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Journal Cover JACC : Heart Failure
  [SJR: 4.318]   [H-I: 18]   [8 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Online) 2213-1779
   Published by Elsevier Homepage  [3089 journals]
  • Cardiac Transplantation
    • Authors: Michelle M. Kittleson; Jon A. Kobashigawa
      Pages: 857 - 868
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Michelle M. Kittleson, Jon A. Kobashigawa
      Despite advances in pharmacologic and device treatment of chronic heart failure, long-term morbidity and mortality remain high, and many patients progress to end-stage heart failure. Over the last 5 decades, heart transplantation (HTx) has become the preferred therapy for select patients with end-stage heart disease. However, although HTx has become standard of care for the management of end-stage heart failure, challenges continue to exist. The number of patients with end-stage heart failure is increasing, whereas the number of donor organs remains constant and a limiting factor in HTx. Not only are there more potential heart transplantation candidates, but HTx candidates today are more complex: older, sensitized, and in need of mechanical circulatory support. Such candidates are at higher risk for poor outcomes including primary graft dysfunction and antibody-mediated rejection. This article focuses on current post-transplantation outcomes and recent advances in HTx that could address the current challenges. These advances include: 1) attempts to expand the donor pool; 2) proposed changes in HTx allocation policy for more equitable organ distribution; 3) a better understanding of the definition and management of primary graft dysfunction; and 4) advances in the management of sensitized HTx candidates. Developments in these areas could result in expansion and more equitable distribution of the donor pool and improved survival and quality of life for HTx recipients.
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      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.08.021
       
  • Evolving Areas in Heart Transplantation
    • Authors: Brittany N. Weber; Jon A. Kobashigawa; Michael M. Givertz
      Pages: 869 - 878
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Brittany N. Weber, Jon A. Kobashigawa, Michael M. Givertz
      It has been 50 years since Dr. Christiaan Barnard performed the first human-to-human heart transplant in December 1967 in South Africa. Remarkable progress has been made since that time, including changes in surgical techniques, immunosuppression, donor and recipient selection, and post-transplant care. In this paper, we provide a perspective on the changing face of heart transplantation and highlight key evolving areas. Topics that are covered include advances in immunosuppression, screening for acute and chronic rejection, cardiac allograft vasculopathy, and ongoing advancements in cardiac replacement therapy, including xenotransplantation, stem-cell research, tissue engineering, and the total artificial heart.
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      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.10.009
       
  • Outcomes of Early Adolescent Donor Hearts in Adult Transplant Recipients
    • Authors: Shivank Madan; Snehal R. Patel; Peter Vlismas; Omar Saeed; Sandhya Murthy; Stephen Forest; William Jakobleff; Daniel Sims; Jacqueline M. Lamour; Daphne T. Hsu; Julia Shin; Daniel Goldstein; Ulrich P. Jorde
      Pages: 879 - 887
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Shivank Madan, Snehal R. Patel, Peter Vlismas, Omar Saeed, Sandhya Murthy, Stephen Forest, William Jakobleff, Daniel Sims, Jacqueline M. Lamour, Daphne T. Hsu, Julia Shin, Daniel Goldstein, Ulrich P. Jorde
      Objectives This study sought to determine outcomes of adult recipients of early adolescent (EA) (10 to 14 years) donor hearts. Background Despite a shortage of donor organs, EA donor hearts (not used for pediatric patients) are seldom used for adults because of theoretical concerns for lack of hormonal activation and changes in left ventricular mass. Nonetheless, the outcomes of adult transplantation using EA donor hearts are not clearly established. Methods All adult (≥18 years of age) heart transplant recipients in the United Network for Organ Sharing database between April 1994 and September 2015 were eligible for this analysis. Recipients of EA donor hearts were compared with recipients of donor hearts from the usual adult age group (ages 18 to 55 years). Main outcomes were all-cause mortality and cardiac allograft vasculopathy up to 5 years, and primary graft failure up to 90 days post-transplant. Propensity score analysis was used to identify a cohort of recipients with similar baseline characteristics. Results Of the 35,054 eligible adult recipients, 1,123 received hearts from EA donors and 33,931 from usual-age adult donors. With the use of propensity score matching, 944 recipients of EA donor hearts were matched to 944 recipients of usual-age adult donor hearts. There was no difference in 30-day, 1-year, 3-year, and 5-year recipient survival or primary graft failure rates in the 2 groups using both Cox hazards ratio and Kaplan-Meier analysis. Of note, adult patients who received EA donor hearts had a trend toward less cardiac allograft vasculopathy (Cox hazard ratio, 0.80; 95% confidence interval: 0.62 to 1.01; p = 0.07). Conclusions In this largest analysis to date, we found strong evidence that EA donor hearts, not used for pediatric patients, can be safely transplanted in appropriate adult patients and have good outcomes. This finding should help increase the use of EA donor hearts.
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      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.05.004
       
  • Why Ruin a Good Story With a Few Facts'∗
    • Authors: Maria Rosa Costanzo
      Pages: 888 - 890
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Maria Rosa Costanzo
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      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.06.008
       
  • Changes in Outcomes of Cardiac Allograft Vasculopathy Over 30 Years
           Following Heart Transplantation
    • Authors: Maxime Tremblay-Gravel; Normand Racine; Simon de Denus; Anique Ducharme; Guy B. Pelletier; Geneviève Giraldeau; Mark Liszkowski; Marie-Claude Parent; Michel Carrier; Annik Fortier; Michel White
      Pages: 891 - 901
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Maxime Tremblay-Gravel, Normand Racine, Simon de Denus, Anique Ducharme, Guy B. Pelletier, Geneviève Giraldeau, Mark Liszkowski, Marie-Claude Parent, Michel Carrier, Annik Fortier, Michel White
      Objectives This study investigated temporal changes in the demographics and the prognosis of cardiac allograft vasculopathy (CAV) over 30 years following heart transplantation (HTx). Background Effects of the changing HTx demographics on CAV outcomes, based on International Society for Heart and Lung Transplantation (ISHLT) classification of CAV, have been incompletely investigated. Methods Patients who underwent HTx at the Montreal Heart Institute were classified according to the severity of CAV (CAV 0 is no presence of CAV; CAV 1 is mild, CAV 2 to 3 is moderate to severe) and era of HTx (early: 1983 to 1998; recent: 1999 to 2011). We compared the risk of progression, survival, and independent predictors of outcomes among the groups. Results A total of 298 patients were followed for 11.6 ± 6.6 years. Patients who received transplants in the early era exhibited a higher risk for progression from CAV 1 to a higher grade (adjusted odds ratio: 8.0; 95% confidence interval [CI]: 1.01 to 62.6). The presence of CAV was associated with a significantly increased risk for all-cause mortality in the early era (hazard ratio [HR]: 1.6; 95% CI: 1.1 to 2.5) but not in the recent era (HR: 1.1; 95% CI: 0.2 to 4.9). Regardless of the era, CAV classes 2 to 3 and CAV 1 were associated with a significantly increased risk for all-cause mortality compared to CAV 0 (HR: 6.5; 95% CI: 2.7 to 15.7; and HR: 1.750; 95% CI: 1.001 to 3.046, respectively). Conclusions The progression and prognosis of CAV have improved over 30 years. The ISHLT CAV classification accurately and independently predicts long-term outcome following HTx.
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      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.09.014
       
  • Cardiac Allograft Vasculopathy
    • Authors: Sharon A. Hunt
      Pages: 902 - 903
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Sharon A. Hunt
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      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.09.013
       
