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Journal Cover JACC : Heart Failure
  [SJR: 4.318]   [H-I: 18]   [9 followers]  Follow
    
   Full-text available via subscription Subscription journal  (Not entitled to full-text)
   ISSN (Online) 2213-1779
   Published by Elsevier Homepage  [3043 journals]
  • Racial Tension in Hypertension
    • Authors: Walter J. Paulus; Mark T. Waddingham
      Pages: 166 - 168
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Walter J. Paulus, Mark T. Waddingham
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.004
       
  • Left Ventricular Architecture, Long-Term Reverse Remodeling, and Clinical
           Outcome in Mild Heart Failure With Cardiac Resynchronization
    • Authors: Martin St. John Sutton; Cecilia Linde; Michael R. Gold; William T. Abraham; Stefano Ghio; Jeffrey Cerkvenik; Jean-Claude Daubert
      Pages: 169 - 178
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Martin St. John Sutton, Cecilia Linde, Michael R. Gold, William T. Abraham, Stefano Ghio, Jeffrey Cerkvenik, Jean-Claude Daubert
      Objectives This study sought to determine the effects of abnormal left ventricular (LV) architecture on cardiac remodeling and clinical outcomes in mild heart failure (HF). Background Cardiac resynchronization therapy (CRT) is an established treatment for HF that improves survival in part by favorably remodeling LV architecture. LV shape is a dynamic component of LV architecture on which contractile function depends. Methods Transthoracic 2-dimensional echocardiography was used to quantify changes in LV architecture over 5 years of follow-up of patients with mild HF from the REVERSE study. REVERSE was a prospective study of patients with large hearts (LV end-diastolic dimension ≥55 mm), LV ejection fraction <40%, and QRS duration >120 ms randomly assigned to CRT-ON (n = 419) and CRT-OFF (n = 191). CRT-OFF patients were excluded from this analysis. LV dimensions, volumes, mass index, and LV ejection fraction were calculated. LV architecture was assessed using the sphericity index, as follows: (LV end-diastolic volume)/(4/3 × π × r3) × 100%. Results LV architecture improved over time and demonstrated significant associations between LV shape, age, sex, and echocardiography metrics. Changes in LV architecture were strongly correlated with changes in LV end-systolic volume index and LV end-diastolic volume index (both p < 0.0001). Sphericity index emerged as a predictor of death and HF hospitalization in spite of the low adverse event rate. A decrease in LV end-systolic volume index >15% occurred in more than two-thirds of patients, which indicates considerable reverse remodeling. Conclusions We demonstrated that change in LV architecture in patients with mild HF with CRT is associated with structural and functional remodeling. Mean LV filling pressure was elevated, and the inability to lower it was an additional predictor of HF hospitalization or death. (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction [REVERSE]; NCT00271154)
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.012
       
  • Left Ventricular Shape
    • Authors: James E. Udelson
      Pages: 179 - 181
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): James E. Udelson
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2017.01.005
       
  • The Hope That Early Detection Can Tip the Scale Towards Heart Failure
           Prevention∗
    • Authors: Eldrin F. Lewis
      Pages: 191 - 193
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Eldrin F. Lewis
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2017.02.001
       
  • Can Vaccinations Improve Heart Failure Outcomes'
    • Authors: Ankeet S. Bhatt; Adam D. DeVore; Adrian F. Hernandez; Robert J. Mentz
      Pages: 194 - 203
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Ankeet S. Bhatt, Adam D. DeVore, Adrian F. Hernandez, Robert J. Mentz
      Heart failure (HF) is a chronic syndrome characterized by acute exacerbations. There is significant overlap between respiratory infections and exacerbation of underlying HF. Vaccination against respiratory infections in patients with HF could serve as a potential cost-effective intervention to improve patients’ quality of life and clinical outcomes. The benefits of influenza vaccination in secondary prevention of ischemic heart disease have been previously studied. However, the evidence for influenza and pneumococcal vaccination specifically in the HF population is less well established. Furthermore, questions around the optimal timing, dose, frequency, and implementation strategies are largely unanswered. This review highlights the current evidence for vaccination against influenza and pneumococcal pneumonia in HF and cardiovascular disease. It summarizes current understanding of the pathophysiologic mechanisms in which vaccination may provide cardioprotection. Finally, it offers opportunities for further investigation on the effects of vaccination in the HF population, spanning basic science, translational research, and large clinical trials.
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.007
       
  • Economic Value and Cost-Effectiveness of Cardiac Resynchronization
           Therapy Among Patients With Mild Heart Failure
    • Authors: Michael R. Gold; Amie Padhiar; Stuart Mealing; Manpreet K. Sidhu; Stelios I. Tsintzos; William T. Abraham
      Pages: 204 - 212
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Michael R. Gold, Amie Padhiar, Stuart Mealing, Manpreet K. Sidhu, Stelios I. Tsintzos, William T. Abraham
      Objectives This study investigated the cost effectiveness of early cardiac resynchronization therapy (CRT) implantation among patients with mild heart failure (HF). The differential cost effectiveness between CRT using a defibrillator (CRT-Ds) and CRT using a pacemaker (CRT-P) was also assessed. Background Cardiac resynchronization has been shown to be cost effective in New York Heart Association (NYHA) functional classes III/IV but is less studied in class II HF. The incremental costs of early CRT implementation in mild HF compared with the costs potentially avoided because of delaying disease progression to advanced HF are also unknown. Finally, combined biventricular pacing and defibrillator (CRT-D) devices are more expensive than biventricular pacemakers (CRT-P), but the relative cost effectiveness is controversial. Methods Data from the 5-year follow-up phase of REVERSE (REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction) were used. The economics were evaluated from the U.S. Medicare perspective based on published clinical projections. Results Probabilistic estimates yielded $8,840/quality-adjusted life year (QALY) gained (95% confidence interval [CI]: $6,705 to $10,804/QALY gained) for CRT-ON versus CRT-OFF (i.e., programmed “ON” or “OFF” at pre-specified post-implantation timings) and $43,678/QALY gained for CRT-D versus CRT-P (95% CI: $35,164 to $53,589/QALY gained) over the patient’s lifetime. Results were robust to choice of patient subgroup and alterations of ±10% to key model parameters. An “early” CRT-D class II strategy totaled $95,292 compared with $91,511 for a “late” implantation. An “early” implant offered on average 1.00 year of additional survival for $3,781, resulting in an ICER of $3,795/LY gained. Conclusions This study demonstrates CRT cost effectiveness in mild HF. The incremental CRT-D costs are justified by the anticipated benefits, despite increased procurement costs and shorter generator longevities. “Early” CRT-D implants have essential cost parity with “late” implants while increasing the patient’s survival. (REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction [REVERSE]; NCT00271154)
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.10.014
       
