in univariable analysis. The predictive model consisting of LVGFI (C-statistic: 0.724) had significantly better predictive performance than the others (all P < 0.001). These results were consistent in patients (N = 79) with LVEF > median (63.54%). DATA CONCLUSION LVGFI is a novel marker for MACE risk stratification in patients with ESRD and was better able to predict MACE than native T1 mapping and GLS. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Tian-Yi Zhang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dong-Aolei An
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Fang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hang Zhou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hao Yan
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Binghua Chen
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Renhua Lu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Fang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qin Wang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiajing Che
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yao Xu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiaying Huang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haijiao Jin
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianxiao Shen
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shan Mou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lian-Ming Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Wang X, Zhao X, Wang X, Cao L, Lu B, Wang Z, Zhang W, Ti Y, Zhong M. Effect of levosimendan on ventricular remodelling in patients with left ventricular systolic dysfunction: a meta-analysis. ESC Heart Fail 2024; 11:1352-1376. [PMID: 38419326 PMCID: PMC11098670 DOI: 10.1002/ehf2.14714] [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: 11/17/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 03/02/2024] Open
Abstract
Heart failure is the final stage of several cardiovascular diseases, and the key to effectively treating heart failure is to reverse or delay ventricular remodelling. Levosimendan is a novel inotropic and vasodilator agent used in heart failure, whereas the impact of levosimendan on ventricular remodelling is still unclear. This study aims to investigate the impact of levosimendan on ventricular remodelling in patients with left ventricular systolic dysfunction. Electronic databases were searched to identify eligible studies. A total of 66 randomized controlled trials involving 7968 patients were included. Meta-analysis results showed that levosimendan increased left ventricular ejection fraction [mean difference (MD) = 3.62, 95% confidence interval (CI) (2.88, 4.35), P < 0.00001] and stroke volume [MD = 6.59, 95% CI (3.22, 9.96), P = 0.0001] and significantly reduced left ventricular end-systolic volume [standard mean difference (SMD) = -0.52, 95% CI (-0.67, -0.37), P < 0.00001], left ventricular end-diastolic volume index [SMD = -1.24, 95% CI (-1.61, -0.86), P < 0.00001], and left ventricular end-systolic volume index [SMD = -1.06, 95% CI (-1.43, -0.70), P < 0.00001]. In terms of biomarkers, levosimendan significantly reduced the level of brain natriuretic peptide [SMD = -1.08, 95% CI (-1.60, -0.56), P < 0.0001], N-terminal pro-brain natriuretic peptide [SMD = -0.99, 95% CI (-1.41, -0.56), P < 0.00001], and interleukin-6 [SMD = -0.61, 95% CI (-0.86, -0.35), P < 0.00001]. Meanwhile, levosimendan may increase the incidence of hypotension [risk ratio (RR) = 1.24, 95% CI (1.12, 1.39), P < 0.0001], hypokalaemia [RR = 1.57, 95% CI (1.08, 2.28), P = 0.02], headache [RR = 1.89, 95% CI (1.50, 2.39), P < 0.00001], atrial fibrillation [RR = 1.31, 95% CI (1.12, 1.52), P = 0.0005], and premature ventricular complexes [RR = 1.86, 95% CI (1.27, 2.72), P = 0.001]. In addition, levosimendan reduced all-cause mortality [RR = 0.83, 95% CI (0.74, 0.94), P = 0.002]. In conclusion, our study found that levosimendan might reverse ventricular remodelling when applied in patients with left ventricular systolic dysfunction, especially in patients undergoing cardiac surgery, decompensated heart failure, and septic shock.
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Affiliation(s)
- Xia Wang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of CardiologyQilu Hospital of Shandong UniversityChina
| | - Xiu‐Zhi Zhao
- Department of CardiologyPeople's Hospital of Lixia District of JinanJinanShandongChina
| | - Xi‐Wen Wang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of CardiologyQilu Hospital of Shandong UniversityChina
| | - Lu‐Ying Cao
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of CardiologyQilu Hospital of Shandong UniversityChina
| | - Bin Lu
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of CardiologyQilu Hospital of Shandong UniversityChina
| | - Zhi‐Hao Wang
- Department of Geriatric MedicineShandong Key Laboratory of Cardiovascular Proteomics, Qilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
| | - Wei Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of CardiologyQilu Hospital of Shandong UniversityChina
| | - Yun Ti
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of CardiologyQilu Hospital of Shandong UniversityChina
| | - Ming Zhong
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of CardiologyQilu Hospital of Shandong UniversityChina
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Trimarchi G, Teresi L, Licordari R, Pingitore A, Pizzino F, Grimaldi P, Calabrò D, Liotta P, Micari A, de Gregorio C, Di Bella G. Transient Left Ventricular Dysfunction from Cardiomyopathies to Myocardial Viability: When and Why Cardiac Function Recovers. Biomedicines 2024; 12:1051. [PMID: 38791012 PMCID: PMC11117605 DOI: 10.3390/biomedicines12051051] [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: 04/15/2024] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Transient left ventricular dysfunction (TLVD), a temporary condition marked by reversible impairment of ventricular function, remains an underdiagnosed yet significant contributor to morbidity and mortality in clinical practice. Unlike the well-explored atherosclerotic disease of the epicardial coronary arteries, the diverse etiologies of TLVD require greater attention for proper diagnosis and management. The spectrum of disorders associated with TLVD includes stress-induced cardiomyopathy, central nervous system injuries, histaminergic syndromes, various inflammatory diseases, pregnancy-related conditions, and genetically determined syndromes. Furthermore, myocardial infarction with non-obstructive coronary arteries (MINOCA) origins such as coronary artery spasm, coronary thromboembolism, and spontaneous coronary artery dissection (SCAD) may also manifest as TLVD, eventually showing recovery. This review highlights the range of ischemic and non-ischemic clinical situations that lead to TLVD, gathering conditions like Tako-Tsubo Syndrome (TTS), Kounis syndrome (KS), Myocarditis, Peripartum Cardiomyopathy (PPCM), and Tachycardia-induced cardiomyopathy (TIC). Differentiation amongst these causes is crucial, as they involve distinct clinical, instrumental, and genetic predictors that bode different outcomes and recovery potential for left ventricular function. The purpose of this review is to improve everyday clinical approaches to treating these diseases by providing an extensive survey of conditions linked with TLVD and the elements impacting prognosis and outcomes.
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Affiliation(s)
- Giancarlo Trimarchi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
| | - Lucio Teresi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
| | - Roberto Licordari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98100 Messina, Italy; (R.L.); (A.M.)
| | - Alessandro Pingitore
- Istituto di Fisiologia Clinica, Clinical Physiology Institute, CNR, 56124 Pisa, Italy;
| | - Fausto Pizzino
- Cardiology Unit, Heart Centre, Fondazione Gabriele Monasterio—Regione Toscana, 54100 Massa, Italy;
| | - Patrizia Grimaldi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
| | - Danila Calabrò
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
| | - Paolo Liotta
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98100 Messina, Italy; (R.L.); (A.M.)
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, 98100 Messina, Italy; (L.T.); (P.G.); (D.C.); (P.L.); (C.d.G.); (G.D.B.)
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Hsu C, Fu T, Wang C, Huang T, Cherng W, Wang J. High-Intensity Interval Training Is Associated With Improved 10-Year Survival by Mediating Left Ventricular Remodeling in Patients With Heart Failure With Reduced and Mid-Range Ejection Fraction. J Am Heart Assoc 2024; 13:e031162. [PMID: 38240219 PMCID: PMC11056167 DOI: 10.1161/jaha.123.031162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/07/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND This study aimed to assess the left ventricular (LV) remodeling response and long-term survival after high-intensity interval training (HIIT) in patients with various heart failure (HF) phenotypes during a 10-year longitudinal follow-up. METHODS AND RESULTS Among 214 patients with HF receiving guideline-directed medical therapy, those who underwent an additional 36 sessions of aerobic exercise at alternating intensities of 80% and 40% peak oxygen consumption (V ̇ $$ \dot{\mathrm{V}} $$ O2peak) were considered HIIT participants (n=96). Patients who did not undergo HIIT were considered participants receiving guideline-directed medical therapy (n=118). Participants with LV ejection fraction (EF) <40%, ≥40% and <50%, and ≥50% were considered to have HF with reduced EF, HF with mid-range EF, and HF with preserved EF, respectively. V ̇ $$ \dot{\mathrm{V}} $$ O2peak, serial LV geometry, and time to death were recorded. In all included participants, 10-year survival was better (P=0.015) for participants who underwent HIIT (80.3%) than for participants receiving guideline-directed medical therapy (68.6%). An increased V ̇ $$ \dot{\mathrm{V}} $$ O2peak, decreased minute ventilation carbon dioxide production slope, and reduced LV end-diastolic diameter were protective factors against all-cause mortality. Regarding 138 patients with HF with reduced EF (P=0.044) and 36 patients with HF with mid-range EF (P=0.036), 10-year survival was better for participants who underwent HIIT than for participants on guideline-directed medical therapy. Causal mediation analysis showed a significant mediation path for LV end-diastolic diameter on the association between HIIT and 10-year mortality in all included patients with HF (P<0.001) and those with LV ejection fraction <50% (P=0.006). HIIT also had a significant direct association with 10-year mortality in patients with HF with LV ejection fraction <50% (P=0.027) but not in those with LV ejection fraction ≥50% (n=40). CONCLUSIONS Reversal of LV remodeling after HIIT could be a significant mediating factor for 10-year survival in patients with HF with reduced EF and those with HF with mid-range EF.
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Affiliation(s)
- Chih‐Chin Hsu
- Department of Physical Medicine and RehabilitationKeelung Chang Gung Memorial HospitalKeelungTaiwan
- School of Medicine, College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Tieh‐Cheng Fu
- Department of Physical Medicine and RehabilitationKeelung Chang Gung Memorial HospitalKeelungTaiwan
- Division of Cardiology, Department of Internal MedicineHeart Failure Center, Chang Gung Memorial HospitalKeelungTaiwan
| | - Chao‐Hung Wang
- School of Medicine, College of MedicineChang Gung UniversityTaoyuanTaiwan
- Division of Cardiology, Department of Internal MedicineHeart Failure Center, Chang Gung Memorial HospitalKeelungTaiwan
| | - Ting‐Shuo Huang
- Division of General Surgery, Department of SurgeryKeelung Chang Gung Memorial HospitalKeelungTaiwan
- Department of Chinese Medicine, College of MedicineChang Gung UniversityTaoyuanTaiwan
- Community Medicine Research CenterKeelung Chang Gung Memorial HospitalKeelungTaiwan
| | - Wen‐Jin Cherng
- School of Medicine, College of MedicineChang Gung UniversityTaoyuanTaiwan
- Division of Cardiology, Department of Internal MedicineChang Gung Memorial HospitalLinkou Branch, TaoyuanTaiwan
| | - Jong‐Shyan Wang
- Department of Physical Medicine and RehabilitationKeelung Chang Gung Memorial HospitalKeelungTaiwan
- Healthy Aging Research CenterChang Gung UniversityTaoyuanTaiwan
- Research Center for Chinese Herbal Medicine, College of Human EcologyChang Gung University of Science and TechnologyTaoyuanTaiwan
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Kodsi M, Makarious D, Gan GC, Choudhary P, Thomas L. Cardiac reverse remodelling by imaging parameters with recent changes to guideline medical therapy in heart failure. ESC Heart Fail 2023; 10:3258-3275. [PMID: 37871982 PMCID: PMC10682888 DOI: 10.1002/ehf2.14555] [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: 03/28/2023] [Revised: 08/29/2023] [Accepted: 09/20/2023] [Indexed: 10/25/2023] Open
Abstract
Recently established heart failure therapies, including sodium glucose co-transporter 2 inhibitors, angiotensin-neprilysin inhibitors, and cardiac resynchronization therapy, have led to both clinical and structural improvements. Reverse remodelling describes the structural and functional responses to therapy and has been shown to correlate with patients' clinical response, acting as a biomarker for treatment success. The introduction of these new therapeutic agents in addition to advances in non-invasive cardiac imaging has led to an expansion in the evaluation and the validation of cardiac reverse remodelling. Methods including volumetric changes as well as strain and myocardial work have all been shown to be non-invasive end-points of reverse remodelling, correlating with clinical outcomes. Our review summarizes the current available evidence on reverse remodelling in heart failure by the non-invasive cardiac imaging techniques, in particular transthoracic echocardiography.