  • Verification of Heart Disease
    • Authors: Pejman Raeisi-Giglou; E. Rene Rodriguez; Eugene H. Blackstone; Carmela D. Tan; Eileen M. Hsich
      Pages: 904 - 913
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Pejman Raeisi-Giglou, E. Rene Rodriguez, Eugene H. Blackstone, Carmela D. Tan, Eileen M. Hsich
      Objectives This study sought to determine the accuracy of the pre-transplantation clinical diagnosis of heart disease in the United Network for Organ Sharing (UNOS) database. Background Because survival on the heart transplantation waitlist depends on underlying heart disease, a new allocation system will include the type of heart disease. Accuracy of the pre-transplantation clinical diagnosis and the effect of misclassification are unknown. Methods We included all adults who received transplants at our center between January 2009 to December 2015. We compared the pre-transplantation clinical diagnosis at listing with pathology of the explanted heart and determined the potential effect of misclassification with the proposed allocation system. Results A total of 334 patients had the following clinical cardiac diagnoses at listing: 148 had dilated cardiomyopathy, 19 had restrictive cardiomyopathy, 103 had ischemic cardiomyopathy, 24 had hypertrophic cardiomyopathy, 11 had valvular disease, 16 had congenital heart disease (CHD), and 13 patients had a diagnosis of “other.” Pathology of the explanted hearts revealed 82% concordance and 18% discordance (10% coding errors and 8% incorrect diagnosis). The most common incorrect diagnoses were sarcoidosis (66%), arrhythmogenic right ventricular dysplasia (60%), and other causes of predominately right-sided heart failure (33%). Among the misclassified diagnoses, 40% were listed as UNOS status 2, 8% remained at status 2 at transplantation, and only sarcoidosis and CHD were potentially at a disadvantage with the new allocation. Conclusions There is high concordance between clinical and pathologic diagnosis, except for sarcoidosis and genetic diseases. Few misclassifications result in disadvantages to patients based on the new allocation system, but rare diseases like sarcoidosis remain problematic. To improve the UNOS database and enhance outcome research, pathology of the explanted hearts should be required post-transplantation.
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      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.09.022
       
  • Demanding Truth in a Complex Heart Allocation System∗
    • Authors: Scott C. Silvestry
      Pages: 914 - 915
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Scott C. Silvestry
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      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.10.012
       
  • Implantable Cardioverter-Defibrillators in Patients With a
           Continuous-Flow Left Ventricular Assist Device
    • Authors: Kevin J. Clerkin; Veli K. Topkara; Ryan T. Demmer; Jose M. Dizon; Melana Yuzefpolskaya; Justin A. Fried; Xingchen Mai; Donna M. Mancini; Koji Takeda; Hiroo Takayama; Yoshifumi Naka; Paolo C. Colombo; A. Reshad Garan
      Pages: 916 - 926
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Kevin J. Clerkin, Veli K. Topkara, Ryan T. Demmer, Jose M. Dizon, Melana Yuzefpolskaya, Justin A. Fried, Xingchen Mai, Donna M. Mancini, Koji Takeda, Hiroo Takayama, Yoshifumi Naka, Paolo C. Colombo, A. Reshad Garan
      Objectives This study sought to determine if the presence of implantable cardioverter-defibrillators (ICD) provided a mortality benefit during continuous-flow left ventricular assist device (LVAD) support. Background An ICD decreases mortality in selected patients with advanced heart failure and have been associated with reduced mortality in patients with pulsatile LVAD. However, it is unclear whether that benefit extends to patients with a contemporary continuous-flow LVAD. Methods Propensity score matching was used to generate a cohort of patients with similar baseline characteristics. The primary outcome was freedom from death during LVAD support. Secondary endpoints included freedom from unexpected death, likelihood of transplantation and recovery, and adverse events. Results Among 16,384 eligible patients in the Interagency Registry for Mechanically Assisted Circulatory Support registry, 2,209 patients with an ICD and 2,209 patients without one had similar propensity scores and were included. The presence of an ICD was associated with an increased mortality risk (hazard ratio: 1.20; 95% confidence interval [CI]: 1.04 to 1.39; p = 0.013) and an increased risk of unexpected death during device support (HR: 1.33; 95% CI: 1.03 to 1.71; p = 0.03). Patients with an ICD were more likely to undergo transplantation (HR: 1.16; 95% CI: 0.99 to 1.35; p = 0.06) and less likely to have LVAD explant for recovery (HR: 0.53, 95% CI: 0.29 to 0.98; p = 0.04). Patients with an ICD had a higher rate of treated ventricular arrhythmias (rate ratio: 1.27; 95% CI: 1.10 to 1.48; p = 0.001) and rehospitalization (rate ratio: 1.08; 95% CI: 1.04 to 1.12; p < 0.0001), but rates of hemorrhagic stroke were similar (rate ratio: 1.01; 95% CI: 0.81 to 1.26; p = 0.98). Conclusions Among patients with a continuous flow LVAD, the presence of an ICD was not associated with reduced mortality.
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      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.08.014
       
  • Implantable Cardioverter-Defibrillators in Patients With Left
           Ventricular Assist Devices
    • Authors: Sean D. Pokorney; Sana M. Al-Khatib
      Pages: 927 - 929
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Sean D. Pokorney, Sana M. Al-Khatib
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      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.09.008
       
  • Incremental Value of Deformation Imaging and Hemodynamics
           Following Heart Transplantation
    • Authors: Yukari Kobayashi; Naga Lakshmi Sudini; June-Wha Rhee; Marie Aymami; Kegan J. Moneghetti; Sara Bouajila; Yuhei Kobayashi; Juyong B. Kim; Ingela Schnittger; Jeffery J. Teuteberg; Kiran K. Khush; William F. Fearon; Francois Haddad
      Pages: 930 - 939
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Yukari Kobayashi, Naga Lakshmi Sudini, June-Wha Rhee, Marie Aymami, Kegan J. Moneghetti, Sara Bouajila, Yuhei Kobayashi, Juyong B. Kim, Ingela Schnittger, Jeffery J. Teuteberg, Kiran K. Khush, William F. Fearon, Francois Haddad
      Objectives This study investigated to define graft dysfunction and to determine its incremental association with long-term outcome after heart transplantation (HT). Background Although graft failure is an established cause of late mortality after HT, few studies have analyzed the prognostic value of graft dysfunction at 1- and 5-year follow-up of HT. Methods Patients who underwent HT and completed their first annual evaluation with right heart catheterization and echocardiography at Stanford University between January 1999 and December 2011 were included in the study. Hierarchical clustering was used to identify modules to capture independent features of graft dysfunction at 1 year. The primary endpoint for analysis consisted of the composite of cardiovascular mortality, re-transplantation, or heart failure hospitalization within 5 years of HT. The study further explored whether changes in graft dysfunction between 1 and 5 years were associated with 10-year all-cause mortality. Results A total of 215 HT recipients were included in the study. Using hierarchical clustering, 3 functional modules were identified; among them, left ventricular global longitudinal strain (LVGLS), stroke volume index, and right atrial pressure (RAP) or pulmonary capillary wedge pressure (PCWP) captured key features of graft function. Graft dysfunction based on pre defined LVGLS in absolute value <14%, stroke volume index <35 ml/m2, RAP >10 mm Hg, or PCWP >15 mm Hg were present in 41%, 36%, and 27%, respectively. The primary endpoint at 5 years occurred in 52 patients (24%), whereas 10-year all-cause mortality occurred in 30 (27%) of 110 patients alive at 5 years. On multivariate analysis, RAP (standardized hazard ratio: 1.63), LVGLS (standardized hazard ratio: 1.39), and a history of hemodynamically compromising rejection within 1 year (hazard ratio: 2.18) were independent predictors of 5-year outcome. RAP at 5 years, as well as change in RAP from 1 to 5 years, was predictive of 10-year all-cause mortality. Conclusions RAP and LVGLS at the first annual evaluation provide complementary prognostic information in predicting 5-year outcome after HT.
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      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.10.011
       