  • Return on Investment in Implantable Devices
    • Authors: Benjamin A. Steinberg; Robert J. Mentz
      Pages: 213 - 215
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Benjamin A. Steinberg, Robert J. Mentz
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2017.01.004
       
  • A Multisensor Algorithm Predicts Heart Failure Events in Patients
           With Implanted Devices
    • Authors: John P. Boehmer; Ramesh Hariharan; Fausto G. Devecchi; Andrew L. Smith; Giulio Molon; Alessandro Capucci; Qi An; Viktoria Averina; Craig M. Stolen; Pramodsingh H. Thakur; Julie A. Thompson; Ramesh Wariar; Yi Zhang; Jagmeet P. Singh
      Pages: 216 - 225
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): John P. Boehmer, Ramesh Hariharan, Fausto G. Devecchi, Andrew L. Smith, Giulio Molon, Alessandro Capucci, Qi An, Viktoria Averina, Craig M. Stolen, Pramodsingh H. Thakur, Julie A. Thompson, Ramesh Wariar, Yi Zhang, Jagmeet P. Singh
      Objectives The aim of this study was to develop and validate a device-based diagnostic algorithm to predict heart failure (HF) events. Background HF involves costly hospitalizations with adverse impact on patient outcomes. The authors hypothesized that an algorithm combining a diverse set of implanted device-based sensors chosen to target HF pathophysiology could detect worsening HF. Methods The MultiSENSE (Multisensor Chronic Evaluation in Ambulatory Heart Failure Patients) study enrolled patients with investigational chronic ambulatory data collection via implanted cardiac resynchronization therapy defibrillators. HF events (HFEs), defined as HF admissions or unscheduled visits with intravenous treatment, were independently adjudicated. The development cohort of patients was used to construct a composite index and alert algorithm (HeartLogic) combining heart sounds, respiration, thoracic impedance, heart rate, and activity; the test cohort was sequestered for independent validation. The 2 coprimary endpoints were sensitivity to detect HFE >40% and unexplained alert rate <2 alerts per patient-year. Results Overall, 900 patients (development cohort, n = 500; test cohort, n = 400) were followed for up to 1 year. Coprimary endpoints were evaluated using 320 patient-years of follow-up data and 50 HFEs in the test cohort (72% men; mean age 66.8 ± 10.3 years; New York Heart Association functional class at enrollment: 69% in class II, 25% in class III; mean left ventricular ejection fraction 30.0 ± 11.4%). Both endpoints were significantly exceeded, with sensitivity of 70% (95% confidence interval [CI]: 55.4% to 82.1%) and an unexplained alert rate of 1.47 per patient-year (95% CI: 1.32 to 1.65). The median lead time before HFE was 34.0 days (interquartile range: 19.0 to 66.3 days). Conclusions The HeartLogic multisensor index and alert algorithm provides a sensitive and timely predictor of impending HF decompensation. (Evaluation of Multisensor Data in Heart Failure Patients With Implanted Devices [MultiSENSE]; NCT01128166)
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.011
       
  • Easy to Predict, Difficult to Prevent∗
    • Authors: David J. Whellan; JoAnn Lindenfeld
      Pages: 226 - 228
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): David J. Whellan, JoAnn Lindenfeld
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2017.01.006
       
  • JACC: Heart Failure Series: FDA in the 21st Century
    • Authors: Mona Fiuzat; Susan T. Mayne; Matt Hillebrenner; Norman Stockbridge; Bram Zuckerman; Robert M. Califf
      Pages: 229 - 231
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Mona Fiuzat, Susan T. Mayne, Matt Hillebrenner, Norman Stockbridge, Bram Zuckerman, Robert M. Califf


      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.012
       
  • Double Vision
    • Authors: Milton Packer
      Pages: 232 - 235
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Milton Packer


      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.017
       
  • Living With Heart Failure With Preserved Ejection Fraction
    • Authors: Cynthia Chauhan
      Pages: 236 - 237
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Cynthia Chauhan


      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.013
       
  • The 30-Day Readmission Metric for Heart Failure
    • Authors: Demi Adedinsewo; Eric Chang; Titilope Olanipekun; Anekwe Onwuanyi
      First page: 240
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Demi Adedinsewo, Eric Chang, Titilope Olanipekun, Anekwe Onwuanyi


      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.006
       
  • The Importance of Mitral Regurgitation in Patients With
           Left Ventricular Assist Devices
    • Authors: Simon Maltais; Lucman A. Anwer
      Pages: 89 - 91
      Abstract: Publication date: February 2017
      Source:JACC: Heart Failure, Volume 5, Issue 2
      Author(s): Simon Maltais, Lucman A. Anwer
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.002
       
  • Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction
    • Authors: Carolyn S.P. Lam; Michiel Rienstra; Wan Ting Tay; Licette C.Y. Liu; Yoran M. Hummel; Peter van der Meer; Rudolf A. de Boer; Isabelle C. Van Gelder; Dirk J. van Veldhuisen; Adriaan A. Voors; Elke S. Hoendermis
      Pages: 92 - 98
      Abstract: Publication date: February 2017
      Source:JACC: Heart Failure, Volume 5, Issue 2
      Author(s): Carolyn S.P. Lam, Michiel Rienstra, Wan Ting Tay, Licette C.Y. Liu, Yoran M. Hummel, Peter van der Meer, Rudolf A. de Boer, Isabelle C. Van Gelder, Dirk J. van Veldhuisen, Adriaan A. Voors, Elke S. Hoendermis
      Objectives This study sought to study the association of atrial fibrillation (AF) with exercise capacity, left ventricular filling pressure, natriuretic peptides, and left atrial size in heart failure with preserved ejection fraction (HFpEF). Background The diagnosis of HFpEF in patients with AF remains a challenge because both contribute to impaired exercise capacity, and increased natriuretic peptides and left atrial volume. Methods We studied 94 patients with symptomatic heart failure and left ventricular ejection fractions ≥45% using treadmill cardiopulmonary exercise testing and right- and/or left-sided cardiac catheterization with simultaneous echocardiography. Results During catheterization, 62 patients were in sinus rhythm, and 32 patients had AF. There were no significant differences in age, sex, body size, comorbidities, or medications between groups; however, patients with AF had lower peak oxygen consumption (VO2) compared with those with sinus rhythm (10.8 ± 3.1 ml/min/kg vs. 13.5 ± 3.8 ml/min/kg; p = 0.002). Median (25th to 75th percentile) N-terminal pro−B-type natriuretic peptide (NT-proBNP) was higher in AF versus sinus rhythm (1,689; 851 to 2,637 pg/ml vs. 490; 272 to 1,019 pg/ml; p < 0.0001). Left atrial volume index (LAVI) was higher in AF than sinus rhythm (57.8 ± 17.0 ml/m2 vs. 42.5 ± 15.1 ml/m2; p = 0.001). Invasive hemodynamics showed higher mean pulmonary capillary wedge pressure (PCWP) (19.9 ± 3.7 vs. 15.2 ± 6.8) in AF versus sinus rhythm (all p < 0.001), with a trend toward higher left ventricular end-diastolic pressure (17.7 ± 3.0 mm Hg vs. 15.7 ± 6.9 mm Hg; p = 0.06). After adjusting for clinical covariates and mean PCWP, AF remained associated with reduced peak VO2 increased log NT-proBNP, and enlarged LAVI (all p ≤0.005). Conclusions AF is independently associated with greater exertional intolerance, natriuretic peptide elevation, and left atrial remodeling in HFpEF. These data support the application of different thresholds of NT-proBNP and LAVI for the diagnosis of HFpEF in the presence of AF versus the absence of AF.
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.10.005
       
