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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]
  • Where’s the “Label” for Beet Juice The Value of the Food
           and Drug Administration ∗
    • Authors: Roizen MF.
      Abstract: Olympic marathon runners and college football stars chug-a-lug beet juice for a performance boost. This humble edible is now an international superstar with top billing in pricey juices. This juice is proposed to work wonders by increasing levels of artery-relaxing nitric oxide (NO). Relaxed arteries, the ads blast, mean increased blood flow, and that means better athletic (and don’t forget sexual) performance. Some studies suggest beet juice could give elite competitors the edge at the finish line (1).
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Diffusion Capacity and Mortality in Patients With Pulmonary
           Hypertension Due to Heart Failure With Preserved Ejection Fraction
    • Authors: Hoeper MM; Meyer K, Rademacher J, et al.
      Abstract: ObjectivesThis study sought to investigate the prognostic importance of a low diffusion capacity of the lung for carbon monoxide (DLCO) in patients with a catheter-based diagnosis of pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF).BackgroundIn patients with pulmonary arterial hypertension, a low DLCO is associated with poor outcome. It is unclear whether the same is true in patients with PH-HFpEF.MethodsThis study retrospectively analyzed clinical characteristics, smoking history, lung function measurements, chest computed tomography, hemodynamics, and survival in 108 patients with PH-HFpEF. The presence of post-capillary PH was determined by right heart catheterization. Patients with moderate or severe lung function abnormalities were excluded.ResultsOn the basis of previous studies and receiver-operating characteristic curve analysis, the study cohort was divided into patients with a DLCO 
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • The Lungs in Heart Failure Not an Innocent Bystander ∗
    • Authors: Borlaug BA; Olson TP.
      Abstract: The focus in heart failure with preserved ejection fraction (HFpEF) has historically centered on the heart, and afflicted patients clearly display abnormalities in left ventricular (LV) function that play a dominant role in the pathophysiology (1). Recent studies have identified important roles for structures outside of the heart, including the systemic vasculature, endothelium, kidneys, and skeletal muscle (1–4). Left heart disease also causes problems in the lungs in HFpEF. Pulmonary hypertension (PH) develops in a substantial number of patients with HFpEF, which may lead to right ventricular dysfunction and increased risk of death (5–7).
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • One Week of Daily Dosing With Beetroot Juice Improves Submaximal
           Endurance and Blood Pressure in Older Patients With
           Heart Failure and Preserved Ejection Fraction
    • Authors: Eggebeen J; Kim-Shapiro DB, Haykowsky M, et al.
      Abstract: ObjectivesThis study sought to determine whether a relatively low single dose or a week-long dosage of dietary inorganic nitrate could improve exercise tolerance in patients with heart failure with preserved ejection fraction (HFpEF).BackgroundExercise intolerance is the primary manifestation of HFpEF and is largely due to noncardiac factors that reduce oxygen delivery to active skeletal muscles. A recent study showed improved exercise capacity in patients with HFpEF after a single, acute dose of beetroot juice (BRJ) (12.9 mmol inorganic nitrate) while another recent study showed neutral and negative effects of an organic nitrate.MethodsTwenty HFpEF patients (69 ± 7 years of age ) were enrolled in an initial cross-over design comparing a single, acute dose of BRJ (6.1 mmol nitrate) to a nitrate-depleted placebo BRJ. A second phase, 1 week of daily doses, used an all-treated design in which patients consumed BRJ for an average of 7 days. The primary outcome of the study was submaximal aerobic endurance, measured as cycling time to exhaustion at 75% of measured maximal power output.ResultsNo adverse events were associated with the intervention. Submaximal aerobic endurance improved 24% after 1 week of daily BRJ dosing (p = 0.02) but was not affected by the single, acute dose of the BRJ compared to placebo. Consumption of BRJ significantly reduced resting systolic blood pressure and increased plasma nitrate and nitrite in both of the dosing schemes.ConclusionsOne week of daily dosing with BRJ (6.1 mmol inorganic nitrate) significantly improves submaximal aerobic endurance and blood pressure in elderly HFpEF patients.