  • Are Neurogenic Stress Cardiomyopathy and Takotsubo Different Syndromes
           With Common Pathways'
    • Authors: Guido Tavazzi; Marinella Zanierato; Gabriele Via; Giorgio Antonio Iotti; Francesco Procaccio
      Pages: 940 - 942
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Guido Tavazzi, Marinella Zanierato, Gabriele Via, Giorgio Antonio Iotti, Francesco Procaccio


      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.09.006
       
  • Older and Wiser
    • Authors: Richa Gupta; Kelly Schlendorf; JoAnn Lindenfeld
      Pages: 943 - 945
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Richa Gupta, Kelly Schlendorf, JoAnn Lindenfeld
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      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.10.010
       
  • Happy 50th Birthday, Cardiac Transplantation
    • Authors: Joseph G. Rogers; JoAnn Lindenfeld
      Pages: 946 - 947
      Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12
      Author(s): Joseph G. Rogers, JoAnn Lindenfeld


      PubDate: 2017-12-01T06:08:19Z
      DOI: 10.1016/j.jchf.2017.11.001
       
  • Structural and Functional Phenotyping of the Failing Heart
    • Authors: Michael R. Bristow; David P. Kao; Khadijah K. Breathett; Natasha L. Altman; John Gorcsan; Edward A. Gill; Brian D. Lowes; Edward M. Gilbert; Robert A. Quaife; Douglas L. Mann
      Pages: 772 - 781
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): Michael R. Bristow, David P. Kao, Khadijah K. Breathett, Natasha L. Altman, John Gorcsan, Edward A. Gill, Brian D. Lowes, Edward M. Gilbert, Robert A. Quaife, Douglas L. Mann
      Diagnosis, prognosis, treatment, and development of new therapies for diseases or syndromes depend on a reliable means of identifying phenotypes associated with distinct predictive probabilities for these various objectives. Left ventricular ejection fraction (LVEF) provides the current basis for combined functional and structural phenotyping in heart failure by classifying patients as those with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF). Recently the utility of LVEF as the major phenotypic determinant of heart failure has been challenged based on its load dependency and measurement variability. We review the history of the development and adoption of LVEF as a critical measurement of LV function and structure and demonstrate that, in chronic heart failure, load dependency is not an important practical issue, and we provide hemodynamic and molecular biomarker evidence that LVEF is superior or equal to more unwieldy methods of identifying phenotypes of ventricular remodeling. We conclude that, because it reliably measures both left ventricular function and structure, LVEF remains the best current method of assessing pathologic remodeling in heart failure in both individual clinical and multicenter group settings. Because of the present and future importance of left ventricular phenotyping in heart failure, LVEF should be measured by using the most accurate technology and methodologic refinements available, and improved characterization methods should continue to be sought.
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      PubDate: 2017-11-19T02:27:43Z
      DOI: 10.1016/j.jchf.2017.09.009
       
  • Heart Failure With a Mid-Range Ejection Fraction
    • Authors: Milton Packer
      Pages: 805 - 807
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): Milton Packer


      PubDate: 2017-11-19T02:27:43Z
      DOI: 10.1016/j.jchf.2017.08.012
       
  • Refining Classification of Heart Failure Based on Ejection Fraction
    • Authors: Gregg C. Fonarow
      Pages: 808 - 809
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): Gregg C. Fonarow


      PubDate: 2017-11-19T02:27:43Z
      DOI: 10.1016/j.jchf.2017.08.011
       
  • Reverse J-Curve Relationship Between On-Treatment Blood Pressure and
           Mortality in Patients With Heart Failure
    • Authors: Sang Eun Lee; Hae-Young Lee; Hyun-Jai Cho; Won-Seok Choe; Hokon Kim; Jin-Oh Choi; Eun-Seok Jeon; Min-Seok Kim; Kyung-Kuk Hwang; Shung Chull Chae; Sang Hong Baek; Seok-Min Kang; Dong-Ju Choi; Byung-Su Yoo; Kye Hun Kim; Myeong-Chan Cho; Jae-Joong Kim; Byung-Hee Oh
      Pages: 810 - 819
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): Sang Eun Lee, Hae-Young Lee, Hyun-Jai Cho, Won-Seok Choe, Hokon Kim, Jin-Oh Choi, Eun-Seok Jeon, Min-Seok Kim, Kyung-Kuk Hwang, Shung Chull Chae, Sang Hong Baek, Seok-Min Kang, Dong-Ju Choi, Byung-Su Yoo, Kye Hun Kim, Myeong-Chan Cho, Jae-Joong Kim, Byung-Hee Oh
      Objectives This study aimed to assess the relationship between on-treatment blood pressure (BP) and clinical outcomes of patients with heart failure (HF). Background Lower BP has been reported to be related to increased mortality in various cardiovascular diseases. The optimal BP level for patients already experiencing HF is contentious. Methods The Korean Acute Heart Failure registry prospectively enrolled a total of 5,625 consecutive patients hospitalized for acute HF in 10 tertiary university hospitals in Korea between March 2011 and February 2014. Clinical profiles including BP were collected at admission, discharge, and during outpatient follow-up. Mean on-treatment BP was calculated from BP at discharge and at each follow-up visit. We evaluated the effects of mean on-treatment BP on the clinical outcomes of patients. Results Patients were followed up for a median 2.2 years. One-year mortality after discharge was 18.2%. The relationship between on-treatment BP and all-cause mortality followed a reversed J-curve relationship. A nonlinear, multivariable Cox proportional hazard model identified a nadir of systolic and diastolic BPs of 132.4/74.2 mm Hg in patients, for whom the mortality rate was lowest (p < 0.0001). The relationship with increased mortality above and below the reference BP was more definitive for diastolic BP and for HF with a preserved ejection fraction. Conclusions Systolic and diastolic BPs <130/70 mm Hg at discharge and during follow-up was associated with worse survival in HF patients. These data suggest that the lowest BP possible might not be an optimal target for HF patients. Further studies should establish a proper BP goal in HF patients. (Registry [Prospective Cohort] for Heart Failure in Korea [KorAHF]; NCT01389843)
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      PubDate: 2017-11-19T02:27:43Z
      DOI: 10.1016/j.jchf.2017.08.015
       
  • Blood Pressure Risk Associations in Heart Failure
    • Authors: Michael Böhm; Sebastian Ewen
      Pages: 820 - 822
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): Michael Böhm, Sebastian Ewen
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      PubDate: 2017-11-19T02:27:43Z
      DOI: 10.1016/j.jchf.2017.09.010
       
