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Abdin A, Komajda M, Borer JS, Ford I, Tavazzi L, Batailler C, Swedberg K, Rosano GM, Mahfoud F, Böhm M. Efficacy of ivabradine in heart failure patients with a high-risk profile (analysis from the SHIFT trial). ESC Heart Fail 2023; 10:2895-2902. [PMID: 37427483 PMCID: PMC10567656 DOI: 10.1002/ehf2.14455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/04/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023] Open
Abstract
AIMS Early start and patient profile-oriented heart failure (HF) management has been recommended. In this post hoc analysis from the SHIFT trial, we analysed the treatment effects of ivabradine in HF patients with systolic blood pressure (SBP) < 110 mmHg, resting heart rate (RHR) ≥ 75 b.p.m., left ventricular ejection fraction (LVEF) ≤ 25%, New York Heart Association (NYHA) Class III/IV, and their combination. METHODS AND RESULTS The SHIFT trial enrolled 6505 patients (LVEF ≤ 35% and RHR ≥ 70 b.p.m.), randomized to ivabradine or placebo on the background of guideline-defined standard care. Compared with placebo, ivabradine was associated with a similar relative risk reduction of the primary endpoint (cardiovascular death or HF hospitalization) in patients with SBP < 110 and ≥110 mmHg [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.74-1.08 vs. HR 0.80, 95% CI 0.72-0.89, P interaction = 0.34], LVEF ≤ 25% and >25% (HR 0.85, 95% CI 0.72-1.01 vs. HR 0.80, 95% CI 0.71-0.90, P interaction = 0.53), and NYHA III-IV and II (HR 0.83, 95% CI 0.74-0.94 vs. HR 0.81, 95% CI 0.69-0.94, P interaction = 0.79). The effect was more pronounced in patients with RHR ≥ 75 compared with <75 (HR 0.76, 95% CI 0.68-0.85 vs. HR 0.97, 95% CI 0.81-0.1.16, P interaction = 0.02). When combining these profiling parameters, treatment with ivabradine was also associated with risk reductions comparable with patients with low-risk profiles for the primary endpoint (relative risk reduction 29%), cardiovascular death (11%), HF death (49%), and HF hospitalization (38%; all P values for interaction: 0.40). No safety concerns were observed between study groups. CONCLUSIONS Our analysis shows that RHR reduction with ivabradine is effective and improves clinical outcomes in HF patients across various risk indicators such as low SBP, high RHR, low LVEF, and high NYHA class to a similar extent and without safety concern.
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Affiliation(s)
- Amr Abdin
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care MedicineSaarland University Medical CenterKirrberger Strasse 100Homburg/Saar66421Germany
| | - Michel Komajda
- Department of CardiologyHospital Saint JosephParisFrance
| | - Jeffrey S. Borer
- The Howard Gilman Institute for Heart Valve Diseases and Schiavone Institute for Cardiovascular Translational ResearchState University of New York Downstate Health Sciences UniversityBrooklyn and New YorkNYUSA
| | - Ian Ford
- Robertson Centre for BiostatisticsUniversity of GlasgowGlasgowUK
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
| | | | - Karl Swedberg
- Department of Molecular and Clinical MedicineUniversity of GothenburgGothenburgSweden
| | | | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care MedicineSaarland University Medical CenterKirrberger Strasse 100Homburg/Saar66421Germany
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care MedicineSaarland University Medical CenterKirrberger Strasse 100Homburg/Saar66421Germany
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Saag KG, Becker MA, White WB, Whelton A, Borer JS, Gorelick PB, Hunt B, Castillo M, Gunawardhana L. Evaluation of Serum Urate Levels and the Clinical Manifestation of Gout with Cardiovascular Mortality from the CARES Trial. Arthritis Rheumatol 2022; 74:1593-1601. [PMID: 35536764 PMCID: PMC9541704 DOI: 10.1002/art.42160] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 04/01/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
Objective To investigate whether serum urate levels, number of gout flares, and tophi burden are related to death from cardiovascular (CV) causes after treatment with febuxostat or allopurinol in patients with gout from the Cardiovascular Safety of Febuxostat or Allopurinol in Patients With Gout and Cardiovascular Comorbidities (CARES) trial. Methods Patients were randomly assigned to receive febuxostat (40 mg or 80 mg once daily, according to serum urate levels at week 2) or allopurinol titrated in 100‐mg increments from 200–400 mg or 300–600 mg (with dose determined according to kidney function). Changes from baseline in serum urate level, gout flares, and tophus resolution were key exploratory efficacy parameters in the overall population and in subgroups of patients who died and those who did not die from a CV‐related cause. The latter subgroup included patients who died due to non‐CV causes and those who did not die due to any cause. Results Patients received treatment with febuxostat (n = 3,098) or allopurinol (n = 3,092) for a median follow‐up period of 32 months (for a maximum of 85 months). In the overall population, mean serum urate levels were lower in those receiving febuxostat compared with those receiving allopurinol at most study visits. There were no associations between serum urate levels and death from CV causes with febuxostat. The number of gout flares requiring treatment was higher within 1 year of treatment with febuxostat compared with allopurinol (mean incidence of gout flares per patient‐years of exposure 1.33 versus 1.20), but was comparable thereafter and decreased overall throughout the study period (mean incidence of gout flares per patient‐years of exposure 0.35 versus 0.34 after 1 year of treatment; overall mean incidence 0.68 versus 0.63) irrespective of whether the patient died from a CV‐related cause. Overall, 20.8% of patients had ≥1 tophus at baseline; tophus resolution rates were similar between treatment groups, with cumulative resolution rates of >50%. Conclusion In the CARES trial, febuxostat and allopurinol (≤600 mg doses) had comparable efficacy in patients with gout and CV disease, and there was no evidence of a relationship between death from CV causes and serum urate levels, number of gout flares, or tophus resolution among the patients receiving febuxostat.
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Affiliation(s)
- Kenneth G Saag
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael A Becker
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - William B White
- Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | | | - Jeffrey S Borer
- State University of New York Downstate University of the Health Sciences, Brooklyn, New York
| | - Philip B Gorelick
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Barbara Hunt
- Takeda Development Center Americas, Inc., Lexington, Massachusetts
| | - Majin Castillo
- Takeda Development Center Americas, Inc., Lexington, Massachusetts
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Reil JC, Reil GH, Hecker N, Sequeira V, Borer JS, Stierle U, Lavall D, Marquetand C, Busch C, Patzelt J, Heringlake M, Schäfers HJ, Sievers HH, Ensminger S, Aboud A. Reduced left ventricular contractility, increased diastolic operant stiffness and high energetic expenditure in patients with severe aortic regurgitation without indication for surgery. Interact Cardiovasc Thorac Surg 2021; 32:29-38. [PMID: 33221839 DOI: 10.1093/icvts/ivaa232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/13/2020] [Accepted: 09/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Recent mortality studies showed worse prognosis in patients (ARNS) with severe aortic regurgitation and preserved ejection fraction (EF) not fulfilling the criteria of current guidelines for surgery. The aim of our study was to analyse left ventricular (LV) systolic and diastolic function and mechanical energetics to find haemodynamic explanations for the reduced prognosis of these patients and to seek a new concept for surgery. METHODS Global longitudinal strain (GLS) and echo-based single-beat pressure-volume analyses were performed in patients with ARNS (LV end-diastolic diameter <70 mm, EF >50%, GLS > -19% n = 41), with indication for surgery (ARS; n = 19) and in mild hypertensive controls (C; n = 20). Additionally, end-systolic elastance (LV contractility), stroke work and total energy (pressure-volume area) were calculated. RESULTS ARNS demonstrated significantly depressed LV contractility versus C: end-systolic elastance (1.58 ± 0.7 vs 2.54 ± 0.8 mmHg/ml; P < 0.001), despite identical EF (EF: 59 ± 6% vs 59 ± 7%). Accordingly, GLS was decreased [-15.7 ± 2.7% (n = 31) vs -21.2 ± 2.4%; P < 0.001], end-diastolic volume (236 ± 90 vs 136 ± 30 ml; P < 0.001) and diastolic operant stiffness were markedly enlarged, as were pressure-volume area and stroke work, indicating waste of energy. The correlation of GLS versus end-systolic elastance was good (r = -0.66; P < 0.001). ARNS and ARS patients demonstrated similar haemodynamic disorders, whereas only GLS was worse in ARS. CONCLUSIONS ARNS patients almost matched the ARS patients in their haemodynamic and energetic deterioration, thereby explaining poor prognosis reported in literature. GLS has been shown to be a reliable surrogate for LV contractility, possibly overestimating contractility due to exhausted preload reserve in aortic regurgitation patients. GLS may outperform conventional echo parameters to predict more precisely the timing of surgery.
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Affiliation(s)
- Jan-Christian Reil
- Klinik für Innere Medizin II, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Gert-Hinrich Reil
- Klinik für Innere Medizin I, Kardiologie und Internistische Intensivmedizin, Klinikum Oldenburg, Oldenburg, Germany
| | - Nora Hecker
- Klinik für Innere Medizin II, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Vasco Sequeira
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Jeffrey S Borer
- The Howard Gilman Institute for Heart Valve Disease and the Schiavone Institute for Cardiovascular Translational Research, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Ulrich Stierle
- Klinik für Herzchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Daniel Lavall
- Klinik und Polikliinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Christoph Marquetand
- Klinik für Innere Medizin II, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Claudia Busch
- Klinik für Herzchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Johannes Patzelt
- Klinik für Innere Medizin II, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Matthias Heringlake
- Klinik für Anästhesie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Hans-Joachim Schäfers
- Klinik für Herz-und Thoraxchirurgie, Universitätsklinikum des Saarlandes, Homburg Saar, Germany
| | - Hans-Hinrich Sievers
- Klinik für Herzchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Stephan Ensminger
- Klinik für Herzchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Anas Aboud
- Klinik für Herzchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
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Borer JS. Iatrogenic Atrial Septal Defect After Mitral Valve Repair for Mitral Regurgitation: To Close or Not to Close, That Is the Question. JACC Cardiovasc Interv 2021; 14:67-68. [PMID: 33413866 DOI: 10.1016/j.jcin.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Jeffrey S Borer
- The Howard Gilman Institute for Heart Valve Diseases and Schiavone Institute for Cardiovascular Translational Research, State University of New York Downstate Health Sciences University, Brooklyn and New York, New York, USA.
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Tyl B, Lopez Sendon J, Borer JS, Lopez De Sa E, Lerebours G, Varin C, De Montigny A, Pannaux M, Komajda M. Comparison of Outcome Adjudication by Investigators and by a Central End Point Committee in Heart Failure Trials. Circ Heart Fail 2020; 13:e006720. [DOI: 10.1161/circheartfailure.119.006720] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The usefulness of adjudication by central end point committees (CECs) is poorly assessed in heart failure (HF) trials. We aimed to assess its impact on the outcome of the SHIFT trial (Systolic HF Treatment With the If Inhibitor Ivabradine Trial).
Methods:
SHIFT was a randomized placebo-controlled trial investigating the effect of ivabradine in 6505 HF patients with reduced ejection fraction. Prespecified end points, reported by investigators (all cardiologists) using specific case report form pages, included all-cause and specific causes of deaths and hospitalizations. The primary end point was a composite of cardiovascular deaths or hospitalizations for worsening HF. We compared the adjudication of prespecified end points made by investigators and by the CEC.
Results:
Investigators identified 7529 prespecified end points, 6793 of which were confirmed by the CEC: 98.1% of cardiovascular deaths, 88.6% of all hospitalizations, and 84.4% of hospitalizations for worsening HF. These differences had no meaningful impact on the study results; hazard ratio for the primary composite end point: investigators, 0.83 (95% CI, 0.76–0.91) versus CEC, 0.82 (95% CI, 0.75–0.90), with similar results for each component of the primary end point (hazard ratio of 0.92 versus 0.91 for cardiovascular death and 0.78 versus 0.74 for hospitalization for worsening HF).
Conclusions:
Central adjudication by a CEC in the SHIFT study confirmed most of cardiovascular deaths and worsening HF hospitalizations assessed by cardiologists and did not result in a significant change of the final result as compared to investigator judgment. In this context, the benefits of CEC in blinded HF trials should be reconsidered.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02441218. URL:
http://www.isrctn.com/ISRCTN70429960
; Unique identifier: ISRCTN70429960.