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Affiliation(s)
- Matthew Kodsi
- Department of CardiologyWestmead HospitalSydneyAustralia
| | - David Makarious
- Department of CardiologyWestmead HospitalSydneyAustralia
- Westmead Clinical School, Westmead HospitalUniversity of SydneySydneyAustralia
| | - Gary C.H. Gan
- Department of CardiologyWestmead HospitalSydneyAustralia
| | - Preeti Choudhary
- Department of CardiologyWestmead HospitalSydneyAustralia
- Westmead Clinical School, Westmead HospitalUniversity of SydneySydneyAustralia
| | - Liza Thomas
- Department of CardiologyWestmead HospitalSydneyAustralia
- Westmead Clinical School, Westmead HospitalUniversity of SydneySydneyAustralia
- South West clinical SchoolUniversity of New South WalesSydneyAustralia
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Yamashita H, Fujii M, Bessho R, Ishii Y. Effect of esaxerenone on ischaemia and reperfusion injury in rat hearts. Eur J Cardiothorac Surg 2023; 64:ezad405. [PMID: 38060261 DOI: 10.1093/ejcts/ezad405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 11/08/2023] [Accepted: 12/06/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVES In myocardial infarction, the addition of mineralocorticoid receptor blockers to standard therapies, such as angiotensin-converting enzyme inhibitors or beta-blockers, reportedly reduces mortality and cardiac events. We investigated whether the non-steroidal mineralocorticoid receptor blocker esaxerenone has cardioprotective effects and its protective mechanisms. METHODS Isolated rat hearts were Langendorff-perfused (constant pressure, 80 mmHg) with oxygenated Krebs-Henseleit bicarbonate buffer and reperfused for 60 min; afterwards, recovery of function (left ventricular pressure, measured with an intraventricular balloon) and myocardial injury were measured. In a preliminary study, we determined the optimal concentration of esaxerenone required for myocardial protection. Next, esaxerenone was administered in the pre- and post-ischaemic phases to determine the optimal timing of administration. In addition, we assessed coronary flow response to acetylcholine with and without esaxerenone. We examined whether esaxerenone-induced cardioprotection was prevented by targeting putative components in the preconditioning manner (the mitochondrial ATP-sensitive potassium [KATP] channel). RESULTS Myocardial protection by esaxerenone was observed when esaxerenone was administered before ischaemia but not after ischaemia. The coronary flow response to acetylcholine was significantly better in the esaxerenone group than in the control group. The cardioprotective effect of esaxerenone was eliminated by the mitochondrial KATP channel blocker, 5-hydroxy decanoate. CONCLUSIONS This study confirmed the myocardial protective effect of the pre-ischaemic administration of esaxerenone. Esaxerenone may contribute to coronary endothelial protection and exert pharmacological preconditioning via the mitochondrial KATP channel.
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Affiliation(s)
- Hiromasa Yamashita
- Department of Cardiovascular Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Masahiro Fujii
- Department of Cardiovascular Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Ryuzo Bessho
- Department of Cardiovascular Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
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Ndumele CE, Neeland IJ, Tuttle KR, Chow SL, Mathew RO, Khan SS, Coresh J, Baker-Smith CM, Carnethon MR, Després JP, Ho JE, Joseph JJ, Kernan WN, Khera A, Kosiborod MN, Lekavich CL, Lewis EF, Lo KB, Ozkan B, Palaniappan LP, Patel SS, Pencina MJ, Powell-Wiley TM, Sperling LS, Virani SS, Wright JT, Rajgopal Singh R, Elkind MSV, Rangaswami J. A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1636-1664. [PMID: 37807920 DOI: 10.1161/cir.0000000000001186] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
A growing appreciation of the pathophysiological interrelatedness of metabolic risk factors such as obesity and diabetes, chronic kidney disease, and cardiovascular disease has led to the conceptualization of cardiovascular-kidney-metabolic syndrome. The confluence of metabolic risk factors and chronic kidney disease within cardiovascular-kidney-metabolic syndrome is strongly linked to risk for adverse cardiovascular and kidney outcomes. In addition, there are unique management considerations for individuals with established cardiovascular disease and coexisting metabolic risk factors, chronic kidney disease, or both. An extensive body of literature supports our scientific understanding of, and approach to, prevention and management for individuals with cardiovascular-kidney-metabolic syndrome. However, there are critical gaps in knowledge related to cardiovascular-kidney-metabolic syndrome in terms of mechanisms of disease development, heterogeneity within clinical phenotypes, interplay between social determinants of health and biological risk factors, and accurate assessments of disease incidence in the context of competing risks. There are also key limitations in the data supporting the clinical care for cardiovascular-kidney-metabolic syndrome, particularly in terms of early-life prevention, screening for risk factors, interdisciplinary care models, optimal strategies for supporting lifestyle modification and weight loss, targeting of emerging cardioprotective and kidney-protective therapies, management of patients with both cardiovascular disease and chronic kidney disease, and the impact of systematically assessing and addressing social determinants of health. This scientific statement uses a crosswalk of major guidelines, in addition to a review of the scientific literature, to summarize the evidence and fundamental gaps related to the science, screening, prevention, and management of cardiovascular-kidney-metabolic syndrome.
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Li X, Zhang X, Zeng Z, Mai W, Peng Z, Li B, Hong W, Liu Y, Shu F, Tang J, Xu L, Tan N, Ma J, Jiang L. Serum albumin and prognosis in elderly patients with nonischemic dilated cardiomyopathy. J Cardiovasc Med (Hagerstown) 2023; 24:752-757. [PMID: 37577864 PMCID: PMC10481926 DOI: 10.2459/jcm.0000000000001530] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/31/2023] [Accepted: 06/18/2023] [Indexed: 08/15/2023]
Abstract
AIMS Hypoalbuminemia was extensively used to diagnose malnutrition in older adults. Malnutrition was associated with mortality in elderly patients with cardiovascular diseases. The relationship between hypoalbuminemia and clinical outcomes in elderly patients with nonischemic dilated cardiomyopathy (NIDCM) remains unknown. METHODS A total of 1058 consecutive patients with NIDCM (age ≥60 years) were retrospectively enrolled from January 2010 to December 2019. Univariate and multivariate analyses were performed to assess the association of hypoalbuminemia with clinical outcomes. RESULTS Patients with hypoalbuminemia were older (69.29 ± 6.67 vs. 67.61 ± 5.90 years, P < 0.001) and had higher prevalence of in-hospital and long-term death than those without (6.9 vs. 1.7%, 50.7 vs. 35.2%, P < 0.001). Logistic regression analysis showed that hypoalbuminemia was significantly related to in-hospital death [odds ratio (OR): 4.334, 95% confidence interval (CI): 2.185-8.597, P < 0.001]. Kaplan-Meier survival analysis showed that patients with hypoalbuminemia had worse prognosis than those with nonhypoalbuminemia (log-rank χ2 28.96, P < 0.001). After adjusting for age, serum creatinine, HDL-C, AST/ALT hypoalbuminemia, LVEF and diabetes, hypoalbuminemia remained an independent predictor for long-term death (hazard ratio 1.322, 95% CI 0.046-1.670, P = 0.019). CONCLUSION Hypoalbuminemia was associated with increased risk of in-hospital and long-term mortality in elderly patients with NIDCM.
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Affiliation(s)
- Xinyi Li
- School of Medicine, South China University of Technology
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Xiaonan Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Zhigang Zeng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Wenzhi Mai
- School of Pharmacy, Guangdong Pharmaceutical University
| | - Zishan Peng
- The Second Clinical Medical School, Southern Medical University
| | - Binjia Li
- The Second Clinical Medical School, Southern Medical University
| | - Wanzi Hong
- School of Medicine, South China University of Technology
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Yaoxin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Fen Shu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Jiehua Tang
- The Third People's Hospital of Baiyun District, Guangzhou, China
| | - Lishu Xu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
| | - Jinjin Ma
- School of Medicine, South China University of Technology
| | - Lei Jiang
- School of Medicine, South China University of Technology
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University
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Bin Atan NMAS, Bin Hadi MF, Teoh VWY, Danaee M, Loch A. ARNI Versus Perindopril for Remodeling in HFrEF. A Cohort Study. J Cardiovasc Pharmacol Ther 2023; 28:10742484231195019. [PMID: 37635324 DOI: 10.1177/10742484231195019] [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] [Indexed: 08/29/2023]
Abstract
Introduction: Ventricular remodeling is a mal-adaptive process. Both angiotensin-converting enzyme inhibitors and sacubitril/valsartan have been shown to reverse remodeling in mostly uncontrolled observational studies. There is a lack of head-to-head studies. Methods: This cohort study compares the remodeling effects of angiotensin receptor blockers combined with a neprilysin inhibitor (ARNI) and perindopril in heart failure with reduced ejection fraction (HFrEF) patients between January 2017 and December 2020. Inclusion criteria: (i) age > 18 years, (ii) recent diagnosis of de-novo HFrEF (EF < 40%), (iii) baseline echocardiography performed not more than 2 months prior to treatment onset, and (iv) follow-up echocardiography performed not earlier than 6 months and not later than 18 months posttreatment onset. No prior treatment with renin-angiotensin-aldosterone system inhibitors was permitted in the ARNI group. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV) were analyzed. A two-way repeated measure ANOVA (for normally distributed) and generalized estimating equation test for nonnormally distributed interval dependent variables. Mean comparison between and within groups was performed using the Bonferroni test. Results: Following an average treatment period of 9 months, LVEF improved from 24.9% to 36.4% for ARNI and from 28.7% to 40.5% for perindopril, increments of 11.5% and 11.8% resp. (Bonferroni test [P ≤ .05]). LVEDV was reduced by 8.4 mL and 3.2 mL, and LVESV by 17.9 mL and 10.8 mL for ARNI and perindopril resp. Only the reduction of LVESV for ARNI was statistically significant (P = .007). Conclusion: Both ARNI and perindopril yielded a significant improvement in the LVEF within 9 months. The remodeling effect of ARNI seems stronger because of the greater improvements in left ventricular volumes.
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Affiliation(s)
| | | | | | - Mahmoud Danaee
- Department of Social and Preventive Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Alexander Loch
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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11
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Hou C, Hao X, Sun N, Luo X, Gao Z, Chen L, Liu X, Qin Z. Predicting Hospital Readmissions in Patients Receiving Novel-Dose Sacubitril/Valsartan Therapy: A Competing-Risk, Causal Mediation Analysis. J Cardiovasc Pharmacol Ther 2023; 28:10742484231219603. [PMID: 38099726 DOI: 10.1177/10742484231219603] [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] [Indexed: 12/18/2023]
Abstract
Backgrounds: Our study aimed to identify and predict patients with heart failure (HF) taking novel-dose Sacubitril/Valsartan (S/V) at risk for all-cause readmission, as well as investigate the possible role of left ventricular reverse remodeling (LVRR). Methods and results: There were 464 patients recruited from December 2017 to September 2021 in our hospital with a median follow-up of 660 days (range, 17-1494). Competing risk analysis with Gray's Test showed statistically significant differences in all-cause readmission (p-value< .001) across the three different dose groups. Models 1 and 2 were developed based on the results of univariable competing risk analysis, least absolute shrinkage and selection operator approach, backward stepwise regression, and multivariable competing risk analysis. The internal verification (data-splitting method) indicated that Model 1 had better discrimination, calibration, and clinical utility. The corresponding nomogram showed that patients aged 75 years and above, or taking the lowest-dose S/V (≤50 mg twice a day), or diagnosed with ventricular tachycardia, or valvular heart disease, or chronic obstructive pulmonary disease, or diabetes mellitus were at the highest risk of all-cause readmission. In the causal mediation analysis, LVRR was considered as a critical mediator that negatively affected the difference of novel-dose S/V in readmission. Conclusions: A significant association was detected between novel-dose S/V and all-cause readmission in HF patients, in part negatively mediated by LVRR. The web-based nomogram could provide individual prediction of all-cause readmission in HF patients receiving novel-dose S/V. The effects of different novel-dose S/V are still needed to be explored further in the future.