  • Decreased Mortality With Beta-Blockers in Patients With Heart Failure and
           Coexisting Atrial Fibrillation
    • Authors: Julia Cadrin-Tourigny; Azadeh Shohoudi; Denis Roy; Mario Talajic; Rafik Tadros; Blandine Mondésert; Katia Dyrda; Léna Rivard; Jason G. Andrade; Laurent Macle; Peter G. Guerra; Bernard Thibault; Marc Dubuc; Paul Khairy
      Pages: 99 - 106
      Abstract: Publication date: February 2017
      Source:JACC: Heart Failure, Volume 5, Issue 2
      Author(s): Julia Cadrin-Tourigny, Azadeh Shohoudi, Denis Roy, Mario Talajic, Rafik Tadros, Blandine Mondésert, Katia Dyrda, Léna Rivard, Jason G. Andrade, Laurent Macle, Peter G. Guerra, Bernard Thibault, Marc Dubuc, Paul Khairy
      Objectives The impact of beta-blockers on mortality and hospitalizations was assessed in the largest randomized trial of patients with both atrial fibrillation (AF) and heart failure with a reduced ejection fraction (HFrEF): the Atrial Fibrillation-Congestive Heart Failure trial. Background Although beta-blockers are the cornerstone of therapy for HFrEF, a recent patient-level meta-analysis cast doubt on their efficacy in patients with coexisting AF. Methods From a total of 1,376 subjects randomized in the AF-CHF trial, those without beta-blockers at baseline were propensity matched to a maximum of 2 exposed patients. All absolute standardized differences after matching were ≤10%. Primary analyses respected the intention-to-treat principle. In on-treatment sensitivity analyses, beta-blocker status was modeled as a time-dependent covariate. Results Baseline characteristics were comparable among the matched cohorts (mean age 70 ± 11 years, 81% male, and mean left ventricular ejection fraction 27 ± 6%). During a median follow-up of 37 months, beta-blockers were associated with significantly lower all-cause mortality (hazard ratio [HR]: 0.721, 95% confidence interval [CI]: 0.549 to 0.945; p = 0.0180) but not hospitalizations (HR: 0.886; 95% CI: 0.715 to 1.100; p = 0.2232). Similar results were obtained in sensitivity analyses that modeled beta-blockers as a time-dependent variable (HR: 0.668 for all-cause mortality; 95% CI: 0.511 to 0.874; p = 0.0032; HR: 0.814 for hospitalizations; 95% CI: 0.653 to 1.014; p = 0.0658). There were no significant interactions between beta-blockers and patterns (i.e., persistent vs. paroxysmal) or burden of AF with respect to mortality or hospitalizations. Conclusions In propensity-matched analyses, beta-blockers were associated with significantly lower mortality but not hospitalizations in patients with HFrEF and AF, irrespective of the pattern or burden of AF. These results support current evidence-based recommendations for beta-blockers in patients with HFrEF, whether or not they have associated AF.
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.10.015
       
  • Heart Failure Complicated by Atrial Fibrillation
    • Authors: Jonathan P. Piccini; Larry A. Allen
      Pages: 107 - 109
      Abstract: Publication date: February 2017
      Source:JACC: Heart Failure, Volume 5, Issue 2
      Author(s): Jonathan P. Piccini, Larry A. Allen
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.003
       
  • Cost-Effectiveness of Left Ventricular Assist Devices in Ambulatory
           Patients With Advanced Heart Failure
    • Authors: Jacqueline Baras Shreibati; Jeremy D. Goldhaber-Fiebert; Dipanjan Banerjee; Douglas K. Owens; Mark A. Hlatky
      Pages: 110 - 119
      Abstract: Publication date: February 2017
      Source:JACC: Heart Failure, Volume 5, Issue 2
      Author(s): Jacqueline Baras Shreibati, Jeremy D. Goldhaber-Fiebert, Dipanjan Banerjee, Douglas K. Owens, Mark A. Hlatky
      Objectives This study assessed the cost-effectiveness of left ventricular assist devices (LVADs) as destination therapy in ambulatory patients with advanced heart failure. Background LVADs improve survival and quality of life in inotrope-dependent heart failure, but data are limited as to their value in less severely ill patients. Methods We determined costs of care among Medicare beneficiaries before and after LVAD implantation from 2009 to 2010. We used these costs and efficacy data from published studies in a Markov model to project the incremental cost-effectiveness ratio (ICER) of destination LVAD therapy compared with that of medical management. We discounted costs and benefits at 3% annually and report costs as 2016 U.S. dollars. Results The mean cost of LVAD implantation was $175,420. The mean cost of readmission was lower before LVAD than after ($12,377 vs. $19,465, respectively; p < 0.001), while monthly outpatient costs were similar ($3,364 vs. $2,974, respectively; p = 0.54). In the lifetime simulation model, LVAD increased quality-adjusted life-years (QALYs) (4.41 vs. 2.67, respectively), readmissions (13.03 vs. 6.35, respectively), and costs ($726,200 vs. $361,800, respectively) compared with medical management, yielding an ICER of $209,400 per QALY gained and $597,400 per life-year gained. These results were sensitive to LVAD readmission rates and outpatient care costs; the ICER would be $86,900 if these parameters were 50% lower. Conclusions LVADs in non–inotrope-dependent heart failure patients improved quality of life but substantially increased lifetime costs because of frequent readmissions and costly follow-up care. LVADs may provide good value if outpatient costs and adverse events can be reduced.
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.09.008
       
  • Optimism, Pessimism, and Pragmatism
    • Authors: Joseph G. Rogers
      Pages: 120 - 122
      Abstract: Publication date: February 2017
      Source:JACC: Heart Failure, Volume 5, Issue 2
      Author(s): Joseph G. Rogers
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.003
       
