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Zaher W, Della Rocca DG, Pannone L, Boveda S, de Asmundis C, Chierchia GB, Sorgente A. Anti-Arrhythmic Effects of Heart Failure Guideline-Directed Medical Therapy and Their Role in the Prevention of Sudden Cardiac Death: From Beta-Blockers to Sodium-Glucose Cotransporter 2 Inhibitors and Beyond. J Clin Med 2024; 13:1316. [PMID: 38592135 PMCID: PMC10931968 DOI: 10.3390/jcm13051316] [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: 01/10/2024] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Sudden cardiac death (SCD) accounts for a substantial proportion of mortality in heart failure with reduced ejection fraction (HFrEF), frequently triggered by ventricular arrhythmias (VA). This review aims to analyze the pathophysiological mechanisms underlying VA and SCD in HFrEF and evaluate the effectiveness of guideline-directed medical therapy (GDMT) in reducing SCD. Beta-blockers, angiotensin receptor-neprilysin inhibitors, and mineralocorticoid receptor antagonists have shown significant efficacy in reducing SCD risk. While angiotensin-converting enzyme inhibitors and angiotensin receptor blockers exert beneficial impacts on the renin-angiotensin-aldosterone system, their direct role in SCD prevention remains less clear. Emerging treatments like sodium-glucose cotransporter 2 inhibitors show promise but necessitate further research for conclusive evidence. The favorable outcomes of those molecules on VA are notably attributable to sympathetic nervous system modulation, structural remodeling attenuation, and ion channel stabilization. A multidimensional pharmacological approach targeting those pathophysiological mechanisms offers a complete and synergy approach to reducing SCD risk, thereby highlighting the importance of optimizing GDMT for HFrEF. The current landscape of HFrEF pharmacotherapy is evolving, with ongoing research needed to clarify the full extent of the anti-arrhythmic benefits offered by both existing and new treatments.
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Affiliation(s)
- Wael Zaher
- Department of Cardiology, Centre Hospitalier EpiCURA, Route de Mons 63, 7301 Hornu, Belgium;
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklan 101, Jette, 1090 Brussels, Belgium; (D.G.D.R.); (L.P.); (C.d.A.); (G.-B.C.)
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklan 101, Jette, 1090 Brussels, Belgium; (D.G.D.R.); (L.P.); (C.d.A.); (G.-B.C.)
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, 31076 Toulouse, France;
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklan 101, Jette, 1090 Brussels, Belgium; (D.G.D.R.); (L.P.); (C.d.A.); (G.-B.C.)
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklan 101, Jette, 1090 Brussels, Belgium; (D.G.D.R.); (L.P.); (C.d.A.); (G.-B.C.)
| | - Antonio Sorgente
- Department of Cardiology, Centre Hospitalier EpiCURA, Route de Mons 63, 7301 Hornu, Belgium;
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklan 101, Jette, 1090 Brussels, Belgium; (D.G.D.R.); (L.P.); (C.d.A.); (G.-B.C.)
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2
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Conway KM, Thomas S, Ciafaloni E, Khan RS, Mann JR, Romitti PA, Mathews KD. Prophylactic use of cardiac medications for delay of left ventricular dysfunction in Duchenne muscular dystrophy. Birth Defects Res 2024; 116:e2260. [PMID: 37850663 DOI: 10.1002/bdr2.2260] [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: 06/27/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Epidemiological support for prophylactic treatment of left ventricular dysfunction (LVD) in Duchenne muscular dystrophy is limited. We used retrospective, population-based surveillance data from the Muscular Dystrophy Surveillance, Tracking and Research Network to evaluate whether prophylaxis delays LVD onset. METHODS We analyzed 455 males born during 1982-2009. Age at first abnormal echocardiogram (ejection fraction <55% or shortening fraction <28%) determined LVD onset. Prophylaxis was defined as cardiac medication use at least 1 year prior to LVD. Corticosteroid use was also coded. Kaplan-Meier curve estimation and Cox Proportional Hazard modeling with time-varying covariates describe associations. RESULTS LVD was identified among 40.7%; average onset age was 14.2 years. Prophylaxis was identified for 20.2% and corticosteroids for 57.4%. Prophylaxis showed delayed LVD onset (p < .001) and lower hazard of dysfunction (adjusted hazard ratio [aHR] = 0.39, 95%CL = 0.22, 0.65) compared to untreated. Compared to no treatment, continuous corticosteroids only (aHR = 1.01, 95%CL = 0.66, 1.53) and prophylaxis only (aHR = 0.67, 95%CL = 0.25, 1.50) were not cardioprotective, but prophylaxis plus continuous corticosteroids were associated with lower hazard of dysfunction (aHR = 0.37, 95%CL = 0.15, 0.80). CONCLUSIONS Proactive cardiac treatment and monitoring are critical aspects of managing Duchenne muscular dystrophy. Consistent with clinical care guidelines, this study supports clinical benefit from cardiac medications initiated prior to documented LVD and suggests further benefit when combined with corticosteroids.
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Affiliation(s)
- Kristin M Conway
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - Shiny Thomas
- New York State Department of Health, Albany, New York, USA
| | - Emma Ciafaloni
- Department of Neurology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Rabia S Khan
- Department of Pediatrics, UCLA Health Sciences, Los Angeles, California, USA
- Department of Pediatrics, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Joshua R Mann
- Department of Preventive Medicine, School of Medicine and John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - Katherine D Mathews
- Department of Pediatrics, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
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Díez-Villanueva P, Jimenez-Mendez C, Pérez Á, Esteban-Fernández A, Datino T, Martínez-Sellés M, Ayesta A. Do Elderly Patients with Heart Failure and Reduced Ejection Fraction Benefit from Pharmacological Strategies for Prevention of Arrhythmic Events? Cardiology 2023; 148:195-206. [PMID: 37040727 DOI: 10.1159/000530424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/20/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Heart failure is associated with aging. It is one of the leading causes of morbidity and mortality in Western countries and constitutes the main cause of hospitalization among elderly patients. The pharmacological therapy of patients with heart failure with reduced ejection fraction (HFrEF) has greatly improved during the last years. However, elderly patients less frequently receive recommended medical treatment. SUMMARY The quadruple therapy (sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors) is nowadays the cornerstone of medical treatment since it associates lower risk of heart failure hospitalizations and mortality (also of arrhythmic origin). Cardiac arrhythmias, including sudden cardiac death, are common in patients with HFrEF, entailing worse prognosis. Previous studies addressing the role of blocking the renin-angiotensin-aldosterone system and beta-adrenergic receptors in HFrEF have suggested different beneficial effects on arrhythmia mechanisms. Therefore, the lower mortality associated with the use of the four pillars of HFrEF therapy depends, in part, on lower sudden (mostly arrhythmic) cardiac death. KEY MESSAGES In this review, we highlight and assess the role of the four pharmacological groups that constitute the central axis of the medical treatment of patients with HFrEF in clinical prognosis and prevention of arrhythmic events, with special focus on the elderly patient, since evidence supports that most benefits provided are irrespective of age, but elderly patients receive less often guideline-recommended medical treatment.
