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Journal Cover JACC : Heart Failure
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   Full-text available via subscription Subscription journal
   ISSN (Online) 2213-1779
   Published by American College of Cardiology Homepage  [1 journal]
  • Statins and Exercise Training Response in Heart Failure Patients
           Insights From HF-ACTION
    • Authors: Kelly JP; Dunning A, Schulte PJ, et al.
      Abstract: ObjectivesThe aim of this study was to assess for a treatment interaction between statin use and exercise training (ET) response.BackgroundRecent data suggest that statins may attenuate ET response, but limited data exist in patients with heart failure (HF).MethodsHF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) was a randomized trial of 2,331 patients with chronic HF with ejection fraction ≤35% who were randomized to usual care with or without ET. We evaluated whether there was a treatment interaction between statins and ET response for the change in quality of life and aerobic capacity (peak oxygen consumption and 6-min walk distance) from baseline to 3 months. We also assessed for a treatment interaction among atorvastatin, simvastatin, and pravastatin and change in these endpoints with ET. Multiple linear regression analyses were performed for each endpoint, adjusting for baseline covariates.ResultsOf 2,331 patients in the HF-ACTION trial, 1,353 (58%) were prescribed statins at baseline. Patients treated with statins were more likely to be older men with ischemic HF etiology but had similar use of renin angiotensin system blockers and beta-blockers. There was no evidence of a treatment interaction between statin use and ET on changes in quality of life or exercise capacity, nor was there evidence of differential association between statin type and ET response for these endpoints (all p values >0.05).ConclusionsIn a large chronic HF cohort, there was no evidence of a treatment interaction between statin use and short-term change in aerobic capacity and quality of life with ET. These findings contrast with recent reports of an attenuation in ET response with statins in a different population, highlighting the need for future prospective studies. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437)
      PubDate: Mon, 01 Aug 2016 00:00:00 GMT
  • Right Ventricular Contractile Reserve and Pulmonary Circulation Uncoupling
           During Exercise Challenge in Heart Failure Pathophysiology and Clinical
    • Authors: Guazzi M; Villani S, Generati G, et al.
      Abstract: ObjectivesRight ventricular (RV) exercise contractile reserve (RVECR), its phenotypes, and its functional correlates are among the unresolved issues with regard to the role of the right ventricle in heart failure (HF) syndrome, and understanding these issues constitutes the objective of this study.BackgroundAlthough the role of the right ventricle in HF syndrome might be fundamental, the pathophysiology of the failing right ventricle has not been extensively investigated.MethodsNinety-seven patients with HF (mean age 64 years, 70% men, mean left ventricular ejection fraction 33 ± 10%) underwent maximal exercise stress echocardiographic and cardiopulmonary exercise testing. RVECR and RV–to–pulmonary circulation (PC) coupling were assessed using the length-force relationship (tricuspid annular plane systolic excursion [TAPSE] vs. pulmonary artery systolic pressure) and the slope of mean pulmonary artery pressure versus cardiac output. On the basis of TAPSE, patients were categorized into 3 groups: those with TAPSE at rest ≥16 mm (group A, n = 60) and those with TAPSE at rest 
      PubDate: Mon, 01 Aug 2016 00:00:00 GMT
  • Can Academic Cardiology Divisions Survive'
    • PubDate: Mon, 01 Aug 2016 00:00:00 GMT
  • Intrarenal Venous Flow A Window Into the Congestive Kidney Failure
           Phenotype of Heart Failure' ∗
    • Authors: Tang W; Kitai T.
      Abstract: Although the importance of congestion in the disease progression of heart failure has long been recognized (1), much has focused on how cardiac impairment can lead to renal dysfunction. Over the past decade, there is increasing recognition that the ability of the kidneys to compensate for fluid overload can be influenced not only by reduced arterial perfusion or underlying intrinsic renal abnormalities, but also by increased venous pressure (2–4). However, unlike the heart, the lack of reliable bedside tools that can provide insights into real-time renal physiology has somewhat limited our abilities to better understand the factors contributing to cardio-renal syndrome. To date, clinicians rely on surrogates of venous congestion that are primarily inferred by structural and vascular flow abnormalities in the right heart, inferior vena cava, or hepatic veins (Figure 1) (5–7). Although there have been promises of directly quantifying renal perfusion using ultrasound contrast, they are yet to be clinically applicable (8).
      PubDate: Mon, 01 Aug 2016 00:00:00 GMT
  • Putting Together the Pieces of the Natriuretic Peptide Puzzle ∗
    • Abstract: “Sometimes something has to happen before something can happen.”—Johan Cruyff (1947–2016), soccer player/philosopher (1)
      PubDate: Mon, 01 Aug 2016 00:00:00 GMT
  • Clinical Implications of Intrarenal Hemodynamic Evaluation by Doppler
           Ultrasonography in Heart Failure
    • Authors: Iida N; Seo Y, Sai S, et al.