  • Does Size Matter With Continuous Left Ventricular Assist
           Devices'∗
    • Authors: Eileen M. Hsich
      Pages: 132 - 135
      Abstract: Publication date: February 2017
      Source:JACC: Heart Failure, Volume 5, Issue 2
      Author(s): Eileen M. Hsich
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.10.002
       
  • Affordable Care
    • Authors: Marvin A. Konstam
      Pages: 148 - 151
      Abstract: Publication date: February 2017
      Source:JACC: Heart Failure, Volume 5, Issue 2
      Author(s): Marvin A. Konstam
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.005
       
  • FDA in the 21st Century
    • Authors: Mona Fiuzat; Tamar S. Nordenberg; Mitchell Zeller; Matthew G. Hillebrenner; Norman Stockbridge; Bram Zuckerman; Robert M. Califf
      Pages: 152 - 153
      Abstract: Publication date: February 2017
      Source:JACC: Heart Failure, Volume 5, Issue 2
      Author(s): Mona Fiuzat, Tamar S. Nordenberg, Mitchell Zeller, Matthew G. Hillebrenner, Norman Stockbridge, Bram Zuckerman, Robert M. Califf


      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.010
       
  • 21st Century Cures
    • Authors: Christopher M. O’Connor
      First page: 154
      Abstract: Publication date: February 2017
      Source:JACC: Heart Failure, Volume 5, Issue 2
      Author(s): Christopher M. O’Connor


      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.004
       
  • Insulin-Like Growth Factor-1 Bioregulation System Abnormalities
    • Authors: Georgios Tzanis; Anastasios Philippou; Stavros Dimopoulos; Michael Koutsilieris; Serafim Nanas
      Pages: 155 - 156
      Abstract: Publication date: February 2017
      Source:JACC: Heart Failure, Volume 5, Issue 2
      Author(s): Georgios Tzanis, Anastasios Philippou, Stavros Dimopoulos, Michael Koutsilieris, Serafim Nanas


      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.001
       
  • Under Pressure
    • Authors: Jacob Abraham; Rebecca S. Lewis; Lian Wang; Kateri J. Spinelli; Josh Remick; Jeff Paulsen; Jay Chappell
      First page: 156
      Abstract: Publication date: February 2017
      Source:JACC: Heart Failure, Volume 5, Issue 2
      Author(s): Jacob Abraham, Rebecca S. Lewis, Lian Wang, Kateri J. Spinelli, Josh Remick, Jeff Paulsen, Jay Chappell


      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.007
       
  • Body Weight Change During and After Hospitalization for Acute
           Heart Failure: Patient Characteristics, Markers of Congestion, and
           Outcomes
    • Authors: Andrew P. Ambrosy; Lukasz P. Cerbin; Paul W. Armstrong; Javed Butler; Adrian Coles; Adam D. DeVore; Mark E. Dunlap; Justin A. Ezekowitz; G. Michael Felker; Marat Fudim; Stephen J. Greene; Adrian F. Hernandez; Christopher M. O'Connor; Philip Schulte; Randall C. Starling; John R. Teerlink; Adriaan A. Voors; Robert J. Mentz
      Pages: 1 - 13
      Abstract: Publication date: January 2017
      Source:JACC: Heart Failure, Volume 5, Issue 1
      Author(s): Andrew P. Ambrosy, Lukasz P. Cerbin, Paul W. Armstrong, Javed Butler, Adrian Coles, Adam D. DeVore, Mark E. Dunlap, Justin A. Ezekowitz, G. Michael Felker, Marat Fudim, Stephen J. Greene, Adrian F. Hernandez, Christopher M. O'Connor, Philip Schulte, Randall C. Starling, John R. Teerlink, Adriaan A. Voors, Robert J. Mentz
      Objectives This study sought to examine the relationships between in-hospital and post-discharge body weight changes and outcomes among patients hospitalized for acute heart failure (AHF). Background Body weight changes during and after hospitalization for AHF and the relationships with outcomes have not been well characterized. Methods A post hoc analysis was performed of the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure) trial, which enrolled patients admitted for AHF regardless of ejection fraction. In-hospital body weight change was defined as the difference between baseline and discharge/day 10, whereas post-discharge body weight change was defined as the difference between discharge/day 10 and day 30. Spearman rank correlations of weight change, urine output (UOP), and dyspnea relief as assessed by a 7-point Likert scale are described. Logistic and Cox proportional hazards regression was used to evaluate the relationship between weight change and outcomes. Results Study participants with complete body weight data (n = 4,172) had a mean age of 65 ± 14 years, and 66% were male. Ischemic heart disease was reported in 60% of patients and the average ejection fraction was 30 ± 13%. The median change in body weight was −1.0 kg (interquartile range: −2.1 to 0.0 kg) at 24 h and −2.3 kg (interquartile range: −5.0 to −0.7 kg) by discharge/day 10. At hour 24, there was a weak correlation between change in body weight and UOP (r = −0.381), and minimal correlation between body weight change and dyspnea relief (r = −0.096). After risk adjustment, increasing body weight during hospitalization was associated with a 16% increase per kg in the likelihood of 30-day mortality or HF readmission for patients showing weight loss ≤1 kg or weight gain during hospitalization (odds ratio per kg increase 1.16, 95% confidence interval [CI]: 1.09 to 1.27; p < 0.001). Among the subset of patients experiencing >1-kg increase in body weight post-discharge, increasing body weight was associated with higher risk of 180-day mortality (hazard ratio per kg increase 1.16; 95% CI: 1.09 to 1.23; p < 0.001). Conclusions A substantial number of patients experienced minimal weight loss or frank weight gain in the context of an AHF trial, and increasing body weight in this subset of patients was independently associated with a worse post-discharge prognosis.
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      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.09.012
       