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Affiliation(s)
| | | | - Ángel Pérez
- Cardiology Department, Hospital Universitario de Burgos, Burgos, Spain
- Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain
| | | | - Tomás Datino
- Cardiology Department, Hospital Universitario Quirón and Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain
- Universidad Europea de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense and Universidad Europea, Madrid, Spain
| | - Ana Ayesta
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
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4
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Filippatos G, Anker SD, August P, Coats AJS, Januzzi JL, Mankovsky B, Rossing P, Ruilope LM, Pitt B, Sarafidis P, Teerlink JR, Kapelios CJ, Gebel M, Brinker M, Joseph A, Lage A, Bakris G, Agarwal R. Finerenone and effects on mortality in chronic kidney disease and type 2 diabetes: a FIDELITY analysis. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2023; 9:183-191. [PMID: 36639130 PMCID: PMC9892867 DOI: 10.1093/ehjcvp/pvad001] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/20/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
AIMS Finerenone reduces the risk of cardiovascular events in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). We investigated the causes of mortality in the FIDELITY population. METHODS AND RESULTS The FIDELITY prespecified pooled data analysis from FIDELIO-DKD and FIGARO-DKD excluded patients with heart failure and reduced ejection fraction. Outcomes included intention-to-treat and prespecified on-treatment analyses of the risk of all-cause and cardiovascular mortality. Of 13 026 patients [mean age, 64.8 years; mean estimated glomerular filtration rate (eGFR), 57.6 mL/min/1.73 m2], 99.8% were on renin-angiotensin system inhibitors. Finerenone reduced the incidence of all-cause and cardiovascular mortality vs. placebo (8.5% vs. 9.4% and 4.9% vs. 5.6%, respectively) and demonstrated significant on-treatment reductions [hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.70-0.96; P = 0.014 and HR, 0.82; 95% CI, 0.67-0.99; P = 0.040, respectively]. Cardiovascular-related mortality was most common, and finerenone lowered the incidence of sudden cardiac death vs. placebo [1.3% (incidence rate 0.44/100 patient-years) vs. 1.8% (0.58/100 patient-years), respectively; HR, 0.75; 95% CI, 0.57-0.996; P = 0.046]. The effects of finerenone on mortality were similar across all Kidney Disease: Improving Global Outcomes risk groups. Event probability with finerenone at 4 years was consistent irrespective of baseline urine albumin-to-creatinine ratio, but seemingly more pronounced in patients with higher baseline eGFR. CONCLUSION In FIDELITY, finerenone significantly reduced the risk of all-cause and cardiovascular mortality vs. placebo in patients with T2D across a broad spectrum of CKD stages while on treatment, as well as sudden cardiac death in the intention-to-treat population. CLINICAL TRIALS REGISTRATION FIDELIO-DKD and FIGARO-DKD are registered with ClinicalTrials.gov, numbers NCT02540993 and NCT02545049, respectively (funded by Bayer AG).
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Affiliation(s)
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies, German Centre for Cardiovascular Research Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Phyllis August
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital–Weill Cornell Medical College, New York, NY, USA,Department of Transplantation Medicine, New York Presbyterian Hospital–Weill Cornell Medical College, New York, NY, USA
| | | | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School, and Baim Institute for Clinical Research, Boston, MA, USA
| | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Luis M Ruilope
- Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research imas12, Madrid, Spain,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain,Faculty of Sport Sciences, European University of Madrid, Madrid, Spain
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Chris J Kapelios
- Department of Cardiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, Chaidari 124 62, Athens, Greece,Department of Cardiology, Laiko General Hospital, Athens, Greece
| | - Martin Gebel
- Statistics & Data Insights, Bayer AG, Wuppertal, Germany
| | - Meike Brinker
- Cardiology and Nephrology Clinical Development, Bayer AG, Wuppertal, Germany
| | - Amer Joseph
- Research and Development, Chiesi S.p.A., Parma, Italy
| | - Andrea Lage
- Cardiology and Nephrology Clinical Development, Bayer SA, São Paulo, Brazil
| | - George Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Rajiv Agarwal
- Richard L. Roudebush VA Medical Center and Indiana University, Indianapolis, IN, USA
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5
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Butler J, Talha KM, Aktas MK, Zareba W, Goldenberg I. Role of Implantable Cardioverter Defibrillator in Heart Failure With Contemporary Medical Therapy. Circ Heart Fail 2022; 15:e009634. [PMID: 35726617 DOI: 10.1161/circheartfailure.122.009634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Implantable cardioverter defibrillator therapy is indicated in a subset of patients with heart failure with reduced ejection as primary prevention for sudden cardiac death. The advent of novel medical therapies including mineralocorticoid receptor antagonists, angiotensin receptor blocker/neprilysin inhibitors, and sodium-glucose transporter 2 inhibitor in the past 2 decades has revolutionized heart failure with reduced ejection management. Current guideline-directed medical therapy has reduced all-cause mortality and sudden cardiac death and confers a considerable improvement in left ventricular ejection fraction over a short period of time. However, there is limited evidence at present to suggest whether implantable cardioverter defibrillator therapy continues to have the same benefit in sudden cardiac death prevention at current left ventricular ejection fraction cutoff indications for patients on contemporary guideline-directed medical therapy for heart failure with reduced ejection. In this review, the authors propose in lieu of current evidence that it is reasonable to reevaluate indications for implantable cardioverter defibrillator therapy in patients on contemporary guideline-directed medical therapy for heart failure with reduced ejection.
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Affiliation(s)
- Javed Butler
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (J.B.).,Department of Medicine, University of Mississippi Medical Center, Jackson (J.B., K.M.T.)
| | - Khawaja M Talha
- Department of Medicine, University of Mississippi Medical Center, Jackson (J.B., K.M.T.)
| | - Mehmet K Aktas
- Department of Medicine, Cardiology Division, University of Rochester Medical Center, NY (M.K.A, W.Z., I.G.)
| | - Wojciech Zareba
- Department of Medicine, Cardiology Division, University of Rochester Medical Center, NY (M.K.A, W.Z., I.G.)
| | - Ilan Goldenberg
- Department of Medicine, Cardiology Division, University of Rochester Medical Center, NY (M.K.A, W.Z., I.G.)
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6
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Tsartsalis D, Korela D, Karlsson LO, Foukarakis E, Svensson A, Anastasakis A, Venetsanos D, Aggeli C, Tsioufis C, Braunschweig F, Dragioti E, Charitakis E. Risk and Protective Factors for Sudden Cardiac Death: An Umbrella Review of Meta-Analyses. Front Cardiovasc Med 2022; 9:848021. [PMID: 35783841 PMCID: PMC9246322 DOI: 10.3389/fcvm.2022.848021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSudden cardiac death (SCD) is a global public health issue, accounting for 10–20% of deaths in industrialized countries. Identification of modifiable risk factors may reduce SCD incidence.MethodsThis umbrella review systematically evaluates published meta-analyses of observational and randomized controlled trials (RCT) for the association of modifiable risk and protective factors of SCD.ResultsFifty-five meta-analyses were included in the final analysis, of which 31 analyzed observational studies and 24 analyzed RCTs. Five associations of meta-analyses of observational studies presented convincing evidence, including three risk factors [diabetes mellitus (DM), smoking, and early repolarization pattern (ERP)] and two protective factors [implanted cardiac defibrillator (ICD) and physical activity]. Meta-analyses of RCTs identified five protective factors with a high level of evidence: ICDs, mineralocorticoid receptor antagonist (MRA), beta-blockers, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors in patients with HF. On the contrary, other established, significant protective agents [i.e., amiodarone and statins along with angiotensin-converting enzyme (ACE) inhibitors in heart failure (HF)], did not show credibility. Likewise, risk factors as left ventricular ejection fraction in HF, and left ventricular hypertrophy, non-sustain ventricular tachycardia, history of syncope or aborted SCD in pediatric patients with hypertrophic cardiomyopathy, presented weak or no evidence.ConclusionsLifestyle risk factors (physical activity, smoking), comorbidities like DM, and electrocardiographic features like ERP constitute modifiable risk factors of SCD. Alternatively, the use of MRA, beta-blockers, SGLT-2 inhibitors, and ICD in patients with HF are credible protective factors. Further investigation targeted in specific populations will be important for reducing the burden of SCD.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020216363, PROSPERO CRD42020216363.