      Abstract: ObjectivesThis study clarified the characteristics of intrarenal Doppler ultrasonography (IRD) profiles and their prognostic implications in heart failure (HF).BackgroundIRD can assess intrarenal hemodynamics.MethodsInitially, 224 patients with HF were prospectively enrolled; 151 inpatients were enrolled during hospitalization for HF, and 73 were outpatients in our institution. In IRD profiles of interlobar vessels, the arterial resistance index (RI), venous impedance index (VII), and intrarenal venous flow (IRVF) pattern were assessed. Patients were followed to evaluate the associations with 1-year prognosis. Primary endpoints included death from cardiovascular disease and unplanned hospitalization for HF.ResultsFinally, 217 patients with adequate IRD images were enrolled. IRD profiles were associated with conventional risk factors for HF. In particular, IRVF was associated with mean right atrial pressure (RAP); 3 IRVF patterns were stratified by RAP (in a continuous pattern: 5.4 ± 2.5; in a biphasic pattern: 9.5 ± 3.5; and in a monophasic pattern: 14.9 ± 4.3 mm Hg; p < 0.001). In addition, the monophasic IRVF pattern had a poorer prognosis than the other patterns (log rank p < 0.001), and prognosis was poorer for the biphasic pattern than for the continuous flow pattern (log rank p = 0.01). Multivariate Cox proportional hazard model analysis revealed that IRVF patterns were associated with the endpoints, independent of other HF risk factors.ConclusionsIRVF patterns, rather than RI, depended on RAP, suggesting a correlation with renal congestion. In addition, IRVF patterns strongly correlated with clinical outcomes independent of RAP and other risk factors and might provide additional information to stratify vulnerable HF patients.
      PubDate: Mon, 01 Aug 2016 00:00:00 GMT
  • Plasma Corin as a Predictor of Cardiovascular Events in Patients
           With Chronic Heart Failure
    • Authors: Zhou X; Chen J, Liu Y, et al.
      Abstract: ObjectivesThe aim of this study was to determine the prognostic value of plasma corin in patients with chronic heart failure (CHF).BackgroundIn recent years, accumulating evidence has indicated that corin plays a critical role in regulating blood pressure and cardiac function.MethodsWe enrolled 1,148 consecutive CHF patients in a prospective cohort study and explored the association between plasma corin levels and clinical prognosis using multivariate Cox regression analysis.ResultsPatients with low corin levels (
      PubDate: Mon, 01 Aug 2016 00:00:00 GMT
  • Goal-Directed Heart Failure Care in Patients With Chronic Kidney Disease
           and End-Stage Renal Disease ∗
    • Authors: McCullough PA; Afzal A, Kale P.
      Abstract: Investigators have long recognized that renal function and cardiac performance are integrally linked through hemodynamic, neural, humoral, cell signaling, proteomic, and metabolomic pathways (1). Among risk factors for the development of heart failure (HF), chronic kidney disease (CKD) is the most powerful because it contributes to the three fundamental mechanisms of left ventricular failure: 1) pressure overload; 2) volume overload; and 3) cardiomyopathy (2). When CKD progresses to end-stage renal disease (ESRD), these three mechanisms driving HF become more difficult to control because patients undergoing dialysis have on average higher blood pressures; poor volume control only partially addressed by thrice weekly hemodialysis in most cases; and a well-described form of cardiomyopathy characterized by severe left ventricular hypertrophy, marked cardiac fibrosis, reduced capillary density, and calcific deposits on the mitral and aortic valves (3). None of the goal-directed medical or device therapies proven to reduce HF-related hospitalization and cardiovascular death in the general population with HF have been demonstrated to be effective in patients with ESRD (4). This reason is that randomized trials have not been performed, and when these interventions are evaluated in nonrandomized studies, they appear to have a reduced benefit and a worse safety profile. For example, although observational data suggest that angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and mineralocorticoid antagonists could improve survival in ESRD, these agents are associated with greater degrees of hypotension and hyperkalemia than in patients in the general population with HF (5,6). Similarly, despite high rates of sudden death in patients with ESRD, implantable cardioverter-defibrillators have higher defibrillation thresholds in ESRD, greater risks of infection, and lesser degrees of efficacy than in the general population with HF (7,8).
      PubDate: Mon, 01 Aug 2016 00:00:00 GMT
  • Trends in the Use of Guideline-Directed Therapies Among Dialysis
           Patients Hospitalized With Systolic Heart Failure Findings From the
           American Heart Association Get With The Guidelines-Heart
           Failure Program
    • Authors: Pandey A; Golwala H, DeVore AD, et al.