  • Prevalence and Clinical Significance of Diabetes in Asian Versus White
           Patients With Heart Failure
    • Authors: Ingrid E.M. Bank; Crystel M. Gijsberts; Tiew-Hwa K. Teng; Lina Benson; David Sim; Poh Shuan Daniel Yeo; Hean Yee Ong; Fazlur Jaufeerally; Gerard K.T. Leong; Lieng H. Ling; A. Mark Richards; Dominique P.V. de Kleijn; Ulf Dahlström; Lars H. Lund; Carolyn S.P. Lam
      Pages: 14 - 24
      Abstract: Publication date: January 2017
      Source:JACC: Heart Failure, Volume 5, Issue 1
      Author(s): Ingrid E.M. Bank, Crystel M. Gijsberts, Tiew-Hwa K. Teng, Lina Benson, David Sim, Poh Shuan Daniel Yeo, Hean Yee Ong, Fazlur Jaufeerally, Gerard K.T. Leong, Lieng H. Ling, A. Mark Richards, Dominique P.V. de Kleijn, Ulf Dahlström, Lars H. Lund, Carolyn S.P. Lam
      Objectives The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure (HF) with preserved or reduced ejection fraction. Background Diabetes mellitus is common in HF and is associated with impaired prognosis. Asia is home to the majority of the world’s diabetic population, yet data on the prevalence and clinical significance of diabetes in Asian patients with HF are sparse, and no studies have directly compared Asian and white patients. Methods Two contemporary population-based HF cohorts were combined: from Singapore (n = 1,002, median [25th to 75th percentile] age 62 [54 to 70] years, 76% men, 19.5% obesity) and Sweden (n = 19,537, 77 [68 to 84] years, 60% men, 24.8% obesity). The modifying effect of ethnicity on the relationship between diabetes and clinical correlates or prognosis (HF hospitalization and all-cause mortality) was examined using interaction terms. Results Diabetes was present in 569 (57%) Asian patients versus 4,680 (24%) white patients (p < 0.001). Adjusting for clinical covariates, obesity was more strongly associated with diabetes in white patients (odds ratio [OR]: 3.45; 95% confidence interval [CI]: 2.86 to 4.17) than in Asian patients (OR: 1.82; 95% CI: 1.13 to 2.96; pinteraction = 0.026). Diabetes was more strongly associated with increased HF hospitalization and all-cause mortality in Asian patients (hazard ratio: 1.50; 95% CI: 1.21 to 1.87) than in white patients (hazard ratio: 1.29; 95% CI: 1.22 to 1.36; pinteraction = 0.045). Conclusions Diabetes was 3-fold more common in Southeast Asian compared to white patients with HF, despite younger age and less obesity, and more strongly associated with poor outcomes in Asian patients than white patients. These results underscore the importance of ethnicity-tailored aggressive strategies to prevent diabetes and its complications.
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.09.015
       
  • Diabetes Mellitus in Patients With Heart Failure
    • Authors: Neda Dianati-Maleki; Javed Butler
      Pages: 25 - 27
      Abstract: Publication date: January 2017
      Source:JACC: Heart Failure, Volume 5, Issue 1
      Author(s): Neda Dianati-Maleki, Javed Butler
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.002
       
  • Late Gadolinium Enhancement and the Risk for Ventricular Arrhythmias or
           Sudden Death in Dilated Cardiomyopathy
    • Authors: Andrea Di Marco; Ignasi Anguera; Matthias Schmitt; Igor Klem; Tomas G. Neilan; James A. White; Marek Sramko; Pier Giorgio Masci; Andrea Barison; Peter Mckenna; Ify Mordi; Kristina H. Haugaa; Francisco Leyva; Jorge Rodriguez Capitán; Hiroshi Satoh; Takeru Nabeta; Paolo Domenico Dallaglio; Niall G. Campbell; Xavier Sabaté; Ángel Cequier
      Pages: 28 - 38
      Abstract: Publication date: January 2017
      Source:JACC: Heart Failure, Volume 5, Issue 1
      Author(s): Andrea Di Marco, Ignasi Anguera, Matthias Schmitt, Igor Klem, Tomas G. Neilan, James A. White, Marek Sramko, Pier Giorgio Masci, Andrea Barison, Peter Mckenna, Ify Mordi, Kristina H. Haugaa, Francisco Leyva, Jorge Rodriguez Capitán, Hiroshi Satoh, Takeru Nabeta, Paolo Domenico Dallaglio, Niall G. Campbell, Xavier Sabaté, Ángel Cequier
      Objectives The aim of this study was to evaluate the association between late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging and ventricular arrhythmias or sudden cardiac death (SCD) in patients with dilated cardiomyopathy (DCM). Background Risk stratification for SCD in DCM needs to be improved. Methods A systematic review and meta-analysis were conducted. A systematic search of PubMed and Ovid was performed, and observational studies that analyzed the arrhythmic endpoint (sustained ventricular arrhythmia, appropriate implantable cardioverter-defibrillator [ICD] therapy, or SCD) in patients with DCM, stratified by the presence or absence of LGE, were included. Results Twenty-nine studies were included, accounting for 2,948 patients. The studies covered a wide spectrum of DCM, with a mean left ventricular ejection fraction between 20% and 43%. LGE was significantly associated with the arrhythmic endpoint both in the overall population (odds ratio: 4.3; p < 0.001) and when including only those studies that performed multivariate analysis (hazard ratio: 6.7; p < 0.001). The association between LGE and the arrhythmic endpoint remained significant among studies with mean left ventricular ejection fractions >35% (odds ratio: 5.2; p < 0.001) and was maximal in studies that included only patients with primary prevention ICDs (odds ratio: 7.8; p = 0.008). Conclusions Across a wide spectrum of patients with DCM, LGE is strongly and independently associated with ventricular arrhythmia or SCD. LGE could be a powerful tool to improve risk stratification for SCD in patients with DCM. These results raise 2 major questions to be addressed in future studies: whether patients with LGE could benefit from primary prevention ICDs irrespective of their left ventricular ejection fractions, while patients without LGE might not need preventive ICDs despite having severe left ventricular dysfunction.
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.09.017
       
  • Primary Prevention of Sudden Arrhythmic Death in Dilated Cardiomyopathy
    • Authors: Eloisa Arbustini; Marcello Disertori; Jagat Narula
      Pages: 39 - 43
      Abstract: Publication date: January 2017
      Source:JACC: Heart Failure, Volume 5, Issue 1
      Author(s): Eloisa Arbustini, Marcello Disertori, Jagat Narula
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.009
       