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Affiliation(s)
- Dimitrios Tsartsalis
- Department of Emergency Medicine, “Hippokration” Hospital, Athens, Greece
- First Department of Cardiology, “Hippokration” Hospital, University of Athens, Medical School, Athens, Greece
| | - Dafni Korela
- Department of Cardiology, Venizeleio General Hospital, Heraklion, Greece
| | - Lars O. Karlsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Anneli Svensson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Aris Anastasakis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Constantina Aggeli
- First Department of Cardiology, “Hippokration” Hospital, University of Athens, Medical School, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, “Hippokration” Hospital, University of Athens, Medical School, Athens, Greece
| | | | - Elena Dragioti
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Emmanouil Charitakis
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- *Correspondence: Emmanouil Charitakis
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Valderrábano M. The Future of Antiarrhythmic Drug Therapy: Will Drugs Be Entirely Replaced by Procedures? Methodist Debakey Cardiovasc J 2022; 18:58-63. [PMID: 36561081 PMCID: PMC9733159 DOI: 10.14797/mdcvj.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Antiarrhythmic drug therapy has traditionally been centered in modulating the generation or propagation of the cardiac action potential by drugs acting on membrane ion channels. The history of this approach has been disappointing, marked by catastrophic failures such as those of sodium channel blockers or sotalol to treat ventricular arrhythmias in the setting of structural cardiomyopathies, which led to increased mortality, and by modest clinical efficacy in paroxysmal atrial fibrillation. As catheter ablation has become an established effective therapy for most tachyarrhythmias, membrane-acting drugs have been relegated to symptomatic control of benign arrhythmias in normal hearts or to adjunctive treatments of ventricular tachycardia (combined with catheter ablation and cardiac defibrillators) in the setting of cardiomyopathies. Novel targets of biological modulation of arrhythmia substrates beyond the membrane potential appear promising and could represent future opportunities for arrhythmia pharmacotherapy.
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Affiliation(s)
- Miguel Valderrábano
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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8
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Fong MC, Feng AN, Yin WH, Tsao TP, Chang HY. Defibrillation therapies following sodium-glucose cotransporter 2 inhibitor treatment: A report of two cases. HeartRhythm Case Rep 2021; 7:338-342. [PMID: 34026528 PMCID: PMC8134786 DOI: 10.1016/j.hrcr.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Man-Cai Fong
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - An-Ning Feng
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tien-Ping Tsao
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung-Yu Chang
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Address reprint requests and correspondence: Dr Hung-Yu Chang, Heart Center, Cheng Hsin General Hospital, No.45 Cheng-Hsin Street, 112 Beitou, Taipei, Taiwan.
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9
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Hasin T, Davarashvili I, Michowitz Y, Farkash R, Presman H, Glikson M, Rav-Acha M. Association of Guideline-Based Medical Therapy with Malignant Arrhythmias and Mortality among Heart Failure Patients Implanted with Cardioverter Defibrillator (ICD) or Cardiac Resynchronization-Defibrillator Device (CRTD). J Clin Med 2021; 10:1753. [PMID: 33920719 PMCID: PMC8073338 DOI: 10.3390/jcm10081753] [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: 03/08/2021] [Revised: 04/04/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022] Open
Abstract
AIM Evaluate prevalence of heart failure (HF) medications and their association with ventricular arrhythmia (VA) and survival among patients implanted with primary prevention implantable cardiac defibrillator (ICD)/cardiac resynchronization therapy + defibrillator (CRTD) devices. METHODS Association of treatment and dose (% guideline recommended target) of beta-adrenergic receptor antagonist (BB), angiotensin-antagonists (AngA), and mineralocorticoid-antagonists (MRA), after ICD/CRTD implant with VA and mortality was retrospectively analyzed. RESULTS Study included 186 HF patients; 42.5% and 57.5% implanted with ICD and CRTD, respectively. During 3.8 (2.1;6.7) years; 52 (28%) had VA and 77 (41.4%) died. Treatment (% of patients) included: BB (83%), AngA (87%), and MRA (59%). Median doses were 25(12.5;50)% of target for all medications. BB treatment >25% target dose was associated with reduced VA incidence. In the multivariable model including age, gender, diabetes, heart rate, and medication doses, increased BB dose was associated with reduced VA (hazard ratio (HR) 0.443 95% CI 0.222-0.885; p = 0.021). In the multivariable model for overall mortality including age, gender, renal disease, VA, and medical treatment, VA was associated with increased mortality (HR 2.672; 95% CI 1.429-4.999; p = 0.002) and AngA treatment was associated with reduced mortality (HR 0.515; 95% CI 0.285-0.929; p = 0.028). CONCLUSIONS In this cohort of real-life HF patients discharged after ICD/CRTD implant, prevalence of guideline-based HF medications was high, albeit with low doses. Higher BB dose was associated with reduced VA, while AngA was associated with improved survival.
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Affiliation(s)
- Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem 9103102, Israel; (T.H.); (I.D.); (Y.M.); (R.F.); (M.G.)
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel;
| | - Ilia Davarashvili
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem 9103102, Israel; (T.H.); (I.D.); (Y.M.); (R.F.); (M.G.)
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem 9103102, Israel; (T.H.); (I.D.); (Y.M.); (R.F.); (M.G.)
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel;
| | - Rivka Farkash
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem 9103102, Israel; (T.H.); (I.D.); (Y.M.); (R.F.); (M.G.)
| | - Haya Presman
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel;
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem 9103102, Israel; (T.H.); (I.D.); (Y.M.); (R.F.); (M.G.)
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel;
| | - Moshe Rav-Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem 9103102, Israel; (T.H.); (I.D.); (Y.M.); (R.F.); (M.G.)
- Faculty of Medicine, Hebrew University, Jerusalem 9103102, Israel;
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Frankenstein L, Seide S, Täger T, Jensen K, Fröhlich H, Clark AL, Seiz M, Katus HA, Nee P, Uhlmann L, Naci H, Atar D. Relative Efficacy of Spironolactone, Eplerenone, and cAnRenone in patients with Chronic Heart failure (RESEARCH): a systematic review and network meta-analysis of randomized controlled trials. Heart Fail Rev 2021; 25:161-171. [PMID: 31364027 DOI: 10.1007/s10741-019-09832-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study aims to assess the comparative benefit and risk profile of treatment with mineralocorticoid receptor antagonists (MRAs) with regard to all-cause mortality (primary endpoint), cardiovascular mortality, or heart failure (HF)-related hospitalization (secondary endpoints) and the safety endpoints hyperkalemia, acute renal failure, and gynecomastia in patients with chronic HF. We conducted a systematic review and network meta-analysis following PRISMA-P and PRISMA-NMA guidelines. From 16 different sources, 14 randomized controlled trials totaling 12,213 patients testing an active treatment of either spironolactone, eplerenone, or canrenone/potassium-canreonate in adults with symptomatic HF due to systolic dysfunction reporting any of the above endpoints were retained. Efficacy in comparison to placebo/standard medical care with respect to all-cause mortality was confirmed for spironolactone and eplerenone while no conclusion could be drawn for canrenone (HR 0.69 (0.62; 0.77), 0.82 (0.75; 0.91), and 0.50 (0.17; 1.45), respectively). Indirect comparisons hint a potential (non-significant) preference of spironolactone over eplerenone (HR 0.84 (0.68; 1.03)). The overall risk of bias was low to intermediate. Results for secondary endpoints as well as sensitivity analyses essentially mirrored these findings. The beta-blocker adjusted meta-analysis for the primary endpoint showed the same tendency as the unadjusted one (HR 0.39 (0.07; 2.03)). Results need to be interpreted with caution, though, as the resultant mix of patient- and study-level covariates produced unstable statistical modeling. We found no significant and systematic superiority of either MRA regarding efficacy toward all endpoints considered in both direct and indirect comparisons.