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Volume Overload Profiles in Patients With Preserved and Reduced Ejection
           Fraction Chronic Heart Failure Are There Differences' A Pilot Study
    • Authors: Miller WL; Mullan BP.
      Abstract: ObjectivesThis study aimed to characterize volume profiles and their differences in heart failure (HF) patients with preserved (HFpEF) and reduced (HFrEF) ventricular systolic function.BackgroundThe extent and distribution of volume overload and the associated implications for volume management have not been studied in decompensated HFpEF compared with HFrEF.MethodsTotal blood volume (TBV) was quantitated using a standardized computer-based radiolabeled albumin dilution technique.ResultsTwenty HFpEF and 35 HFrEF patients were evaluated at hospital admission. TBV was expanded by 27 ± 21% (range -5.2% to 77%; p = 0.002) and 37 ± 25% (0% to 107%; p < 0.001), respectively, above normal volumes. Red cell mass (RBCM) was expanded in HFrEF (24 ± 31%; p = 0.004) but within normal limits in HFpEF (8 ± 34%; p = 0.660) with, however, large variability in both groups. RBCM excess was more prominent in HFrEF (63% vs. 45%) than the RBCM deficit in HFpEF (35% vs.14%). With diuresis, TBV decreased to 25 ± 20% (p = 0.029) in HFrEF but was not changed in HFpEF (18 ± 20% [p = 0.173]). Body weight declined 6.6 ± 4.4 kg in HFrEF and 10.5 ± 8.3 kg (p = 0.026) in HFpEF. Interstitial fluid losses accounted for 85 ± 13% (HFrEF) and 93 ± 6% (HFpEF) (p = 0.012) of total volume removed.ConclusionsTBV profiles differ between HFpEF and HFrEF patients with DCHF. Quantitated volume analysis revealed both significant RBCM (polycythemia) and plasma volume excess in HFrEF, whereas a higher RBCM deficit (true anemia) was demonstrated in HFpEF. Diuresis produced only a modest reduction in intravascular volumes with persistent hypervolemia in both groups at discharge, but overall more total body fluid was lost in HFpEF. These profile differences have implications for individualizing volume management.
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • “One Size Does Not Fit All” How to Individualize Decongestive
           Therapy Strategies in Heart Failure ∗
    • Abstract: Most admissions for acute heart failure (AHF) occur in patients with chronic heart failure (HF). Despite significant improvements in prognosis for patients with stable HF, there has been essentially no progress in the treatment of AHF. After admission for decompensation, data showed high short-term mortality rates of 11% to 15% (1). The prognosis does thus not differ between HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) (2). Most of these admissions are for clinical congestion, not hypotension nor shock, regardless of ejection fraction (1,2). Hypervolemia is a significant risk marker in HF and is linked to impaired prognosis (3). An important goal for decongestive treatment strategies is rapid attainment of stable euvolemic status. It is not clear to which extent values from euvolemic healthy persons are ideal for patients with HF (4). However, global and uncontrolled therapeutic interventions to reduce “increased” blood volume in decompensated HF can lead to excessive preload reduction, systemic hypoperfusion, and increased organ damage. Therefore, knowledge of a patient’s actual volume status is important to monitor decongestive therapies.
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Heart Failure Clinical Trials in East and Southeast Asia Understanding the
           Importance and Defining the Next Steps
    • Authors: Mentz RJ; Roessig L, Greenberg BH, et al.
      Abstract: Heart failure (HF) is a major and increasing global public health problem. In Asia, aging populations and recent increases in cardiovascular risk factors have contributed to a particularly high burden of HF, with outcomes that are poorer than those in the rest of the world. Representation of Asians in landmark HF trials has been variable. In addition, HF patients from Asia demonstrate clinical differences from patients in other geographic regions. Thus, the generalizability of some clinical trial results to the Asian population remains uncertain. In this article, we review differences in HF phenotype, HF management, and outcomes in patients from East and Southeast Asia. We describe lessons learned in Asia from recent HF registries and clinical trial databases and outline strategies to improve the potential for success in future trials. This review is based on discussions among scientists, clinical trialists, industry representatives, and regulatory representatives at the CardioVascular Clinical Trialist Asia Forum in Singapore on July 4, 2014.