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Affiliation(s)
- Benoît Tyl
- CardioVascular & Metabolic Disease Center for Therapeutic Innovation (B.T., C.V.), Institut de Recherches Internationales Servier, Suresnes, France
| | - José Lopez Sendon
- Cardiology Department (J.L.S.), University Hospital La Paz, UAM, IdiPaz, CiberCV, Madrid, Spain
| | - Jeffrey S. Borer
- College of Medicine, School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York (J.S.B.)
- Weill Cornell Medicine, New York, NY (J.S.B.)
| | - Esteban Lopez De Sa
- Acute Cardiac Care Unit (E.L.D.S.), University Hospital La Paz, UAM, IdiPaz, CiberCV, Madrid, Spain
| | | | - Claire Varin
- CardioVascular & Metabolic Disease Center for Therapeutic Innovation (B.T., C.V.), Institut de Recherches Internationales Servier, Suresnes, France
| | - Aurélie De Montigny
- Center of Excellence Methodology and Valorisation of Data (A.D.M., M.P.), Institut de Recherches Internationales Servier, Suresnes, France
| | - Matthieu Pannaux
- Center of Excellence Methodology and Valorisation of Data (A.D.M., M.P.), Institut de Recherches Internationales Servier, Suresnes, France
| | - Michel Komajda
- Department of Cardiology, Hospital Saint Joseph, Paris, France (M.K.)
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Butchart EG, Chambers J, Borer JS, Grunkemeier G, Yoganathan A. Long-Term Durability of Transcatheter Valves. JACC Cardiovasc Interv 2020; 13:253-256. [DOI: 10.1016/j.jcin.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
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Sharma A, Lavie CJ, Elmariah S, Borer JS, Sharma SK, Vemulapalli S, Yerokun BA, Li Z, Matsouaka RA, Marmur JD. Relationship of Body Mass Index With Outcomes After Transcatheter Aortic Valve Replacement: Results From the National Cardiovascular Data-STS/ACC TVT Registry. Mayo Clin Proc 2020; 95:57-68. [PMID: 31902429 DOI: 10.1016/j.mayocp.2019.09.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/21/2019] [Accepted: 09/30/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate the relationship of body mass index (BMI) with short- and long-term outcomes after transcatheter aortic valve replacement (TAVR). PATIENTS AND METHODS The relationship between BMI and baseline characteristics and procedural characteristics was assessed for 31,929 patients who underwent TAVR between November 1, 2011, and March 31, 2015, from the STS/ACC TVT Registry. Registry data on 20,429 patients were linked to the Centers for Medicare and Medicaid Services to assess the association of BMI with 30-day and 1-year mortality using multivariable Cox proportional hazards models. The effect of BMI on mortality was also assessed with BMI as a continuous variable. Restricted cubic regression splines were used to model the effect of BMI and to determine appropriate cut points of BMI. RESULTS Among 31,929 patients, 806 (2.5%) were underweight (BMI, <18.5 kg/m2), 10,755 (33.7%) had normal weight (BMI, 18.5- 24.9 kg/m2), 10,691 (33.5%) were overweight (BMI, 25.0-29.9 kg/m2), 5582 (17.5%) had class I obesity (BMI, 30.0-34.9 kg/m2), 2363 (7.4%) had class II obesity (BMI, 35.0-39.9 kg/m2), and 1732 (5.4%) had class III obesity (BMI, ≥40 kg/m2). Patients in various BMI categories were different in most baseline and procedural characteristics. On multivariable analysis, compared with normal-weight patients, underweight patients had higher mortality at 30 days and at 1 year after TAVR (hazard ratio [HR], 1.35; 95% CI, 1.02-1.78 and HR, 1.41; 95% CI, 1.17-1.69, respectively), whereas overweight patients and those with class I and II obesity had a decreased risk of mortality at 1 year (HR, 0.88; 95% CI, 0.81-0.95, HR, 0.80; 95% CI, 0.72-0.89, and HR, 0.84; 95% CI, 0.72-0.98, respectively). For BMI of 30 kg/m2 or less, each 1-kg/m2 increase was associated with a 2% and 4% decrease in the risk of 30-day and 1-year mortality, respectively; for BMI greater than 30 kg/m2, a 1-kg/m2 increase was associated with a 3% increased risk of 30-day mortality but not with 1-year mortality. CONCLUSION Results of this large registry study evaluating the relationship of BMI and outcomes after TAVR support the existence of an obesity paradox among patients with severe aortic stenosis undergoing TAVR.
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Affiliation(s)
- Abhishek Sharma
- Division of Cardiovascular Medicine, Gundersen Health System, La Crosse, WI; Institute of Cardiovascular Research and Technology, Brooklyn, NY.
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA
| | - Sammy Elmariah
- Cardiology Division, Massachusetts General Hospital, and Harvard Clinical Research Institute, Boston, MA
| | - Jeffrey S Borer
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, NY
| | - Samin K Sharma
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Babatunde A Yerokun
- Duke Clinical Research Institute; Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Roland A Matsouaka
- Duke Clinical Research Institute; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Jonathan D Marmur
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, NY
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Reil JC, Reil GH, Borer JS, Hecker N, Aboud A, Schaefers HS, Langer HF, Sievers HH, Ensminger S. P1421 Patients with severe aortic regurgitation showed systolic dysfunction and increased stroke work despite preserved EF; clues for reconsidering optimal time point of surgery. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Current guidelines recommend surgery in patients with severe aortic regurgitation (AR) with clinical symptoms or subnormal ejection fraction (EF). Furthermore, surgery should be considered in patients with severe AR, preserved EF and increased left ventricular diameters (LVEDD >70mm, LVESD >50mm). The aim of the study was to investigate LV systolic function as well as mechanical energetics using non-invasive pressure-volume- and strain analysis in patients with severe AR and preserved EF as well as moderately dilated ventricles (LVEDD <70mm).
Methods and Results
Echocardiographic strain and single beat pressure-volume analyses were performed in patients with severe AR and moderately increased ventricular size (LVEDD < 70mm, EF >50% n = 39) as well as healthy, age-matched controls (n = 20) using echo-derived volume and arm-cuff blood pressure measurements. Load independent parameters of systolic contractile function like end-systolic elastance (Ees) and end-systolic volume at 100mmHg (ESV100) were calculated as well as stroke work ((SW) and total pressure volume area (PVA = SW + potential energy). Patients with AR demonstrated significant depression of systolic function beyond ejection fraction: global longitudinal strain was reduced compared to controls (-16 ±2.5% vs. -21.5 ±2%; p < 0.001). Accordingly load independent parameters of LV contractility like Ees (1.5mmHg/ml ±0.7 vs. 2.25mmHg/ml ±0.7; p < 0.001), ESV100 (65.7ml ±19.4 vs. 42.4ml ±19.8; p < 0.05) were reduced despite comparable ejection fractions (EF: 0.56% ±0.05 vs. 0.60% ±0.07 p = 0,10). End-diastolic volume of AR patients was markedly elevated (236ml ±90 vs. 136ml ±30; p < 0.001), while PVA (20470mmHg x ml ±10400 vs. 11907mmHg x ml ±2877; p < 0.01) and stroke work (13200mmHg x ml ±5700 vs. 7606 mmHG x ml ±2048; p< 0.01) were markedly elevated indicating waste of energy.
Conclusion
Patients with severe AR and moderately enhanced LV showed depressed values of contractility and waste of energy using more advanced parameters of LV systolic function although EF was preserved. The data may demonstrate that surgery is performed too late in many of those patients and may give clues for reconsidering guidelines to meet the optimal time point of surgery.
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Affiliation(s)
- J C Reil
- University of Lubeck, Luebeck, Germany
| | - G-H Reil
- Oldenburg Hospital, Cardiology, Oldenburg, Germany
| | - J S Borer
- State University of New York Downstate Medical Center, The Howard Gilman Institute for Heart Valve Disease and the Schiavone Institute for Cardiovascular , New York, United States of America
| | - N Hecker
- University of Lubeck, Luebeck, Germany
| | - A Aboud
- University of Lubeck, Luebeck, Germany
| | - H-S Schaefers
- University Hospital Saarland, heart surgery, Homburg, Germany
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Hill JA, Agewall S, Baranchuk A, Booz GW, Borer JS, Camici PG, Chen PS, Dominiczak AF, Erol Ç, Grines CL, Gropler R, Guzik TJ, Heinemann MK, Iskandrian AE, Knight BP, London B, Lüscher TF, Metra M, Musunuru K, Nallamothu BK, Natale A, Saksena S, Picard MH, Rao SV, Remme WJ, Rosenson RS, Sweitzer NK, Timmis A, Vrints C. Medical misinformation: vet the message! Cardiovasc Res 2019; 115:e187-e188. [PMID: 30689762 PMCID: PMC10155815 DOI: 10.1093/cvr/cvz007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Hill JA, Agewall S, Baranchuk A, Booz GW, Borer JS, Camici PG, Chen PS, Dominiczak AF, Erol Ç, Grines CL, Gropler R, Guzik TJ, Heinemann MK, Iskandrian AE, Knight BP, London B, Lüscher TF, Metra M, Musunuru K, Nallamothu BK, Natale A, Saksena S, Picard MH, Rao SV, Remme WJ, Rosenson RS, Sweitzer NK, Timmis A, Vrints C. Medical Misinformation. Circulation 2019; 139:571-572. [PMID: 30689419 DOI: 10.1161/circulationaha.118.039193] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Stefan Agewall
- Editor-in-Chief, European Heart Journal Cardiovascular Pharmacotherapy
| | | | - George W Booz
- Editor-in-Chief, Journal of Cardiovascular Pharmacology
| | | | | | | | | | - Çetin Erol
- Editor-in-Chief, Anatolian Journal of Cardiology
| | | | | | | | | | | | | | - Barry London
- Editor-in-Chief, Journal of the American Heart Association
| | | | - Marco Metra
- Editor-in-Chief, European Journal of Heart Failure
| | - Kiran Musunuru
- Editor-in-Chief, Circulation: Genomic and Precision Medicine
| | | | - Andrea Natale
- Editors-in-Chief, Journal of Interventional Cardiac Electrophysiology
| | - Sanjeev Saksena
- Editors-in-Chief, Journal of Interventional Cardiac Electrophysiology
| | - Michael H Picard
- Editor-in-Chief, Journal of the American Society of Echocardiography
| | - Sunil V Rao
- Editor-in-Chief, Circulation: Cardiovascular Interventions
| | | | | | | | - Adam Timmis
- Editor-in-Chief, European Heart Journal: Quality of Care and Clinical Outcomes
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Bouabdallaoui N, O'Meara E, Bernier V, Komajda M, Swedberg K, Tavazzi L, Borer JS, Bohm M, Ford I, Tardif JC. Beneficial effects of ivabradine in patients with heart failure, low ejection fraction, and heart rate above 77 b.p.m. ESC Heart Fail 2019; 6:1199-1207. [PMID: 31591826 PMCID: PMC6989297 DOI: 10.1002/ehf2.12513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 08/01/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022] Open
Abstract
Aims Ivabradine has been approved in heart failure with reduced ejection fraction (HFrEF) and elevated heart rate despite guideline‐directed medical therapy (GDMT) to reduce cardiovascular (CV) death and hospitalization for worsening HF. The median value of 77 b.p.m. is the lower bound selected for the regulatory approval in Canada, South Africa, and Australia. Patient‐reported outcomes (PROs) including symptoms, quality of life, and global assessment are considered of major interest in the global plan of care of patients with HF. However, the specific impact of GDMT, and specifically ivabradine, on PRO remains poorly studied. In the subgroup of patients from the Systolic Heart failure treatment with the If inhibitor ivabradine Trial (SHIFT) who had heart rate above the median of 77 b.p.m. (pre‐specified analysis) and for whom the potential for improvement was expected to be larger, we aimed (i) to evaluate the effects of ivabradine on PRO (symptoms, quality of life, and global assessment); (ii) to consolidate the effects of ivabradine on the primary composite endpoint of CV death and hospitalization for HF; and (iii) to reassess the effects of ivabradine on left ventricular (LV) remodelling. Methods and results Comparisons were made according to therapy, and proportional hazards models (adjusted for baseline beta‐blocker therapy) were used to estimate the association between ivabradine and various outcomes. In SHIFT, n = 3357 (51.6%) patients had a baseline heart rate > 77 b.p.m. After a median follow‐up of 22.9 months (inter‐quartile range 18–28 months), ivabradine on top of GDMT improved symptoms (28% vs. 23% improvement in New York Heart Association functional class, P = 0.0003), quality of life (5.3 vs. 2.2 improvement in Kansas City Cardiomyopathy Questionnaire overall summary score, P = 0.005), and global assessment [from both patient (improved in 72.3%) and physician (improved in 61.0%) perspectives] significantly more than did placebo (both P < 0.0001). Ivabradine induced a 25% reduction in the combined endpoint of CV death and hospitalization for HF (hazard ratio 0.75; P < 0.0001), which translates into a number of patients needed to be treated for 1 year of 17. Patients under ivabradine treatment demonstrated a significant reduction in LV dimensions when reassessed at 8 months (P < 0.05). Conclusions In patients with chronic HFrEF, sinus rhythm, and a heart rate > 77 b.p.m. while on GDMT, the present analysis brings novel insights into the role of ivabradine in improving the management of HFrEF, particularly with regard to PRO (ISRCTN70429960).