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Affiliation(s)
- Lutz Frankenstein
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Svenja Seide
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Tobias Täger
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Hanna Fröhlich
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Andrew L Clark
- Hull York Medical School at Castle Hill Hospital, Hull, UK
| | - Mirjam Seiz
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Paul Nee
- Marketing Group, Gamida-Cell, Cambridge, MA, USA
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ulleval and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
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11
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Parajuli DR, Shakib S, Eng-Frost J, McKinnon RA, Caughey GE, Whitehead D. Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients. BMC Cardiovasc Disord 2021; 21:104. [PMID: 33602125 PMCID: PMC7893887 DOI: 10.1186/s12872-021-01868-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/13/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Studies have demonstrated that heart failure (HF) patients who receive direct pharmacist input as part of multidisciplinary care have better clinical outcomes. This study evaluated/compared the difference in prescribing practices of guideline-directed medical therapy (GDMT) for chronic HF patients between two multidisciplinary clinics-with and without the direct involvement of a pharmacist. METHODS A retrospective audit of chronic HF patients, presenting to two multidisciplinary outpatient clinics between March 2005 and January 2017, was performed; a Multidisciplinary Ambulatory Consulting Service (MACS) with an integrated pharmacist model of care and a General Cardiology Heart Failure Service (GCHFS) clinic, without the active involvement of a pharmacist. RESULTS MACS clinic patients were significantly older (80 vs. 73 years, p < .001), more likely to be female (p < .001), and had significantly higher systolic (123 vs. 112 mmHg, p < .001) and diastolic (67 vs. 60 mmHg, p < .05) blood pressures compared to the GCHF clinic patients. Moreover, the MACS clinic patients showed more polypharmacy and higher prevalence of multiple comorbidities. Both clinics had similar prescribing rates of GDMT and achieved maximal tolerated doses of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in HFrEF. However, HFpEF patients in the MACS clinic were significantly more likely to be prescribed ACEIs/ARBs (70.5% vs. 56.2%, p = 0.0314) than the GCHFS patients. Patients with both HFrEF and HFpEF (MACS clinic) were significantly less likely to be prescribed β-blockers and mineralocorticoid receptor antagonists. Use of digoxin in chronic atrial fibrillation (AF) in MACS clinic was significantly higher in HFrEF patients (82.5% vs. 58.5%, p = 0.004), but the number of people anticoagulated in presence of AF (27.1% vs. 48.0%, p = 0.002) and prescribed diuretics (84.0% vs. 94.5%, p = 0.022) were significantly lower in HFpEF patients attending the MACS clinic. Age, heart rate, systolic blood pressure (SBP), anemia, chronic renal failure, and other comorbidities were the main significant predictors of utilization of GDMT in a multivariate binary logistic regression. CONCLUSIONS Lower prescription rates of some medications in the pharmacist-involved multidisciplinary team were found. Careful consideration of demographic and clinical characteristics, contraindications for use of medications, polypharmacy, and underlying comorbidities is necessary to achieve best practice.
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Affiliation(s)
- Daya Ram Parajuli
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
- Flinders Rural Health, College of Medicine and Public Health, Flinders University, Ral Ral Avenue, PO Box 852, Renmark, SA, 5341, Australia.
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Joanne Eng-Frost
- Department of Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Cardiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Ross A McKinnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Gillian E Caughey
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Dean Whitehead
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- College of Health and Medicine, University of Tasmania, Tasmania, Australia
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12
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Schupp T, Akin I, Reiser L, Bollow A, Taton G, Borggrefe M, Reichelt T, Ellguth D, Engelke N, Barre M, Müller J, Weidner K, Kim S, Akin M, Große Meininghaus D, Behnes M. No impact of mineralocorticoid receptor antagonists on long‐term recurrences of ventricular tachyarrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:213-224. [DOI: 10.1111/pace.14137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/12/2020] [Accepted: 11/29/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Tobias Schupp
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Ibrahim Akin
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Linda Reiser
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Armin Bollow
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Gabriel Taton
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Martin Borggrefe
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Thomas Reichelt
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Dominik Ellguth
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Niko Engelke
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Max Barre
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Julian Müller
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Kathrin Weidner
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Seung‐hyun Kim
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | | | - Michael Behnes
- First Department of Medicine University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim Mannheim Germany
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13
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Cambio en la causa de muerte e influencia de la mejora terapéutica con el tiempo en pacientes con insuficiencia cardiaca y fracción de eyección reducida. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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14
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Fernández-Vázquez D, Ferrero-Gregori A, Álvarez-García J, Gómez-Otero I, Vázquez R, Delgado Jiménez J, Worner Diz F, Bardají A, García-Pavía P, Bayés-Genís A, González-Juanatey JR, Cinca J, Pascual Figal DA. Changes in causes of death and influence of therapeutic improvement over time in patients with heart failure and reduced ejection fraction. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:561-568. [PMID: 31974070 DOI: 10.1016/j.rec.2019.09.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/13/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION AND OBJECTIVES In patients with heart failure and reduced ejection fraction (HFrEF), several therapies have been proven to reduce mortality in clinical trials. However, there are few data on the effect of the use of evidence-based therapies on causes of death in clinical practice. METHODS This study included 2351 outpatients with HFrEF (< 40%) from 2 multicenter prospective registries: MUSIC (n=641, period: 2003-2004) and REDINSCOR I (n=1710, period: 2007-2011). Variables were recorded at inclusion and all patients were followed-up for 4 years. Causes of death were validated by an independent committee. RESULTS Patients in REDINSCOR I more frequently received beta-blockers (85% vs 71%; P <.001), mineralocorticoid antagonists (64% vs 44%; P <.001), implantable cardioverter-defibrillators (19% vs 2%; P <.001), and resynchronization therapy (7.2% vs 4.8%; P=.04). In these patients, sudden cardiac death was less frequent than in those in MUSIC (6.8% vs 11.4%; P <.001). After propensity score matching, we obtained 2 comparable populations differing only in treatments (575 vs 575 patients). In patients in REDINSCOR I, we found a lower risk of total mortality (HR, 0.70; 95%CI, 0.57-0.87; P=.001) and sudden cardiac death (sHR, 0.46; 95%CI, 0.30-0.70; P <.001), and a trend toward lower mortality due to end-stage HF (sHR, 0.73; 95%CI, 0.53-1.01; P=.059), without differences in other causes of death (sHR, 1.17; 95%CI, 0.78-1.75; P=.445), regardless of functional class. CONCLUSIONS In ambulatory patients with HFrEF, implementation of evidence-based therapies was associated with a lower risk of death, mainly due to a significant reduction in sudden cardiac death.
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Affiliation(s)
- David Fernández-Vázquez
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - Andreu Ferrero-Gregori
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Jesús Álvarez-García
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Inés Gómez-Otero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain; Servicio de Cardiología, Hospital Universitario de Santiago de Compostela, IDIS, Santiago de Compostela, A Coruña, Spain
| | - Rafael Vázquez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Juan Delgado Jiménez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Facultad de Medicina UCM, Madrid, Spain
| | - Fernando Worner Diz
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Alfredo Bardají
- Servicio de Cardiología, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - Pablo García-Pavía
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, Spain
| | - Antoni Bayés-Genís
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - José R González-Juanatey
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain; Servicio de Cardiología, Hospital Universitario de Santiago de Compostela, IDIS, Santiago de Compostela, A Coruña, Spain
| | - Juan Cinca
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Domingo A Pascual Figal
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, IMIB-Arrixaca, El Palmar, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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15
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Abstract
PURPOSE OF REVIEW To provide a framework for approaching ventricular arrhythmias in the setting of cardiomyopathy, outline the latest evidence-based recommendations for catheter ablation and device therapy, and discuss novel treatment strategies. RECENT FINDINGS Risk stratification of ventricular arrhythmias in systolic heart failure has evolved, with an increasing role for cardiac magnetic resonance imaging to identify underlying substrate and scar burden. Medical therapy for heart failure has greatly improved, and the role of primary prevention defibrillators in nonischemic cardiomyopathy has become more ambiguous. Catheter ablation is superior to medical therapy for arrhythmia control and should be considered early, particularly for premature ventricular complex mediated cardiomyopathy. Novel technologies to deliver energy to previously inaccessible sites include high-impedance catheter irrigants, multicatheter bipolar ablation, specialized catheters with extendable needles, transcoronary ethanol infusion, and stereotactic body radiation therapy. SUMMARY Assessment and management of ventricular arrhythmias in systolic heart failure requires a systematic, multimodality approach aimed at identifying the underlying cause and reversible causes, optimizing medical therapy, assessing need for an implantable cardioverter defibrillator, and considering catheter ablation. Further research will focus on prevention of disease progression, improved risk stratification, and ablation technologies that minimize procedure duration and enable delivery of durable lesions.