  • Targeted Metabolomic Profiling of Plasma and Survival in Heart Failure
           Patients
    • Authors: David E. Lanfear; Joseph J. Gibbs; Jia Li; Ruicong She; Christopher Petucci; Jeffrey A. Culver; W.H. Wilson Tang; Yigal M. Pinto; L. Keoki Williams; Hani N. Sabbah; Stephen J. Gardell
      Pages: 823 - 832
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): David E. Lanfear, Joseph J. Gibbs, Jia Li, Ruicong She, Christopher Petucci, Jeffrey A. Culver, W.H. Wilson Tang, Yigal M. Pinto, L. Keoki Williams, Hani N. Sabbah, Stephen J. Gardell
      Objectives This study sought to derive and validate plasma metabolite associations with survival in heart failure (HF) patients. Background Profiling of plasma metabolites to predict the course of HF appears promising, but validation and incremental value of these profiles are less established. Methods Patients (n = 1,032) who met Framingham HF criteria with a history of reduced ejection fraction were randomly divided into derivation and validation cohorts (n = 516 each). Amino acids, organic acids, and acylcarnitines were quantified using mass spectrometry in fasting plasma samples. We derived a prognostic metabolite profile (PMP) in the derivation cohort using Lasso-penalized Cox regression. Validity was assessed by 10-fold cross validation in the derivation cohort and by standard testing in the validation cohort. The PMP was analyzed as both a continuous variable (PMPscore) and dichotomized at the median (PMPcat), in univariate and multivariate models adjusted for clinical risk score and N-terminal pro–B-type natriuretic peptide. Results Overall, 48% of patients were African American, 35% were women, and the average age was 69 years. After a median follow-up of 34 months, there were 256 deaths (127 and 129 in derivation and validation cohorts, respectively). Optimized modeling defined the 13 metabolite PMPs, which was cross validated as both the PMPscore (hazard ratio [HR]: 3.27; p < 2 × 10−16) and PMPcat (HR: 3.04; p = 2.93 × 10−8). The validation cohort showed similar results (PMPscore HR: 3.9; p < 2 × 10−16 and PMPcat HR: 3.99; p = 3.47 × 10−9). In adjusted models, PMP remained associated with mortality in the cross-validated derivation cohort (PMPscore HR: 1.63; p = 0.0029; PMPcat HR: 1.47; p = 0.081) and the validation cohort (PMPscore HR: 1.54; p = 0.037; PMPcat HR: 1.69; p = 0.043). Conclusions Plasma metabolite profiles varied across HF subgroups and were associated with survival incremental to conventional predictors. Additional investigation is warranted to define mechanisms and clinical applications.
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      PubDate: 2017-11-19T02:27:43Z
      DOI: 10.1016/j.jchf.2017.07.009
       
  • Realizing the Potential of Metabolomics in Heart Failure
    • Authors: Svati H. Shah; Wynn G. Hunter
      Pages: 833 - 836
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): Svati H. Shah, Wynn G. Hunter
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      PubDate: 2017-11-19T02:27:43Z
      DOI: 10.1016/j.jchf.2017.08.025
       
  • Goodbye Mihai
    • Authors: Christopher M. O’Connor
      Pages: 848 - 849
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): Christopher M. O’Connor


      PubDate: 2017-11-19T02:27:43Z
      DOI: 10.1016/j.jchf.2017.09.007
       
  • Diabetic Hypertensives and Diastolic Dysfunction
    • Authors: Anil K. Pareek; Ravi T. Mehta; Indranil Purkait; Anu Grover
      Pages: 850 - 851
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): Anil K. Pareek, Ravi T. Mehta, Indranil Purkait, Anu Grover


      PubDate: 2017-11-19T02:27:43Z
      DOI: 10.1016/j.jchf.2017.08.003
       
  • An Opportunity to Definitively Evaluate the Theoretical Risks of
           Neprilysin Inhibition
    • Authors: Arthur M. Feldman
      Pages: 851 - 852
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): Arthur M. Feldman


      PubDate: 2017-11-19T02:27:43Z
      DOI: 10.1016/j.jchf.2017.08.001
       
  • Cardiac Magnetic Resonance as an Alternative to Endomyocardial Biopsy to
           Predict Recoverability of Left Ventricular Function in Methamphetamine-
           Associated Cardiomyopathy
    • Authors: Margarida Pujol-López; Luis Ortega-Paz; Eduardo J. Flores-Umanzor; Rosario J. Perea; Xavier Bosch
      Pages: 853 - 854
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): Margarida Pujol-López, Luis Ortega-Paz, Eduardo J. Flores-Umanzor, Rosario J. Perea, Xavier Bosch


      PubDate: 2017-11-19T02:27:43Z
      DOI: 10.1016/j.jchf.2017.08.009
       
  • Are We Approaching Chronotropy (In)competently'∗
    • Abstract: Publication date: Available online 6 December 2017
      Source:JACC: Heart Failure
      Author(s): Brett D. Atwater, Daniel J. Friedman
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      PubDate: 2017-12-11T06:36:57Z
       
  • The Twittersphere Needs Academic Cardiologists!
    • Abstract: Publication date: Available online 6 December 2017
      Source:JACC: Heart Failure
      Author(s): Sumeet Pawar, Gina Siddiqui, Nihar R. Desai, Tariq Ahmad
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      PubDate: 2017-12-11T06:36:57Z
       
  • Rate-Response Programming Tailored to the Force-Frequency Relationship
           Improves Exercise Tolerance in Chronic Heart Failure
    • Abstract: Publication date: Available online 6 December 2017
      Source:JACC: Heart Failure
      Author(s): John Gierula, Maria F. Paton, Judith E. Lowry, Haqeel A. Jamil, Rowenna Byrom, Michael Drozd, Jack O. Garnham, Richard M. Cubbon, David A. Cairns, Mark T. Kearney, Klaus K. Witte
      Objectives This study sought to examine whether the heart rate (HR) at which the force-frequency relationship (FFR) slope peaks (critical HR) could be used to tailor HR response in chronic heart failure (CHF) patients with cardiac pacemakers and whether this favorably influences exercise capacity. Background CHF secondary to left ventricular (LV) systolic dysfunction is characterized by blunting of the positive relationship between HR and LV contractility known as the FFR. Methods This observational study was carried out in patients with CHF and healthy subjects with pacemaker devices. The study assessed the 3 important features of the FFR (critical HR, peak contractility, and the FFR slope), and their reproducibility was measured noninvasively using echocardiography. The investigators then undertook a double-blind, randomized, controlled crossover study comparing the effects of tailored pacemaker rate-response programming on the basis of the FFR with conventional rate-response programming on exercise time and maximal oxygen consumption. Results The study enrolled 90 patients with CHF into the observational cohort study: mean age, 73.6 ± 8.9 years; mean left ventricular ejection fraction (LVEF), 33.5 ± 10.9%. The study investigated 15 control subjects with normal LV function (LVEF, 55.6 ± 5.3%). The critical HR (103 ± 22 beats/min vs. 126 ± 15 beats/min; p = 0.0002), peak contractility (3.8 ± 3.7 SBP/LVESVI vs. 9.8 ± 4.1 SPB/LVESVI; p = 0.0001), and the slope of the FFR (p < 10−15) were lower in patients with CHF than in control subjects. A total of 52 patients, with a mean LVEF of 32 ± 11% on optimal therapy, took part in the crossover study. Rate-response settings limiting HR rise to below the critical HR led to greater exercise time (475 ± 189 s vs. 425 ± 196 s; p = 0.003) and higher peak oxygen consumption (17.3 ± 4.6 ml/kg/min vs. 16.6 ± 4.7 ml/kg/min; p = 0.01). Conclusions A personalized approach to rate-response programming, determined using a reproducible noninvasive method for assessing the FFR, improves exercise time in patients with CHF and pacemaker devices. (Bowditch Revisited: Defining the Optimum Heart Rate Range in Chronic Heart Failure; NCT02563873)
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      PubDate: 2017-12-11T06:36:57Z
       