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Affiliation(s)
- Nadia Bouabdallaoui
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, H1T 1C8, Quebec, Canada
| | - Eileen O'Meara
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, H1T 1C8, Quebec, Canada
| | - Virginie Bernier
- Scientific and Medical Affairs, Servier Canada Inc., Laval, Quebec, Canada
| | - Michel Komajda
- Department of Cardiology, Paris Saint Joseph Hospital, Paris, France
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Jeffrey S Borer
- Howard Gilman and Schiavone Institutes, State University of New York Downstate Medical Center, New York, NY, USA
| | - Michael Bohm
- Internal Medicine Clinic III, Saarland University Clinic, Saarland University, Homburg, Saar, Germany
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, H1T 1C8, Quebec, Canada
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Kiehl EL, Menon V, Mandsager KT, Wolski KE, Wisniewski L, Nissen SE, Lincoff AM, Borer JS, Lüscher TF, Cantillon DJ. Effect of Left Ventricular Conduction Delay on All-Cause and Cardiovascular Mortality (from the PRECISION Trial). Am J Cardiol 2019; 124:1049-1055. [PMID: 31395295 DOI: 10.1016/j.amjcard.2019.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
The prognosis associated with prolonged intraventricular conduction on electrocardiogram (ECG) remains uncertain. We aimed to compare clinical outcomes of narrow versus prolonged intraventricular conduction on ECG stratified by QRS morphology and cardiovascular disease (CVD) status. A post-hoc analysis was performed of the randomized-control PRECISION trial. Patients with centrally adjudicated, nonpaced baseline ECGs were included. QRS duration was classified narrow (≤100 ms) versus prolonged (>100 ms) with additional categorization into left (LBBB) or right (RBBB) bundle branch block or nonspecific intraventricular conduction delay (IVCD). IVCD was subclassified if left ventricular conduction delay (LVCD) was present (L-IVCD) or absent (O-IVCD). The primary outcome was adjudicated all-cause and cardiovascular (CV) mortality. Of 24,081 patients randomized, 22,067 (92%) were included with follow-up 34 ± 13 months. Study patients were 63 ± 9 years, 64% female, 75% Caucasian, 23% with established CVD. The prevalence of QRS prolongation was 5.6% (1,240): 760 right bundle branch block (3.4%), 313 LBBB (1.4%), and 161 IVCD (0.7%), 95 subclassified L-IVCD (0.4%). After adjustment, LBBB and L-IVCD were similarly associated with increased all-cause (LBBB: 2.3 [1.4 to 3.8], p = 0.001; L-IVCD: 4.0 [2.1 to 7.9], p <0.001) and CV (LBBB: 3.6 [2.0 to 6.5], p <0.001; L-IVCD 3.6 [1.3 to 9.7], p = 0.001) mortality. The presence of LVCD (LBBB or L-IVCD) was associated with all-cause (2.8 [1.8 to 4.2], p <0.001) and CV (3.6 [2.2 to 6.1], p <0.001) mortality exceeding the observed risks of coronary artery disease, left ventricular hypertrophy, or diabetes. The LVCD hazard persisted across QRS durations (100 to 120 vs >120 ms) and CVD status. In conclusion, LVCD, whether LBBB or L-IVCD, was strongly associated with increased mortality in patients with and at-risk for CVD.
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Borer JS. Application of Transcatheter Repair to Tricuspid Regurgitation: Still Looking Through a Dark Glass. J Am Coll Cardiol 2019; 73:1916-1918. [PMID: 30999994 DOI: 10.1016/j.jacc.2019.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Jeffrey S Borer
- College of Medicine, School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York; Weill Cornell Medicine, New York, New York.
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Hill JA, Agewall S, Baranchuk A, Booz GW, Borer JS, Camici PG, Chen PS, Dominiczak AF, Erol Ç, Grines CL, Gropler R, Guzik TJ, Heinemann MK, Iskandrian AE, Knight BP, London B, Lüscher TF, Metra M, Musunuru K, Nallamothu BK, Natale A, Saksena S, Picard MH, Rao SV, Remme WJ, Rosenson RS, Sweitzer NK, Timmis A, Vrints C. Medical misinformation: vet the message! European Heart Journal - Quality of Care and Clinical Outcomes 2019; 5:83-84. [PMID: 30689789 PMCID: PMC6440437 DOI: 10.1093/ehjqcco/qcy057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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15
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Hill JA, Agewall S, Baranchuk A, Booz GW, Borer JS, Camici PG, Chen PS, Dominiczak AF, Erol Ç, Grines CL, Gropler R, Guzik TJ, Heinemann MK, Iskandrian AE, Knight BP, London B, Lüscher TF, Metra M, Musunuru K, Nallamothu BK, Natale A, Saksena S, Picard MH, Rao SV, Remme WJ, Rosenson RS, Sweitzer NK, Timmis A, Vrints C. Medical misinformation: vet the message! European Heart Journal - Cardiovascular Pharmacotherapy 2019; 5:62-63. [PMID: 30689786 PMCID: PMC6418469 DOI: 10.1093/ehjcvp/pvz001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hill JA, Agewall S, Baranchuk A, Booz GW, Borer JS, Camici PG, Chen PS, Dominiczak AF, Erol Ç, Grines CL, Gropler R, Guzik TJ, Heinemann MK, Iskandrian AE, Knight BP, London B, Lüscher TF, Metra M, Musunuru K, Nallamothu BK, Natale A, Saksena S, Picard MH, Rao SV, Remme WJ, Rosenson RS, Sweitzer NK, Timmis A, Vrints C. Medical Misinformation: Vet the Message! Eur Heart J 2019; 40:404-405. [PMID: 30689805 PMCID: PMC6356051 DOI: 10.1093/eurheartj/ehz009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | | | - Stefan Agewall
- Editor-in-Chief, European Heart Journal Cardiovascular Pharmacotherapy
| | | | - George W Booz
- Editor-in-Chief; Journal of Cardiovascular Pharmacology
| | | | | | | | | | - Çetin Erol
- Editor-in-Chief, Anatolian Journal of Cardiology
| | | | | | | | | | | | | | - Barry London
- Editor-in-Chief, Journal of the American Heart Association
| | | | - Marco Metra
- Editor-in-Chief, European Journal of Heart Failure
| | - Kiran Musunuru
- Editor-in-Chief, Circulation: Genomic and Precision Medicine
| | | | - Andrea Natale
- Editor-in-Chief, Journal of Interventional Cardiac Electrophysiology
| | - Sanjeev Saksena
- Editor-in-Chief, Journal of Interventional Cardiac Electrophysiology
| | - Michael H Picard
- Editor-in-Chief, Journal of the American Society of Echocardiography
| | - Sunil V Rao
- Editor-in-Chief, Circulation: Cardiovascular Interventions
| | | | | | | | - Adam Timmis
- Editor-in-Chief, European Heart Journal: Quality of Care and Clinical Outcomes
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17
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Hill JA, Agewall S, Baranchuk A, Booz GW, Borer JS, Camici PG, Chen PS, Dominiczak AF, Erol Ç, Grines CL, Gropler R, Guzik TJ, Heinemann MK, Iskandrian AE, Knight BP, London B, Lüscher TF, Metra M, Musunuru K, Nallamothu BK, Natale A, Saksena S, Picard MH, Rao SV, Remme WJ, Rosenson RS, Sweitzer NK, Timmis A, Vrints C. Medical misinformation: Vet the message! Heart Rhythm 2019; 16:332-333. [PMID: 30703343 DOI: 10.1016/j.hrthm.2018.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Indexed: 10/27/2022]
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18
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Hill JA, Agewall S, Baranchuk A, Booz GW, Borer JS, Camici PG, Chen PS, Dominiczak AF, Erol Ç, Grines CL, Gropler R, Guzik TJ, Heinemann MK, Iskandrian AE, Knight BP, London B, Lüscher TF, Metra M, Musunuru K, Nallamothu BK, Natale A, Saksena S, Picard MH, Rao SV, Remme WJ, Rosenson RS, Sweitzer NK, Timmis A, Vrints C. Medical Misinformation. Circ Cardiovasc Interv 2019; 12:e007796. [PMID: 30688520 DOI: 10.1161/circinterventions.119.007796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam Timmis
- European Heart Journal: Quality of Care and Clinical Outcomes
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19
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Hill JA, Agewall S, Baranchuk A, Booz GW, Borer JS, Camici PG, Chen PS, Dominiczak AF, Erol Ç, Grines CL, Gropler R, Guzik TJ, Heinemann MK, Iskandrian AE, Knight BP, London B, Lüscher TF, Metra M, Musunuru K, Nallamothu BK, Natale A, Saksena S, Picard MH, Rao SV, Remme WJ, Rosenson RS, Sweitzer NK, Timmis A, Vrints C. Medical Misinformation. Circ Genom Precis Med 2019; 12:e002439. [PMID: 30688515 DOI: 10.1161/circgen.118.002439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Stefan Agewall
- Editor-in-Chief, European Heart Journal Cardiovascular Pharmacotherapy
| | | | - George W Booz
- Editor-in-Chief, Journal of Cardiovascular Pharmacology
| | | | | | | | | | - Çetin Erol
- Editor-in-Chief, Anatolian Journal of Cardiology
| | | | | | | | | | | | | | - Barry London
- Editor-in-Chief, Journal of the American Heart Association
| | | | - Marco Metra
- Editor-in-Chief, European Journal of Heart Failure
| | - Kiran Musunuru
- Editor-in-Chief, Circulation: Genomic and Precision Medicine
| | | | - Andrea Natale
- Editors-in-Chief, Journal of Interventional Cardiac Electrophysiology
| | - Sanjeev Saksena
- Editors-in-Chief, Journal of Interventional Cardiac Electrophysiology
| | - Michael H Picard
- Editor-in-Chief, Journal of the American Society of Echocardiography
| | - Sunil V Rao
- Editor-in-Chief, Circulation: Cardiovascular Interventions
| | | | | | | | - Adam Timmis
- Editor-in-Chief, European Heart Journal: Quality of Care and Clinical Outcomes
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20
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Hill JA, Agewall S, Baranchuk A, Booz GW, Borer JS, Camici PG, Chen PS, Dominiczak AF, Erol Ç, Grines CL, Gropler R, Guzik TJ, Heinemann MK, Iskandrian AE, Knight BP, London B, Lüscher TF, Metra M, Musunuru K, Nallamothu BK, Natale A, Saksena S, Picard MH, Rao SV, Remme WJ, Rosenson RS, Sweitzer NK, Timmis A, Vrints C. Medical Misinformation. Circ Cardiovasc Imaging 2019; 12:e008809. [PMID: 30688516 DOI: 10.1161/circimaging.118.008809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam Timmis
- European Heart Journal: Quality of Care and Clinical Outcomes
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21
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Hill JA, Agewall S, Baranchuk A, Booz GW, Borer JS, Camici PG, Chen PS, Dominiczak AF, Erol Ç, Grines CL, Gropler R, Guzik TJ, Heinemann MK, Iskandrian AE, Knight BP, London B, Lüscher TF, Metra M, Musunuru K, Nallamothu BK, Natale A, Saksena S, Picard MH, Rao SV, Remme WJ, Rosenson RS, Sweitzer NK, Timmis A, Vrints C. Medical Misinformation. Hypertension 2019; 73:506-507. [PMID: 30686083 DOI: 10.1161/hypertensionaha.118.12518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Stefan Agewall
- European Heart Journal: Cardiovascular Pharmacotherapy (S.A.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Barry London
- Journal of the American Heart Association (B.L.)
| | | | | | | | | | - Andrea Natale
- Journal of Interventional Cardiac Electrophysiology (A.N., S.S.)
| | - Sanjeev Saksena
- Journal of Interventional Cardiac Electrophysiology (A.N., S.S.)
| | | | - Sunil V Rao
- Circulation: Cardiovascular Interventions (S.V.R.)
| | | | | | | | - Adam Timmis
- European Heart Journal: Quality of Care and Clinical Outcomes (A.T.)