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16
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Papademetriou V, Toumpourleka M, Imprialos KP, Alataki S, Manafis A, Stavropoulos K. The Role of Mineralocorticoid Receptor Antagonists in Heart Failure with Reduced Ejection Fraction. Curr Pharm Des 2019; 24:5517-5524. [DOI: 10.2174/1381612825666190219141326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/13/2019] [Indexed: 12/20/2022]
Abstract
Background:
Heart failure (HF) is a worldwide modern epidemic, associated with significant morbidity
and mortality. Several causes have been identified for the syndrome, most of which share common pathophysiologic
pathways, including neurohormonal activation. Central to the latter lies activation of the reninangiotensin-
aldosterone system, and its effects on cardiovascular disease progression.
Objectives:
The aim of this review is to summarize the pathophysiology of aldosterone and the effects of its
blockage in the failing heart, as well as to provide state-of-the-art evidence, and address future perspectives regarding
the use of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction.
Method:
Literature was reviewed for studies that assess the pathophysiology of aldosterone in HF with reduced
ejection fraction (HFrEF), and the effects of mineralocorticoid receptor antagonists (MRAs) in this condition.
Results:
Several major society guidelines have synthesized the available evidence on HFrEF management, and
drugs that block the renin-angiotensin-aldosterone system at different levels continue to form the key component
of standard of care for these patients. Mineralocorticoid receptor antagonists are an important part of HFrEF
pharmacologic treatment, and their use is supported by a high level of evidence studies. This class of drugs demonstrated
significant benefits for morbidity and mortality, across the spectrum oh HFrEF, including patients after
acute myocardial infarction.
Conclusion:
Current evidence supports the central role of aldosterone in HFrEF progression, and the significant
benefits on outcomes with the use of MRAs.
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Affiliation(s)
| | - Maria Toumpourleka
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos P. Imprialos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Alataki
- Medical Clinic IV-Department of Cardiology, Manicipal Hospital Karlsruhe, Academic Teaching Hospital, University of Freiburg, Karlsruhe, Germany
| | - Alexandros Manafis
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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17
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Lee TC, Qian M, Mu L, Di Tullio MR, Graham S, Mann DL, Nakanishi K, Teerlink JR, Lip GYH, Freudenberger RS, Sacco RL, Mohr JP, Labovitz AJ, Ponikowski P, Lok DJ, Estol C, Anker SD, Pullicino PM, Buchsbaum R, Levin B, Thompson JLP, Homma S, Ye S. Association between mortality and implantable cardioverter-defibrillators by aetiology of heart failure: a propensity-matched analysis of the WARCEF trial. ESC Heart Fail 2019; 6:297-307. [PMID: 30816013 PMCID: PMC6437435 DOI: 10.1002/ehf2.12407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/12/2018] [Indexed: 12/28/2022] Open
Abstract
Aims There is debate on whether the beneficial effect of implantable cardioverter‐defibrillators (ICDs) is attenuated in patients with non‐ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial. Methods and results We performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity‐matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow‐up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all‐cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131). Conclusions The presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.
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Affiliation(s)
- Tetz C Lee
- Columbia University Irving Medical Center, New York, NY, USA
| | - Min Qian
- Columbia University Irving Medical Center, New York, NY, USA
| | - Lan Mu
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Susan Graham
- The State University of New York at Buffalo, Buffalo, NY, USA
| | - Douglas L Mann
- Washington University School of Medicine, St. Louis, MO, USA
| | - Koki Nakanishi
- Columbia University Irving Medical Center, New York, NY, USA
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Jay P Mohr
- Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Dirk J Lok
- Deventer Hospital, Deventer, The Netherlands
| | - Conrado Estol
- Neurological Center for Treatment and Rehabilitation, Buenos Aires, Argentina
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology; and Berlin-Brandenburg Center for Regenerative Therapies; Deutsches Zentrum für Herz-Kreislauf-Forschung partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany
| | | | | | - Bruce Levin
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Shunichi Homma
- Columbia University Irving Medical Center, New York, NY, USA
| | - Siqin Ye
- Columbia University Irving Medical Center, New York, NY, USA
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18
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Impact of eplerenone on major cardiovascular outcomes in patients with systolic heart failure according to baseline heart rate. Clin Res Cardiol 2019; 108:806-814. [DOI: 10.1007/s00392-018-1410-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/18/2018] [Indexed: 12/21/2022]
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19
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Rossello X, Ariti C, Pocock SJ, Ferreira JP, Girerd N, McMurray JJV, Van Veldhuisen DJ, Pitt B, Zannad F. Impact of mineralocorticoid receptor antagonists on the risk of sudden cardiac death in patients with heart failure and left-ventricular systolic dysfunction: an individual patient-level meta-analysis of three randomized-controlled trials. Clin Res Cardiol 2018; 108:477-486. [DOI: 10.1007/s00392-018-1378-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/24/2018] [Indexed: 12/15/2022]
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20
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Al-Gobari M, Al-Aqeel S, Gueyffier F, Burnand B. Effectiveness of drug interventions to prevent sudden cardiac death in patients with heart failure and reduced ejection fraction: an overview of systematic reviews. BMJ Open 2018; 8:e021108. [PMID: 30056380 PMCID: PMC6067373 DOI: 10.1136/bmjopen-2017-021108] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To summarise and synthesise the current evidence regarding the effectiveness of drug interventions to prevent sudden cardiac death (SCD) and all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). DESIGN Overview of systematic reviews. DATA SOURCES MEDLINE, Embase, ISI Web of Science and Cochrane Library from inception to May 2017; manual search of references of included studies for potentially relevant reviews. ELIGIBILITY CRITERIA FOR STUDY SELECTION We reviewed the effectiveness of drug interventions for SCD and all-cause mortality prevention in patients with HFrEF. We included overviews, systematic reviews and meta-analyses of randomised controlled trials of beta-blockers, angiotensin-converting enzyme inhibitors (ACE-i), angiotensin receptor blockers (ARBs), antialdosterones or mineralocorticoid-receptor antagonists, amiodarone, other antiarrhythmic drugs, combined ARB/neprilysin inhibitors, statins and fish oil supplementation. REVIEW METHODS Two independent reviewers extracted data and assessed the methodological quality of the reviews and the quality of evidence for the primary studies for each drug intervention, using Assessing the Methodological Quality of Systematic Reviews (AMSTAR) and Grading of Recommendations, Assessment, Development and Evaluation(GRADE), respectively. RESULTS We identified 41 reviews. Beta-blockers, antialdosterones and combined ARB/neprilysin inhibitors appeared effective to prevent SCD and all-cause mortality. ACE-i significantly reduced all-cause mortality but not SCD events. ARBs and statins were ineffective where antiarrhythmic drugs and omega-3 fatty acids had unclear evidence of effectiveness for prevention of SCD and all-cause mortality. CONCLUSIONS This comprehensive overview of systematic reviews confirms that beta-blockers, antialdosterone agents and combined ARB/neprilysin inhibitors are effective on SCD prevention but not ACE-i or ARBs. In patients with high risk of SCD, an alternative therapeutic strategy should be explored in future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2017: CRD42017067442.