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Affiliation(s)
- Changchun Hou
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xinxin Hao
- Clinical Research Center, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ning Sun
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xiaolin Luo
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zhichun Gao
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ling Chen
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xi Liu
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zhexue Qin
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
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12
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Bhullar S, Shah A, Dhalla N. Mechanisms for the development of heart failure and improvement of cardiac function by angiotensin-converting enzyme inhibitors. SCRIPTA MEDICA 2022. [DOI: 10.5937/scriptamed53-36256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Angiotensin-converting enzyme (ACE) inhibitors, which prevent the conversion of angiotensin I to angiotensin II, are well-known for the treatments of cardiovascular diseases, such as heart failure, hypertension and acute coronary syndrome. Several of these inhibitors including captopril, enalapril, ramipril, zofenopril and imidapril attenuate vasoconstriction, cardiac hypertrophy and adverse cardiac remodeling, improve clinical outcomes in patients with cardiac dysfunction and decrease mortality. Extensive experimental and clinical research over the past 35 years has revealed that the beneficial effects of ACE inhibitors in heart failure are associated with full or partial prevention of adverse cardiac remodeling. Since cardiac function is mainly determined by coordinated activities of different subcellular organelles, including sarcolemma, sarcoplasmic reticulum, mitochondria and myofibrils, for regulating the intracellular concentration of Ca2+ and myocardial metabolism, there is ample evidence to suggest that adverse cardiac remodelling and cardiac dysfunction in the failing heart are the consequence of subcellular defects. In fact, the improvement of cardiac function by different ACE inhibitors has been demonstrated to be related to the attenuation of abnormalities in subcellular organelles for Ca2+-handling, metabolic alterations, signal transduction defects and gene expression changes in failing cardiomyocytes. Various ACE inhibitors have also been shown to delay the progression of heart failure by reducing the formation of angiotensin II, the development of oxidative stress, the level of inflammatory cytokines and the occurrence of subcellular defects. These observations support the view that ACE inhibitors improve cardiac function in the failing heart by multiple mechanisms including the reduction of oxidative stress, myocardial inflammation and Ca2+-handling abnormalities in cardiomyocytes.
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13
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Greenberg B. Medical Management of Patients With Heart Failure and Reduced Ejection Fraction. Korean Circ J 2022; 52:173-197. [PMID: 35257531 PMCID: PMC8907986 DOI: 10.4070/kcj.2021.0401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022] Open
Abstract
The options for treating heart failure with reduced ejection fraction (HFrEF) have expanded considerably over the past decade. While neurohormonal modulation using angiotensin converting enzyme inhibitors and angiotensin receptor blockers, beta blockers and mineralocorticoid receptor antagonists remain the cornerstone of therapy, additional novel approaches including angiotensin receptor neprilysin inhibitors, sodium glucose cotransporter 2 inhibitors, ivrabradine, vericiguat and omecamtiv mecarbil have been shown to improve outcomes in patients with HFrEF. This reviews summarizes currently available approaches as well as promising additional strategies that may be used in the future. Treatment options for patients with heart failure (HF) with reduced ejection fraction (HFrEF) have expanded considerably over the past few decades. Whereas neurohormonal modulation remains central to the management of patients with HFrEF, other pathways have been targeted with drugs that have novel mechanisms of action. The angiotensin receptor-neprilysin inhibitors (ARNIs) which enhance levels of compensatory molecules such as the natriuretic peptides while simultaneously providing angiotensin receptor blockade have emerged as the preferred strategy for inhibiting the renin angiotensin system. Sodium glucose cotransporter 2 (SGLT2) inhibitors which were developed as hypoglycemic agents have been shown to improve outcomes in patients with HF regardless of their diabetic status. These agents along with beta blockers and mineralocorticoid receptor antagonists are the core medical therapies for patients with HFrEF. Additional approaches using ivabradine to slow heart rate in patients with sinus rhythm, the hydralazine/isosorbide dinitrate combination to unload the heart, digoxin to provide inotropic support and vericiguat to augment cyclic guanosine monophosphate production have been shown in well-designed trials to have beneficial effects in the HFrEF population and are used as adjuncts to the core therapies in selected patients. This review provides an overview of the medical management of patients with HFrEF with focus on the major developments that have taken place in the field. It offers prospective of how these drugs should be employed in clinical practice and also a glimpse into some strategies that may prove to be useful in the future.
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Kutumova E, Kiselev I, Sharipov R, Lifshits G, Kolpakov F. Thoroughly Calibrated Modular Agent-Based Model of the Human Cardiovascular and Renal Systems for Blood Pressure Regulation in Health and Disease. Front Physiol 2021; 12:746300. [PMID: 34867451 PMCID: PMC8632703 DOI: 10.3389/fphys.2021.746300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Here we present a modular agent-based mathematical model of the human cardiovascular and renal systems. It integrates the previous models primarily developed by A. C. Guyton, F. Karaaslan, K. M. Hallow, and Y. V. Solodyannikov. We performed the model calibration to find an equilibrium state within the normal vital sign ranges for a healthy adult. We verified the model's abilities to reproduce equilibrium states with abnormal physiological values related to different combinations of cardiovascular diseases (such as systemic hypertension, chronic heart failure, pulmonary hypertension, etc.). For the model creation and validation, we involved over 200 scientific studies covering known models of the human cardiovascular and renal functions, biosimulation platforms, and clinical measurements of physiological quantities in normal and pathological conditions. We compiled detailed documentation describing all equations, parameters and variables of the model with justification of all formulas and values. The model is implemented in BioUML and available in the web-version of the software.
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Affiliation(s)
- Elena Kutumova
- Department of Computational Biology, Sirius University of Science and Technology, Sochi, Russia
- Laboratory of Bioinformatics, Federal Research Center for Information and Computational Technologies, Novosibirsk, Russia
- Biosoft.Ru, Ltd., Novosibirsk, Russia
| | - Ilya Kiselev
- Department of Computational Biology, Sirius University of Science and Technology, Sochi, Russia
- Laboratory of Bioinformatics, Federal Research Center for Information and Computational Technologies, Novosibirsk, Russia
- Biosoft.Ru, Ltd., Novosibirsk, Russia
| | - Ruslan Sharipov
- Department of Computational Biology, Sirius University of Science and Technology, Sochi, Russia
- Laboratory of Bioinformatics, Federal Research Center for Information and Computational Technologies, Novosibirsk, Russia
- Biosoft.Ru, Ltd., Novosibirsk, Russia
- Specialized Educational Scientific Center, Novosibirsk State University, Novosibirsk, Russia
| | - Galina Lifshits
- Laboratory for Personalized Medicine, Center of New Medical Technologies, Institute of Chemical Biology and Fundamental Medicine SB RAS, Novosibirsk, Russia
| | - Fedor Kolpakov
- Department of Computational Biology, Sirius University of Science and Technology, Sochi, Russia
- Laboratory of Bioinformatics, Federal Research Center for Information and Computational Technologies, Novosibirsk, Russia
- Biosoft.Ru, Ltd., Novosibirsk, Russia
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Stanford AH, Reyes M, Rios DR, Giesinger RE, Jetton JG, Bischoff AR, McNamara PJ. Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic Dysfunction. J Clin Med 2021; 10:jcm10194519. [PMID: 34640535 PMCID: PMC8509219 DOI: 10.3390/jcm10194519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 11/16/2022] Open
Abstract
Neonatal hypertension has been increasingly recognized in premature infants with bronchopulmonary dysplasia (BPD); of note, a sub-population of these infants may have impaired left ventricular (LV) diastolic function, warranting timely treatment to minimize long term repercussions. In this case series, enalapril, an angiotensin-converting enzyme (ACE) inhibitor, was started in neonates with systemic hypertension and echocardiography signs of LV diastolic dysfunction. A total of 11 patients were included with birth weight of 785 ± 239 grams and gestational age of 25.3 (24, 26.1) weeks. Blood pressure improvement was noticed within 2 weeks of treatment. Improvement in LV diastolic function indices were observed with a reduction in Isovolumic Relaxation Time (IVRT) from 63.1 ± 7.2 to 50.9 ± 7.4 msec and improvement in the left atrium size indexed to aorta (LA:Ao) from1.73 (1.43, 1.88) to 1.23 (1.07, 1.29). Neonatal systemic hypertension is often underappreciated in ex-preterm infants and may be associated with important maladaptive cardiac changes with long term implications. It is biologically plausible that identifying and treating LV diastolic dysfunction in neonates with systemic hypertension may have a positive modulator effect on cardiovascular health in childhood and beyond.
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Affiliation(s)
- Amy H. Stanford
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; (A.H.S.); (M.R.); (D.R.R.); (R.E.G.); (A.R.B.)
| | - Melanie Reyes
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; (A.H.S.); (M.R.); (D.R.R.); (R.E.G.); (A.R.B.)
| | - Danielle R. Rios
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; (A.H.S.); (M.R.); (D.R.R.); (R.E.G.); (A.R.B.)
| | - Regan E. Giesinger
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; (A.H.S.); (M.R.); (D.R.R.); (R.E.G.); (A.R.B.)
| | - Jennifer G. Jetton
- Division of Pediatric Nephrology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA;
| | - Adrianne R. Bischoff
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; (A.H.S.); (M.R.); (D.R.R.); (R.E.G.); (A.R.B.)
| | - Patrick J. McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; (A.H.S.); (M.R.); (D.R.R.); (R.E.G.); (A.R.B.)
- Department of Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
- Correspondence: ; Tel.: +1-319-467-7435
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Shukkoor AA, George NE, Radhakrishnan S, Velusamy S, Kaliappan T, Gopalan R, Anandan P, Palanimuthu R, Balasubramanian VR. Impact of Clinical Audit on Adherence to the Guidelines Directed Medical Therapy in Patients Admitted with Heart Failure. Curr Drug Saf 2021; 15:117-123. [PMID: 32156240 DOI: 10.2174/1574886315666200310114528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/19/2019] [Accepted: 02/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The adoption of guideline recommendations of pharmacotherapy to improve the clinical course of Heart Failure (HF) remains below par. Our objective is to evaluate the impact of clinical audit on adherence to the Guideline-Directed Medical Therapy (GDMT) in patients admitted with acute heart failure with reduced ejection fraction (EF). METHODS A prospective interventional study was conducted over a period of 12 months from June 2018 to May 2019 in all patients admitted with acute heart failure with reduced ejection fraction. The discharge prescriptions of patients who met the inclusion criteria were audited for appropriateness in the usage of neurohormonal blockers and Ivabradine, by a clinical pharmacist on a monthly basis. Audit results were presented to the practicing physicians every month and feedback was given. RESULTS Discharge prescriptions of 716 patients who presented with HF were audited for the reasonable or unreasonable omission of neurohormonal blocking drugs. The first-month audit revealed that the unreasonable omission of Angiotensin-Converting Enzyme Inhibitors/ Angiotensin Receptor Blockers/ Angiotensin Receptor Neprilisin Inhibitors ( ACEI/ARB/ARNI), Betablockers and Mineralocorticoid Receptor Antagonists (MRA) were 24.5%, 13.1%, and 9.09% respectively, which reduced to nil at the end of the study period (p=0.00). Initiation of Ivabradine before prescribing or achieving the target dose of Betablocker was noted in 38.18% of patients in the first month, which was also reduced to nil (p=0.00) at the end of the study. CONCLUSION This study reveals that periodic clinical audit improves adherence to GDMT in patients admitted with heart failure with reduced ejection fraction.