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22
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Hill JA, Agewall S, Baranchuk A, Booz GW, Borer JS, Camici PG, Chen PS, Dominiczak AF, Erol Ç, Grines CL, Gropler R, Guzik TJ, Heinemann MK, Iskandrian AE, Knight BP, London B, Lüscher TF, Metra M, Musunuru K, Nallamothu BK, Natale A, Saksena S, Picard MH, Rao SV, Remme WJ, Rosenson RS, Sweitzer NK, Timmis A, Vrints C. Medical Misinformation. Circ Heart Fail 2019; 12:e005869. [PMID: 30688079 DOI: 10.1161/circheartfailure.119.005869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam Timmis
- European Heart Journal: Quality of Care and Clinical Outcomes
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23
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Hill JA, Agewall S, Baranchuk A, Booz GW, Borer JS, Camici PG, Chen PS, Dominiczak AF, Erol C, Grines CL, Gropler R, Guzik TJ, Heinemann MK, Iskandrian AE, Knight BP, London B, Lüscher TF, Metra M, Musunuru K, Nallamothu BK, Natale A, Saksena S, Picard MH, Rao SV, Remme WJ, Rosenson RS, Sweitzer NK, Timmis A, Vrints C. Medical Misinformation. Circ Cardiovasc Qual Outcomes 2019; 12:e005496. [PMID: 30688519 DOI: 10.1161/circoutcomes.119.005496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Adam Timmis
- European Heart Journal: Quality of Care and Clinical Outcomes
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Borer JS, Supino PG, Herrold EM, Innasimuthu A, Hochreiter C, Krieger K, Girardi LN, Isom OW. Survival after Aortic Valve Replacement for Aortic Regurgitation: Prediction from Preoperative Contractility Measurement. Cardiology 2018; 140:204-212. [PMID: 30138945 DOI: 10.1159/000490848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Noninvasive measurement of myocardial contractility (end-systolic wall stress-adjusted change in left ventricular ejection fraction from rest to exercise [ΔLVEF - ΔESS]) predicts heart failure, subnormal LVEFrest, and sudden death in asymptomatic patients with chronic severe aortic regurgitation (AR). Here we assess the relation of preoperative ΔLVEF - ΔESS to survival after aortic valve replacement (AVR). METHODS Patients who underwent AVR for chronic, isolated, pure severe AR (n = 66) were followed for 13.0 ± 6.4 event-free years. Preoperative ΔLVEF - ΔESS (from combined echocardiographic and radionuclide cineangiographic data) enabled cohort stratification into 3 terciles (-1 to -11% [normal or mild] contractility deficit, -12 to -16% [moderate], and ≤-17% [severe], identical with segregation in our earlier study) to relate preoperative contractility to postoperative survival and to age- and gender-matched US census data. RESULTS Since AVR, 22 patients died (average annual risk [AAR] for all-cause mortality for the entire co hort = 3.15%). Preoperative ΔLVEF - ΔESS predicted postoperative survival (p = 0.009, log rank test). By contractility terciles, all-cause AARs were 1.44, 2.58, and 6.40%. Survival was lower than among US census comparators (p < 0.02), but the "mild" tercile was indistinguishable from census data (p = ns). By multivariable Cox regression, survival prediction by pre-AVR ΔLVEF - ΔESS was independent of, and superior to, prediction by age at surgery, gender, preoperative functional class, LVEFrest, LVEFexercise, change in LVEFrest to exercise, and LV diastolic or systolic dimensions (p ≤ 0.01, pre-AVR ΔLVEF - ΔESS vs. other covariates). CONCLUSION In severe AR, preoperative contractility predicts post-AVR survival and may be prognostically superior to clinical, geometric and performance descriptors, potentially impacting on patient selection for surgery.
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Affiliation(s)
- Jeffrey S Borer
- Division of Cardiovascular Medicine and The Howard Gilman Institute for Heart Valve Disease, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Phyllis G Supino
- Division of Cardiovascular Medicine and The Howard Gilman Institute for Heart Valve Disease, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Edmund McM Herrold
- Division of Cardiovascular Medicine and The Howard Gilman Institute for Heart Valve Disease, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Antony Innasimuthu
- Division of Cardiovascular Medicine and The Howard Gilman Institute for Heart Valve Disease, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Clare Hochreiter
- Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York, New York, USA
| | - Karl Krieger
- Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York, New York, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York, New York, USA
| | - O Wayne Isom
- Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York, New York, USA
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Ruschitzka F, Borer JS, Krum H, Flammer AJ, Yeomans ND, Libby P, Lüscher TF, Solomon DH, Husni ME, Graham DY, Davey DA, Wisniewski LM, Menon V, Fayyad R, Beckerman B, Iorga D, Lincoff AM, Nissen SE. Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: the PRECISION-ABPM (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen Ambulatory Blood Pressure Measurement) Trial. Eur Heart J 2018; 38:3282-3292. [PMID: 29020251 DOI: 10.1093/eurheartj/ehx508] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/21/2017] [Indexed: 12/24/2022] Open
Abstract
Aims Non-steroidal anti-inflammatory drugs (NSAIDs), both non-selective and selective cyclooxygenase-2 (COX-2) inhibitors, are among the most widely prescribed drugs worldwide, but associate with increased blood pressure (BP) and adverse cardiovascular (CV) events. PRECISION-ABPM, a substudy of PRECISION was conducted at 60 sites, to determine BP effects of the selective COX-2 inhibitor celecoxib vs. the non-selective NSAIDs naproxen and ibuprofen. Methods and results In this double-blind, randomized, multicentre non-inferiority CV-safety trial, 444 patients (mean age 62 ± 10 years, 54% female) with osteoarthritis (92%) or rheumatoid arthritis (8%) and evidence of or at increased risk for coronary artery disease received celecoxib (100-200 mg bid), ibuprofen (600-800 mg tid), or naproxen (375-500 mg bid) with matching placebos in a 1: 1: 1 allocation, to assess the effect on 24-h ambulatory BP after 4 months. The change in mean 24-h systolic BP (SBP) in celecoxib, ibuprofen and naproxen-treated patients was -0.3 mmHg [95% confidence interval (CI), -2.25, 1.74], 3.7 (95% CI, 1.72, 5.58) and 1.6 mmHg (95% CI, -0.40, 3.57), respectively. These changes resulted in a difference of - 3.9 mmHg (P = 0.0009) between celecoxib and ibuprofen, of - 1.8 mmHg (P = 0.12) between celecoxib and naproxen, and of - 2.1 mmHg (P = 0.08) between naproxen and ibuprofen. The percentage of patients with normal baseline BP who developed hypertension (mean 24-h SBP ≥ 130 and/or diastolic BP ≥ 80 mmHg) was 23.2% for ibuprofen, 19.0% for naproxen, and 10.3% for celecoxib (odds ratio 0.39, P = 0.004 and odds ratio 0.49, P = 0.03 vs. ibuprofen and naproxen, respectively). Conclusions In PRECISION-ABPM, allocation to the non-selective NSAID ibuprofen, compared with the COX-2 selective inhibitor celecoxib was associated with a significant increase of SBP, and a higher incidence of new-onset hypertension. ClinicalTrials gov number NCT00346216.
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Affiliation(s)
- Frank Ruschitzka
- Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Jeffrey S Borer
- Cardiovascular Medicine, Schiavone Cardiovascular Translational Research Institute, State University of New York, Downstate College of Medicine, New York, NY, USA
| | | | - Andreas J Flammer
- Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Neville D Yeomans
- Cardiovascular Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Peter Libby
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas F Lüscher
- Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Daniel H Solomon
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - David Y Graham
- Cardiovascular Medicine, Baylor College of Medicine, Veterans Affairs Medical Center, Houston, TX, USA
| | - Deborah A Davey
- Department for Cleveland Clinic, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa M Wisniewski
- Department for Cleveland Clinic, Cleveland Clinic, Cleveland, OH, USA
| | - Venu Menon
- Department for Cleveland Clinic, Cleveland Clinic, Cleveland, OH, USA
| | - Rana Fayyad
- Cardiovascular Medicine, Pfizer, New York, NY, USA
| | | | - Dinu Iorga
- Cardiovascular Medicine, Pfizer, New York, NY, USA
| | - A Michael Lincoff
- Cardiovascular Medicine, Baylor College of Medicine, Veterans Affairs Medical Center, Houston, TX, USA
| | - Steven E Nissen
- Cardiovascular Medicine, Baylor College of Medicine, Veterans Affairs Medical Center, Houston, TX, USA
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Komajda M, Böhm M, Borer JS, Ford I, Tavazzi L, Pannaux M, Swedberg K. Incremental benefit of drug therapies for chronic heart failure with reduced ejection fraction: a network meta-analysis. Eur J Heart Fail 2018; 20:1315-1322. [DOI: 10.1002/ejhf.1234] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/25/2018] [Accepted: 05/05/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Michel Komajda
- Department of Cardiology; Saint Joseph Hospital; Paris France
| | - Michael Böhm
- Universitätsklinikum des Saarlandes; Universität des Saarlandes, Klinik für Innere Medizin III; Homburg/Saar Germany
| | - Jeffrey S. Borer
- Howard Gilman and Schiavone Institutes; State University of New York Downstate Medical Center; Brooklyn and New York NY USA
| | - Ian Ford
- Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
| | - Luigi Tavazzi
- Maria Cecilia Hospital-GVM Care and Research; Ettore Sansavini Health Science Foundation; Cotignola Italy
| | | | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy; University of Gothenburg, Göteborg, Sweden, and National Heart and Lung Institute, Imperial College; London UK
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Bax JJ, Delgado V, Sogaard P, Singh JP, Abraham WT, Borer JS, Dickstein K, Gras D, Brugada J, Robertson M, Ford I, Krum H, Holzmeister J, Ruschitzka F, Gorcsan J. Prognostic implications of left ventricular global longitudinal strain in heart failure patients with narrow QRS complex treated with cardiac resynchronization therapy: a subanalysis of the randomized EchoCRT trial. Eur Heart J 2018; 38:720-726. [PMID: 28426885 DOI: 10.1093/eurheartj/ehw506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/29/2016] [Indexed: 11/13/2022] Open
Abstract
Aim Left ventricular (LV) global longitudinal strain (GLS) reflects LV systolic function and correlates inversely with the extent of LV myocardial scar and fibrosis. The present subanalysis of the Echocardiography Guided CRT trial investigated the prognostic value of LV GLS in patients with narrow QRS complex. Methods and results Left ventricular (LV) global longitudinal strain (GLS) was measured on the apical 2-, 4- and 3-chamber views using speckle tracking analysis. Measurement of baseline LV GLS was feasible in 755 patients (374 with cardiac resynchronization therapy (CRT)-ON and 381 with CRT-OFF). The median value of LV GLS in the overall population was 7.9%, interquartile range 6.2-10.1%. After a mean follow-up period of 19.4 months, 95 patients in the CRT-OFF group and 111 in the CRT-ON group reached the combined primary endpoint of all-cause mortality and heart failure hospitalization. Each 1% absolute unit decrease in LV GLS was independently associated with 11% increase in the risk to reach the primary endpoint (Hazard ratio 1.11; 95% confidence interval 95% 1.04-1.17, P < 0.001), after adjusting for ischaemic cardiomyopathy and randomization treatment among other clinically relevant variables. When categorizing patients according to quartiles of LV GLS, the primary endpoint occurred more frequently in patients in the lowest quartile (<6.2%) treated with CRT-ON vs. CRT-OFF (45.6% vs. 28.7%, P = 0.009) whereas, no differences were observed in patients with LV GLS ≥6.2% treated with CRT-OFF vs. CRT-ON (23.7% vs. 24.5%, respectively; P = 0.62). Conclusion Low LV GLS is associated with poor outcome in heart failure patients with QRS width <130 ms, independent of randomization to CRT or not. Importantly, in the group of patients with the lowest LV GLS quartile, CRT may have a detrimental effect on clinical outcomes.