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Reply Antibody-Based Protection of von Willebrand Factor Degradation
    • Authors: Bartoli C.
      Abstract: Thank you for the opportunity to respond to Dr. Lenting and colleagues. In our paper that examined doxycycline to reduce ADAMTS-13-mediated von Willebrand factor (vWF) degradation during left ventricular assist device (LVAD)-like shear stress (1), we referenced a recent paper by Rauch et al. (2).
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Prognosis in Patients With Takotsubo Cardiomyopathy
    • Authors: Stiermaier T; Thiele H, Eitel I.
      Abstract: Recently, increasing research efforts have been directed to the prognosis of patients with Takotsubo cardiomyopathy (TTC). Several study groups have published outcome data during the last year. A Swedish registry study found a 30-day mortality of 4.1% in 302 patients with TTC (1). The large International Takotsubo Registry included 1,750 patients, and it reported 5.9% mortality after 30 days (2). The rate of death during long-term follow-up was 5.6% per patient-year. Furthermore, our bicentric study in 286 prospectively identified TTC patients revealed 28-day, 1-year, and long-term mortality rates of 5.5%, 12.5%, and 24.7%, respectively (3). Of note, all these trials compared mortality in TTC with matched cohorts of patients with acute myocardial infarction or acute coronary syndrome, and found a similar risk of death (1–3). Long-term mortality in TTC even exceeded that of patients presenting with ST-segment elevation myocardial infarction in 1 study (3). These findings challenge the initial opinion of a favorable prognosis in TTC patients due to complete recovery of left ventricular dysfunction within days to weeks. Murugiah et al. (4) examined the United States Medicare database and reported 30-day and 1-year mortality rates of 2.5% and 6.9% for patients with principal TTC and 4.7% and 11.4% for patients with secondary TTC, respectively. These results illustrate the indisputable prognostic difference between principal and secondary TTC, which has also been demonstrated previously (5). However, the observed mortality in the overall TTC population is comparable to the aforementioned trials in unselected TTC patients, albeit at the lower end of the reported rates.
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Antibody-Based Protection of von Willebrand Factor Degradation
    • Authors: Lenting PJ; Denis CV, Susen S, et al.
      Abstract: Recently, Bartoli et al. (1) reported on the use of doxycycline to reduce ADAMTS-13-mediated von Willebrand factor degradation during supraphysiological shear stress. We have read their article with interest, noticing reference in their discussion to one of our recent publications that appeared in Thrombosis and Haemostasis(2). However, we would like to correct some significant misinterpretations of our data as cited by the investigators. Indeed, our antibody is referred to as a monoclonal antihuman ADAMTS-13 antibody. This is incorrect. In fact, we have reported on the discovery and characterization of a monoclonal antihuman von Willebrand factor antibody, designated Mab508. This is not only clearly written in the abstract, but our article also describes in detail the epitope within von Willebrand factor that is recognized by this antibody. Describing our antibody as being antihuman ADAMTS-13 is therefore an important oversight.
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Social Media Can It Reduce Heart Failure Events'
    • PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Bad Air Revisited
    • Authors: RuDusky BM.
      Abstract: The benefits of a respiratory filter researched by Vieira et al. (1) and the constructive editorial by Mentz and O’Brien (2) enhance the attention that has been given to the cardiovascular effects of air pollution.
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Reply Bad Air Revisited
    • Abstract: We thank Dr. RuDusky for taking an interest in our work. Our study was intended to address the role of a respiratory filter intervention during controlled pollution exposure in patients with heart failure (HF). In 2007, HF was associated with 39.4% of all hospitalizations due to cardiovascular diseases in Brazil, and it may be responsible for 6.3% of all causes of deaths in South America (1). Regarding hypertension, it is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality as long as it remains uncontrolled (2). A large body of evidence indicates that patients with hypertension are characterized by endothelial dysfunction (3). We excluded volunteers with uncontrolled hypertension because it could play an important role as a confounder and selection bias, especially in a small sample of patients with HF. Blood pressure (BP) was recorded during the initial pre-study evaluation and history and also at the beginning of each session. Uncontrolled hypertension was defined as an average systolic BP ≥140 mm Hg or an average diastolic BP ≥90 mm Hg, among those with diagnosed hypertension and who are currently using BP-lowering medication. As outlined in the article, patients with HF were receiving optimal medical therapy, and 2 volunteers from the control group were receiving beta-blocker therapy.