      Abstract: ObjectivesThe purpose of this study was to determine the temporal trends in the adherence to heart failure (HF)–related process of care measures and clinical outcomes among patients with acute decompensated HF with reduced ejection fraction (HFrEF) and end-stage renal disease (ESRD).BackgroundPrevious studies have demonstrated significant underuse of evidence-based HF therapies among patients with coexisting ESRD and HFrEF. However, it is unclear if the proportional use of evidence-based medical therapies and associated clinical outcomes among these patients has changed over time.MethodsGet With The Guidelines-HF study participants who were admitted for acute HFrEF between January 2005 and June 2014 were stratified into 3 groups on the basis of their admission renal function: normal renal function, renal insufficiency without dialysis, and dialysis. Temporal change in proportional adherence to the HF-related process of care measures and incidence of clinical outcomes (1-year mortality, HF hospitalization, and all-cause hospitalization) during the study period was evaluated across the 3 renal function groups.ResultsThe study included 111,846 patients with HFrEF from 390 participating centers, of whom 19% had renal insufficiency but who did not require dialysis, and 3% were on dialysis. There was a significant temporal increase in adherence to evidence-based medical therapies (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker: p trend
      PubDate: Mon, 01 Aug 2016 00:00:00 GMT
  • Exploring the Mechanisms of Exercise Intolerance in Patients With HFpEF
           Are We too “Cardiocentric'” ∗
    • Authors: Wolfel EE.
      Abstract: Despite having a normal left ventricular ejection fraction, patients with heart failure with preserved ejection fraction (HFpEF) have limited exercise capacity, represented by a peak oxygen consumption (VO2) that is less than what would be predicted for age, and comorbidities including obesity, metabolic syndrome, diabetes, or hypertension. Exercise intolerance is their main symptom, even when fluid balance, systemic blood pressure, and heart rate are optimized. In addition to a reduction in quality of life, reduced peak VO2 in these patients has also been shown to determine prognosis. Knowledge of the physiological factors that limit exercise capacity in these patients may result in approaches to improve functional capacity and perhaps alter the natural history of the syndrome.
      PubDate: Mon, 01 Aug 2016 00:00:00 GMT
  • Skeletal Muscle Mitochondrial Content, Oxidative Capacity, and Mfn2
           Expression Are Reduced in Older Patients With Heart Failure and Preserved
           Ejection Fraction and Are Related to Exercise Intolerance
    • Authors: Molina AA; Bharadwaj MS, Van Horn C, et al.
      Abstract: ObjectivesThe aim of this study was to examine skeletal muscle mitochondria content, oxidative capacity, and the expression of key mitochondrial dynamics proteins in patients with heart failure with preserved ejection fraction (HFpEF), as well as to determine potential relationships with measures of exercise performance.BackgroundMultiple lines of evidence indicate that severely reduced peak exercise oxygen uptake (peak VO2) in older patients with HFpEF is related to abnormal skeletal muscle oxygen utilization. Mitochondria are key regulators of skeletal muscle metabolism; however, little is known about how these organelles are affected in HFpEF.MethodsBoth vastus lateralis skeletal muscle citrate synthase activity and the expression of porin and regulators of mitochondrial fusion were examined in older patients with HFpEF (n = 20) and healthy, age-matched control subjects (n = 17).ResultsCompared with age-matched healthy control subjects, mitochondrial content assessed by porin expression was 46% lower (p = 0.01), citrate synthase activity was 29% lower (p = 0.01), and Mfn2 (mitofusin 2) expression was 54% lower (p 
      PubDate: Mon, 01 Aug 2016 00:00:00 GMT
  • Cardiopulmonary Exercise Testing in Heart Failure
    • Abstract: Exercise intolerance, indicated by dyspnea and fatigue during exertion, is a cardinal manifestation of heart failure (HF). Cardiopulmonary exercise testing (CPET) precisely defines maximum exercise capacity through measurement of peak oxygen uptake (VO2). Peak VO2 values have a critical role in informing patient selection for advanced HF interventions such as heart transplantation and ventricular assist devices. Oxygen uptake and ventilatory patterns obtained during the submaximal portion of CPET are also valuable to recognize because of their ease of ascertainment during low-level exercise, relevance to ability to perform activities of daily living, independence from volitional effort, and strong relationship to prognosis in HF. The ability of peak VO2 and other CPET variables to be measured reproducibly and to accurately reflect HF severity is increasingly recognized and endorsed by scientific statements. Integration of CPET with invasive hemodynamic monitoring and cardiac imaging during exercise provides comprehensive characterization of multisystem reserve capacity that can inform prognosis and the need for cardiac interventions. Here, we review both practical aspects of conducting CPETs in patients with HF for clinical and research purposes as well as interpretation of gas exchange patterns across the spectrum of preclinical HF to advanced HF.
      PubDate: Mon, 01 Aug 2016 00:00:00 GMT
School of Mathematical and Computer Sciences
Heriot-Watt University
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