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Affiliation(s)
- Muaamar Al-Gobari
- Institute of Social and Preventive Medicine (IUMSP), Cochrane Switzerland, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sinaa Al-Aqeel
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - François Gueyffier
- Laboratoire de Biologie et Biométrie Evolutive-Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Bernard Burnand
- Institute of Social and Preventive Medicine (IUMSP), Cochrane Switzerland, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Gilbert EM, Xu WD. Rationales and choices for the treatment of patients with NYHA class II heart failure. Postgrad Med 2017; 129:619-631. [PMID: 28670961 DOI: 10.1080/00325481.2017.1344082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) in the United States represents a significant burden for patients and a tremendous strain on the healthcare system. Patients receiving a diagnosis of HF can be placed into 1 of 4 New York Heart Association (NYHA) functional classifications; the greatest proportion of patients are in the NYHA class II category, which is defined as patients having a slight limitation of physical activity but who are comfortable at rest, and for whom ordinary physical activity results in symptoms of HF. Because the severity of NYHA class II HF may be perceived as mild or unalarming by this definition, the urgency to treat this type of HF may be overlooked. However, these patients are optimal candidates for active intervention because their HF is at a critical point on the disease progression continuum when untoward changes can be halted or reversed. This review discusses the physiological consequences of NYHA class II HF with reduced ejection fraction and describes recent clinical trials that have demonstrated a therapeutic benefit for patients in this population. In doing so, we hope to establish that patients with NYHA class II disease merit careful attention and to provide reassurance to the treating community that options are available for these patients.
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Affiliation(s)
- Edward M Gilbert
- a Division of Cardiology , University of Utah , Salt Lake City , UT , USA
| | - Weining David Xu
- a Division of Cardiology , University of Utah , Salt Lake City , UT , USA
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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: 333] [Impact Index Per Article: 47.6] [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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Borne RT, Katz D, Betz J, Peterson PN, Masoudi FA. Implantable Cardioverter-Defibrillators for Secondary Prevention of Sudden Cardiac Death: A Review. J Am Heart Assoc 2017; 6:JAHA.117.005515. [PMID: 28258050 PMCID: PMC5524042 DOI: 10.1161/jaha.117.005515] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ryan T Borne
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - David Katz
- Division of Cardiology, Medical Center of the Rockies, University of Colorado Health, Loveland, CO
| | - Jarrod Betz
- Division of Cardiology, The Ohio State University Medical Center, Columbus, OH
| | - Pamela N Peterson
- Division of Cardiology, Denver Health and Hospital Authority, Denver, CO
| | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
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Duong E, Xiao J, Qi XY, Nattel S. MicroRNA-135a regulates sodium-calcium exchanger gene expression and cardiac electrical activity. Heart Rhythm 2017; 14:739-748. [PMID: 28188930 DOI: 10.1016/j.hrthm.2017.01.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Complete atrioventricular block (CAVB) causes arrhythmogenic remodeling and increases the risk of torsades de pointes arrhythmias. MicroRNAs (miRNAs) are key regulators of gene expression that contribute to cardiac remodeling. OBJECTIVE The purpose of this study was to assess miRNA changes after CAVB and identify novel candidates potentially involved in arrhythmogenic cardiac remodeling. METHODS CAVB was induced in mice via His-bundle ablation. Expression of miRNAs was evaluated by pan-miRNA microarray with quantitative polymerase chain reaction (qPCR) confirmation, on samples obtained 24 hours and 4 weeks post-CAVB. MiRNA target prediction algorithms were used to identify potential target genes. Targets confirmed by luciferase assays in HEK293 cells were followed up with overexpression studies in neonatal rat ventricular myocytes to evaluate regulation using real time- quantitative polymerase chain reaction (RT-qPCR), western blots, cell shortening measurements, and fura-2 Ca2+ fluorescence imaging. RESULTS Of >400 miRNAs assayed, only miRNA-135a (miR-135a) was altered at 24 hours, down-regulated 78% (P <.001). Algorithms predicted miR-135a regulation of the sodium-calcium exchanger type 1 (NCX1). miR-135a transfection suppressed NCX1 3'UTR reporter activity by 42% (P <.001), mRNA expression by 34% (P <.001), and protein levels by 45% (P <.001) vs noncoding miRNA control. miR-135a overexpression reduced spontaneous beating frequency of neonatal rat ventricular myocytes by 63% (P <.001) while slowing decay (by 56%, P <.05) of caffeine-induced Ca2+ transients. miR-135a also suppressed the Ca2+ loading effects of ouabain and ouabain-induced spontaneous Ca2+ release events. CONCLUSION NCX1 is negatively regulated by miR-135a, a microRNA that is down-regulated in the heart after CAVB in mice. By controlling NCX1 expression, miR-135a modulates cardiomyocyte automaticity, Ca2+ extrusion, and arrhythmogenic Ca2+ loading/spontaneous Ca2+ release events. Therefore, miR-135a may contribute to proarrhythmic remodeling after CAVB.
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Affiliation(s)
- Eric Duong
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada; Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Canada
| | - Jiening Xiao
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Canada
| | - Xiao Yan Qi
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Canada
| | - Stanley Nattel
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada; Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Canada; Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.
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Scheen A. Reappraisal of the diuretic effect of empagliflozin in the EMPA-REG OUTCOME trial: Comparison with classic diuretics. DIABETES & METABOLISM 2016; 42:224-33. [DOI: 10.1016/j.diabet.2016.05.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 12/23/2022]
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Chia N, Fulcher J, Keech A. Beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, nitrate-hydralazine, diuretics, aldosterone antagonist, ivabradine, devices and digoxin (BANDAID(2) ): an evidence-based mnemonic for the treatment of systolic heart failure. Intern Med J 2016; 46:653-62. [PMID: 26109136 DOI: 10.1111/imj.12839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Heart failure causes significant morbidity and mortality, with recognised underutilisation rates of guideline-based therapies. Our aim was to review current evidence for heart failure treatments and derive a mnemonic summarising best practice, which might assist physicians in patient care. Treatments were identified for review from multinational society guidelines and recent randomised trials, with a primary aim of examining their effects in systolic heart failure patients on mortality, hospitalisation rates and symptoms. Secondary aims were to consider other clinical benefits. MEDLINE and EMBASE were searched using a structured keyword strategy and the retrieved articles were evaluated methodically to produce an optimised reference list for each treatment. We devised the mnemonic BANDAID (2) , standing for beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, nitrate-hydralazine (or potentially neprilysin inhibitor), diuretics, aldosterone antagonist, ivabradine, devices (automatic implantable cardioverter defibrillator, cardiac resynchronisation therapy or both) and digoxin as a representation of treatments with strong evidence for their use in systolic heart failure. Treatment with omega-3 fatty acids, statins or anti-thrombotic therapies has limited benefits in a general heart failure population. Adoption of this mnemonic for current evidence-based treatments for heart failure may help improve prescribing rates and patient outcomes in this debilitating, high mortality condition.