  • Adherence to Mediterranean Diet and All-Cause Mortality After an Episode
           of Acute Heart Failure
    • Abstract: Publication date: Available online 6 December 2017
      Source:JACC: Heart Failure
      Author(s): Òscar Miró, Ramon Estruch, Francisco J. Martín-Sánchez, Víctor Gil, Javier Jacob, Pablo Herrero-Puente, Sergio Herrera Mateo, Alfons Aguirre, Juan A. Andueza, Pere Llorens
      Objectives The authors sought to evaluate clinical outcomes of patients after an episode of acute heart failure (AHF) according to their adherence to the Mediterranean diet (MedDiet). Background It has been proved that MedDiet is a useful tool in primary prevention of cardiovascular diseases. However, it is unknown whether adherence to MedDiet is associated with better outcomes in patients who have already experienced an episode of AHF. Methods We designed a prospective study that included consecutive patients diagnosed with AHF in 7 Spanish emergency departments (EDs). Patients were included if they or their relatives were able to answer a 14-point score of adherence to the MedDiet, which classified patients as adherents (≥9 points) or nonadherents (≤8 points). The primary endpoint was all-cause mortality at the end of follow-up, and secondary endpoints were 1-year ED revisit without hospitalization, rehospitalization, death, and a combined endpoint of all these variables for patients discharged after the index episode. Unadjusted and adjusted hazard ratios (HRs) were calculated. Results We included 991 patients (mean age of 80 ± 10 years, 57.8% women); 523 (52.9%) of whom were adherent to the MedDiet. After a mean follow-up period of 2.1 ± 1.3 years, no differences were observed in survival between adherent and nonadherent patients (HR of adherents [HRadh] = 0.86; 95% confidence interval [CI]: 0.73 to 1.02). The 1-year cumulative ED revisit for the whole cohort was 24.5% (HRadh = 1.10; 95% CI: 0.84 to 1.42), hospitalization 43.7% (HRadh = 0.74; 95% CI: 0.61 to 0.90), death 22.7% (HRadh = 1.05; 95% CI: 0.8 to 1.38), and combined endpoint 66.8% (HRadh = 0.89; 95% CI: 0.76 to 1.04). Adjustment by age, hypertension, peripheral arterial disease, previous episodes of AHF, treatment with statins, air-room pulsioxymetry, and need for ventilation support in the ED rendered similar results, with no statistically significant differences in mortality (HRadh = 0.94; 95% CI: 0.80 to 1.13) and persistence of lower 1-year hospitalization for adherents (HRadh = 0.76; 95% CI: 0.62 to 0.93). Conclusions Adherence to the MedDiet did not influence long-term mortality after an episode of AHF, but it was associated with decreased rates of rehospitalization during the next year.
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      PubDate: 2017-12-11T06:36:57Z
       
  • Yet Another (Important) Goal for Heart Failure Patients∗
    • Abstract: Publication date: Available online 6 December 2017
      Source:JACC: Heart Failure
      Author(s): Marc A. Silver
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      PubDate: 2017-12-11T06:36:57Z
       
  • Integrative Assessment of Congestion in Heart Failure Throughout the
           Patient Journey
    • Abstract: Publication date: Available online 6 December 2017
      Source:JACC: Heart Failure
      Author(s): Nicolas Girerd, Marie-France Seronde, Stefano Coiro, Tahar Chouihed, Pascal Bilbault, François Braun, David Kenizou, Bruno Maillier, Pierre Nazeyrollas, Gérard Roul, Ludivine Fillieux, William T. Abraham, James Januzzi, Laurent Sebbag, Faiez Zannad, Alexandre Mebazaa, Patrick Rossignol
      Congestion is one of the main predictors of poor patient outcome in patients with heart failure. However, congestion is difficult to assess, especially when symptoms are mild. Although numerous clinical scores, imaging tools, and biological tests are available to assist physicians in ascertaining and quantifying congestion, not all are appropriate for use in all stages of patient management. In recent years, multidisciplinary management in the community has become increasingly important to prevent heart failure hospitalizations. Electronic alert systems and communication platforms are emerging that could be used to facilitate patient home monitoring that identifies congestion from heart failure decompensation at an earlier stage. This paper describes the role of congestion detection methods at key stages of patient care: pre-admission, admission to the emergency department, in-hospital management, and lastly, discharge and continued monitoring in the community. The multidisciplinary working group, which consisted of cardiologists, emergency physicians, and a nephrologist with both clinical and research backgrounds, reviewed the current literature regarding the various scores, tools, and tests to detect and quantify congestion. This paper describes the role of each tool at key stages of patient care and discusses the advantages of telemedicine as a means of providing true integrated patient care.
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      PubDate: 2017-12-11T06:36:57Z
       
  • Efficacy of Intravenous Furosemide Versus a Novel, pH-Neutral Furosemide
           Formulation Administered Subcutaneously in Outpatients With Worsening
           Heart Failure
    • Abstract: Publication date: Available online 6 December 2017
      Source:JACC: Heart Failure
      Author(s): Nisha A. Gilotra, Oluseyi Princewill, Bonnie Marino, Ike S. Okwuosa, Jessica Chasler, Johana Almansa, Abby Cummings, Parker Rhodes, Julianne Chambers, Kimberly Cuomo, Stuart D. Russell
      Objectives This study sought to determine the efficacy and safety of a novel, pH-neutral formulation of furosemide administered subcutaneously (SC) for treatment of acute decompensated heart failure (HF). Background Congestion requiring intravenous (IV) administration of a diuretic agent is the main reason patients with HF present for acute medical care. Methods Outpatients presenting with decompensated HF were randomized to receive a single SC or IV dose of furosemide. Primary outcome was 6-h urine output, and secondary outcomes were weight change, natriuresis, and adverse events. Results Forty-one patients were randomized: 19 were treated with IV (mean dose: 123 ± 47 mg) and 21 with SC furosemide (fixed dose of 80 mg over 5 h). The 6-h urine output in the IV group was not significantly different from that in the SC furosemide group (median IV: 1,425 ml; interquartile range [IQR]: 1,075 to 1,950 ml; vs. median SC: 1,350 ml; IQR: 900 to 1,900 ml; p = 0.84). Additionally, mean weight loss was not significantly different (−1.5 ± 1.1 kg in the IV group vs. −1.5 ± 1.2 kg in the SC group; p = 0.95). Hourly urine output was significantly higher in the IV group at hour 2 (425 ml in the IV group vs. 250 ml in the SC group; p = 0.02) and higher in the SC group at hour 6 (125 ml, IV group vs. 325 ml, SC group; p = 0.005). Natriuresis was higher in the SC group (IV: 7.3 ± 35.3 mEq/l vs. SC: 32.8 ± 43.6 mEq/l; p = 0.05). There was no worsening renal function, ototoxicity, or skin irritation with either formulation. Thirty-day hospitalization rates were similar. Conclusions In this phase II trial, we did not identify significant differences between urine output obtained with pH-neutral furosemide administered SC and that obtained by IV. This method of decongestion may allow treatment at home and reduced HF resources and warrants further investigation. (Sub-Q Versus IV Furosemide in Acute Heart Failure; NCT02579057)
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      PubDate: 2017-12-11T06:36:57Z
       
  • The Right Diet for Heart Failure
    • Abstract: Publication date: Available online 6 December 2017
      Source:JACC: Heart Failure
      Author(s): Sumeet S. Mitter, Rajesh Vedanthan, Valentin Fuster
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      PubDate: 2017-12-11T06:36:57Z
       
  • Evidence-Based Therapy and Its Association With Workforce Detachment After
           First Hospitalization for Heart Failure
    • Abstract: Publication date: Available online 6 December 2017
      Source:JACC: Heart Failure
      Author(s): Rasmus Rørth, Emil L. Fosbøl, Ulrik M. Mogensen, Kristian Kragholm, Pardeep S. Jhund, Mark C. Petrie, Morten Schou, Gunnar H. Gislason, John J.V. McMurray, Christian Torp-Pedersen, Lars Køber, Søren L. Kristensen
      Objectives This study investigated the association between the use of evidence-based medicine (EBM) for heart failure (HF) and risk of workforce detachment. Background The ability to work can be a marker of functional capacity and quality of life. Methods We examined a nationwide cohort of patients in the workforce 1 year after first hospitalization for HF. EBM was defined as treatment with β-blockers and renin angiotensin system inhibitors. The fraction of target dose (0-1) for each drug was calculated. The sum of the fractions gave each patient a score between 0 and 2. Patients were stratified into 4 groups according to this score: group 4 score = 2 (target dose of both drugs); group 3 score <2 to >1; group 2 score ≤1 to >0.5; and group 1 score ≤0.5. The risk of subsequent workforce detachment was estimated in cause specific Cox regression models. Results One year after first HF hospitalization, 10,185 patients were part of the workforce, and 7,561 (74%) were in treatment with at least 1 of the components of EBM. During a median follow-up of 727 days, 2,698 individuals (36%) became detached from the workforce. Patients receiving more EBM had a significantly lower risk of workforce detachment compared with those receiving less EBM (group 4 hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.77 to 0.98; group 3 HR: 0.85; 95% CI: 0.77 to 0.94; and group 2 HR 0.92; 95% CI: 0.83 to 1.02), all compared to group 1. Conclusions Patients in the workforce 1 year after first HF hospitalization and treated with target or near-target doses of EBM were associated with a significantly lower risk of subsequent workforce detachment.
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      PubDate: 2017-12-11T06:36:57Z
       