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Affiliation(s)
| | - Nimmy E George
- Department of Cardiology, PSG Hospitals, Tamilnadu, India
| | | | - Sivakumar Velusamy
- Department of Pharmacy Practice, PSG College of Pharmacy, Tamil Nadu, India
| | - Tamilarasu Kaliappan
- Department of Cardiology, PSG Institute of Medical Science and Research, Tamil Nadu, India
| | - Rajendiran Gopalan
- Department of Cardiology, PSG Institute of Medical Science and Research, Tamil Nadu, India
| | - Premkrishna Anandan
- Department of Cardiology, PSG Institute of Medical Science and Research, Tamil Nadu, India
| | - Ramasamy Palanimuthu
- Department of Cardiology, PSG Institute of Medical Science and Research, Tamil Nadu, India
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Suciu-Petrescu M, Truta A, Suciu MD, Trifa AP, Petrescu D, Roșianu HȘ, Sabin O, Popa DE, Macarie AE, Vesa ȘC, Buzoianu AD. Clinical impact of echocardiography parameters and molecular biomarkers in heart failure: Correlation of ACE2 and MCP-1 polymorphisms with echocardiography parameters: A comparative study. Exp Ther Med 2021; 22:686. [PMID: 33986851 DOI: 10.3892/etm.2021.10118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/08/2021] [Indexed: 12/15/2022] Open
Abstract
Heart failure is still the leading cause of hospitalization in patients over 65 years of age and is defined as a multifactorial pathology which involves environmental factors and also genetic predispositions. The aim of the present study was to evaluate a possible correlation between single nucleotide polymorphisms (SNPs) of angiotensin converting enzyme 2 (ACE2) and monocyte chemoattractant protein-1 (MCP-1) genes and cardiac remodeling in Caucasian patients diagnosed with heart failure. Our comparative translational research study included 116 patients diagnosed with heart failure and was carried out in Cluj-Napoca, Romania between September 2017 and March 2019. Three SNPs, namely rs4646156, rs4646174 and rs1024611, were genotyped using a Taqman real-time PCR technique. Our results showed that carriers of the AA genotype for ACE2 rs4646156 had a significant dilatation of the left ventricle (LV) with signs of LV hypertrophy (LVH), while TT carriers had a significant left atrial dilatation. For ACE2 rs4646174, homozygotes for the C allele presented a dilated LV with signs of LVH with statistical significance and had a tendency towards a lower ejection fraction. MCP-1 rs1024611 AA variant carriers had a significant LVH in the dominant model. In conclusion, our study showed a strong association between echocardiographic parameters of cardiac remodeling and SNPs rs4646156, rs4646174 of ACE2 and rs1024611 of MCP-1.
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Affiliation(s)
- Mălina Suciu-Petrescu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania.,Department of Cardiology, 'Regina Maria' Hospital, 400117 Cluj-Napoca, Romania
| | - Anamaria Truta
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Mihai Domnutiu Suciu
- Department of Urology, Clinical Institute of Urology and Kidney Transplant, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400066 Cluj-Napoca, Romania
| | - Adrian Pavel Trifa
- Department of Medical Genetics, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Denisa Petrescu
- Department of Endocrinology, Emergency Clinical County Hospital Cluj, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Horia Ștefan Roșianu
- Department of Cardiology, 'Niculae Stăncioiu' Heart Institute, 400001 Cluj-Napoca, Romania
| | - Octavia Sabin
- Department of Pharmacology, Toxicology and Clinical Pharmacology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Daciana Elena Popa
- Department of Cardiology, 'Niculae Stăncioiu' Heart Institute, 400001 Cluj-Napoca, Romania
| | - Antonia Eugenia Macarie
- Department of Geriatrics-Gerontology, 'Iuliu Haţieganu' University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania
| | - Ștefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Anca Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
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Butenas ALE, Colburn TD, Baumfalk DR, Ade CJ, Hageman KS, Copp SW, Poole DC, Musch TI. Angiotensin converting enzyme inhibition improves cerebrovascular control during exercise in male rats with heart failure. Respir Physiol Neurobiol 2021; 286:103613. [PMID: 33421609 DOI: 10.1016/j.resp.2020.103613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/21/2020] [Accepted: 12/27/2020] [Indexed: 01/08/2023]
Abstract
We investigated the effects of chronic (∼7 weeks) treatment with the angiotensin converting enzyme (ACE) inhibitor Captopril in rats with heart failure with reduced ejection fraction (HF-rEF) on brain blood flow (BF; radiolabeled microspheres) at rest and during submaximal exercise. We hypothesized that middle cerebral, posterior cerebral, and cerebellar BF during submaximal exercise (20 m/min, 5% incline) would be reduced in rats with HF-rEF (n = 10) compared to healthy (SHAM, n = 10) controls and HF-rEF rats chronically treated with Captopril (HF-rEF + Cap., n = 20). During submaximal exercise middle cerebral (HF-rEF + Cap.: 274 ± 12; HF-rEF: 234 ± 23; SHAM: 248 ± 24 ml/min/100 g) and cerebellar (HF-rEF + Cap.: 222 ± 14; HF-rEF: 243 ± 22; SHAM: 214 ± 23 ml/min/100 g) BF increased from rest in all groups with no difference among groups (P > 0.24). Posterior cerebral BF increased from rest in all groups but was lower than SHAM (394 ± 46 ml/min/100 g; P = 0.03) in HF-rEF (298 ± 19 ml/min/100 g) but not HF-rEF + Cap. (356 ± 18 ml/min/100 g; P = 0.14), supporting the concept that ACE inhibition in HF-rEF elevates brain BF increases, at least to the posterior cerebral region, during moderate intensity exercise/physical activity.
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Affiliation(s)
- Alec L E Butenas
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States
| | - Trenton D Colburn
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States
| | - Dryden R Baumfalk
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States
| | - Carl J Ade
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States
| | - K Sue Hageman
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, United States
| | - Steven W Copp
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States
| | - David C Poole
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States; Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, United States
| | - Timothy I Musch
- Department of Kinesiology, Kansas State University, Manhattan, KS, United States; Department of Anatomy and Physiology, Kansas State University, Manhattan, KS, United States.
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20
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Adachi Y, Kiyosue A, Ando J, Kawahara T, Kodera S, Minatsuki S, Kikuchi H, Inaba T, Kiriyama H, Hirose K, Shinohara H, Saito A, Fujiwara T, Hara H, Ueda K, Sakakura K, Hatano M, Harada M, Takimoto E, Akazawa H, Morita H, Momomura SI, Fujita H, Komuro I. Factors associated with left ventricular reverse remodelling after percutaneous coronary intervention in patients with left ventricular systolic dysfunction. Sci Rep 2021; 11:239. [PMID: 33420237 PMCID: PMC7794568 DOI: 10.1038/s41598-020-80491-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022] Open
Abstract
Percutaneous coronary intervention (PCI) is sometimes considered as an alternative therapeutic strategy to surgical revascularization in patients with coronary artery disease (CAD) and reduced left ventricular ejection fraction (LVEF). However, the types or conditions of patients that receive the clinical benefit of left ventricular reverse remodelling (LVRR) remain unknown. The purpose of this study was to investigate the determinants of LVRR following PCI in CAD patients with reduced LVEF. From 4394 consecutive patients who underwent PCI, a total of 286 patients with reduced LV systolic function (LVEF < 50% at initial left ventriculography) were included in the analysis. LVRR was defined as LV end-systolic volume reduction ≥ 15% and improvement of LVEF ≥ 10% at 6 months follow-up left ventriculography. Patients were divided into LVRR (n = 63) and non-LVRR (n = 223) groups. Multivariate logistic regression analysis revealed that unprotected left main coronary artery (LMCA) intervention was significantly associated with LVRR (P = 0.007, odds ratios [OR] 4.70, 95% confidence interval [CI] 1.54-14.38), while prior PCI (P = 0.001, OR 0.35, 95% CI 0.19-0.66), presence of in-stent restenosis (P = 0.016, OR 0.32, 95% CI 0.12-0.81), and presence of de-novo stenosis (P = 0.038, OR 0.36, 95% CI 0.14-0.95) were negatively associated with LVRR. These data suggest the potential prognostic benefit of unprotected LMCA intervention for LVRR and importance of angiographic follow-up in patients with CAD and LV systolic dysfunction.
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Affiliation(s)
- Yusuke Adachi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Arihiro Kiyosue
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Jiro Ando
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takuya Kawahara
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hironobu Kikuchi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshiro Inaba
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Kiriyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazutoshi Hirose
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroki Shinohara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akihito Saito
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takayuki Fujiwara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hironori Hara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazutaka Ueda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mutsuo Harada
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Eiki Takimoto
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Akazawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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21
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Pugliese NR, Masi S, Taddei S. The renin-angiotensin-aldosterone system: a crossroad from arterial hypertension to heart failure. Heart Fail Rev 2020; 25:31-42. [PMID: 31512149 DOI: 10.1007/s10741-019-09855-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The renin-angiotensin-aldosterone system (RAAS) plays a pivotal role in the regulation of blood pressure and volume homeostasis, promoting critical structural changes in every component of the cardiovascular system, including the heart and blood vessels. Consequently, the RAAS is a crucial therapeutic target for several chronic diseases of the cardiovascular system, spanning from arterial hypertension (AH) to heart failure (HF). AH represents a leading risk factor for the development of symptomatic HF, particularly with left ventricle (LV) preserved ejection fraction (HFpEF). LV diastolic dysfunction and cardiac remodelling are the first discernible manifestations of heart disease in patients with AH. Typically, AH develops many years before the diagnosis of overt HF, providing a therapeutic target for preventive strategies. Treatment of AH is based on different classes of antihypertensive drugs, which show differences in their capacity to prevent the evolution towards HF. The blockers of the RAAS are effective drugs to treat AH and prevent HF with reduced ejection fraction (HFrEF), but the evidence of the potential benefits in patients with HFpEF remains limited. In this review, the authors summarise data from several clinical trials of HFpEF and HFrEF, focusing on the mechanisms leading the transition from AH to HF and late complications.
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Affiliation(s)
- Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
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22
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Yu H, Tang W, Greasley PJ, Penland RC, Boulton DW, Hallow KM. Predicted Cardiac Hemodynamic Consequences of the Renal Actions of SGLT2i in the DAPA-HF Study Population: A Mathematical Modeling Analysis. J Clin Pharmacol 2020; 61:636-648. [PMID: 33091173 DOI: 10.1002/jcph.1769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022]
Abstract
The Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) study demonstrated that dapagliflozin, a sodium-glucose cotransporter-2 inhibitor (SGLT2i), reduced heart failure hospitalization and cardiovascular death in patients with heart failure with reduced ejection fraction (HF-rEF), with and without type 2 diabetes mellitus. Multiple potential mechanisms have been proposed to explain this benefit, which may be multifactorial. This study aimed to quantify the contribution of the known natriuretic/diuretic effects of SGLT2is to changes in cardiac hemodynamics, remodeling, and fluid homeostasis in the setting of HF-rEF. An integrated cardiorenal mathematical model was used to simulate inhibition of SGLT2 and its consequences on cardiac hemodynamics in a virtual population of HF-rEF patients generated by varying model parameters over physiologically plausible ranges and matching to baseline characteristics of individual DAPA-HF trial patients. Cardiovascular responses to placebo and SGLT2i over time were then simulated. The baseline characteristics of the HF-rEF virtual population and DAPA-HF were in good agreement. SGLT2i-induced diuresis and natriuresis that reduced blood volume and interstitial fluid volume, relative to placebo within 14 days. This resulted in decreased left ventricular end-diastolic volume and pressure, indicating reduced cardiac preload. Thereafter, blood volume and interstitial fluid volume again began to accumulate, but pressures and volumes remained shifted lower relative to placebo. After 1 year, left ventricle mass was lower and ejection fraction was higher than placebo. These simulations considered only hemodynamic consequences of the natriuretic/diuretic effects of SGLT2i, as other mechanisms may contribute additional benefits besides those predictions.
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Affiliation(s)
- Hongtao Yu
- School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, Georgia, USA
| | - Weifeng Tang
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Peter J Greasley
- Early Clinical Development, Research, and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Robert C Penland
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Boston, Massachusetts, USA
| | - David W Boulton
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - K Melissa Hallow
- School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, Georgia, USA
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA
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23
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Smeets NJL, Schreuder MF, Dalinghaus M, Male C, Lagler FB, Walsh J, Laer S, de Wildt SN. Pharmacology of enalapril in children: a review. Drug Discov Today 2020; 25:S1359-6446(20)30336-6. [PMID: 32835726 DOI: 10.1016/j.drudis.2020.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 12/28/2022]
Abstract
Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that is used for the treatment of (paediatric) hypertension, heart failure and chronic kidney diseases. Because its disposition, efficacy and safety differs across the paediatric continuum, data from adults cannot be automatically extrapolated to children. This review highlights paediatric enalapril pharmacokinetic data and demonstrates that these are inadequate to support with certainty an age-related effect on enalapril/enalaprilat pharmacokinetics. In addition, our review shows that evidence to support effective and safe prescribing of enalapril in children is limited, especially in young children and heart failure patients; studies in these groups are either absent or show conflicting results. We provide explanations for observed differences between age groups and indications, and describe areas for future research.
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Affiliation(s)
- Nori J L Smeets
- Department of Pharmacology and Toxicology, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, the Netherlands
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, Radboud Institute of Molecular Sciences, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Erasmus MC - Sophia, Rotterdam, the Netherlands
| | - Christoph Male
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | | | | | - Stephanie Laer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Saskia N de Wildt
- Department of Pharmacology and Toxicology, Radboud Institute of Health Sciences, Radboudumc, Nijmegen, the Netherlands; Department of Intensive Care and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.