  • Predictors and Prognostic Implications of Incident Heart Failure in
           Patients With Prevalent Atrial Fibrillation
    • Authors: Ambarish Pandey; Sunghee Kim; Curtiss Moore; Laine Thomas; Bernard Gersh; Larry A. Allen; Peter R. Kowey; Kenneth W. Mahaffey; Elaine Hylek; Eric D. Peterson; Jonathan P. Piccini; Gregg C. Fonarow
      Pages: 44 - 52
      Abstract: Publication date: January 2017
      Source:JACC: Heart Failure, Volume 5, Issue 1
      Author(s): Ambarish Pandey, Sunghee Kim, Curtiss Moore, Laine Thomas, Bernard Gersh, Larry A. Allen, Peter R. Kowey, Kenneth W. Mahaffey, Elaine Hylek, Eric D. Peterson, Jonathan P. Piccini, Gregg C. Fonarow
      Objectives The purpose of this study was to determine the significant clinical predictors of incident heart failure (HF) and its prognostic effect on long-term outcomes among community-based patients with established atrial fibrillation (AF). Background AF is associated with an increased risk of HF. However, in this population, little focus is placed on risk stratification for and the prevention of HF. Methods Patients with AF but without HF at baseline enrolled in the ORBIT-AF (Outcomes Registry for Informed Treatment of Atrial Fibrillation) registry were included. Separate multivariable-adjusted Cox frailty regression models were used to identify significant predictors of HF incidence and determine the associated risk of adverse clinical events. Results The study included 6,545 participants with AF from 173 participating sites. Incident HF developed in 236 participants (3.6%) over the 2-year follow-up period; ejection fraction was preserved (>40%) in 64%, reduced (≤40%) in 13.5%, and missing in 22.5%. In multivariable analysis, traditional HF risk factors (age, coronary artery disease, renal dysfunction, and valvular disease), presence of permanent AF (hazard ratio [HR]: 1.60 [95% confidence interval (CI): 1.18 to 2.16]; reference group: paroxysmal AF), and elevated baseline heart rate (HR: 1.07 [95% CI: 1.02 to 1.13] per 5 beats/min higher heart rate) were independently associated with incident HF risk. Incident HF among patients with AF was independently associated with higher risk of mortality, all-cause hospitalization, and bleeding events. Conclusions Incident HF among patients with AF is common, is more likely to be HF with preserved ejection fraction, and is associated with poor long-term outcomes. Traditional HF risk factors, AF type, and baseline heart rate are independent clinical predictors of incident HF.
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.09.016
       
  • Atrial Fibrillation and Heart Failure Prevention
    • Authors: Jagmeet P. Singh; Sunu S. Thomas
      Pages: 53 - 55
      Abstract: Publication date: January 2017
      Source:JACC: Heart Failure, Volume 5, Issue 1
      Author(s): Jagmeet P. Singh, Sunu S. Thomas
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.005
       
  • Myocardial Injury, Obesity, and the Obesity Paradox
    • Authors: Yashashwi Pokharel; Wensheng Sun; Salim S. Virani; Vijay Nambi; Ron C. Hoogeveen; Patricia P. Chang; Chiadi E. Ndumele; Scott D. Solomon; Biykem Bozkurt; Elizabeth Selvin; Christie M. Ballantyne; Anita Deswal
      Pages: 56 - 63
      Abstract: Publication date: January 2017
      Source:JACC: Heart Failure, Volume 5, Issue 1
      Author(s): Yashashwi Pokharel, Wensheng Sun, Salim S. Virani, Vijay Nambi, Ron C. Hoogeveen, Patricia P. Chang, Chiadi E. Ndumele, Scott D. Solomon, Biykem Bozkurt, Elizabeth Selvin, Christie M. Ballantyne, Anita Deswal
      Objectives This study sought to determine whether pre-heart failure (HF) myocardial injury explains the differential mortality after HF across weight categories. Background Obesity is a risk factor for HF, but pre-HF obesity is associated with lower mortality after incident HF. High-sensitivity cardiac troponin T (hs-cTnT) is a sensitive marker of myocardial injury, and predicts incident HF and mortality. Methods Stratifying 1,279 individuals with incident HF hospitalizations by their pre-HF hs-cTnT levels (< and ≥ 14 ng/l), we examined the association of pre-HF body mass index (BMI) with mortality after incident HF hospitalization in the ARIC (Atherosclerosis Risk In Communities) study. Results Mean age at HF was 74 years (53% women, 27% black). Individuals with pre-HF hs-cTnT ≥14 ng/l had higher mortality after incident HF (hazard ratio [HR]: 1.46; 95% confidence interval [CI]: 1.18 to 1.80) compared to individuals with hs-cTnT <14 ng/l in an adjusted model including BMI. Compared with normal weight subjects, the mortality was lower in overweight (HR: 0.69, 95% CI 0.48-0.98) and obese individuals (HR: 0.50; 95% CI: 0.35 to 0.72) with hs-cTnT <14 ng/l; and in those with hs-cTnT ≥14 ng/l (overweight HR: 0.50; 95% CI: 0.30 to 0.83; obese HR: 0.56; 95% CI: 0.34 to 0.91; interaction: p = 0.154 between BMI and hs-cTnT). The lower mortality risk in obese and overweight subjects remained similar when log hs-cTnT was added as a continuous variable to a multivariable model, and in sensitivity analyses after further adjusting for left ventricular hypertrophy or high-sensitivity C-reactive protein. Conclusion Although greater pre-existing subclinical myocardial injury was associated with higher mortality after incident HF hospitalization, it did not explain the obesity paradox in HF, which was observed irrespective of subclinical myocardial injury. (Atherosclerosis Risk In Communities [ARIC]; NCT00005131)
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.10.010
       
  • Obesity and Survival With Heart Failure
    • Authors: Christopher R. deFilippi; Stephen L. Seliger
      Pages: 64 - 66
      Abstract: Publication date: January 2017
      Source:JACC: Heart Failure, Volume 5, Issue 1
      Author(s): Christopher R. deFilippi, Stephen L. Seliger
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.011
       
  • The FDA in the 21st Century
    • Authors: Norman Stockbridge; Kristen Miller; Shashi Amur; Matthew Hillebrenner; Bram Zuckerman; Mona Fiuzat; Robert M. Califf
      Pages: 67 - 70
      Abstract: Publication date: January 2017
      Source:JACC: Heart Failure, Volume 5, Issue 1
      Author(s): Norman Stockbridge, Kristen Miller, Shashi Amur, Matthew Hillebrenner, Bram Zuckerman, Mona Fiuzat, Robert M. Califf
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.10.009
       
  • Developing Breakthrough Drugs for Heart Failure
    • Authors: Christopher M. O'Connor
      Pages: 71 - 72
      Abstract: Publication date: January 2017
      Source:JACC: Heart Failure, Volume 5, Issue 1
      Author(s): Christopher M. O'Connor


      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.008
       
  • Is Counting One's Chickens Before They Are Hatched an Inevitable
           Ending'
    • Authors: Levent Cerit; Hamza Duygu
      First page: 73
      Abstract: Publication date: January 2017
      Source:JACC: Heart Failure, Volume 5, Issue 1
      Author(s): Levent Cerit, Hamza Duygu