  • Furosemide Reimagined
    • Abstract: Publication date: Available online 6 December 2017
      Source:JACC: Heart Failure
      Author(s): Gary S. Francis, Tamas Alexy
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      PubDate: 2017-12-11T06:36:57Z
       
  • Left Ventricular Dysfunction in Cancer Treatment: Is it Relevant'
    • Abstract: Publication date: Available online 1 December 2017
      Source:JACC: Heart Failure
      Author(s): Benjamin Kenigsberg, Anton Wellstein, Ana Barac


      PubDate: 2017-12-11T06:36:57Z
       
  • Correction
    • Abstract: Publication date: December 2017
      Source:JACC: Heart Failure, Volume 5, Issue 12


      PubDate: 2017-12-01T06:08:19Z
       
  • Anemia in Heart Failure
    • Authors: Niels Grote Beverborg; Dirk J. van Veldhuisen; Peter van der Meer
      Abstract: Publication date: Available online 8 November 2017
      Source:JACC: Heart Failure
      Author(s): Niels Grote Beverborg, Dirk J. van Veldhuisen, Peter van der Meer
      One-third of all patients with heart failure have anemia, and its presence is associated with more symptoms, increased rates of hospitalization, and mortality. The etiology of anemia is multifactorial, complex, and varies between patients. The most important factors leading to anemia in heart failure are inadequate erythropoietin production resulting from renal failure, intrinsic bone marrow defects, medication use, and nutritional deficiencies such as iron deficiency. Erythropoiesis-stimulating agents (ESAs) have been proven to successfully correct hemoglobin levels, albeit without significant improvement in clinical outcome. On the contrary, the use of ESAs has led to increased rates of thromboembolic events and ischemic stroke. This use of ESAs for the treatment of anemia in heart failure, therefore, cannot be recommended. In addition, these results question whether anemia is a therapeutic target or merely a marker of disease severity. Other therapies are being studied and include agents targeting the erythropoietin receptor, hepcidin pathway, or iron availability. This review focuses on the pathophysiology of anemia in heart failure, explanations why investigated therapies might not have led to the desired results, and discussions of promising future therapies.
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      PubDate: 2017-11-19T02:27:43Z
      DOI: 10.1016/j.jchf.2017.08.023
       
  • Reply
    • Authors: Franz Messerli; Stefano Rimoldi Sripal Bangalore
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): Franz H. Messerli, Stefano F. Rimoldi, Sripal Bangalore


      PubDate: 2017-11-19T02:27:43Z
       
  • Reply
    • Authors: Scott Solomon; John J.V. McMurray
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): Scott D. Solomon, John J.V. McMurray


      PubDate: 2017-11-19T02:27:43Z
       
  • Reply
    • Authors: Stephan Karin; Klingel Philipp Lurz Axel Linke Norman Mangner
      Abstract: Publication date: November 2017
      Source:JACC: Heart Failure, Volume 5, Issue 11
      Author(s): Stephan Schürer, Karin Klingel, Philipp Lurz, Axel Linke, Norman Mangner


      PubDate: 2017-11-19T02:27:43Z
       
  • A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of the
           Efficacy and Safety of the Oral Soluble Guanylate Cyclase Stimulator
    • Authors: Paul W. Armstrong; Lothar Roessig; Mahesh J. Patel; Kevin J. Anstrom; Javed Butler; Adriaan A. Voors; Carolyn S.P. Lam; Piotr Ponikowski; Tracy Temple; Burkert Pieske; Justin Ezekowitz; Adrian F. Hernandez; Joerg Koglin; Christopher M. O'Connor
      Abstract: Publication date: Available online 11 October 2017
      Source:JACC: Heart Failure
      Author(s): Paul W. Armstrong, Lothar Roessig, Mahesh J. Patel, Kevin J. Anstrom, Javed Butler, Adriaan A. Voors, Carolyn S.P. Lam, Piotr Ponikowski, Tracy Temple, Burkert Pieske, Justin Ezekowitz, Adrian F. Hernandez, Joerg Koglin, Christopher M. O'Connor
      This trial sought to evaluate whether vericiguat, a novel oral soluble guanylate cyclase (sGC) stimulator, was superior to placebo, on a background of standard of care, in increasing the time to the first occurrence of the composite endpoints of cardiovascular (CV) death and heart failure (HF) hospitalization in patients with HF with reduced ejection fraction (HFrEF). Deficiency in sGC-derived cyclic guanosine monophosphate (cGMP) causes both myocardial dysfunction and impaired endothelium-dependent vasomotor regulation that includes the myocardial microcirculation. Experimental studies have suggested multiple potential benefits of sGC stimulators including prevention, or even reversal, of left ventricular hypertrophy and fibrosis, as well as reduction of ventricular afterload through both systemic and pulmonary vasodilation. Hence, restoration of sufficient nitric oxide (NO)-sGC–cGMP signaling has been proposed as an important treatment target in HF. Vericiguat has been shown to directly stimulate sGC and enhance sGC sensitivity to endogenous NO. Available phase IIb data in HFrEF patients indicate vericiguat is safe and well-tolerated, and exploratory analyses indicate that it results in a dose-dependent, clinically significant reduction in N-terminal pro–B-type natriuretic peptide (NT-proBNP) at the highest tested dose. VICTORIA (Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction) is a randomized, placebo-controlled, parallel group, multicenter, double-blind, event-driven phase 3 trial of vericiguat in subjects with HFrEF. Approximately 4,872 subjects will be randomized to evaluate the efficacy and safety of vericiguat compared with placebo on a background of standard of care. After a screening phase of up to 30 days, eligible subjects will be treated until the required number of cardiovascular deaths is observed. The estimated median follow-up duration is approximately 18 months. All subjects will be followed until study completion to assess for the occurrence of endpoint events. VICTORIA will establish the efficacy and safety of vericiguat on cardiovascular death and HF hospitalization in patients with HFrEF. (A Randomized Parallel-Group, Placebo-Controlled, Double-Blind, Event-Driven, Multi-Center Pivotal Phase III Clinical Outcome Trial of Efficacy and Safety of the Oral sGC Stimulator Vericiguat in Subjects With Heart Failure With Reduced Ejection Fraction [HFrEF]—VerICiguaT Global Study in Subjects With Heart Failure With Reduced Ejection Fraction [VICTORIA]; NCT02861534)
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      PubDate: 2017-10-14T06:58:47Z
      DOI: 10.1016/j.jchf.2017.08.013
       