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24
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Imamura T, Mehta P, Nguyen A, Chung B, Narang N, Rodgers D, Raikhelkar J, Smith B, Song T, Ota T, Jeevanandam V, Kim G, Sayer G, Uriel N. Neurohormonal Blockade During Left Ventricular Assist Device Support. ASAIO J 2020; 66:881-885. [PMID: 32740347 DOI: 10.1097/mat.0000000000001104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Neurohormonal blockade (NHB) is the mainstay of therapy for patients with systolic heart failure (HF). However, the efficacy in patients with left ventricular assist devices (LVADs) remains unknown. Of all, 114 LVAD patients (57 [48, 65] years old and 78% male) were enrolled and followed during the early period (6 months after index discharge), and 98 were followed during the late period (6-12 months following index discharge). Of them, 46% were on beta-blocker (BB), 49% on angiotensin-converting enzyme inhibitor (ACEi) and/or angiotensin II receptor blocker (ARB), and 51% on aldosterone antagonist at baseline. Prevalence of BB and ACEi/ARB use increased during the study period. During the early period, similar event rates were found irrespective of the NHB uses. During the late period, BB was associated with reduced HF readmission, and ACEi/ARB was associated with reduced HF readmission and gastrointestinal bleeding (p < 0.05 for all). In conclusion, BB and ACEi/ARB use during the late period was associated with a reduction in HF recurrence in LVAD patients. Further prospective randomized control trials are warranted to clarify the utility of NHB therapy in LVAD patients.
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Affiliation(s)
- Teruhiko Imamura
- From the Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Priya Mehta
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Ann Nguyen
- From the Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Ben Chung
- From the Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Nikhil Narang
- From the Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Daniel Rodgers
- From the Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Jayant Raikhelkar
- From the Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Bryan Smith
- From the Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Tae Song
- From the Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Takeyoshi Ota
- Section of Cardiothoracic Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Valluvan Jeevanandam
- Section of Cardiothoracic Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Gene Kim
- From the Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Gabriel Sayer
- From the Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Nir Uriel
- From the Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois
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25
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Yu H, Basu S, Hallow KM. Cardiac and renal function interactions in heart failure with reduced ejection fraction: A mathematical modeling analysis. PLoS Comput Biol 2020; 16:e1008074. [PMID: 32804929 PMCID: PMC7451992 DOI: 10.1371/journal.pcbi.1008074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/27/2020] [Accepted: 06/18/2020] [Indexed: 01/10/2023] Open
Abstract
Congestive heart failure is characterized by suppressed cardiac output and arterial filling pressure, leading to renal retention of salt and water, contributing to further volume overload. Mathematical modeling provides a means to investigate the integrated function and dysfunction of heart and kidney in heart failure. This study updates our previously reported integrated model of cardiac and renal functions to account for the fluid exchange between the blood and interstitium across the capillary membrane, allowing the simulation of edema. A state of heart failure with reduced ejection fraction (HF-rEF) was then produced by altering cardiac parameters reflecting cardiac injury and cardiovascular disease, including heart contractility, myocyte hypertrophy, arterial stiffness, and systemic resistance. After matching baseline characteristics of the SOLVD clinical study, parameters governing rates of cardiac remodeling were calibrated to describe the progression of cardiac hemodynamic variables observed over one year in the placebo arm of the SOLVD clinical study. The model was then validated by reproducing improvements in cardiac function in the enalapril arm of SOLVD. The model was then applied to prospectively predict the response to the sodium-glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin, which has been shown to reduce heart failure events in HF-rEF patients in the recent DAPAHF clinical trial by incompletely understood mechanisms. The simulations predict that dapagliflozin slows cardiac remodeling by reducing preload on the heart, and relieves congestion by clearing interstitial fluid without excessively reducing blood volume. This provides a quantitative mechanistic explanation for the observed benefits of SGLT2i in HF-rEF. The model also provides a tool for further investigation of heart failure drug therapies.
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Affiliation(s)
- Hongtao Yu
- School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, Georgia, United States of America
| | - Sanchita Basu
- School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, Georgia, United States of America
| | - K. Melissa Hallow
- School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, Georgia, United States of America
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, United States of America
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26
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Brener MI, Uriel N, Burkhoff D. Left Ventricular Volume Reduction and Reshaping as a Treatment Option for Heart Failure. STRUCTURAL HEART 2020. [DOI: 10.1080/24748706.2020.1777359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Dilated cardiomyopathy (DCM) represents one of the primary cardiomyopathies and may lead to heart failure and sudden death. Until recently, ventricular arrhythmias were considered to be a direct consequence of the systolic dysfunction of the left ventricle (LV) and guidelines for implantable cardioverter defibrillator implantation were established on this basis. However, the identification of heritable dilated cardiomyopathy phenotypes that presented with mildly impaired or moderate LV dysfunction, with or without chamber dilatation, and ventricular arrhythmias exceeding the degree of the underlying morphological abnormalities lead to the identification of the arrhythmogenic phenotypes and genotypes of DCM. This subset of DCM patients presents phenotypic and in many cases genotypic overlaps with left dominant arrhythmogenic cardiomyopathy (LDAC). LMNA, SCN5A, FLNC, TTN, and RBM20 are the main genes responsible for arrhythmogenic DCM. Moreover, desmosomal genes such as DSP and other non-desmosomal such as DES and PLN have been associated with both LDAC and arrhythmogenic DCM. The aim of this review is to highlight the importance of genetic profiling among DCM patients with disproportionate arrhythmic burden and the significance of the electrocardiogram, cardiac magnetic resonance, Holter monitoring, detailed family history, and other assays in order to identify red flags for arrhythmogenic DCM and proceed to an early preventive approach for sudden cardiac death. A special consideration was given to the phenotypic and genotypic overlap with LDAC. The role of myocarditis as a common disease expression of LDAC and arrhythmogenic DCM is also analyzed supporting the premise of their phenotypic overlap.
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Affiliation(s)
- Thomas Zegkos
- 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece.
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28
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Brann A, Tran H, Greenberg B. Contemporary approach to treating heart failure. Trends Cardiovasc Med 2019; 30:507-518. [PMID: 31901378 DOI: 10.1016/j.tcm.2019.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 01/01/2023]
Abstract
Over the past several decades, important advances have been made in the treatment of patients with heart failure (HF). Whereas in the past, the main goal of drug therapy was to relieve congestion, there is now compelling evidence from randomized clinical trials (RCTs) showing that several classes of drugs, most of which work predominantly by blocking or modulating neurohormonal activity, can substantially reduce morbidity and mortality as well as improve quality of life in patients with HF. Most of these trials, however, separated patients according to whether their ejection fraction (EF) was reduced (HFrEF) or preserved (HFpEF) and for the most part, favorable effects on clinical outcomes were demonstrated only in patients with HFrEF. In addition to the paucity of effective agents for managing patients with HFpEF, it has become apparent that underutilization of available therapies has greatly limited the overall impact of medical therapy on outcomes. This review provides an overview of current medical management of HF across the spectrum of EF, including the underutilization of treatment modalities. The focus is to provide clinicians the rationale for the use of specific agents and to present a practical approach for patient management. The strategies discussed are based on results of RCTs, guideline recommendations and the authors' own experience in managing patients with HF over the years.
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Affiliation(s)
- Alison Brann
- Department of Cardiology and the Sulpizio Family Cardiovascular Center, University of California, San Diego Medical Center, La Jolla, CA, United States
| | - Hao Tran
- Department of Cardiology and the Sulpizio Family Cardiovascular Center, University of California, San Diego Medical Center, La Jolla, CA, United States
| | - Barry Greenberg
- Department of Cardiology and the Sulpizio Family Cardiovascular Center, University of California, San Diego Medical Center, La Jolla, CA, United States.
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29
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Mount S, Kanda P, Parent S, Khan S, Michie C, Davila L, Chan V, Davies RA, Haddad H, Courtman D, Stewart DJ, Davis DR. Physiologic expansion of human heart-derived cells enhances therapeutic repair of injured myocardium. Stem Cell Res Ther 2019; 10:316. [PMID: 31685023 PMCID: PMC6829847 DOI: 10.1186/s13287-019-1418-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/03/2019] [Accepted: 09/13/2019] [Indexed: 01/08/2023] Open
Abstract
Background Serum-free xenogen-free defined media and continuous controlled physiological cell culture conditions have been developed for stem cell therapeutics, but the effect of these conditions on the relative potency of the cell product is unknown. As such, we conducted a head-to-head comparison of cell culture conditions on human heart explant-derived cells using established in vitro measures of cell potency and in vivo functional repair. Methods Heart explant-derived cells cultured from human atrial or ventricular biopsies within a serum-free xenogen-free media and a continuous physiological culture environment were compared to cells cultured under traditional (high serum) cell culture conditions in a standard clean room facility. Results Transitioning from traditional high serum cell culture conditions to serum-free xenogen-free conditions had no effect on cell culture yields but provided a smaller, more homogenous, cell product with only minor antigenic changes. Culture within continuous physiologic conditions markedly boosted cell proliferation while increasing the expression of stem cell-related antigens and ability of cells to stimulate angiogenesis. Intramyocardial injection of physiologic cultured cells into immunodeficient mice 1 week after coronary ligation translated into improved cardiac function and reduced scar burden which was attributable to increased production of pro-healing cytokines, extracellular vesicles, and microRNAs. Conclusions Continuous physiological cell culture increased cell growth, paracrine output, and treatment outcomes to provide the greatest functional benefit after experimental myocardial infarction.
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Affiliation(s)
- Seth Mount
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, University of Ottawa, H3214 40 Ruskin Ave, Ottawa, ON, K1Y4W7, Canada
| | - Pushpinder Kanda
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, University of Ottawa, H3214 40 Ruskin Ave, Ottawa, ON, K1Y4W7, Canada
| | - Sandrine Parent
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, University of Ottawa, H3214 40 Ruskin Ave, Ottawa, ON, K1Y4W7, Canada
| | - Saad Khan
- Ottawa Hospital Research Institute, Division of Regenerative Medicine, Department of Medicine, University of Ottawa, Ottawa, K1H8L6, Canada
| | - Connor Michie
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, University of Ottawa, H3214 40 Ruskin Ave, Ottawa, ON, K1Y4W7, Canada
| | - Liliana Davila
- Ottawa Hospital Research Institute, Division of Regenerative Medicine, Department of Medicine, University of Ottawa, Ottawa, K1H8L6, Canada
| | - Vincent Chan
- University of Ottawa Heart Institute, Division of Cardiac Surgery, Department of Medicine, University of Ottawa, Ottawa, K1Y4W7, Canada
| | - Ross A Davies
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, University of Ottawa, H3214 40 Ruskin Ave, Ottawa, ON, K1Y4W7, Canada
| | | | - David Courtman
- Ottawa Hospital Research Institute, Division of Regenerative Medicine, Department of Medicine, University of Ottawa, Ottawa, K1H8L6, Canada
| | - Duncan J Stewart
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, University of Ottawa, H3214 40 Ruskin Ave, Ottawa, ON, K1Y4W7, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, K1H8M5, Canada.,Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, K1H8L6, Canada
| | - Darryl R Davis
- University of Ottawa Heart Institute, Division of Cardiology, Department of Medicine, University of Ottawa, H3214 40 Ruskin Ave, Ottawa, ON, K1Y4W7, Canada. .,Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, K1H8L6, Canada.