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Affiliation(s)
- Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Peter Sogaard
- Aalborg University, Fredrik Bajers Vej 7-D3, Aalborg 9220, Denmark
| | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Corrigan Minehan Heart Center, 55 Fruit Street, Boston, MA 02114, USA
| | - William T Abraham
- The Division of Cardiovascular Medicine, Ohio State University Medical Center, Davis Heart and Lung Research Institute, 473 West 12th Avenue, Room 110P, Columbus, OH 43210-1252, USA
| | - Jeffrey S Borer
- The Division of Cardiovascular Medicine and Howard Gilman and Ron and Jean Schiavone Institutes, State University of New York Downstate College of Medicine, 450 Clarkson Avenue, Division of Cardiovascular Medicine, Sixth Floor, Brooklyn, NY, New York, USA
| | - Kenneth Dickstein
- University of Bergen, Stavanger University Hospital, Postboks 8600 Forus, 4036 Stavanger, Norway
| | - Daniel Gras
- Nouvelles Cliniques Nantaises, 2 - 4 Rue Eric Tabarly, 44200 Nantes, France
| | - Josep Brugada
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Michele Robertson
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Henry Krum
- Monash Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Victoria 3800, Australia
| | - Johannes Holzmeister
- Clinic for Cardiology, University Hospital Zurich, Moussonstrasse 4, CH 8091 Zürich, Switzerland
| | - Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Moussonstrasse 4, CH 8091 Zürich, Switzerland
| | - John Gorcsan
- The University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA
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Yeomans ND, Graham DY, Husni ME, Solomon DH, Stevens T, Vargo J, Wang Q, Wisniewski LM, Wolski KE, Borer JS, Libby P, Lincoff AM, Lüscher TF, Bao W, Walker C, Nissen SE. Randomised clinical trial: gastrointestinal events in arthritis patients treated with celecoxib, ibuprofen or naproxen in the PRECISION trial. Aliment Pharmacol Ther 2018; 47:1453-1463. [PMID: 29667211 DOI: 10.1111/apt.14610] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/09/2017] [Accepted: 02/21/2018] [Indexed: 12/18/2022]
Abstract
AIM To evaluate GI safety of celecoxib compared with 2 nonselective (ns) NSAIDs, as a secondary objective of a large trial examining multiorgan safety. METHODS This randomised, double-blind controlled trial analysed 24 081 patients. Osteoarthritis or rheumatoid arthritis patients, needing ongoing NSAID treatment, were randomised to receive celecoxib 100-200 mg b.d., ibuprofen 600-800 mg t.d.s. or naproxen 375-500 mg b.d. plus esomeprazole, and low-dose aspirin or corticosteroids if already prescribed. Clinically significant GI events (CSGIE-bleeding, obstruction, perforation events from stomach downwards or symptomatic ulcers) and iron deficiency anaemia (IDA) were adjudicated blindly. RESULTS Mean treatment and follow-up durations were 20.3 and 34.1 months. While on treatment or 30 days after, CSGIE occurred in 0.34%, 0.74% and 0.66% taking celecoxib, ibuprofen and naproxen. Hazard ratios (HR) were 0.43 (95% CI 0.27-0.68, P = 0.0003) celecoxib vs ibuprofen and 0.51 (0.32-0.81, P = 0.004) vs naproxen. There was also less IDA on celecoxib: HR 0.43 (0.27-0.68, P = 0.0003) vs ibuprofen; 0.40 (0.25-0.62, P < 0.0001) vs naproxen. Even taken with low-dose aspirin, fewer CSGIE occurred on celecoxib than ibuprofen (HR 0.52 [0.29-0.94], P = 0.03), and less IDA vs naproxen (0.42 [0.23-0.77, P = 0.005]). Corticosteroid use increased total GI events and CSGIE. H. pylori serological status had no influence. CONCLUSIONS Arthritis patients taking NSAIDs plus esomeprazole have infrequent clinically significant gastrointestinal events. Co-prescribed with esomeprazole, celecoxib has better overall GI safety than ibuprofen or naproxen at these doses, despite treatment with low-dose aspirin or corticosteroids.
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Affiliation(s)
- N D Yeomans
- Department of Medicine, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Western Sydney University, Campbelltown, NSW, Australia
| | - D Y Graham
- Baylor College of Medicine, Veterans Affairs Medical Center, Houston, TX, USA
| | - M E Husni
- Cleveland Clinic, Cleveland, OH, USA
| | - D H Solomon
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - T Stevens
- Cleveland Clinic, Cleveland, OH, USA
| | - J Vargo
- Cleveland Clinic, Cleveland, OH, USA
| | - Q Wang
- Cleveland Clinic, Cleveland, OH, USA
| | | | | | - J S Borer
- Downstate College of Medicine, State University of New York, New York, NY, USA
| | - P Libby
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - T F Lüscher
- Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - W Bao
- Pfizer, New York, NY, USA
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Varma N, Sogaard P, Bax JJ, Abraham WT, Borer JS, Dickstein K, Singh JP, Gras D, Holzmeister J, Brugada J, Ruschitzka F. Interaction of Left Ventricular Size and Sex on Outcome of Cardiac Resynchronization Therapy Among Patients With a Narrow QRS Duration in the EchoCRT Trial. J Am Heart Assoc 2018; 7:JAHA.118.009592. [PMID: 29807890 PMCID: PMC6015380 DOI: 10.1161/jaha.118.009592] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Longer QRS duration (QRSd) improves, but increased left ventricular (LV) end-diastolic volume (LVEDV) reduces, efficacy of cardiac resynchronization therapy (CRT). QRSd/LVEDV ratios differ between sexes. We hypothesized that in the EchoCRT (Echocardiography Guided Cardiac Resynchronization Therapy) trial enrolling patients with heart failure with QRSd <130 ms, those with larger LVEDV would deteriorate but those with the highest QRSd/LVEDV would improve with CRT. METHODS AND RESULTS Primary outcome in patients (n=787, 72% men, 93% New York Heart Association class III, QRSd <130 ms, LV ejection fraction ≤35%, LV dilation and dyssynchrony) randomized to CRT-ON or CRT-OFF and followed up for 19 months was compared according to LVEDV (height indexed) or QRSd/LVEDV ratio, in multivariable analysis. Structural remodeling was assessed echocardiographically 6 months after implantation. Patients with baseline LVEDV higher than or equal to median worsened with CRT (death/heart failure hospitalization: CRT-ON versus CRT-OFF, 35.2% versus 24.5% [hazard ratio, 1.64; 95% confidence interval, 1.11-2.42; P=0.012]), but those with LVEDV lower than median remained unaffected. Patients with the highest QRSd/LVEDV ratio improved with CRT (death/heart failure hospitalization in top quartile: 20.9% in CRT-ON [n=91] versus 28.3% in CRT-OFF [n=106] [hazard ratio, 0.64; 95% confidence interval, 0.34-1.24; P=0.188], versus the remaining quartiles: 31.7% in CRT-ON [n=300] versus 24.8% in CRT-OFF [n=290] [hazard ratio, 1.47; 95% confidence interval, 1.07-2.02; P=0.016], test for interaction P=0.046). QRSd and dyssynchrony were similar between groups. The 3-way test for interaction indicated no sex-specific effects. However, numerically, men with LVEDV higher than or equal to median accounted for worse outcomes of CRT-ON. Women, with the highest QRSd/LVEDV ratio exhibited significant reverse remodeling. CONCLUSION CRT has opposite effects among patients with heart failure with QRSd <130 ms according to LV size: worsening outcomes in patients with larger LV, but inducing beneficial effects in those with smaller LV. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00683696.
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Affiliation(s)
- Niraj Varma
- Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - William T Abraham
- Division of Cardiovascular Medicine, Ohio State University Medical Center, Davis Heart and Lung Research Institute, Columbus, OH
| | - Jeffrey S Borer
- Division of Cardiovascular Medicine and Howard Gilman and Ron and Jean Schiavone Institutes, State University of New York Downstate College of Medicine, Brooklyn, NY
| | - Kenneth Dickstein
- University of Bergen Stavanger University Hospital, Stavanger, Norway
| | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Corrigan Minehan Heart Center, Boston, MA
| | - Daniel Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | | | - Josep Brugada
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Spain
| | - Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
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Solomon DH, Husni ME, Wolski KE, Wisniewski LM, Borer JS, Graham DY, Libby P, Lincoff AM, Lüscher TF, Menon V, Yeomans ND, Wang Q, Bao W, Berger MF, Nissen SE. Differences in Safety of Nonsteroidal Antiinflammatory Drugs in Patients With Osteoarthritis and Patients With Rheumatoid Arthritis. Arthritis Rheumatol 2018; 70:537-546. [DOI: 10.1002/art.40400] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/12/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel H. Solomon
- Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | | | | | | | - Jeffrey S. Borer
- State University of New York; Downstate College of Medicine; Brooklyn New York
| | - David Y. Graham
- Baylor College of Medicine; Veterans Affairs Medical Center; Houston Texas
| | - Peter Libby
- Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
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White WB, Saag KG, Becker MA, Borer JS, Gorelick PB, Whelton A, Hunt B, Castillo M, Gunawardhana L. Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout. N Engl J Med 2018. [PMID: 29527974 DOI: 10.1056/nejmoa1710895] [Citation(s) in RCA: 483] [Impact Index Per Article: 80.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiovascular risk is increased in patients with gout. We compared cardiovascular outcomes associated with febuxostat, a nonpurine xanthine oxidase inhibitor, with those associated with allopurinol, a purine base analogue xanthine oxidase inhibitor, in patients with gout and cardiovascular disease. METHODS We conducted a multicenter, double-blind, noninferiority trial involving patients with gout and cardiovascular disease; patients were randomly assigned to receive febuxostat or allopurinol and were stratified according to kidney function. The trial had a prespecified noninferiority margin of 1.3 for the hazard ratio for the primary end point (a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or unstable angina with urgent revascularization). RESULTS In total, 6190 patients underwent randomization, received febuxostat or allopurinol, and were followed for a median of 32 months (maximum, 85 months). The trial regimen was discontinued in 56.6% of patients, and 45.0% discontinued follow-up. In the modified intention-to-treat analysis, a primary end-point event occurred in 335 patients (10.8%) in the febuxostat group and in 321 patients (10.4%) in the allopurinol group (hazard ratio, 1.03; upper limit of the one-sided 98.5% confidence interval [CI], 1.23; P=0.002 for noninferiority). All-cause and cardiovascular mortality were higher in the febuxostat group than in the allopurinol group (hazard ratio for death from any cause, 1.22 [95% CI, 1.01 to 1.47]; hazard ratio for cardiovascular death, 1.34 [95% CI, 1.03 to 1.73]). The results with regard to the primary end point and all-cause and cardiovascular mortality in the analysis of events that occurred while patients were being treated were similar to the results in the modified intention-to-treat analysis. CONCLUSIONS In patients with gout and major cardiovascular coexisting conditions, febuxostat was noninferior to allopurinol with respect to rates of adverse cardiovascular events. All-cause mortality and cardiovascular mortality were higher with febuxostat than with allopurinol. (Funded by Takeda Development Center Americas; CARES ClinicalTrials.gov number, NCT01101035 .).