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Affiliation(s)
- N Chia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - J Fulcher
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - A Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2016; 374:1092-1094. [DOI: 10.1056/nejmc1600827#sa1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Zinman B, Lachin JM, Inzucchi SE. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2016; 374:1093-4. [PMID: 26981940 DOI: 10.1056/nejmc1600827] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Le HH, El-Khatib C, Mombled M, Guitarian F, Al-Gobari M, Fall M, Janiaud P, Marchant I, Cucherat M, Bejan-Angoulvant T, Gueyffier F. Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One 2016; 11:e0145958. [PMID: 26891235 PMCID: PMC4758660 DOI: 10.1371/journal.pone.0145958] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 12/10/2015] [Indexed: 01/06/2023] Open
Abstract
Background and Objectives Sudden cardiac death (SCD) is a severe burden of modern medicine. Aldosterone antagonist is publicized as effective in reducing mortality in patients with heart failure (HF) or post myocardial infarction (MI). Our study aimed to assess the efficacy of AAs on mortality including SCD, hospitalization admission and several common adverse effects. Methods We searched Embase, PubMed, Web of Science, Cochrane library and clinicaltrial.gov for randomized controlled trials (RCTs) assigning AAs in patients with HF or post MI through May 2015. The comparator included standard medication or placebo, or both. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Event rates were compared using a random effects model. Prospective RCTs of AAs with durations of at least 8 weeks were selected if they included at least one of the following outcomes: SCD, all-cause/cardiovascular mortality, all-cause/cardiovascular hospitalization and common side effects (hyperkalemia, renal function degradation and gynecomastia). Results Data from 19,333 patients enrolled in 25 trials were included. In patients with HF, this treatment significantly reduced the risk of SCD by 19% (RR 0.81; 95% CI, 0.67–0.98; p = 0.03); all-cause mortality by 19% (RR 0.81; 95% CI, 0.74–0.88, p<0.00001) and cardiovascular death by 21% (RR 0.79; 95% CI, 0.70–0.89, p<0.00001). In patients with post-MI, the matching reduced risks were 20% (RR 0.80; 95% CI, 0.66–0.98; p = 0.03), 15% (RR 0.85; 95% CI, 0.76–0.95, p = 0.003) and 17% (RR 0.83; 95% CI, 0.74–0.94, p = 0.003), respectively. Concerning both subgroups, the relative risks respectively decreased by 19% (RR 0.81; 95% CI, 0.71–0.92; p = 0.002) for SCD, 18% (RR 0.82; 95% CI, 0.77–0.88, p < 0.0001) for all-cause mortality and 20% (RR 0.80; 95% CI, 0.74–0.87, p < 0.0001) for cardiovascular mortality in patients treated with AAs. As well, hospitalizations were significantly reduced, while common adverse effects were significantly increased. Conclusion Aldosterone antagonists appear to be effective in reducing SCD and other mortality events, compared with placebo or standard medication in patients with HF and/or after a MI.
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Affiliation(s)
- Hai-Ha Le
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Chadia El-Khatib
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Margaux Mombled
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Frédéric Guitarian
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Muaamar Al-Gobari
- Lausanne University Hospital (CHUV), Institute of social & preventive medicine (IUMSP), Lausanne, Switzerland
| | - Mor Fall
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Perrine Janiaud
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Ivanny Marchant
- Escuela de Medicina, Departamento de Pre-clínicas, Universidad de Valparaíso, Valparaíso, Chile
| | - Michel Cucherat
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
| | - Théodora Bejan-Angoulvant
- CHRU de Tours, Service de Pharmacologie Clinique, Hôpital Bretonneau, Tours, France
- CNRS UMR 7292, Tours, France
- Université François-Rabelais, GICC, Tours, France
| | - François Gueyffier
- Laboratoire de Biologie et Biométrie Evolutive - Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Lyon, France
- Service de Pharmacologie Clinique et essais thérapeutiques, Hospices Civils de Lyon, Lyon, France
- * E-mail:
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Dose doubling, relative potency, and dose equivalence of potassium-sparing diuretics affecting blood pressure and serum potassium. J Hypertens 2016; 34:11-9. [DOI: 10.1097/hjh.0000000000000762] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Bramlage P, Swift SL, Thoenes M, Minguet J, Ferrero C, Schmieder RE. Non-steroidal mineralocorticoid receptor antagonism for the treatment of cardiovascular and renal disease. Eur J Heart Fail 2015; 18:28-37. [DOI: 10.1002/ejhf.444] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/13/2015] [Accepted: 09/21/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Peter Bramlage
- Institute for Pharmacology and Preventive Medicine; Mahlow Germany
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy; University of Sevilla; Spain
| | | | | | - Joan Minguet
- Institute for Pharmacology and Preventive Medicine; Mahlow Germany
| | - Carmen Ferrero
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy; University of Sevilla; Spain
| | - Roland E. Schmieder
- Department of Nephrology and Hypertension; University Hospital of the University Erlangen-Nürnberg; Erlangen Germany
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Prevalence of Hyperuricemia and Gout in Mainland China from 2000 to 2014: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:762820. [PMID: 26640795 PMCID: PMC4657091 DOI: 10.1155/2015/762820] [Citation(s) in RCA: 352] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/20/2015] [Accepted: 10/25/2015] [Indexed: 12/22/2022]
Abstract
We systematically identified the prevalence of hyperuricemia and gout in mainland China and provided informative data that can be used to create appropriate local public health policies. Relevant articles from 2000 to 2014 were identified by searching 5 electronic databases: PubMed, Google Scholar, Chinese Wanfang, CNKI, and Chongqing VIP. All of the calculations were performed using the Stata 11.0 and SPSS 20.0 software. The eligible articles (n = 36; 3 in English and 33 in Chinese) included 44 studies (38 regarding hyperuricemia and 6 regarding gout). The pooled prevalence of hyperuricemia and gout was 13.3% (95% CI: 11.9%, 14.6%) and 1.1% (95% CI: 0.7%, 1.5%), respectively. Although publication bias was observed, the results did not change after a trim and fill test, indicating that that impact of this bias was likely insignificant. The prevalence of hyperuricemia and gout was high in mainland China. The subgroup analysis suggested that the geographical region, whether the residents dwell in urban or rural and coastal or inland areas, the economic level, and sex may be associated with prevalence.
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33
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace 2015; 17:1601-87. [PMID: 26318695 DOI: 10.1093/europace/euv319] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015; 36:2793-2867. [PMID: 26320108 DOI: 10.1093/eurheartj/ehv316] [Citation(s) in RCA: 2528] [Impact Index Per Article: 280.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
MESH Headings
- Acute Disease
- Aged
- Anti-Arrhythmia Agents/therapeutic use
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/therapy
- Autopsy/methods
- Cardiac Resynchronization Therapy/methods
- Cardiomyopathies/complications
- Cardiomyopathies/therapy
- Cardiotonic Agents/therapeutic use
- Catheter Ablation/methods
- Child
- Coronary Artery Disease/complications
- Coronary Artery Disease/therapy
- Death, Sudden, Cardiac/prevention & control
- Defibrillators
- Drug Therapy, Combination
- Early Diagnosis
- Emergency Treatment/methods
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/therapy
- Heart Transplantation/methods
- Heart Valve Diseases/complications
- Heart Valve Diseases/therapy
- Humans
- Mental Disorders/complications
- Myocardial Infarction/complications
- Myocardial Infarction/therapy
- Myocarditis/complications
- Myocarditis/therapy
- Nervous System Diseases/complications
- Nervous System Diseases/therapy
- Out-of-Hospital Cardiac Arrest/therapy
- Pregnancy
- Pregnancy Complications, Cardiovascular/therapy
- Primary Prevention/methods
- Quality of Life
- Risk Assessment
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/therapy
- Sports/physiology
- Stroke Volume/physiology
- Terminal Care/methods
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/therapy
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35
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Pokorney SD, Al-Khatib SM. Management of pace-terminated ventricular arrhythmias. Card Electrophysiol Clin 2015; 7:497-513. [PMID: 26304530 DOI: 10.1016/j.ccep.2015.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
An implantable-cardioverter defibrillator (ICD) can terminate ventricular arrhythmias by delivering a shock or by antitachycardia pacing (ATP). The ATP works by capturing the excitable gap and disrupting re-entrant ventricular arrhythmias. Multiple studies have demonstrated that ATP is successful at terminating ventricular tachycardia (VT). Shocks from the ICD are associated with higher mortality. The data are conflicting about whether appropriate ATP is associated with higher mortality. In a patient with VT that is treated by ATP, the patient's guideline-based heart failure medications should be maximized. The use of VT ablation after appropriate and successful ATP requires additional studies.
