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Givertz MM, Anstrom KJ, Redfield MM, Deswal A, Haddad H, Butler J, Tang WHW, Dunlap ME, LeWinter MM, Mann DL, Felker GM, O'Connor CM, Goldsmith SR, Ofili EO, Saltzberg MT, Margulies KB, Cappola TP, Konstam MA, Semigran MJ, McNulty SE, Lee KL, Shah MR, Hernandez AF. Effects of Xanthine Oxidase Inhibition in Hyperuricemic Heart Failure Patients: The Xanthine Oxidase Inhibition for Hyperuricemic Heart Failure Patients (EXACT-HF) Study. Circulation 2015; 131:1763-71. [PMID: 25986447 PMCID: PMC4438785 DOI: 10.1161/circulationaha.114.014536] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 03/05/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Oxidative stress may contribute to heart failure (HF) progression. Inhibiting xanthine oxidase in hyperuricemic HF patients may improve outcomes. METHODS AND RESULTS We randomly assigned 253 patients with symptomatic HF, left ventricular ejection fraction ≤40%, and serum uric acid levels ≥9.5 mg/dL to receive allopurinol (target dose, 600 mg daily) or placebo in a double-blind, multicenter trial. The primary composite end point at 24 weeks was based on survival, worsening HF, and patient global assessment. Secondary end points included change in quality of life, submaximal exercise capacity, and left ventricular ejection fraction. Uric acid levels were significantly reduced with allopurinol in comparison with placebo (treatment difference, -4.2 [-4.9, -3.5] mg/dL and -3.5 [-4.2, -2.7] mg/dL at 12 and 24 weeks, respectively, both P<0.0001). At 24 weeks, there was no significant difference in clinical status between the allopurinol- and placebo-treated patients (worsened 45% versus 46%, unchanged 42% versus 34%, improved 13% versus 19%, respectively; P=0.68). At 12 and 24 weeks, there was no significant difference in change in Kansas City Cardiomyopathy Questionnaire scores or 6-minute walk distances between the 2 groups. At 24 weeks, left ventricular ejection fraction did not change in either group or between groups. Rash occurred more frequently with allopurinol (10% versus 2%, P=0.01), but there was no difference in serious adverse event rates between the groups (20% versus 15%, P=0.36). CONCLUSIONS In high-risk HF patients with reduced ejection fraction and elevated uric acid levels, xanthine oxidase inhibition with allopurinol failed to improve clinical status, exercise capacity, quality of life, or left ventricular ejection fraction at 24 weeks. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00987415.
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Affiliation(s)
- Michael M Givertz
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.).
| | - Kevin J Anstrom
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Margaret M Redfield
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Anita Deswal
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Haissam Haddad
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Javed Butler
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - W H Wilson Tang
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Mark E Dunlap
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Martin M LeWinter
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Douglas L Mann
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - G Michael Felker
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Christopher M O'Connor
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Steven R Goldsmith
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Elizabeth O Ofili
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Mitchell T Saltzberg
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Kenneth B Margulies
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Thomas P Cappola
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Marvin A Konstam
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Marc J Semigran
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Steven E McNulty
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Kerry L Lee
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Monica R Shah
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Adrian F Hernandez
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
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