      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.09.011
       
  • A Novel Rehabilitation Intervention for Older Patients With Acute
           Decompensated Heart Failure
    • Authors: Gordon R. Reeves; David J. Whellan; Christopher M. O'Connor; Pamela Duncan; Joel D. Eggebeen; Timothy M. Morgan; Leigh Ann Hewston; Amy Pastva; Mahesh J. Patel; Dalane W. Kitzman
      Abstract: Publication date: Available online 8 March 2017
      Source:JACC: Heart Failure
      Author(s): Gordon R. Reeves, David J. Whellan, Christopher M. O'Connor, Pamela Duncan, Joel D. Eggebeen, Timothy M. Morgan, Leigh Ann Hewston, Amy Pastva, Mahesh J. Patel, Dalane W. Kitzman
      Objectives This study sought to assess a novel physical rehabilitation intervention in older patients hospitalized for acute decompensated heart failure (ADHF). Background After ADHF, older patients, who are frequently frail with multiple comorbidities, have prolonged and incomplete recovery of physical function and remain at high risk for poor outcomes. Methods The REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) pilot study was a 3-site, randomized, attention-controlled pilot study of a tailored, progressive, multidomain physical rehabilitation intervention beginning in the hospital and continuing for 12 weeks post-discharge in patients ≥60 years hospitalized with ADHF. The primary purpose was to assess the feasibility and reasonableness of the hypothesis that the novel rehabilitation intervention would improve physical function (Short Physical Performance Battery [SPPB]) over 3 months and reduce all-cause rehospitalizations over 6 months. Results The study enrolled 27 patients with ADHF (ages 60 to 98 years; 59% women; 56% African American; 41% with preserved ejection fraction [≥45%]). At baseline, participants had marked impairments in physical function, multiple comorbidities, and frailty. Study retention (89%) and intervention adherence (93%) were excellent. At 3 months, an intervention effect size was measured for the SPPB score of +1.1 U (7.4 ± 0.5 U vs. 6.3 ± 0.5 U), and at 6 months an effect size was observed for an all-cause rehospitalization rate of −0.48 (1.16 ± 0.35 vs. 1.64 ± 0.39). The change in SPPB score was strongly related to all-cause rehospitalizations, explaining 91% of change. Conclusions These findings support the feasibility and rationale for a recently launched, National Institutes of Health–funded trial to test the safety and efficacy of this novel multidomain physical rehabilitation intervention to improve physical function and reduce rehospitalizations in older, frail patients with ADHF with multiple comorbidities. (Rehabilitation and Exercise Training After Hospitalization [REHAB-HF]; NCT01508650; A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [REHAB-HF]; NCT02196038)
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.019
       
  • Dynamic Changes in Aortic Vascular Stiffness in Patients Bridged to
           Transplant With Continuous-Flow Left Ventricular Assist Devices
    • Authors: Amit C. Patel; R. Blair Dodson; William K. Cornwell; Kendall S. Hunter; Joseph C. Cleveland; Andreas Brieke; JoAnn Lindenfeld; Amrut V. Ambardekar
      Abstract: Publication date: Available online 8 March 2017
      Source:JACC: Heart Failure
      Author(s): Amit C. Patel, R. Blair Dodson, William K. Cornwell, Kendall S. Hunter, Joseph C. Cleveland, Andreas Brieke, JoAnn Lindenfeld, Amrut V. Ambardekar
      Objectives The aim of this study was to measure aortic vascular stiffness from orthotopic heart transplant (OHT) patients exposed to varying types of flow as a result of the presence or absence of left ventricular assist device (LVAD) support pre-OHT. Background The effects of continuous-flow LVADs (CF-LVADs) on vascular properties are unknown, but may contribute to the pathophysiology of CF-LVAD complications such as stroke, hypertension, and bleeding. Methods Echocardiograms were reviewed from 172 OHT patients immediately before LVAD and at 3 time points post-OHT: baseline, 6 months, and 1 year. For each study, pulse pressure and aortic end-systolic and end-diastolic dimensions were used to calculate aortic strain, distensibility, and stiffness index. Patients were categorized into 3 groups based on the presence or absence of a LVAD and a pulse pre-OHT: No LVAD (n = 111), LVAD No Pulse (n = 30), and LVAD With Pulse (n = 31). Results The aortic stiffness index among LVAD No Pulse patients increased from 2.8 ± 1.1 pre–CF-LVAD to 10.9 ± 4.7 immediately post-OHT (p < 0.001). This aortic stiffness index was also significantly higher compared with No LVAD (3.4 ± 1.1; p < 0.001) and LVAD With Pulse (3.7 ± 1.4; p < 0.001) immediately post-OHT with attenuation of these differences by 1 year post-OHT. Similar findings were noted for the other indices of aortic stiffness. Conclusions Aortic stiffness is markedly increased immediately post-OHT among patients bridged with CF-LVADs, with attenuation of this increased stiffness over the first year after transplant. These results suggest that aortic vascular properties are dynamic and may be influenced by alterations in flow pulsatility. As more patients are supported with CF-LVADs and as newer pump technology attempts to modulate pulsatility, further research examining the role of alterations in flow patterns on vascular function and the potential resultant systemic sequelae are needed.
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.009
       
  • Fitness in Young Adulthood and Long-Term Cardiac Structure and Function
    • Authors: Ambarish Pandey; Norrina B. Allen; Colby Ayers; Jared P. Reis; Henrique T. Moreira; Stephen Sidney; Jamal S. Rana; David R. Jacobs; Lisa S. Chow; James A. de Lemos; Mercedes Carnethon; Jarett D. Berry
      Abstract: Publication date: Available online 8 March 2017
      Source:JACC: Heart Failure
      Author(s): Ambarish Pandey, Norrina B. Allen, Colby Ayers, Jared P. Reis, Henrique T. Moreira, Stephen Sidney, Jamal S. Rana, David R. Jacobs, Lisa S. Chow, James A. de Lemos, Mercedes Carnethon, Jarett D. Berry
      Objectives This study sought to evaluate the association between early-life cardiorespiratory fitness (CRF) and measures of left ventricular (LV) structure and function in midlife. Background Low CRF in midlife is associated with a higher risk of heart failure. However, the unique contributions of early-life CRF toward measures of LV structure and function in middle age are not known. Methods CARDIA (Coronary Artery Risk Development in Young Adults) study participants with a baseline maximal treadmill test and an echocardiogram at year 25 were included. Associations among baseline CRF, CRF change, and echocardiographic LV parameters (global longitudinal strain [GLS] and global circumferential strain, E/e′) were assessed using multivariable linear regression. Results The study included 3,433 participants. After adjustment for baseline demographic and clinical characteristics, lower baseline CRF was significantly associated with higher LV strain (standardized parameter estimate [Std β] = −0.06, p = 0.03 for GLS) and ratio of early transmitral flow velocity to early peak diastolic mitral annular velocity (E/e′) (Std β = −0.10, p = 0.0001 for lateral E/e′), findings suggesting impaired contractility and elevated diastolic filling pressure in midlife. After additional adjustment for cumulative cardiovascular risk factor burden observed over the follow-up period, the association of CRF with LV strain attenuated substantially (p = 0.36), whereas the association with diastolic filling pressure remained significant (Std β = −0.05, p = 0.02 for lateral E/e′). In a subgroup of participants with repeat CRF tests at year 20, greater decline in CRF was significantly associated with increased abnormalities in GLS (Std β = −0.05, p = 0.02) and higher diastolic filling pressure (Std β = −0.06, p = 0.006 for lateral E/e′) in middle age. Conclusions CRF in young adulthood and CRF change were associated with measures of LV systolic function and diastolic filling pressure in middle age. Low CRF–associated abnormalities in systolic function were related to the associated higher cardiovascular risk factor burden. In contrast, the inverse association between CRF and LV diastolic filling pressure was independent of cardiovascular risk factor burden.
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.014
       