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Affiliation(s)
- Sean D Pokorney
- Electrophysiology Section, Duke University Medical Center, Durham, NC, USA
| | - Sana M Al-Khatib
- Electrophysiology Section, Duke University Medical Center, Durham, NC, USA.
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36
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Vizzardi E, Regazzoni V, Caretta G, Gavazzoni M, Sciatti E, Bonadei I, Trichaki E, Raddino R, Metra M. Mineralocorticoid receptor antagonist in heart failure: Past, present and future perspectives. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 3:6-14. [PMID: 29450163 PMCID: PMC5801434 DOI: 10.1016/j.ijchv.2014.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/08/2014] [Indexed: 12/24/2022]
Abstract
Aldosterone is involved in various deleterious effects on the cardiovascular system, including sodium and fluid retention, myocardial fibrosis, vascular stiffening, endothelial dysfunction, catecholamine release and stimulation of cardiac arrhythmias. Therefore, aldosterone receptor blockade may have several potential benefits in patients with cardiovascular disease. Mineralocorticoid receptor antagonists (MRAs) have been shown to prevent many of the maladaptive effects of aldosterone, in particular among patients with heart failure (HF). Randomized controlled trials have demonstrated efficacy of MRA in heart failure with reduced ejection fraction, both in patients with NYHA functional classes III and IV and in asymptomatic and mildly symptomatic patients (NYHA classes I and II). Recent data in patients with heart failure with preserved ejection fraction are encouraging. MRA could also have anti-arrhythmic effects on atrial and ventricular arrhythmias and may be helpful in patient ischemic heart disease through prevention of myocardial fibrosis and vascular damage. This article aims to discuss the pathophysiological effects of aldosterone in patients with cardiovascular disease and to review the current data that support the use of MRA in heart failure.
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Affiliation(s)
- Enrico Vizzardi
- Corresponding author. Tel.: + 39 303995679; fax: + 39 303996801Corresponding author.Tel.: + 39 303995679; fax: + 39 303996801
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37
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van den Berg TNA, Rongen GA, Fröhlich GM, Deinum J, Hausenloy DJ, Riksen NP. The cardioprotective effects of mineralocorticoid receptor antagonists. Pharmacol Ther 2013; 142:72-87. [PMID: 24275323 DOI: 10.1016/j.pharmthera.2013.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/04/2013] [Indexed: 01/14/2023]
Abstract
Despite state-of-the-art reperfusion therapy, morbidity and mortality remain significant in patients with an acute myocardial infarction. Therefore, novel strategies to limit myocardial ischemia-reperfusion injury are urgently needed. Mineralocorticoid receptor (MR) antagonists are attractive candidates for this purpose, since several clinical trials in patients with heart failure have reported a survival benefit with MR antagonist treatment. MRs are expressed by several cells of the cardiovascular system, including cardiomyocytes, cardiac fibroblasts, vascular smooth muscle cells, and endothelial cells. Experiments in animal models of myocardial infarction have demonstrated that acute administration of MR antagonists, either before ischemia or immediately at the moment of coronary reperfusion, limits infarct size. This action appears to be independent of the presence of aldosterone and cortisol, which are the endogenous ligands for the MR. The cardioprotective effect is mediated by a nongenomic intracellular signaling pathway, including adenosine receptor stimulation, and activation of several components of the Reperfusion Injury Salvage Kinase (RISK) pathway. In addition to limiting infarct size, MR antagonists can improve scar healing when administered shortly after reperfusion and can reduce cardiac remodeling post myocardial infarction. Clinical trials are currently being performed studying whether early administration of MR antagonists can indeed improve prognosis in patients with an acute myocardial infarction, independent of the presence of heart failure.
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Affiliation(s)
- T N A van den Berg
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of General Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Gerard A Rongen
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of General Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Georg M Fröhlich
- The Hatter Cardiovascular Institute, University College London, United Kingdom
| | - Jaap Deinum
- Department of General Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, United Kingdom
| | - Niels P Riksen
- Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of General Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands.
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38
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Minicucci MF, dos Santos PP, Rafacho BPM, Gonçalves AF, Silva RAC, Chiuso-Minicucci F, Azevedo PS, Polegato BF, Okoshi K, Pereira EJ, Paiva SAR, Zornoff LAM. Mechanisms involved in the beneficial effects of spironolactone after myocardial infarction. PLoS One 2013; 8:e76866. [PMID: 24098808 PMCID: PMC3786966 DOI: 10.1371/journal.pone.0076866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 08/23/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction Our objective was to analyze the effect of spironolactone on cardiac remodeling after experimental myocardial infarction (MI), assessed by matricellular proteins levels, cardiac collagen amount and distribution, myocardial tissue metalloproteinase inhibitor-1(TIMP-1) concentration, myocyte hypertrophy, left ventricular architecture, and invitro and invivo cardiac function. Methods Wistar rats were assigned to 4 groups: control group, in which animals were submitted to simulated surgery (SHAM group; n=9); group that received spironolactone and in which animals were submitted to simulated surgery (SHAM-S group, n=9); myocardial infarction group, in which animals were submitted to coronary artery ligation (MI group, n=15); and myocardial infarction group with spironolactone supplementation (MI-S group, n=15). The rats were observed for 3 months. Results The MI group had higher values of left cardiac chambers and mass index and lower relative wall thicknesses compared with the SHAM group. In addition, diastolic and systolic functions were worse in the MI groups. However, spironolactone did not influence any of these variables. The MI-S group had a lower myocardial hydroxyproline concentration and myocyte cross-sectional area compared with the MI group. Myocardial periostin and collagen type III were lower in the MI-S group compared with the MI-group. In addition, TIMP-1 concentration in myocardium was higher in the MI-S group compared with the MI group. Conclusions The predominant consequence of spironolactone supplementation after MI is related to reductions in collagens, with discrete attenuation of other remodeling variables. Importantly, this effect may be modulated by periostin and TIMP-1 levels.
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Affiliation(s)
- Marcos F. Minicucci
- Internal Medicine Department, Botucatu Medical School, University Estadual Paulista, Botucatu, São Paulo, Brazil
- * E-mail:
| | - Priscila P. dos Santos
- Internal Medicine Department, Botucatu Medical School, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Bruna P. M. Rafacho
- Internal Medicine Department, Botucatu Medical School, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Andrea F. Gonçalves
- Internal Medicine Department, Botucatu Medical School, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Renata A. C. Silva
- Internal Medicine Department, Botucatu Medical School, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Fernanda Chiuso-Minicucci
- Department of Microbiology and Immunology, Institute of Biosciences, University Estadual, Paulista, Botucatu, São Paulo, Brazil
| | - Paula S. Azevedo
- Internal Medicine Department, Botucatu Medical School, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Bertha F. Polegato
- Internal Medicine Department, Botucatu Medical School, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Katashi Okoshi
- Internal Medicine Department, Botucatu Medical School, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Elenize J. Pereira
- Internal Medicine Department, Botucatu Medical School, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Sergio A. R. Paiva
- Internal Medicine Department, Botucatu Medical School, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Leonardo A. M. Zornoff
- Internal Medicine Department, Botucatu Medical School, University Estadual Paulista, Botucatu, São Paulo, Brazil
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