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Abstract
Advanced heart failure (HF) is a progressive disease characterized by recurrent hospitalizations and high risk of mortality. Indeed, outcomes in late stages of HF approximate those seen in patients with various aggressive malignancies. Clinical trials assessing beneficial outcomes of new treatments in patients with cancer have used innovative approaches to measure impact on total disease burden or surrogates to assess treatment efficacy. Although most cardiovascular outcomes trials continue to use time-to-first event analyses to assess the primary efficacy end point, such analyses do not adequately reflect the impact of new treatments on the totality of the chronic disease burden. Consequently, patient enrichment and other strategies for ongoing clinical trial design, as well as new statistical methodologies, are important considerations, particularly when studying a population with advanced chronic HF. The DREAM-HF trial (Double-Blind Randomized Assessment of Clinical Events With Allogeneic Mesenchymal Precursor Cells in Advanced Heart Failure) is an ongoing, randomized, sham-controlled phase 3 study of the efficacy and safety of mesenchymal precursor cells as immunotherapy in patients with advanced chronic HF with reduced ejection fraction. Mesenchymal precursor cells have a unique multimodal mechanism of action that is believed to result in polarization of proinflammatory type 1 macrophages in the heart to an anti-inflammatory type 2 macrophage state, inhibition of maladaptive adverse left ventricular remodeling, reversal of cardiac and peripheral endothelial dysfunction, and recovery of deranged vasculature. The objective of DREAM-HF is to confirm earlier phase 2 results and evaluate whether mesenchymal precursor cells will reduce the rate of nonfatal recurrent HF-related major adverse cardiac events while delaying or preventing progression of HF to terminal cardiac events. DREAM-HF is an example of an ongoing contemporary events-driven cardiovascular cell-based immunotherapy study that has utilized the concepts of baseline disease enrichment, prognostic enrichment, and predictive enrichment to improve its efficiency by using accumulating data from within as well as external to the trial. Adaptive enrichment designs and strategies are important components of a rational approach to achieve clinical research objectives in shorter clinical trial timelines and with increased cost-effectiveness without compromising ethical standards or the overall statistical integrity of the study. The DREAM-HF trial also presents an alternative approach to traditional composite time-to-first event primary efficacy end points. Statistical methodologies such as the joint frailty model provide opportunities to expand the scope of events-driven HF with reduced ejection fraction clinical trials to utilize time to recurrent nonfatal HF-related major adverse cardiac events as the primary efficacy end point without compromising the integrity of the statistical analyses for terminal cardiac events. In advanced chronic HF with reduced ejection fraction studies, the joint frailty model is utilized to reflect characteristics of the high-risk patient population with important unmet therapeutic needs. In some cases, use of the joint frailty model may substantially reduce sample size requirements. In addition, using an end point that is acceptable to the Food and Drug Administration and the European Medicines Agency, such as recurrent nonfatal HF-related major adverse cardiac events, enables generation of clinically relevant pharmacoeconomic data while providing comprehensive views of the patient's overall cardiovascular disease burden. The major goal of this review is to provide lessons learned from the ongoing DREAM-HF trial that relate to biologic plausibility and flexible clinical trial design and are potentially applicable to other development programs of innovative therapies for patients with advanced cardiovascular disease. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02032004.
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Affiliation(s)
| | | | - Barry Greenberg
- University of California, San Diego School of Medicine, La Jolla (B.G.)
- Advanced Heart Failure Treatment Program, Sulpizio Cardiovascular Center, University of California, San Diego Healthcare System, La Jolla (B.G.)
| | - Emerson C. Perin
- Stem Cell Center and Adult Cardiology, Texas Heart Institute, Houston (E.C.P.)
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31
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McCallum W, Tighiouart H, Ku E, Salem D, Sarnak MJ. Acute declines in estimated glomerular filtration rate on enalapril and mortality and cardiovascular outcomes in patients with heart failure with reduced ejection fraction. Kidney Int 2019; 96:1185-1194. [PMID: 31420191 DOI: 10.1016/j.kint.2019.05.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/07/2019] [Accepted: 05/23/2019] [Indexed: 12/28/2022]
Abstract
Angiotensin-converting enzyme inhibitors are beneficial in heart failure with reduced ejection fraction but are associated with acute declines in estimated glomerular filtration rate (eGFR). Prior studies evaluating thresholds of eGFR decline while using angiotensin-converting enzyme inhibitors in heart failure with reduced ejection have not taken into account this medication-driven decline. Here we used data from the Studies of Left Ventricular Dysfunction (SOLVD) trial of 6245 patients and performed Cox proportional hazards regression models to calculate hazard ratios of all-cause mortality and heart failure hospitalization-associated with percent eGFR decline at two- and six-weeks after randomization to enalapril versus placebo. In reference to placebo with equal degree of percent eGFR decline, any eGFR decline in the enalapril arm was associated with lower hazard of both outcomes. Under a conservative estimate using zero percent eGFR decline in the placebo arm as the reference, up to a 10% decline with enalapril was associated with mortality benefit (hazard ratio 0.87 [95% confidence interval 0.77, 0.99]) while up to a 35% decline was associated with decreased risk of heart failure hospitalization (0.78 [0.61, 0.98]). Under an intermediate estimate, up to a 15% decline with enalapril was associated with a mortality benefit (0.86 [0.77, 0.97]) and all levels of eGFR decline were associated with decreased risk of heart failure hospitalization. There was no percent eGFR decline, including up to 40%, in any models at either two- or six-weeks where enalapril was associated with higher mortality risk. Thus, in patients with reduced ejection fraction heart failure, enalapril is associated with decreased risk of mortality and heart failure hospitalizations. Hence, compelling reasons beyond moderate eGFR decline ought to be considered before its use is withdrawn.
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Affiliation(s)
- Wendy McCallum
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts, USA
| | - Elaine Ku
- Division of Nephrology and Pediatric Nephrology, University of California San Francisco, San Francisco, California, USA
| | - Deeb Salem
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mark J Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA.
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Dziewięcka E, Wiśniowska-Śmiałek S, Khachatryan L, Karabinowska A, Szymonowicz M, Podolec P, Rubiś P. Relationships between left ventricular geometry and remodeling in dilated cardiomyopathy. Minerva Cardioangiol 2019; 67:261-271. [PMID: 31115242 DOI: 10.23736/s0026-4725.19.04856-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Since left ventricular reverse remodeling (LVRR) and sphericity index (SI) are correlated with DCM patients' survival, we attempted to establish the relationship between LVRR, SI and left ventricle (LV) dimensions. METHODS In 70 DCM patients, we measured EF, LV transverse (sLVd) and longitudinal (lLVd) diameters at hospital admission, then after 3 and 12 months. SI was assessed thus: SI=sLVd/lLVd. RESULTS LVRR was present in 32 patients (52%). SI measurements were similar in LVRR-present and -absent groups at baseline (0.71 vs. 0.70) and differed after 3 and 12 months (0.61 vs. 0.72, P<0.005; 0.59 vs. 0.73, P<0.001; respectively). During 12 months, SI and sLVd decreased in the LVRR-present (0.71 vs. 0.61 vs. 0.59, P<0.05; 5.75 vs. 5.00 vs. 4.82 cm, P<0.001; respectively) and increased in the LVRR-absent cohort (0.70 vs. 0.72 vs. 0.73, P<0.001; 6.01 vs. 6.15 vs. 6.67, P<0.001; respectively). lLVd remained stable (8.23 vs. 8.16 vs. 8.38cm; 8.66 vs. 8.85 vs. 9.13 cm; respectively). SI was significantly correlated with sLVd but not with lLVd. At 3-month follow-up, SI (P<0.005, OR=14000 [95% CI: 5 - 3.9*107]) was found to be a significant LVRR predictor via univariate logistic regression. CONCLUSIONS To summarize, changes in sLVd are crucial for changes in LV geometry, whereas lLVd has a negligible effect on this process. The presence of LVRR was not always associated with an improvement in SI and its absence with increase in SI. Since the assessment of SI is less complex than LVRR, SI as a significant LVRR predictor can be useful part of a regular echocardiography examination.
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Affiliation(s)
- Ewa Dziewięcka
- Department of Cardiac and Vascular Diseases, Medical College, John Paul II Hospital, Jagiellonian University, Krakow, Poland -
| | - Sylwia Wiśniowska-Śmiałek
- Department of Cardiac and Vascular Diseases, Medical College, John Paul II Hospital, Jagiellonian University, Krakow, Poland
| | - Lusine Khachatryan
- Department of Cardiac and Vascular Diseases, Medical Collage, Jagiellonian University, Krakow, Poland
| | - Aleksandra Karabinowska
- Department of Cardiac and Vascular Diseases, Medical Collage, Jagiellonian University, Krakow, Poland
| | - Maria Szymonowicz
- Department of Cardiac and Vascular Diseases, Medical Collage, Jagiellonian University, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Medical College, John Paul II Hospital, Jagiellonian University, Krakow, Poland
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Medical College, John Paul II Hospital, Jagiellonian University, Krakow, Poland
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Higuchi S, Kohsaka S, Shiraishi Y, Katsuki T, Nagatomo Y, Mizuno A, Sujino Y, Kohno T, Goda A, Yoshikawa T. Association of renin-angiotensin system inhibitors with long-term outcomes in patients with systolic heart failure and moderate-to-severe kidney function impairment. Eur J Intern Med 2019; 62:58-66. [PMID: 30737061 DOI: 10.1016/j.ejim.2019.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/18/2019] [Accepted: 01/29/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Although guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF) should be treated with renin-angiotensin system (RAS) inhibitors, the long-term efficacy of RAS inhibitors in HFrEF patients with moderate-to-severe chronic kidney disease (CKD) remains unclear. METHODS The present study included consecutive patients hospitalized for acute heart failure across five Japanese teaching hospitals. The impact of RAS inhibitors on 2-year all-cause mortality was evaluated in patients with an ejection fraction ≤40% and CKD, defined as an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2, at discharge. Its severity was subclassified from 3B to 5 according to eGFR. RESULTS Overall, 553 patients (age, 76 ± 11 years; 68% male) were included. RAS inhibitors were prescribed more frequently in 227 patients with stage 3B (71.2%) than in 107 patients with stage 4 or 5 CKD (45.7%). All-cause mortality was recorded in 119 patients (23.4%) (55 [18.5%] patients with stage 3B; 64 [30.3%] patients with stage 4 or 5 CKD), within the median follow-up period of 609 (220-983) days. After many-to-one propensity score matching (87 pairs in stage 3; 60 pairs in stage 4 or 5 CKD), those with RAS inhibitors had reduced mortality rate in stage 3B (hazard ratio [HR], 0.39; 95% confidence interval [CI], 0.19-0.83) but not in stage 4 or 5 CKD (HR, 1.08; 95% CI, 0.57-2.03). CONCLUSIONS In HFrEF patients with CKD, RAS inhibitors are associated with reduction in mortality in stage 3B CKD, but the association is less clear in stage 4 or 5 CKD.
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Affiliation(s)
- Satoshi Higuchi
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan.
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Toshiomi Katsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuji Nagatomo
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yasumori Sujino
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ayumi Goda
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan
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35
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van Dissel AC, Winter MM, van der Bom T, Vliegen HW, van Dijk AP, Pieper PG, Sieswerda GT, Roos-Hesselink JW, Zwinderman AH, Mulder BJ, Bouma BJ. Long-term clinical outcomes of valsartan in patients with a systemic right ventricle: Follow-up of a multicenter randomized controlled trial. Int J Cardiol 2019; 278:84-87. [DOI: 10.1016/j.ijcard.2018.11.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/18/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022]
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36
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Germano G, Slomka PJ. Assessing LV remodeling in nuclear cardiology. J Nucl Cardiol 2019; 26:233-235. [PMID: 28616800 DOI: 10.1007/s12350-017-0957-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Guido Germano
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
| | - Piotr J Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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37
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Bourke JP, Watson G, Muntoni F, Spinty S, Roper H, Guglieri M, Speed C, McColl E, Chikermane A, Jayawant S, Adwani S, Willis T, Wilkinson J, Bryant A, Chadwick T, Wood R, Bushby K. Randomised placebo-controlled trial of combination ACE inhibitor and beta-blocker therapy to prevent cardiomyopathy in children with Duchenne muscular dystrophy? (DMD Heart Protection Study): a protocol study. BMJ Open 2018; 8:e022572. [PMID: 30573480 PMCID: PMC6303652 DOI: 10.1136/bmjopen-2018-022572] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 10/15/2018] [Accepted: 10/19/2018] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Although cardiologists were 'late-comers' to the multidisciplinary team-contributing to the complex care of patients with Duchenne muscular dystrophy (DMD), they now recognise the importance of systematic cardiac surveillance and timely therapy to prolonged survival in patients with DMD. Empirical deployment of cardioactive medications has already improved outcomes, but the evidence base for clinical decision making is weak. Fundamental questions remain as to whether prophylactic therapy is justified and convincingly superior to prompt deployment of the same therapies once left ventricular (LV) dysfunction is detected. Even if it were, at what age should therapy be introduced and with what specific drugs? METHODS AND ANALYSIS We are conducting a multicentre, parallel group, randomised, placebo-controlled study of combination therapy with an ACE inhibitor (perindopril) and a beta-blocker (bisoprolol) in boys with DMD aged 5-13 years, with normal LV function by echocardiographic criteria at the time of recruitment. Boys are being followed-up for a minimum of 3 years and a maximum of 5 years and undergo repeat assessments of LV function, heart rate and ECG, forced expiratory volume in the 1 s and forced vital capacity, adverse event reporting and quality of life at 6 monthly intervals.The primary outcome is change in LV function between active and placebo-treated participants over the course of the study. ETHICS AND DISSEMINATION The study was approved by 'NRES Committee East Midlands - Derby'. The results will be disseminated through manuscript publications, an international workshop and presentations to scientific meetings and parent forums. TRANSLATIONAL ASPECTS The study seeks to establish the evidence for prophylactic heart therapies for children with DMD, define the optimum age for their introduction and identify any safety concerns. ARTICLE SUMMARY The protocol describes the design of an ongoing multicentre, double-blind, randomised placebo-controlled study to establish the evidence for the use of prophylactic heart therapies in children with DMD, define the optimum age for their introduction and identify any safety concerns. TRIAL REGISTRATION NUMBERS EudraCT2007-005932-10 and ISRCTN50395346; Pre-results.