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Affiliation(s)
- William B White
- From the University of Connecticut School of Medicine, Farmington (W.B.W.); the University of Alabama, Birmingham (K.G.S.); University of Chicago Medicine, Chicago (M.A.B.), and Takeda Development Center Americas, Deerfield (B.H., M.C., L.G.) - both in Illinois; the State University of New York, Downstate Medical Center, Brooklyn (J.S.B.); Michigan State University College of Human Medicine, Grand Rapids (P.B.G.); and Johns Hopkins University School of Medicine, Baltimore (A.W.)
| | - Kenneth G Saag
- From the University of Connecticut School of Medicine, Farmington (W.B.W.); the University of Alabama, Birmingham (K.G.S.); University of Chicago Medicine, Chicago (M.A.B.), and Takeda Development Center Americas, Deerfield (B.H., M.C., L.G.) - both in Illinois; the State University of New York, Downstate Medical Center, Brooklyn (J.S.B.); Michigan State University College of Human Medicine, Grand Rapids (P.B.G.); and Johns Hopkins University School of Medicine, Baltimore (A.W.)
| | - Michael A Becker
- From the University of Connecticut School of Medicine, Farmington (W.B.W.); the University of Alabama, Birmingham (K.G.S.); University of Chicago Medicine, Chicago (M.A.B.), and Takeda Development Center Americas, Deerfield (B.H., M.C., L.G.) - both in Illinois; the State University of New York, Downstate Medical Center, Brooklyn (J.S.B.); Michigan State University College of Human Medicine, Grand Rapids (P.B.G.); and Johns Hopkins University School of Medicine, Baltimore (A.W.)
| | - Jeffrey S Borer
- From the University of Connecticut School of Medicine, Farmington (W.B.W.); the University of Alabama, Birmingham (K.G.S.); University of Chicago Medicine, Chicago (M.A.B.), and Takeda Development Center Americas, Deerfield (B.H., M.C., L.G.) - both in Illinois; the State University of New York, Downstate Medical Center, Brooklyn (J.S.B.); Michigan State University College of Human Medicine, Grand Rapids (P.B.G.); and Johns Hopkins University School of Medicine, Baltimore (A.W.)
| | - Philip B Gorelick
- From the University of Connecticut School of Medicine, Farmington (W.B.W.); the University of Alabama, Birmingham (K.G.S.); University of Chicago Medicine, Chicago (M.A.B.), and Takeda Development Center Americas, Deerfield (B.H., M.C., L.G.) - both in Illinois; the State University of New York, Downstate Medical Center, Brooklyn (J.S.B.); Michigan State University College of Human Medicine, Grand Rapids (P.B.G.); and Johns Hopkins University School of Medicine, Baltimore (A.W.)
| | - Andrew Whelton
- From the University of Connecticut School of Medicine, Farmington (W.B.W.); the University of Alabama, Birmingham (K.G.S.); University of Chicago Medicine, Chicago (M.A.B.), and Takeda Development Center Americas, Deerfield (B.H., M.C., L.G.) - both in Illinois; the State University of New York, Downstate Medical Center, Brooklyn (J.S.B.); Michigan State University College of Human Medicine, Grand Rapids (P.B.G.); and Johns Hopkins University School of Medicine, Baltimore (A.W.)
| | - Barbara Hunt
- From the University of Connecticut School of Medicine, Farmington (W.B.W.); the University of Alabama, Birmingham (K.G.S.); University of Chicago Medicine, Chicago (M.A.B.), and Takeda Development Center Americas, Deerfield (B.H., M.C., L.G.) - both in Illinois; the State University of New York, Downstate Medical Center, Brooklyn (J.S.B.); Michigan State University College of Human Medicine, Grand Rapids (P.B.G.); and Johns Hopkins University School of Medicine, Baltimore (A.W.)
| | - Majin Castillo
- From the University of Connecticut School of Medicine, Farmington (W.B.W.); the University of Alabama, Birmingham (K.G.S.); University of Chicago Medicine, Chicago (M.A.B.), and Takeda Development Center Americas, Deerfield (B.H., M.C., L.G.) - both in Illinois; the State University of New York, Downstate Medical Center, Brooklyn (J.S.B.); Michigan State University College of Human Medicine, Grand Rapids (P.B.G.); and Johns Hopkins University School of Medicine, Baltimore (A.W.)
| | - Lhanoo Gunawardhana
- From the University of Connecticut School of Medicine, Farmington (W.B.W.); the University of Alabama, Birmingham (K.G.S.); University of Chicago Medicine, Chicago (M.A.B.), and Takeda Development Center Americas, Deerfield (B.H., M.C., L.G.) - both in Illinois; the State University of New York, Downstate Medical Center, Brooklyn (J.S.B.); Michigan State University College of Human Medicine, Grand Rapids (P.B.G.); and Johns Hopkins University School of Medicine, Baltimore (A.W.)
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Tayal B, Gorcsan J, Bax JJ, Risum N, Olsen NT, Singh JP, Abraham WT, Borer JS, Dickstein K, Gras D, Krum H, Brugada J, Robertson M, Ford I, Holzmeister J, Ruschitzka F, Sogaard P. Cardiac Resynchronization Therapy in Patients With Heart Failure and Narrow QRS Complexes. J Am Coll Cardiol 2018; 71:1325-1333. [DOI: 10.1016/j.jacc.2018.01.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 10/17/2022]
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Solomon DH, Husni ME, Libby PA, Yeomans ND, Lincoff AM, Lϋscher TF, Menon V, Brennan DM, Wisniewski LM, Nissen SE, Borer JS. The Risk of Major NSAID Toxicity with Celecoxib, Ibuprofen, or Naproxen: A Secondary Analysis of the PRECISION Trial. Am J Med 2017; 130:1415-1422.e4. [PMID: 28756267 DOI: 10.1016/j.amjmed.2017.06.028] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND The relative safety of long-term use of nonsteroidal anti-inflammatory drugs is unclear. Patients and providers are interested in an integrated view of risk . We examined the risk of major nonsteroidal anti-inflammatory drug toxicity in the PRECISION trial. METHODS We conducted a post hoc analysis of a double-blind, randomized, controlled, multicenter trial enrolling 24,081 patients with osteoarthritis or rheumatoid arthritis at moderate or high cardiovascular risk. Patients were randomized to receive celecoxib 100 to 200 mg twice daily, ibuprofen 600 to 800 mg thrice daily, or naproxen 375 to 500 mg twice daily. All patients were provided with a proton pump inhibitor. The outcome was major nonsteroidal anti-inflammatory drug toxicity, including time to first occurrence of major adverse cardiovascular events, important gastrointestinal events, renal events, and all-cause mortality. RESULTS During follow-up, 4.1% of subjects sustained any major toxicity in the celecoxib arm, 4.8% in the naproxen arm, and 5.3% in the ibuprofen arm. Analyses adjusted for aspirin use and geographic region found that subjects in the naproxen arm had a 20% (95% CI 4-39) higher risk of major toxicity than celecoxib users and that 38% (95% CI 19-59) higher risk. These risks translate into numbers needed to harm of 135 (95% CI, 72-971) for naproxen and 82 (95% CI, 53-173) for ibuprofen, both compared with celecoxib. CONCLUSIONS Among patients with symptomatic arthritis who had moderate to high risk of cardiovascular events, approximately 1 in 20 experienced a major toxicity over 1 to 2 years. Patients using naproxen or ibuprofen experienced significantly higher risk of major toxicity than those using celecoxib.
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Affiliation(s)
| | | | | | - Neville D Yeomans
- Western Sydney University, Sydney, NSW, Australia; University of Melbourne, Melbourne, Australia
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Supino PG, Hai OY, Sharma A, Lampert J, Hochreiter C, Herrold EM, Borer JS. Impact of Beta-Blockade on Cardiac Events in Patients with Chronic Severe Nonischemic Mitral Regurgitation. Cardiology 2017; 139:1-6. [PMID: 29041004 DOI: 10.1159/000481250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/05/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The aim of this study was to examine the impact of beta-blockade on cardiac events among patients with initially asymptomatic chronic severe nonischemic mitral valve regurgitation (MR). METHODS Data from 52 consecutive patients in our prospective natural history study of isolated chronic severe nonischemic MR were assessed post hoc over 19 years to examine the relation of chronic beta-blockade use to subsequent cardiac events (death or indications for mitral valve surgery, MVS). At entry, all patients were free of surgical indications; 9 received beta-blockers. Cardiac event rate differences were analyzed by Kaplan-Meier log rank comparison. RESULTS During follow-up, cardiac events included sudden death (1), heart failure (8), atrial fibrillation (6), left ventricular dimensions at systole ≥4.5 cm (11), left ventricular ejection fraction <60% (6), right ventricular ejection fraction <35% (2), and a combination of cardiac events (7). The cardiac event risk was 4-fold higher among patients receiving beta-blockers (average annual risk = 60.6%) versus those not receiving beta-blockers (average annual risk = 15.2%; p = 0.001). These effects remained statistically significant (p = 0.005) when analysis was adjusted for other baseline covariates. CONCLUSIONS Beta-blockade appears to confer an increased risk of sudden cardiac death or indications for MVS among patients with chronic severe nonischemic MR. Randomized trials are needed to confirm these findings.
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Affiliation(s)
- Phyllis G Supino
- Howard Gilman Institute for Valvular Heart Diseases, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
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Böhm M, Komajda M, Borer JS, Ford I, Maack C, Tavazzi L, Moyne A, Swedberg K. Duration of chronic heart failure affects outcomes with preserved effects of heart rate reduction with ivabradine: findings from SHIFT. Eur J Heart Fail 2017; 20:373-381. [PMID: 29027329 DOI: 10.1002/ejhf.1021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 12/28/2022] Open
Abstract
AIMS In heart failure (HF) with reduced ejection fraction and sinus rhythm, heart rate reduction with ivabradine reduces the composite incidence of cardiovascular death and HF hospitalization. METHODS AND RESULTS It is unclear whether the duration of HF prior to therapy independently affects outcomes and whether it modifies the effect of heart rate reduction. In SHIFT, 6505 patients with chronic HF (left ventricular ejection fraction of ≤35%), in sinus rhythm, heart rate of ≥70 b.p.m., treated with guideline-recommended therapies, were randomized to placebo or ivabradine. Outcomes and the treatment effect of ivabradine in patients with different durations of HF were examined. Prior to randomization, 1416 ivabradine and 1459 placebo patients had HF duration of ≥4 weeks and <1.5 years; 836 ivabradine and 806 placebo patients had HF duration of 1.5 years to <4 years, and 989 ivabradine and 999 placebo patients had HF duration of ≥4 years. Patients with longer duration of HF were older (62.5 years vs. 59.0 years; P < 0.0001), had more severe disease (New York Heart Association classes III/IV in 56% vs. 44.9%; P < 0.0001) and greater incidences of co-morbidities [myocardial infarction: 62.9% vs. 49.4% (P < 0.0001); renal dysfunction: 31.5% vs. 21.5% (P < 0.0001); peripheral artery disease: 7.0% vs. 4.8% (P < 0.0001)] compared with patients with a more recent diagnosis. After adjustments, longer HF duration was independently associated with poorer outcome. Effects of ivabradine were independent of HF duration. CONCLUSIONS Duration of HF predicts outcome independently of risk indicators such as higher age, greater severity and more co-morbidities. Heart rate reduction with ivabradine improved outcomes independently of HF duration. Thus, HF treatments should be initiated early and it is important to characterize HF populations according to the chronicity of HF in future trials.
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Affiliation(s)
- Michael Böhm
- Internal Medicine Clinic III, Saarland University Clinic, Saarland University, Homburg, Saar, Germany
| | - Michel Komajda
- Department of Cardiology, Paris Saint Joseph Hospital, Paris, France
| | - Jeffrey S Borer
- Howard Gilman and Schiavone Institutes, State University of New York Downstate Medical Center, New York, NY, USA
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Christoph Maack
- Internal Medicine Clinic III, Saarland University Clinic, Saarland University, Homburg, Saar, Germany.,Comprehensive Heart Failure Center, University Clinic Würzburg, Würzburg, Germany
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy
| | - Aurélie Moyne
- Department of Methodology and Valorisation of Data, International Research Institute Servier, Suresnes, France
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,National Heart and Lung Institute, Imperial College London, London, UK
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Swedberg K, Böhm M, Borer JS, Ford I, Komajda M, Tavazzi L. Comments on meta-analysis of ivabradine as adjuvant treatment for chronic heart failure by Mizzaci et al. Int J Cardiol 2017; 239:2. [PMID: 28139302 DOI: 10.1016/j.ijcard.2017.01.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
| | - Michael Böhm
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg, Saar, Germany
| | - Jeffrey S Borer
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Division of Cardiovascular Medicine and the Howard Gilman Institute for Heart Valve Disease and the Schiavone Institute for Cardiovascular Translational Research, State University of New York Downstate Medical Center, New York, NY, USA
| | - Michel Komajda
- Institute of Cardiometabolism and Nutrition (ICAN), Pierre et Marie Curie Paris VI University, La Pitié-Salpétrière Hospital, Paris, France
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy
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Zannad F, Pfeffer MA, Bhatt DL, Bonds DE, Borer JS, Calvo-Rojas G, Fiore L, Lund LH, Madigan D, Maggioni AP, Meyers CM, Rosenberg Y, Simon T, Stough WG, Zalewski A, Zariffa N, Temple R. Streamlining cardiovascular clinical trials to improve efficiency and generalisability. Heart 2017; 103:1156-1162. [PMID: 28455296 DOI: 10.1136/heartjnl-2017-311191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/07/2017] [Accepted: 03/19/2017] [Indexed: 11/04/2022] Open
Abstract
Controlled trials provide the most valid determination of the efficacy and safety of an intervention, but large cardiovascular clinical trials have become extremely costly and complex, making it difficult to study many important clinical questions. A critical question, and the main objective of this review, is how trials might be simplified while maintaining randomisation to preserve scientific integrity and unbiased efficacy assessments. Experience with alternative approaches is accumulating, specifically with registry-based randomised controlled trials that make use of data already collected. This approach addresses bias concerns while still capitalising on the benefits and efficiencies of a registry. Several completed or ongoing trials illustrate the feasibility of using registry-based controlled trials to answer important questions relevant to daily clinical practice. Randomised trials within healthcare organisation databases may also represent streamlined solutions for some types of investigations, although data quality (endpoint assessment) is likely to be a greater concern in those settings. These approaches are not without challenges, and issues pertaining to informed consent, blinding, data quality and regulatory standards remain to be fully explored. Collaboration among stakeholders is necessary to achieve standards for data management and analysis, to validate large data sources for use in randomised trials, and to re-evaluate ethical standards to encourage research while also ensuring that patients are protected. The rapidly evolving efforts to streamline cardiovascular clinical trials have the potential to lead to major advances in promoting better care and outcomes for patients with cardiovascular disease.