  • Association Between Type 2 Diabetes and All-Cause Hospitalization and
           Mortality in the UK General Heart Failure Population
    • Authors: Claire A. Lawson; Peter W. Jones; Lucy Teece; Sandra B. Dunbar; Petar M. Seferovic; Kamlesh Khunti; Mamas Mamas; Umesh T. Kadam
      Abstract: Publication date: Available online 11 October 2017
      Source:JACC: Heart Failure
      Author(s): Claire A. Lawson, Peter W. Jones, Lucy Teece, Sandra B. Dunbar, Petar M. Seferovic, Kamlesh Khunti, Mamas Mamas, Umesh T. Kadam
      Objectives This study sought to investigate in the general heart failure (HF) population, whether the associations between type 2 diabetes (T2D) and risk of hospitalization and death, are modified by changing glycemic or drug treatment intensity. Background In the general HF population, T2D confers a higher risk of poor outcomes, but whether this risk is modified by the diabetes status is unknown. Methods A nested case-control study in an incident HF database cohort (2002 to 2014) comparing patients with T2D with those without, for risk of all-cause first hospitalization and death. T2D was stratified by categories of glycosylated hemoglobin (HbA1c) or drug treatments measured 6 months before hospitalization and 1 year before death and compared with the HF group without T2D. Results In HF, T2D was associated with risk of first hospitalization (adjusted odds ratio [aOR]: 1.29; 95% confidence interval [CI]: 1.24 to 1.34) and mortality (aOR: 1.24; 95% CI: 1.29 to 1.40). Stratification of T2D by HbA1c levels, compared with the reference HF group without T2D, showed U-shaped associations with both outcomes. Highest risk categories were HbA1c >9.5% (hospitalization, aOR: 1.75; 95% CI: 1.52 to 2.02; mortality, aOR: 1.30; 95% CI: 1.24 to 1.47) and <5.5% (hospitalization, aOR: 1.42; 95% CI: 1.12 to 1.80; mortality, aOR: 1.29; 95% CI: 1.10 to 1.51, respectively). T2D group with change in HbA1c of >1% decrease was associated with hospitalization (aOR: 1.33; 95% CI: 1.18 to 1.49) and mortality (aOR: 1.36; 95% CI: 1.24 to 1.48). T2D drug group associations with hospitalization were no medication (aOR: 1.12; 95% CI: 1.04 to 1.19), oral antihyperglycemic only (aOR: 1.34; 95% CI: 1.27 to 1.41), oral antihyperglycemic+insulin (aOR: 1.36; 95% CI: 1.21 to 1.52), and insulin only (aOR: 1.61; 95% CI: 1.43 to 1.81); and with mortality the same were 1.31 (95% CI: 1.23 to 1.39), 1.16 (95% CI: 1.11 to 1.22), 1.19 (95% CI: 1.06 to 1.34), and 1.43 (95% CI: 1.31 to 1.57), respectively. The T2D group with reducing drug treatments were associated with hospitalization (aOR: 2.13; 95% CI: 1.68 to 2.69) and mortality (aOR: 2.09; 95% CI: 1.81 to 2.41). Conclusions In the general HF population, T2D stratified by glycemic control and drug treatments showed differential risk associations. Routine measures of dynamic diabetes status provide important prognostic indication of poor outcomes in HF.
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      PubDate: 2017-10-14T06:58:47Z
      DOI: 10.1016/j.jchf.2017.08.020
       
  • Heart Failure With Mid-Range (Borderline) Ejection Fraction
    • Authors: Jeffrey J. Hsu; Boback Ziaeian; Gregg C. Fonarow
      Abstract: Publication date: Available online 11 October 2017
      Source:JACC: Heart Failure
      Author(s): Jeffrey J. Hsu, Boback Ziaeian, Gregg C. Fonarow
      Heart failure (HF) with borderline ejection fraction was first defined in 2013 in the American College of Cardiology/American Heart Association guidelines as the presence of the typical symptoms of HF and a left ventricular ejection fraction (LVEF) of 41% to 49%. In 2016, the European Society of Cardiology specified HF with mid-range ejection fraction (HFmrEF) as LVEF of 40% to 49%. This range of LVEF is less well studied compared with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). Although there are effective, guideline-directed medical therapies for patients with HFrEF, no therapies thus far show measurable benefit in HFpEF. Patients with HFmrEF have a clinical profile and prognosis that are closer to those of patients with HFpEF than those of HFrEF, with certain distinctions. Whether these patients represent a unique and dynamic HF group that may benefit from targeted therapies known to be beneficial in patients with HFrEF, such as neurohormonal blockade, requires further study. This review summarizes what is known about the clinical epidemiology, pathophysiology, and prognosis for patients with HFmrEF and how these features compare with the more well-studied HF groups. Although recommended treatments currently focus on aggressive management of comorbidities, we summarize the studies that identify a potential signal for beneficial therapies. Future studies are needed to not only better characterize the HFmrEF population but to also determine effective management strategies to reduce the high cardiovascular morbidity and mortality burden on this phenotype of patients with HF.
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      PubDate: 2017-10-14T06:58:47Z
      DOI: 10.1016/j.jchf.2017.06.013
       
  • Left Ventricular Filling Pressures in Heart Failure With
           Preserved Ejection Fraction
    • Authors: Masaru Obokata; Barry A. Borlaug
      Abstract: Publication date: Available online 11 October 2017
      Source:JACC: Heart Failure
      Author(s): Masaru Obokata, Barry A. Borlaug
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      PubDate: 2017-10-14T06:58:47Z
      DOI: 10.1016/j.jchf.2017.09.001
       
  • Prognostic Importance of Temporal Changes in Resting Heart Rate in Heart
           Failure and Preserved Ejection Fraction
    • Authors: Ali Vazir; Brian Claggett; Bertram Pitt; Inder Anand; Nancy Sweitzer; James Fang; Jerome Fleg; Jean Rouleau; Sanjiv Shah; Marc A. Pfeffer; Scott D. Solomon
      Abstract: Publication date: Available online 11 October 2017
      Source:JACC: Heart Failure
      Author(s): Ali Vazir, Brian Claggett, Bertram Pitt, Inder Anand, Nancy Sweitzer, James Fang, Jerome Fleg, Jean Rouleau, Sanjiv Shah, Marc A. Pfeffer, Scott D. Solomon
      Objectives The aim of this study was to examine the relationship between baseline heart rate (HR), change in HR from a preceding visit, and time-updated HR with subsequent outcomes in patients with heart failure with preserved ejection fraction (HFpEF) in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial. Background Higher resting HR and increase in HR over time in patients with heart failure are associated with adverse outcomes. Whether these relationships between HR and prognosis are also observed in patients with HFpEF requires further assessment. Methods In 1,767 patients enrolled in the TOPCAT trial from the Americas, the associations between baseline resting HR and change in HR from the preceding visit and clinical outcomes were examined using Cox proportional hazards models, along with the association between HR at each visit and outcome. Results Both baseline HR (adjusted hazard ratio: 1.08; 95% confidence interval: 1.04 to 1.12) and change in HR from the preceding visit (adjusted hazard ratio: 1.09; 95% confidence interval: 1.05 to 1.14; p < 0.001 per 5 beats/min higher HR), after adjusting for covariates, were associated with a higher risk for the primary endpoint of cardiovascular death, hospitalization for HF, or aborted cardiac arrest. Time-updated resting HR at each visit was also associated with risk (adjusted hazard ratio: 1.11; 95% confidence interval: 1.07 to 1.15; p < 0.001 per 5 beats/min higher HR). Furthermore, a rise in resting HR of approximately 10 beats/min, beginning approximately 10 days prior to the primary endpoint, was observed. Conclusions Baseline resting HR and change in HR over time predict outcomes in patients with HFpEF, as does time-updated HR during follow-up. These data suggest that frequent outpatient monitoring of HR, possibly with remote technologies, may identify patients with HFpEF who may be at increased risk for rehospitalization or death.
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      PubDate: 2017-10-14T06:58:47Z
      DOI: 10.1016/j.jchf.2017.08.018
       