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Affiliation(s)
- John P Bourke
- Department of Cardiology, Freeman Hospital, NUTH NHS Hospitals Foundation Trust, Newcastle upon Tyne, Tyne & Wear, UK
| | - Gillian Watson
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Francesco Muntoni
- Developmental Neuroscience, Dubowitz Neuromuscular Centre, London, UK
- Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stefan Spinty
- Department of Paediatric Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Helen Roper
- Department of Paediatrics, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Michela Guglieri
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle upon Tyne, Tyne & Wear, UK
| | - Chris Speed
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Ashish Chikermane
- Department of Cardiology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Sandeep Jayawant
- Department of Paediatric Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Satish Adwani
- Department of Paediatric Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tracey Willis
- Muscle Team, Robert Jones and Agnes Hunt Hospital, Oswestry, UK
| | | | - Andrew Bryant
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas Chadwick
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth Wood
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Kate Bushby
- John Walton Muscular Dystrophy Research Centre, Newcastle University, Newcastle upon Tyne, Tyne & Wear, UK
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Krupickova S, Li W, Cheang MH, Rigby ML, Uebing A, Davlouros P, Dimopoulos K, Di Salvo G, Fraisse A, Swan L, Alonso-Gonzalez R, Kempny A, Pennell DJ, Senior R, Gatzoulis MA, Babu-Narayan SV. Ramipril and left ventricular diastolic function in stable patients with pulmonary regurgitation after repair of tetralogy of Fallot. Int J Cardiol 2018; 272:64-69. [DOI: 10.1016/j.ijcard.2018.07.132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/11/2018] [Accepted: 07/25/2018] [Indexed: 01/15/2023]
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Lee HF, See LC, Chan YH, Yeh YH, Wu LS, Liu JR, Tu HT, Wang CL, Kuo CT, Chang SH. End-stage renal disease patients using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may reduce the risk of mortality: a Taiwanese Nationwide cohort study. Intern Med J 2018; 48:1123-1132. [DOI: 10.1111/imj.13971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 05/06/2018] [Accepted: 05/17/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Hsin-Fu Lee
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine; Chang Gung University; Taoyuan Taiwan
- Biostatistics Core Laboratory, Molecular Medicine Research Center; Chang Gung University; Taoyuan Taiwan
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine; Chang Gung Memorial Hospital; Linkou Taiwan
| | - Yi-Hsin Chan
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
| | - Yung-Hsin Yeh
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
| | - Lung-Sheng Wu
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
| | - Jia-Rou Liu
- Department of Public Health, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Hui-Tzu Tu
- Department of Public Health, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Chun-Li Wang
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
| | - Chi-Tai Kuo
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
| | - Shang-Hung Chang
- Department of Cardiology, Chang Gung Memorial Hospital; Chang Gung University; Linkou Taiwan
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40
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Gulati G, Udelson JE. Heart Failure With Improved Ejection Fraction: Is it Possible to Escape One's Past? JACC-HEART FAILURE 2018; 6:725-733. [PMID: 30098965 DOI: 10.1016/j.jchf.2018.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 12/12/2022]
Abstract
Among patients with heart failure with reduced ejection fraction, investigators have repeatedly identified a subgroup whose left ventricular ejection fraction and structural remodeling can improve to normal or nearly normal levels with or without medical therapy. This subgroup of patients with "heart failure with improved ejection fraction" has distinct clinical characteristics and a more favorable prognosis compared with patients who continue to have reduced ejection fraction. However, many of these patients also manifest clinical and biochemical signs of incomplete resolution of heart failure pathophysiology and remain at some risk of adverse outcomes, thus indicating that they may not have completely recovered. Although rigorous evidence on managing these patients is sparse, there are several reasons to recommend continuation of heart failure therapies, including device therapies, to prevent clinical deterioration. Notable exceptions to this recommendation may include patients who recover from peripartum cardiomyopathy, fulminant myocarditis, or stress cardiomyopathy, whose excellent long-term prognoses may imply true myocardial recovery. More research on these patients is needed to better understand the mechanisms that lead to improvement in ejection fraction and to guide their clinical management.
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Affiliation(s)
- Gaurav Gulati
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - James E Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts.
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Gong FF, Campbell DJ, Prior DL. Noninvasive Cardiac Imaging and the Prediction of Heart Failure Progression in Preclinical Stage A/B Subjects. JACC Cardiovasc Imaging 2018; 10:1504-1519. [PMID: 29216977 DOI: 10.1016/j.jcmg.2017.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 10/25/2017] [Accepted: 11/01/2017] [Indexed: 12/16/2022]
Abstract
Heart failure (HF) continues to grow as a cause of morbidity and mortality in our community and presents a significant public health problem, predominantly in individuals ≥65 years of age. Early intervention in asymptomatic HF subjects (Stage A/B) at risk of progression to symptomatic HF (Stage C/D) may provide an opportunity to halt this epidemic. The ability of cardiac imaging to assess cardiac structure and function permits early identification of those at increased risk of developing symptomatic HF. Systolic, diastolic, and structural left ventricular parameters each predict symptomatic HF, but no single parameter has sufficient sensitivity for screening to identify individuals with Stage A/B HF who are at increased risk of disease progression. Transthoracic echocardiography (TTE) has the advantage over other imaging modalities in being able to measure systolic, diastolic, and structural left ventricular parameters, and it identified at least 1 abnormal parameter in >50% of individuals with Stage A/B HF ≥65 years of age. Moreover, identification of at least 1 abnormality according to TTE in individuals with Stage A/B HF ≥65 years of age had 72% to 82% sensitivity for detection of those who subsequently developed symptomatic HF. Therefore, a case can be made for cardiac imaging by using TTE for community-dwelling populations with Stage A/B HF ≥65 years of age to identify those with increased risk of symptomatic HF who can be offered preventative therapies. Further studies are required to determine the best strategy for identifying the risk of symptomatic HF in younger individuals.
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Affiliation(s)
- Fei Fei Gong
- Department of Medicine, University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Institute of Medical Research, Fitzroy, Australia
| | - Duncan J Campbell
- Department of Medicine, University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Institute of Medical Research, Fitzroy, Australia
| | - David L Prior
- Department of Medicine, University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, Australia; Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy Australia.
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Sharma M, Patel RK, Krishnamurthy M, Snyder R. Determining the Role of Intravenous Hydration on Hospital Readmissions for Acute Congestive Heart Failure. Clin Pract 2018; 8:981. [PMID: 29383227 PMCID: PMC5768159 DOI: 10.4081/cp.2018.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/19/2017] [Accepted: 10/11/2017] [Indexed: 11/23/2022] Open
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Giustino G, Redfors B, Brener SJ, Kirtane AJ, Généreux P, Maehara A, Dudek D, Neunteufl T, Metzger DC, Crowley A, Mehran R, Gibson CM, Stone GW. Correlates and prognostic impact of new-onset heart failure after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: insights from the INFUSE-AMI trial. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:339-347. [DOI: 10.1177/2048872617719649] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The determinants and significance of early (30-day) heart failure symptoms after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) remain unclear. We investigated the clinical and imaging correlates of early post-discharge heart failure in patients with STEMI, and evaluated its impact on clinical outcomes. Methods: Patients from the INFUSE-AMI trial were categorized according to New York Heart Association (NYHA) functional classification at their 30-day visit (NYHA class ≥2 versus 1). Independent correlates of NYHA class ≥2 were determined by multivariable logistic regression. A landmark analysis beyond 30 days was performed to assess the impact of 30-day NYHA class ≥2 on 1-year risk of death or hospitalization for heart failure. Results: Among 402 patients enrolled in the INFUSE-AMI trial with data on NYHA class at 30 days, 76 (18.9%) had NYHA class ≥2. Independent correlates of 30-day NYHA class ≥2 were age, Killip class ≥2 at presentation, heart rate at presentation, intraprocedural no-reflow, and 30-day infarct size (% total ventricular mass). After adjustment for infarct size, patients with NYHA class ≥2 remained at higher risk of death or hospitalization for heart failure at 1-year follow-up compared to those in NYHA class 1 (11.8% vs. 2.8%, adjusted hazard ratio 3.78, 95% confidence interval 1.16–12.22, P=0.03). Conclusions: Clinical, procedural, and imaging variables predict the development of clinical heart failure after primary percutaneous coronary intervention in patients with STEMI. Early post-discharge heart failure symptoms identify a high-risk patient cohort for subsequent heart failure hospitalization and death, independent of infarct size. Trial Registration: ClinicalTrials.gov ; NCT00976521
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Affiliation(s)
- Gennaro Giustino
- Zena and Michael A Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, USA
- Clinical Trials Center, Cardiovascular Research Foundation, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, USA
| | - Sorin J Brener
- Clinical Trials Center, Cardiovascular Research Foundation, USA
- Department of Medicine, New York Methodist Hospital, USA
| | - Ajay J Kirtane
- Clinical Trials Center, Cardiovascular Research Foundation, USA
- Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, USA
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, USA
- Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Canada
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, USA
- Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, USA
| | - Dariusz Dudek
- Department of Medicine, Department of Interventional Cardiology, Jagiellonian University Medical College, Poland
| | | | | | - Aaron Crowley
- Clinical Trials Center, Cardiovascular Research Foundation, USA
| | - Roxana Mehran
- Zena and Michael A Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, USA
- Clinical Trials Center, Cardiovascular Research Foundation, USA
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, USA
- Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, USA
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Stankovic I, Belmans A, Prinz C, Ciarka A, Maria Daraban A, Kotrc M, Aarones M, Szulik M, Winter S, Neskovic AN, Kukulski T, Aakhus S, Willems R, Fehske W, Penicka M, Faber L, Voigt JU. The association of volumetric response and long-term survival after cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2017; 18:1109-1117. [DOI: 10.1093/ehjci/jex188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/26/2017] [Indexed: 01/22/2023] Open
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Shen L, Jhund PS, Petrie MC, Claggett BL, Barlera S, Cleland JGF, Dargie HJ, Granger CB, Kjekshus J, Køber L, Latini R, Maggioni AP, Packer M, Pitt B, Solomon SD, Swedberg K, Tavazzi L, Wikstrand J, Zannad F, Zile MR, McMurray JJV. Declining Risk of Sudden Death in Heart Failure. N Engl J Med 2017; 377:41-51. [PMID: 28679089 DOI: 10.1056/nejmoa1609758] [Citation(s) in RCA: 345] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The risk of sudden death has changed over time among patients with symptomatic heart failure and reduced ejection fraction with the sequential introduction of medications including angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, and mineralocorticoid-receptor antagonists. We sought to examine this trend in detail. METHODS We analyzed data from 40,195 patients who had heart failure with reduced ejection fraction and were enrolled in any of 12 clinical trials spanning the period from 1995 through 2014. Patients who had an implantable cardioverter-defibrillator at the time of trial enrollment were excluded. Weighted multivariable regression was used to examine trends in rates of sudden death over time. Adjusted hazard ratios for sudden death in each trial group were calculated with the use of Cox regression models. The cumulative incidence rates of sudden death were assessed at different time points after randomization and according to the length of time between the diagnosis of heart failure and randomization. RESULTS Sudden death was reported in 3583 patients. Such patients were older and were more often male, with an ischemic cause of heart failure and worse cardiac function, than those in whom sudden death did not occur. There was a 44% decline in the rate of sudden death across the trials (P=0.03). The cumulative incidence of sudden death at 90 days after randomization was 2.4% in the earliest trial and 1.0% in the most recent trial. The rate of sudden death was not higher among patients with a recent diagnosis of heart failure than among those with a longer-standing diagnosis. CONCLUSIONS Rates of sudden death declined substantially over time among ambulatory patients with heart failure with reduced ejection fraction who were enrolled in clinical trials, a finding that is consistent with a cumulative benefit of evidence-based medications on this cause of death. (Funded by the China Scholarship Council and the University of Glasgow.).