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Affiliation(s)
- Faiez Zannad
- Clinical Investigation Center, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Deepak L Bhatt
- Brigham and Women's Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Denise E Bonds
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jeffrey S Borer
- The Howard Gilman Institute, New York, New York, USA.,State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Gonzalo Calvo-Rojas
- Department of Clinical Pharmacology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Louis Fiore
- Department of Veterans Affairs, Cooperative Studies Program, Boston, Massachusetts, USA
| | - Lars H Lund
- Department of Medicine, Unit of Cardiology, Karolinska Institute, Stockholm, Sweden
| | - David Madigan
- Department of Statistics, Columbia University, New York, New York, USA
| | | | - Catherine M Meyers
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Yves Rosenberg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris, Saint Antoine Hospital, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Wendy Gattis Stough
- Campbell University College of Pharmacy and Health Sciences, Research Triangle Park, North Carolina, USA
| | | | | | - Robert Temple
- Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland, USA
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Borer JS, Kansal AR, Dorman ED, Krotneva S, Zheng Y, Patel HK, Tavazzi L, Komajda M, Ford I, Böhm M, Kielhorn A. Budget Impact of Adding Ivabradine to Standard of Care in Patients with Chronic Systolic Heart Failure in the United States. J Manag Care Spec Pharm 2017; 22:1064-71. [PMID: 27579829 PMCID: PMC10398043 DOI: 10.18553/jmcp.2016.22.9.1064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Heart failure (HF) costs $21 billion annually in direct health care costs, 80% of which is directly attributable to hospitalizations. The SHIFT clinical study demonstrated that ivabradine plus standard of care (SoC) reduced HF-related and all-cause hospitalizations compared with SoC alone. OBJECTIVE To estimate the budget impact of ivabradine from a U.S. commercial payer perspective. METHODS A budget impact model estimated the per-member-per month (PMPM) impact of introducing ivabradine to existing formularies by comparing a reference scenario (SoC) and a new drug scenario (ivabradine + SoC) in hypothetical 1 million-member commercial and Medicare Advantage plans. In both scenarios, U.S. claims data were used for the reference cumulative annual rates of hospitalizations (HF, non-HF cardiovascular [CV], and non-CV), and hospitalization rates were adjusted using SHIFT data. The model controlled for mortality risk using SHIFT and U.S. life table data, and hospitalization costs were obtained from U.S. claims data: HF-related = $37,507; non-HF CV = $28,951; and non-CV = $17,904. The annualized wholesale acquisition cost of ivabradine was $4,500, with baseline use for this new drug at 2%, increasing 2% per year. RESULTS Based on the approved U.S. indication, approximately 2,000 commercially insured patients from a 1 million-member commercial plan were eligible to receive ivabradine. Ivabradine resulted in a PMPM cost savings of $0.01 and $0.04 in years 1 and 3 of the core model, respectively. After including the acquisition price for ivabradine, the model showed a decrease in total costs in the commercial ($991,256 and $474,499, respectively) and Medicare populations ($13,849,262 and $4,280,291, respectively) in year 1. This decrease was driven by ivabradine's reduction in hospitalization rates. For the core model, the estimated pharmacy-only PMPM in year 1 was $0.01 for the commercial population and $0.24 for the Medicare Advantage population. CONCLUSIONS Adding ivabradine to SoC led to lower average annual treatment costs. The negative PMPM budget impact indicates that ivabradine is an affordable option for U.S. payers. DISCLOSURES This study was funded by Amgen. Patel is employed by Amgen; Kielhorn was employed by Amgen at the time of the study but is no longer affiliated with Amgen. Borer, Böhm, Ford, and Komajda have received scientific support, consultative fees, and/or speakers honoraria from Servier and Amgen in connection with SHIFT, the trial underlying this analysis. Borer also has received consultative fees from Celladon, Pfizer, ARMGO, Cardiorentis, Novartis, and Takeda USA. Kansal, Dorman, Krotneva, and Zheng are employees of Evidera, which was hired to assist with this study. Tavazzi has received research grants and consultation fees from Servier in connection with this study and has had advisory board memberships with Boston Scientific, Servier, Cardiorentis, Medtronic, St. Jude Medical, and CVie Therapeutics. Study concept and design were contributed by Dorman and Keilhorn, along with the other authors. Tavazzi, Komajda, Ford, BÖhm, and Borer oversaw collection of the data. Tavazzi, Komajda, Ford, BÖhm, and Borer (along with Karl Swedberg) formed the Executive Committee of SHIFT, the trial underlying this analysis. The manuscript was written by Kansal, along with the other authors, and revised by Borer and Patel, with assistance from the other authors.
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Affiliation(s)
- Jeffrey S Borer
- 1 The Howard Gilman Institute for Heart Valve Diseases and Ronald and Joan Schiavone Cardiovascular Translational Research Institute, State University of New York Downstate Medical Center, Brooklyn and New York, New York
| | | | | | | | | | | | - Luigi Tavazzi
- 5 Maria Cecilia Hospital, GVM Care & Research, and Ettore Sansavini Health Science Foundation, Cotignola, Italy
| | - Michel Komajda
- 6 Pitié-Salpétrière Hospital, Pierre and Marie Curie University, and IHU ICAN, Paris, France
| | - Ian Ford
- 7 Robertson Centre for Biostatistics, University of Glasgow, United Kingdom
| | - Michael Böhm
- 8 Saarland University Hospital, Homberg, Germany
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Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O'Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis. Eur Heart J 2017; 39:1224-1245. [DOI: 10.1093/eurheartj/ehx211] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/15/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Carlos E Ruiz
- Hackensack University Medical Center, Structural and Congenital Heart Center, Hackensack, New Jersey
| | - Rebecca T Hahn
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
| | | | - Jeffrey S Borer
- State University of New York Downstate Medical Center and College of Medicine, New York, New York
| | | | - Greg Fontana
- Cedars Sinai Medical Center, Los Angeles, California
| | | | - Reda Ibrahim
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Vladimir Jelnin
- Hackensack University Medical Center, Structural and Congenital Heart Center, Hackensack, New Jersey
| | | | | | - Chad Kliger
- Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York
| | - Itzhak Kronzon
- Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York
| | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Patrick Nataf
- AP-HP Hôpital Bichat Service de Cardiologie, Paris, France
| | | | | | | | | | | | - Paul Sorajja
- Minneapolis Heart Institute and Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | | | - Zoltan G Turi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | | | | | | | - Martin B Leon
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
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40
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Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O'Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis. J Am Coll Cardiol 2017; 69:2067-2087. [DOI: 10.1016/j.jacc.2017.02.038] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/09/2017] [Accepted: 02/15/2017] [Indexed: 01/05/2023]
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Kansal AR, Krotneva S, Tafazzoli A, Patel HK, Borer JS, Böhm M, Komajda M, Maya J, Tavazzi L, Ford I, Kielhorn A. Financial impact of ivabradine on reducing heart failure penalties under the Hospital Readmission Reduction Program. Curr Med Res Opin 2017; 33:185-191. [PMID: 27733074 DOI: 10.1080/03007995.2016.1248381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The introduction of the Hospital Readmission Reduction Program (HRRP) has led to renewed interest in developing strategies to reduce 30 day readmissions among patients with heart failure (HF). In this study, a model was developed to investigate whether the addition of ivabradine to a standard-of-care (SoC) treatment regimen for patients with HF would reduce HRRP penalties incurred by a hypothetical hospital with excess 30 day readmissions. RESEARCH DESIGN A model using a Monte Carlo simulation framework was developed. Model inputs included national hospital characteristics, hospital-specific characteristics, and the ivabradine treatment effect as quantified by a post hoc analysis of the Systolic Heart failure treatment with the If inhibitor ivabradine Trial (SHIFT). RESULTS The model computed an 83% reduction in HF readmission penalty payments in a hypothetical hospital with a readmission rate of 22.95% (excess readmission ratio = 1.056 over the national average readmission rate of 21.73%), translating into net savings of $44,016. A sensitivity analysis indicated that the readmission penalty is affected by the specific characteristics of the hospital, including the readmission rate, size of the ivabradine-eligible population, and ivabradine utilization. CONCLUSIONS The results of this study indicate that the addition of ivabradine to an SoC treatment regimen for patients with HF may lead to a reduction in the penalties incurred by hospitals under the HRRP. This highlights the role ivabradine can play as part of a wider effort to optimize the care of patients with HF.
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Affiliation(s)
| | | | | | | | - Jeffrey S Borer
- c Division of Cardiovascular Medicine , The Howard Gilman Institute for Heart Valve Diseases and Ronald and Joan Schiavone Cardiovascular Translational Research Institute, State University of New York Downstate Medical Center , Brooklyn and New York , NY , USA
| | - Michael Böhm
- d Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes , Homburg/Saar , Germany
| | - Michel Komajda
- e Department of Cardiology , Pitié-Salpétrière Hospital, University Pierre et Marie Curie and IHU ICAN , Paris , France
| | - Juan Maya
- b Amgen Inc. , Thousand Oaks , CA , USA
| | - Luigi Tavazzi
- f Maria Cecilia Hospital, GVM Care & Research, Ettore Sansavini Health Science Foundation , Cotignola , Italy
| | - Ian Ford
- g Robertson Centre for Biostatistics, University of Glasgow , Glasgow , Scotland
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Nissen SE, Yeomans ND, Solomon DH, Lüscher TF, Libby P, Husni ME, Graham DY, Borer JS, Wisniewski LM, Wolski KE, Wang Q, Menon V, Ruschitzka F, Gaffney M, Beckerman B, Berger MF, Bao W, Lincoff AM. Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis. N Engl J Med 2016; 375:2519-29. [PMID: 27959716 DOI: 10.1056/nejmoa1611593] [Citation(s) in RCA: 458] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The cardiovascular safety of celecoxib, as compared with nonselective nonsteroidal antiinflammatory drugs (NSAIDs), remains uncertain. METHODS Patients who required NSAIDs for osteoarthritis or rheumatoid arthritis and were at increased cardiovascular risk were randomly assigned to receive celecoxib, ibuprofen, or naproxen. The goal of the trial was to assess the noninferiority of celecoxib with regard to the primary composite outcome of cardiovascular death (including hemorrhagic death), nonfatal myocardial infarction, or nonfatal stroke. Noninferiority required a hazard ratio of 1.12 or lower, as well as an upper 97.5% confidence limit of 1.33 or lower in the intention-to-treat population and of 1.40 or lower in the on-treatment population. Gastrointestinal and renal outcomes were also adjudicated. RESULTS A total of 24,081 patients were randomly assigned to the celecoxib group (mean [±SD] daily dose, 209±37 mg), the naproxen group (852±103 mg), or the ibuprofen group (2045±246 mg) for a mean treatment duration of 20.3±16.0 months and a mean follow-up period of 34.1±13.4 months. During the trial, 68.8% of the patients stopped taking the study drug, and 27.4% of the patients discontinued follow-up. In the intention-to-treat analyses, a primary outcome event occurred in 188 patients in the celecoxib group (2.3%), 201 patients in the naproxen group (2.5%), and 218 patients in the ibuprofen group (2.7%) (hazard ratio for celecoxib vs. naproxen, 0.93; 95% confidence interval [CI], 0.76 to 1.13; hazard ratio for celecoxib vs. ibuprofen, 0.85; 95% CI, 0.70 to 1.04; P<0.001 for noninferiority in both comparisons). In the on-treatment analysis, a primary outcome event occurred in 134 patients in the celecoxib group (1.7%), 144 patients in the naproxen group (1.8%), and 155 patients in the ibuprofen group (1.9%) (hazard ratio for celecoxib vs. naproxen, 0.90; 95% CI, 0.71 to 1.15; hazard ratio for celecoxib vs. ibuprofen, 0.81; 95% CI, 0.65 to 1.02; P<0.001 for noninferiority in both comparisons). The risk of gastrointestinal events was significantly lower with celecoxib than with naproxen (P=0.01) or ibuprofen (P=0.002); the risk of renal events was significantly lower with celecoxib than with ibuprofen (P=0.004) but was not significantly lower with celecoxib than with naproxen (P=0.19). CONCLUSIONS At moderate doses, celecoxib was found to be noninferior to ibuprofen or naproxen with regard to cardiovascular safety. (Funded by Pfizer; ClinicalTrials.gov number, NCT00346216 .).