  • Unraveling the Relationship Between Aging and Heart Failure With
           Preserved Ejection Fraction
    • Authors: Dalane W. Kitzman; Thomas J. O’Neill; Peter H. Brubaker
      Abstract: Publication date: Available online 8 March 2017
      Source:JACC: Heart Failure
      Author(s): Dalane W. Kitzman, Thomas J. O’Neill, Peter H. Brubaker
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2017.01.009
       
  • Acute Heart Failure
    • Authors: Reka Zsilinszka; Robert J. Mentz; Adam D. DeVore; Zubin J. Eapen; Peter S. Pang; Adrian F. Hernandez
      Abstract: Publication date: Available online 8 March 2017
      Source:JACC: Heart Failure
      Author(s): Reka Zsilinszka, Robert J. Mentz, Adam D. DeVore, Zubin J. Eapen, Peter S. Pang, Adrian F. Hernandez
      Acute heart failure (HF) is a major public health problem with substantial associated economic costs. Because most patients who present to hospitals are admitted irrespective of their level of risk, novel approaches to manage acute HF are needed, such as the use of same-day access clinics for outpatient diuresis and observation units from the emergency department. Current published data lacks a comprehensive overview of the present state of acute HF management in various clinical settings. This review summarizes the strengths and limitations of acute HF care in the outpatient and emergency department settings. Finally, a variety of innovative technologies that have the potential to improve acute HF management are discussed.
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.014
       
  • Is Salt Bad for You'
    • Authors: Christopher
      Abstract: Publication date: March 2017
      Source:JACC: Heart Failure, Volume 5, Issue 3
      Author(s): Christopher M. O’Connor


      PubDate: 2017-03-27T12:18:44Z
       
  • Moving Beyond the Walls of the Clinic
    • Authors: Ariane M. Fraiche; Zubin J. Eapen; Mark B. McClellan
      Abstract: Publication date: Available online 8 February 2017
      Source:JACC: Heart Failure
      Author(s): Ariane M. Fraiche, Zubin J. Eapen, Mark B. McClellan
      Telehealth offers an innovative approach to improve heart failure care that expands beyond traditional management strategies. Yet the use of telehealth in heart failure is infrequent because of several obstacles. Fundamentally, the evidence is inconsistent across studies of telehealth interventions in heart failure, which limits the ability of cardiologists to make general conclusions. Where encouraging evidence exists, there are logistical challenges to broad-scale implementation as a result of insufficient understanding of how to transform telemedicine strategies into clinical practice effectively. Ultimately, when implementation is reasonable, the application of these efforts remains hampered by regulatory, reimbursement, and other policy issues. The primary aim of this paper is to describe these challenges and to outline a path forward to apply telehealth approaches to heart failure in conjunction with payment reform and pragmatic research study design.
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.11.013
       
  • Meta-Analysis of Soluble Suppression of Tumorigenicity-2 and
           Prognosis in Acute Heart Failure
    • Authors: Alberto Aimo; Giuseppe Vergaro; Andrea Ripoli; Antoni Bayes-Genis; Domingo A. Pascual Figal; Rudolf A. de Boer; Johan Lassus; Alexandre Mebazaa; Etienne Gayat; Tobias Breidthardt; Zaid Sabti; Christian Mueller; Hans-Peter Brunner-La Rocca; W.H. Wilson Tang; Justin L. Grodin; Yuhui Zhang; Paulo Bettencourt; Alan S. Maisel; Claudio Passino; James L. Januzzi; Michele Emdin
      Abstract: Publication date: Available online 8 February 2017
      Source:JACC: Heart Failure
      Author(s): Alberto Aimo, Giuseppe Vergaro, Andrea Ripoli, Antoni Bayes-Genis, Domingo A. Pascual Figal, Rudolf A. de Boer, Johan Lassus, Alexandre Mebazaa, Etienne Gayat, Tobias Breidthardt, Zaid Sabti, Christian Mueller, Hans-Peter Brunner-La Rocca, W.H. Wilson Tang, Justin L. Grodin, Yuhui Zhang, Paulo Bettencourt, Alan S. Maisel, Claudio Passino, James L. Januzzi, Michele Emdin
      Objectives The aim of this study was to perform a meta-analysis of currently available data regarding the prognostic significance of soluble suppression of tumorigenecity–2 (sST2) concentration in acute heart failure (AHF). Background Concentration of sST2 may have prognostic value in AHF. A comprehensive assessment of all available studies regarding sST2 in AHF is lacking. Methods Three databases (MEDLINE, Cochrane Library, and Scopus) were searched. Inclusion criteria were follow-up studies, papers published in English, enrollment of patients with AHF, and availability of median hazard ratios for all-cause death and other outcome measures, when available. Results Ten studies were included, with a global population of 4,835 patients and a median follow-up duration of 13.5 months. The following global hazard ratios calculated for log2(sST2) were admission sST2 and all-cause death, 2.46 (95% confidence interval [CI]: 1.80 to 3.37; p < 0.001); discharge sST2 and all-cause death, 2.06 (95% CI: 1.37 to 3.11; p < 0.001); admission sST2 and cardiovascular death, 2.29 (95% CI: 1.41 to 3.73; p < 0.001); discharge sST2 and cardiovascular death, 2.20 (95% CI: 1.48 to 3.25; p < 0.001); admission sST2 and heart failure (HF) hospitalization, 1.21 (95% CI: 0.96 to 1.52; p = 0.060); discharge sST2 and HF hospitalization, 1.54 (95% CI: 1.03 to 2.32; p = 0.007); admission sST2 and all-cause death or HF hospitalization, 1.74 (95% CI: 1.24 to 2.45; p < 0.001); and discharge sST2 and all-cause death or HF hospitalization, 1.63 (95% CI: 1.14 to 2.33; p < 0.001). Conclusions Plasma sST2 has prognostic value with respect to all-cause and cardiovascular death as well as the composite outcome of all-cause death or HF hospitalization, with both admission and discharge values having prognostic efficacy. Discharge sST2, but not admission sST2, is predictive of HF rehospitalization during follow-up.
      Graphical abstract image

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.016
       
 
 
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