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Affiliation(s)
- Li Shen
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Pardeep S Jhund
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Mark C Petrie
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Brian L Claggett
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Simona Barlera
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - John G F Cleland
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Henry J Dargie
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Christopher B Granger
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - John Kjekshus
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Lars Køber
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Roberto Latini
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Aldo P Maggioni
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Milton Packer
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Bertram Pitt
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Scott D Solomon
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Karl Swedberg
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Luigi Tavazzi
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - John Wikstrand
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Faiez Zannad
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Michael R Zile
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - John J V McMurray
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences (L.S., P.S.J., M.C.P., J.J.V.M.), and Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, the Department of Cardiology, Golden Jubilee National Hospital (M.C.P.), and the Cardiology Department, Glasgow Royal Infirmary (H.J.D.), Glasgow, and the National Heart and Lung Institute, Imperial College London, London (J.G.F.C.) - all in the United Kingdom; the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (B.L.C., S.D.S.); the Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto di Ricerche Farmacologiche Mario Negri, Milan (S.B., R.L.), Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence (A.P.M.), and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Ettore Sansavini Health Science Foundation, Cotignola (L.T.) - all in Italy; Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G.); Rikshospitalet University Hospital, Oslo (J.K.); the Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen (L.K.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); the Department of Medicine, University of Michigan, Ann Arbor (B.P.); the Center for Person-Centered Care (K.S.) and Sahlgrenska Academy (J.W.), University of Gothenburg, Gothenburg, Sweden; INSERM Centre d'Investigation Clinique 1433, Université de Lorraine and Centre Hospitalier Universitaire, Nancy, France (F.Z.); and the Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston (M.R.Z.)
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Rinkuniene D, Krivickiene A, Laukaitiene J, Jurkevicius R. Pharmacological treatment changes of chronic heart failure during cardiac resynchronization therapy: A 1-year follow-up study. Int J Cardiol 2017; 238:92-96. [PMID: 28363688 DOI: 10.1016/j.ijcard.2017.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/03/2017] [Accepted: 03/12/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is associated with improved morbidity and mortality in patients with chronic heart failure (HF) on optimal medical therapy. We aimed to evaluate changes of medical therapy during CRT and its influence on the CRT response. METHODS We evaluated 85 HF patients' pharmacological treatment changes during 1-year follow-up of CRT. Statistical analysis was performed using IBM SPSS statistical software (SPSS v.21.0 for Mac OS X). RESULTS Beta-blockers (BAB) were used in 81.2% of patients before CRT, and consumption increased after CRT implantation (96.5% at 1-year follow-up visit) (p<0.002). Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) consumption and dose didn't significantly change statistically during the study. 55.3% of patients were taking spironolactone before CRT, and this number increased at discharge till 76.5% (p<0.001) and till 70.6% (p=0.01) at 1-year follow-up visit. The average dose of spironolactone during the study significantly decreased statistically. The use of diuretics was higher after CRT device implantation, compared with the period before CRT 80% to 84.7% (p<0.001), but torasemide dose hadn't significantly changed statistically and remained almost the same. Cardiovascular medication consumption was significantly lower before CRT, compared with discharge (p<0.001) and follow-up (p<0.001) periods. However, no statistically significant relation between pharmacological treatment and echocardiographic response was found. CONCLUSIONS The present study confirmed that pharmacological treatment has changed during the period before and after CRT. But no statistically significant relation between pharmacological treatment and echocardiographic response was found.
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Affiliation(s)
- Diana Rinkuniene
- Lithuanian University of Health Sciences, Kaunas, Lithuania; Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania.
| | - Ausra Krivickiene
- Lithuanian University of Health Sciences, Kaunas, Lithuania; Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Jolanta Laukaitiene
- Lithuanian University of Health Sciences, Kaunas, Lithuania; Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Renaldas Jurkevicius
- Lithuanian University of Health Sciences, Kaunas, Lithuania; Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
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Hassell MECJ, Vlastra W, Robbers L, Hirsch A, Nijveldt R, Tijssen JGP, van Rossum AC, Zijlstra F, Piek JJ, Delewi R. Long-term left ventricular remodelling after revascularisation for ST-segment elevation myocardial infarction as assessed by cardiac magnetic resonance imaging. Open Heart 2017; 4:e000569. [PMID: 28861274 PMCID: PMC5577529 DOI: 10.1136/openhrt-2016-000569] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/11/2017] [Accepted: 03/21/2017] [Indexed: 01/08/2023] Open
Abstract
Objective Left ventricular remodelling following a ST-segment elevated myocardial infarction (STEMI) is an adaptive response to maintain the cardiac output despite myocardial tissue loss. Limited studies have evaluated long term ventricular function using cardiac magnetic resonance imaging (CMR) after STEMI. Methods Study population consisted of 155 primary percutaneous coronary intervention treated first STEMI patients. CMR was performed at 4±2 days, 4 months and 24 months follow-up. Patients were treated with beta-blockers, ACE-inhibitors or AT-II- inhibitors, statins and dual antiplatelet according to current international guidelines. Results Mean left ventricular ejection fraction (LVEF) at baseline was 44%±8%. Twenty-one per cent of the study population had an increase of more than 5.0% after 4 months of follow-up and 21% of the cohort had a decrease of more than 5.0%. Patients with long-term LVEF deterioration have significantly larger end-systolic volumes than patients with improvement of LVEF (61±23 mL/m2 compared with 52±21 mL/m2, p=0.02) and less wall thickening in the remote zone. Patients with LVEF improvement had significantly greater improvement in wall thickening in the infarct areas and in the non-infarct or remote zone. Conclusion Contrary to previous studies, we demonstrate that myocardial remodelling after STEMI is a long-term process. Long-term LVEF deterioration is characterised by an increase in end-systolic volume and less wall thickening in the remote zones. Patients with LVEF improvement exhibit an increase in left ventricular wall thickening both in the infarct as well as in the remote zones. Trial registration The HEBE study is registered in The Netherlands Trial Register #NTR166 (www.trialregister.nl) and the International Standard Randomised Controlled Trial, #ISRCTN95796863 (https://c-d-qn9pqajji.sec.amc.nl).
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Affiliation(s)
- Mariella ECJ Hassell
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Wieneke Vlastra
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lourens Robbers
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan GP Tijssen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan J Piek
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ronak Delewi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
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Te ALD, Wu TC, Lin YJ, Chen YY, Chung FP, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Chien KL, Lin CY, Chang YT, Chen SA. Increased risk of ventricular tachycardia and cardiovascular death in patients with myocarditis during the long-term follow-up: A national representative cohort from the National Health Insurance Research Database. Medicine (Baltimore) 2017; 96:e6633. [PMID: 28471960 PMCID: PMC5419906 DOI: 10.1097/md.0000000000006633] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/21/2017] [Accepted: 03/25/2017] [Indexed: 11/25/2022] Open
Abstract
The incidence of acute myocarditis complicated with ventricular tachycardia (VT) is unknown. This study aimed to investigate the association between myocarditis and the incidence of VT and mortality. We also aimed to determine the independent predictors that increased the VT risk in those patients. From 2000 to 2004, 13,250 patients with a history of myocarditis were identified from the Taiwan National Health Insurance Research Database. The same number of individuals without heart disease with a matched sex and underlying diseases were selected as the control group. The long-term risks of life-threatening ventricular arrhythmias and mortality in patients with a history of myocarditis were investigated by an adjusted Cox proportional hazards regression. After a mean follow-up of 10.4 ± 2.94 years (interquartile range: 12, 10.19-12), the myocarditis patients showed a higher incidence of new onset VT events compared with healthy controls (5.4% [519 per 100,000 person-year] in the myocarditis group vs, 0.47% [43 per 100,000 person-year] in the healthy controls; adjusted hazard ratio [HR]: 16.1, 95% confidence interval [CI]: 12.4-20.9; P < .001). A higher incidence of cardiovascular death was noted in the myocarditis group than healthy controls (6.52% vs 3.18%; HR: 2.42, 95% CI: 2.14-2.73; P < .001) after adjusting for the multivariate confounders including sex, age, underlying comorbidities, and medications. The results of this study suggested that there was higher incidence of life-threatening VT and mortality during the very long-term follow-up in patients with a history of myocarditis. Future work should focus on an in-depth risk stratification of VT in myocarditis patients.
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Affiliation(s)
- Abigail Louise D. Te
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
| | - Tao-Cheng Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University
| | - Yun-Yu Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University
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Abstract
PURPOSE OF REVIEW The goal of this article is to review potential expanded indications for neprilysin inhibitors. This article reviews the rationale and design for ongoing and future trials of sacubitril/valsartan in cardiovascular and non-cardiovascular disease. RECENT FINDINGS Randomized trial data are lacking for use of sacubitril/valsartan in acute heart failure and advanced heart failure. Mechanistic data from animal studies suggest a role for neprilysin inhibition in the treatment of post-myocardial infarction systolic dysfunction and heart failure with preserved ejection fraction. Beyond the cardiovascular system, renal and neurological function may be impacted by neprilysin inhibition. Forthcoming randomized trials will address the clinical impact of sacubitril/valsartan on these conditions. Neprilysin inhibition with sacubitril/valsartan offers a new therapeutic strategy with a broad range of potential therapeutic actions. In PARADIGM-HF, the combination of neprilysin and RAAS inhibition was proven to be superior to enalapril for patients with stable NYHA class II-III heart failure and reduced left ventricular ejection fraction. Preliminary data suggests it may also have a role in other cardiovascular and non-cardiovascular disease. Several ongoing and planned studies will determine the extent of its benefit for these other indications.
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Affiliation(s)
- Elizabeth Riddell
- Cardiovascular Division, Washington University School of Medicine, 660 S. Euclid Ave., Box 8086, St Louis, MO, 63110, USA
| | - Justin M Vader
- Cardiovascular Division, Washington University School of Medicine, 660 S. Euclid Ave., Box 8086, St Louis, MO, 63110, USA.
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Krzysztofik J, Ponikowski P. Current and emerging pharmacologic options for the management of patients with chronic and acute decompensated heart failure. Expert Rev Clin Pharmacol 2017; 10:517-534. [PMID: 28358228 DOI: 10.1080/17512433.2017.1299574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION For many years heart failure (HF) was known as a fatal disease with an ominous prognosis. In the last decades better understanding of the pathophysiological mechanisms underlying HF has resulted in major breakthrough in the management and improvement in the natural history of this clinical syndrome. Areas covered: The review is focused on current and upcoming pharmacological therapies in patients with chronic and acute HF, starting with brief overview of drugs which improve the outcomes in patients with chronic HF with reduced ejection fraction (EF) including neurohormonal antagonists, angiotensin receptor neprilysin inhibitor and If- channel inhibitor, then presenting the summary of symptomatic treatment, the pharmacotherapy in chronic HF with preserved and mid-range EF and in acute HF. Finally, we report the emerging pharmacologic options and ongoing clinical trials and future directions in pharmacotherapy. Expert commentary: The guidelines-recommended therapies in HF with reduced EF need to be widely implemented into the everyday clinical practice. Better clinical characterization of HF with preserved, mid-range EF and acute HF, with better understanding of the underlying pathophysiological mechanisms may ultimately result in a development of effective strategies improving ominous outcomes in these patients.
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Affiliation(s)
- Justyna Krzysztofik
- a Department of Heart Diseases , Wroclaw Medical University , Wroclaw , Poland.,b 4th Military Hospital, Cardiology Department , Centre for Heart Diseases , Wroclaw , Poland
| | - Piotr Ponikowski
- a Department of Heart Diseases , Wroclaw Medical University , Wroclaw , Poland.,b 4th Military Hospital, Cardiology Department , Centre for Heart Diseases , Wroclaw , Poland
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