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Affiliation(s)
- Steven E Nissen
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Neville D Yeomans
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Daniel H Solomon
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Thomas F Lüscher
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Peter Libby
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - M Elaine Husni
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - David Y Graham
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Jeffrey S Borer
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Lisa M Wisniewski
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Katherine E Wolski
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Qiuqing Wang
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Venu Menon
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Frank Ruschitzka
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Michael Gaffney
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Bruce Beckerman
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Manuela F Berger
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - Weihang Bao
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
| | - A Michael Lincoff
- From the Cleveland Clinic, Cleveland (S.E.N., M.E.H., L.M.W., K.E.W., Q.W., V.M., A.M.L.); Western Sydney University, Campbelltown, NSW, Australia (N.D.Y.); Brigham and Women's Hospital, Harvard Medical School, Boston (D.H.S., P.L.); University Hospital Zurich, Zurich, Switzerland (T.F.L., F.R.); Baylor College of Medicine, Veterans Affairs Medical Center, Houston (D.Y.G.); and State University of New York, Downstate Health Sciences Center (J.S.B.) and Pfizer (M.G., B.B., M.F.B., W.B.), New York
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Borer JS, Deedwania PC, Kim JB, Böhm M. Benefits of Heart Rate Slowing With Ivabradine in Patients With Systolic Heart Failure and Coronary Artery Disease. Am J Cardiol 2016; 118:1948-1953. [PMID: 27780557 DOI: 10.1016/j.amjcard.2016.08.089] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022]
Abstract
Heart rate (HR) is a risk factor in patients with chronic systolic heart failure (HF) that, when reduced, provides outcome benefits. It is also a target for angina pectoris prevention and a risk marker in chronic coronary artery disease without HF. HR can be reduced by drugs; however, among those used clinically, only ivabradine reduces HR directly in the sinoatrial nodal cells without other known effects on the cardiovascular system. This review provides current information regarding the safety and efficacy of HR reduction with ivabradine in clinical studies involving >36,000 patients with chronic stable coronary artery disease and >6,500 patients with systolic HF. The largest trials, Morbidity-Mortality Evaluation of the If Inhibitor Ivabradine in Patients With Coronary Disease and Left Ventricular Dysfunction and Study Assessing the Morbidity-Mortality Benefits of the If Inhibitor Ivabradine in Patients With Coronary Artery Disease, showed no effect on outcomes. The Systolic Heart Failure Treatment With the If Inhibitor Ivabradine Trial, a randomized controlled trial in >6,500 patients with HF, revealed marked and significant HR-mediated reduction in cardiovascular mortality or HF hospitalizations while improving quality of life and left ventricular mechanical function after treatment with ivabradine. The adverse effects of ivabradine predominantly included bradycardia and atrial fibrillation (both uncommon) and ocular flashing scotomata (phosphenes) but otherwise were similar to placebo. In conclusion, ivabradine improves outcomes in patients with systolic HF; rates of overall adverse events are similar to placebo.
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Tavazzi L, Borer JS, Tavazzi G. Use and Disuse of Observational Research: The Case of Remote Monitoring in Heart Failure. Cardiology 2016; 137:14-19. [DOI: 10.1159/000453655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 12/28/2022]
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Nägele MP, Steffel J, Robertson M, Singh JP, Flammer AJ, Bax JJ, Borer JS, Dickstein K, Ford I, Gorcsan J, Gras D, Krum H, Sogaard P, Holzmeister J, Abraham WT, Brugada J, Ruschitzka F. Effect of cardiac resynchronization therapy in patients with diabetes randomized in
EchoCRT. Eur J Heart Fail 2016; 19:80-87. [DOI: 10.1002/ejhf.655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/20/2016] [Accepted: 08/03/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Matthias P. Nägele
- Department of Cardiology University Heart Centre Zurich Zurich Switzerland
| | - Jan Steffel
- Department of Cardiology University Heart Centre Zurich Zurich Switzerland
| | - Michele Robertson
- Robertson Centre for Biostatistics University of Glasgow Glasgow United Kingdom
| | - Jagmeet P. Singh
- Cardiac Arrhythmia Service Massachusetts General Hospital, Harvard Medical School Boston MA USA
| | - Andreas J. Flammer
- Department of Cardiology University Heart Centre Zurich Zurich Switzerland
| | - Jeroen J. Bax
- Department of Cardiology Leiden University Medical Centre Leiden the Netherlands
| | - Jeffrey S. Borer
- Division of Cardiovascular Medicine and Howard Gilman and Ron and Jean Schiavone Institutes State University of New York Downstate College of Medicine New York NY USA
| | - Kenneth Dickstein
- University of Bergen Bergen Norway
- Stavanger University Hospital Stavanger Norway
| | - Ian Ford
- Robertson Centre for Biostatistics University of Glasgow Glasgow United Kingdom
| | | | | | - Henry Krum
- Monash Centre of Cardiovascular Research and Education in Therapeutics Melbourne VIC Australia
| | - Peter Sogaard
- Department of Cardiology and Clinical Institute Aalborg University Hospital Aalborg Denmark
| | | | - William T. Abraham
- Division of Cardiovascular Medicine Ohio State University Medical Center Columbus OH USA
| | - Josep Brugada
- Cardiology Department, Thorax Institute, Hospital Clinic University of Barcelona Spain
| | - Frank Ruschitzka
- Department of Cardiology University Heart Centre Zurich Zurich Switzerland
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Borer JS, Swedberg K, Komajda M, Ford I, Tavazzi L, Böhm M, Depre C, Wu Y, Maya J, Dominjon F. Efficacy Profile of Ivabradine in Patients with Heart Failure plus Angina Pectoris. Cardiology 2016; 136:138-144. [DOI: 10.1159/000449243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/19/2016] [Indexed: 11/19/2022]
Abstract
Objectives: In the Systolic Heart Failure Treatment with the If Inhibitor Ivabradine Trial (SHIFT), slowing of the heart rate with ivabradine reduced cardiovascular death or heart failure hospitalizations among patients with systolic chronic heart failure (CHF). Subsequently, in the Study Assessing the Morbidity-Mortality Benefits of the If Inhibitor Ivabradine in Patients with Coronary Artery Disease (SIGNIFY) slowing of the heart rate in patients without CHF provided no benefit for cardiovascular death or nonfatal myocardial infarction (primary composite end point), with secondary analyses suggesting possible harm in the angina subgroup. Therefore, we examined the impact of ivabradine in the patients with CHF plus angina in SHIFT. Methods: SHIFT enrolled adults with stable, symptomatic CHF, a left ventricular ejection fraction ≤35% and a sinus rhythm with a resting heart rate ≥70 bpm. Outcomes were the SHIFT and SIGNIFY primary composite end points and their components. Results: Of 6,505 patients in SHIFT, 2,220 (34%) reported angina at randomization. Ivabradine numerically, but not significantly, reduced the SIGNIFY primary composite end point by 8, 11 and 11% in the SHIFT angina subgroup, nonangina subgroup and overall population, respectively. Ivabradine also reduced the SHIFT primary composite end point in all 3 subgroups. Conclusions: In SHIFT, ivabradine showed consistent reduction of cardiovascular outcomes in patients with CHF; similar results were seen in the subgroup of SHIFT patients with angina.
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Borer JS, Kansal AR, Dorman ED, Krotneva S, Zheng Y, Patel HK, Tavazzi L, Komajda M, Ford I, Böhm M, Kielhorn A. Budget Impact of Adding Ivabradine to Standard of Care in Patients with Chronic Systolic Heart Failure in the United States. J Manag Care Spec Pharm 2016. [DOI: 10.18553/jmcp.2016.22.9.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Mitral regurgitation is a common heart valve disease. It is defined to be primary when it results from the pathology of the mitral valve apparatus itself and secondary when it is caused by distortion of the architecture or function of the left ventricle. Although the diagnosis and management of mitral regurgitation rely heavily on echocardiography, one should bear in mind the caveats and shortcomings of such an approach. Clinical decision making commonly focuses on the indications for surgery, but it is complex and mandates precise assessment of the mitral pathology, symptom status of the patient, and ventricular performance (right and left) among other descriptors. It is important for healthcare providers at all levels to be familiar with the clinical picture, diagnosis, disease course, and management of mitral regurgitation.
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Affiliation(s)
- Edgar Argulian
- Division of Cardiology, Icahn School of Medicine, Mt Sinai St Luke's Hospital, New York, NY.
| | | | - Franz H Messerli
- Division of Cardiology, Icahn School of Medicine, Mt Sinai St Luke's Hospital, New York, NY
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Borer JS, Lewis BS. Therapeutic Coronary Reperfusion and Reperfusion Injury: An Introduction. Cardiology 2016; 135:67. [PMID: 27271263 DOI: 10.1159/000446522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jeffrey S Borer
- Schiavone Institute of Cardiovascular Translational Research, State University of New York, Downstate Medical Center and College of Medicine, New York, N.Y., USA
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Komajda M, Tavazzi L, Swedberg K, Böhm M, Borer JS, Moyne A, Ford I. Chronic exposure to ivabradine reduces readmissions in the vulnerable phase after hospitalization for worsening systolic heart failure: a post-hoc analysis of SHIFT. Eur J Heart Fail 2016; 18:1182-9. [PMID: 27210035 DOI: 10.1002/ejhf.582] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 12/21/2022] Open
Abstract
AIMS During the post-discharge phase following a heart failure hospitalization (HFH), patients are at high risk of early readmission despite standard of care therapy. We examined the impact of chronic exposure to ivabradine on early readmissions in patients hospitalized for heart failure during the course of the SHIFT study (Systolic Heart Failure treatment with the If inhibitor ivabradine Trial). METHODS AND RESULTS A total of 1186 of the 6505 randomized patients experienced at least one HFH during the study, and had a more severe profile than those without HFH. Of these 1186 patients, 334 patients (28%) were rehospitalized within 3 months for any reason, mostly for cardiovascular causes (86%), including HFH (61%). Ivabradine was associated with fewer all-cause hospitalizations at 1 month [incidence rate ratio (IRR) 0.70, 95% confidence interval (CI) 0.50-1.00, P < 0.05], 2 months (IRR 0.75, 95% CI 0.58-0.98, P = 0.03), and 3 months (IRR 0.79, 95% CI 0.63-0.99, P = 0.04). A trend for a reduction in cardiovascular and HF hospitalizations was also observed in ivabradine-treated patients. CONCLUSION We demonstrate in this post-hoc analysis that chronic exposure to ivabradine reduces the incidence of all-cause hospitalizations during the vulnerable phase after a HFH. Further studies are needed to investigate if in-hospital or early post-discharge initiation of ivabradine could be useful to improve early outcomes in patients hospitalized for HF.
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Affiliation(s)
- Michel Komajda
- Institute of Cardio-Metabolism and Nutrition (ICAN), Department of Cardiology, Pierre et Marie Curie University, Paris VI and Pitié-Salpêtrière Hospital, Paris, France
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden, and National Heart and Lung Institute, Imperial College, London, UK
| | - Michael Böhm
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany
| | - Jeffrey S Borer
- Division of Cardiovascular Medicine, The Howard Gilman Institute for Heart Valve Diseases and the Schiavone Institute for Cardiovascular Translational Research, SUNY Downstate Medical Center, Brooklyn and New York, NY, USA
| | - Aurélie Moyne
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, UK
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