  • Wedge Pressure Rather Than Left Ventricular End-Diastolic Pressure
           Predicts Outcome in Heart Failure With Preserved Ejection Fraction
    • Authors: Julia Mascherbauer; Caroline Zotter-Tufaro; Franz Duca; Christina Binder; Matthias Koschutnik; Andreas A. Kammerlander; Stefan Aschauer; Diana Bonderman
      Abstract: Publication date: Available online 11 October 2017
      Source:JACC: Heart Failure
      Author(s): Julia Mascherbauer, Caroline Zotter-Tufaro, Franz Duca, Christina Binder, Matthias Koschutnik, Andreas A. Kammerlander, Stefan Aschauer, Diana Bonderman
      Objectives This study sought to compare the prognostic power of left ventricular end-diastolic pressure (LVEDP) and pulmonary arterial wedge pressure (PAWP) in heart failure with preserved ejection fraction (HFpEF). Background It is broadly accepted that direct measurement of LVEDP in HFpEF more robustly reflects left ventricular hemodynamics than PAWP. Methods A total of 173 consecutive HFpEF patients were prospectively enrolled. Of these, 152 patients fulfilled registry inclusion criteria. Study participants underwent clinical evaluation, lung function tests, echocardiography, cardiac magnetic resonance, coronary angiography, and invasive hemodynamic assessments with PAWP and LVEDP measurements in 1 procedure. The study endpoint was defined as hospitalization for heart failure or cardiac death. Results A modest pressure difference (2.0 ± 4.4 mm Hg) was observed between PAWP (21.5 ± 5.6 mm Hg) and LVEDP (19.5 ± 5.2 mm Hg) at baseline. After a mean follow-up of 23.5 ± 21.3 months, PAWP was predictive of outcome (p = 0.010), whereas LVEDP was not (p = 0.261) by Kaplan-Meier curves. By multivariate regression analysis, diffusion capacity of carbon monoxide (DLCO) was the only parameter that was independently related to the pressure difference between PAWP and LVEDP. When patients were stratified according to DLCO between ≤45% and >45%, those in the low DLCO group were found to have a more pronounced pressure drop between PAWP and LVEDP (3.1 ± 4.8 mm Hg vs. 0.8 ± 3.8 mm Hg, respectively; p = 0.031) and to be in more advanced disease stages. Conclusions Our data indicate that PAWP but not LVEDP is associated with outcome in HFpEF. A more pronounced difference between PAWP and LVEDP and more advanced disease is found in patients with low DLCO.
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      PubDate: 2017-10-14T06:58:47Z
      DOI: 10.1016/j.jchf.2017.08.005
       
  • Heart Rate in Preserved Ejection Fraction Heart Failure∗
    • Authors: Michael R. Bristow; Natasha L. Altman
      Abstract: Publication date: Available online 11 October 2017
      Source:JACC: Heart Failure
      Author(s): Michael R. Bristow, Natasha L. Altman
      Graphical abstract image

      PubDate: 2017-10-14T06:58:47Z
      DOI: 10.1016/j.jchf.2017.09.004
       
  • Moderate Alcohol Consumption Is Associated With Lower Risk for
           Heart Failure But Not Atrial Fibrillation
    • Authors: Augusto Di Castelnuovo; Simona Costanzo; Marialaura Bonaccio; Livia Rago; Amalia De Curtis; Mariarosaria Persichillo; Francesca Bracone; Marco Olivieri; Chiara Cerletti; Maria Benedetta Donati; Giovanni de Gaetano; Licia Iacoviello; Licia Iacoviello; Maria Benedetta Donati; Giovanni de Gaetano; Jos Vermylen; Ignacio De Paula Carrasco; Simona Giampaoli; Antonio Spagnuolo; Deodato Assanelli; Vincenzo Centritto; Pasquale Spagnuolo; Dante Staniscia; Francesco Zito; Americo Bonanni; Chiara Cerletti; Amalia De Curtis; Augusto Di Castelnuovo; Licia Iacoviello; Roberto Lorenzet; Antonio Mascioli; Marco Olivieri; Domenico Rotilio; Augusto Di Castelnuovo; Marialaura Bonaccio; Simona Costanzo; Francesco Gianfagna; Marco Olivieri; Maurizio Giacci; Antonella Padulo; Dario Petraroia; Amalia De Curtis; Federico Marracino; Maria Spinelli; Christian Silvestri; Americo Bonanni; Marialaura Bonaccio; Francesca De Lucia; Francesco Gianfagna; Branislav Vohnout; Franco Zito; Mariarosaria Persichillo; Angelita Verna; Maura Di Lillo; Irene Di Stefano; Agostino Pannichella; Antonio Rinaldo Vizzarri; Branislav Vohnout; Agnieszka Pampuch; Antonella Arcari; Daniela Barbato; Francesca Bracone; Simona Costanzo; Carmine Di Giorgio; Sara Magnacca; Simona Panebianco; Antonello Chiovitti; Federico Marracino; Sergio Caccamo; Vanesa Caruso; Livia Rago; Daniela Cugino; Francesco Zito; Francesco Gianfagna; Alessandra Ferri; Concetta Castaldi; Marcella Mignogna; Tomasz Guszcz; Romina di Giuseppe; Paola Barisciano; Lorena Buonaccorsi; Floriana Centritto; Antonella Cutrone; Francesca De Lucia; Francesca Fanelli; Iolanda Santimone; Anna Sciarretta; Maura Di Lillo; Isabella Sorella; Irene Di Stefano; Emanuela Plescia; Alessandra Molinaro; Christiana Cavone; Giovanna Galuppo; Maura Di Lillo; Concetta Castaldi; Dolores D'Angelo; Rosanna Ramacciato; Simona Costanzo; Simona Costanzo; Marco Olivieri; Livia Rago; Simona Costanzo; Amalia de Curtis; Licia Iacoviello; Mariarosaria Persichillo
      Abstract: Publication date: Available online 11 October 2017
      Source:JACC: Heart Failure
      Author(s): Augusto Di Castelnuovo, Simona Costanzo, Marialaura Bonaccio, Livia Rago, Amalia De Curtis, Mariarosaria Persichillo, Francesca Bracone, Marco Olivieri, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello
      Objectives The aim of this study was to assess the hypothesis that alcohol consumption is associated with onset of atrial fibrillation (AF) and/or heart failure (HF). Background The connection between ethanol intake and AF or HF remains controversial. Methods The study population was 22,824 AF- or HF-free subjects (48% men, age ≥35 years) randomly recruited from the general population included in the Moli-sani study, for whom complete data on HF, AF, and alcohol consumption were available. The cohort was followed up to December 31, 2015, for a median of 8.2 years (183,912 person-years). Incident cases were identified through linkage to the Molise regional archive of hospital discharges. Hazard ratios were calculated using Cox proportional hazard models and cubic spline regression. Results A total of 943 incident cases of HF and 554 of AF were identified. In comparison with never drinkers, both former and occasional drinkers showed comparable risk for developing HF. Drinking alcohol in the range of 1 to 4 drinks/day was associated with a lower risk for HF, with a 22% maximum risk reduction at 20 g/day, independent of common confounders. In contrast, no association of alcohol consumption with onset of AF was observed. Very similar results were obtained after restriction of the analyses to regular or only wine drinkers or according to sex, age, social status, or adherence to the Mediterranean diet. Conclusions Consumption of alcohol in moderation was associated with a lower incidence of HF but not with development of AF.
      Graphical abstract image

      PubDate: 2017-10-14T06:58:47Z
      DOI: 10.1016/j.jchf.2017.08.017
       
  • The Risks and Benefits of Moderate Alcohol Consumption
    • Authors: Eric S. Leifer
      Abstract: Publication date: Available online 11 October 2017
      Source:JACC: Heart Failure
      Author(s): Eric S. Leifer
      Graphical abstract image

      PubDate: 2017-10-14T06:58:47Z
      DOI: 10.1016/j.jchf.2017.09.005
       
 
 
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