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Prognosis of Adults With Borderline Left Ventricular Ejection Fraction
    • Authors: Tsao CW; Lyass A, Larson MG, et al.
      Abstract: ObjectivesThis study sought to examine the association of a borderline left ventricular ejection fraction (LVEF) of 50% to 55% with cardiovascular morbidity and mortality in a community-based cohort.BackgroundGuidelines stipulate a LVEF >55% as normal, but the optimal threshold, if any, remains uncertain. The prognosis of a “borderline” LVEF, 50% to 55%, is unknown.MethodsThis study evaluated Framingham Heart Study participants who underwent echocardiography between 1979 and 2008 (n = 10,270 person-observations, mean age 60 years, 57% women). Using pooled data with up to 12 years of follow-up and multivariable Cox regression, we evaluated the associations of borderline LVEF and continuous LVEF with the risk of developing a composite outcome (heart failure [HF] or death; primary outcome) and incident HF (secondary outcome).ResultsDuring follow-up (median 7.9 years), HF developed in 355 participants, and 1,070 died. Among participants with an LVEF of 50% to 55% (prevalence 3.5%), rates of the composite outcome and HF were 0.24 and 0.13 per 10 years of follow-up, respectively, versus 0.16 and 0.05 in participants having a normal LVEF. In multivariable-adjusted analyses, LVEF of 50% to 55% was associated with increased risk of the composite outcome (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.05 to 1.80) and HF (HR: 2.15; 95% CI: 1.41 to 3.28). There was a linear inverse relationship of continuous LVEF with the composite outcome (HR per 5 LVEF% decrement: 1.12; 95% CI: 1.07 to 1.16) and HF (HR per 5 LVEF% decrement: 1.23; 95% CI: 1.15 to 1.32).ConclusionsPersons with an LVEF of 50% to 55% in the community have greater risk for morbidity and mortality relative to persons with an LVEF >55%. Additional studies are warranted to elucidate the optimal management of these individuals.
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Left Ventricular Ejection Fraction What Is “Normal”'
    • Authors: Fonarow GC; Hsu JJ.
      Abstract: As the population in the United States ages, the prevalence of heart failure (HF) continues to increase, with approximately 915,000 new HF cases diagnosed annually and >8 million people in the country projected to have HF by 2030 (1,2). Despite advances in medical and device therapy for HF over the past few decades, mortality from HF remains high, with approximately 50% mortality within 5 years of HF diagnosis (3). Additionally, the total costs of HF in the United States are projected to increase to $70 billion by 2030. Given the poor prognosis and growing financial costs of treating HF, the development of effective methods to prevent HF is crucial, and identifying populations at increased risk for developing HF may be the most efficient way to do so. The American College of Cardiology Foundation and American Heart Association (ACCF/AHA) guidelines classify these patients have having Class A or B HF; risk factors for developing HF are well-established and include hypertension, diabetes mellitus, metabolic syndrome, and atherosclerotic disease (4). The high prevalence of these conditions, however, begs the question of how we can narrow our focus to target the at risk population.
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Impaired Alveolar Capillary Membrane Diffusion A Recently Recognized
           Contributor to Exertional Dyspnea in Heart Failure With Preserved
           Ejection Fraction ∗
    • Authors: Kitzman DW; Guazzi M.
      Abstract: Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common form of HF (1). HFpEF patients frequently have episodic acute decompensation with symptomatic pulmonary and peripheral edema. But even when stable and well-compensated, HFpEF patients have severe exercise intolerance with exertional dyspnea and fatigue, and this is a major contributor to their impaired quality of life (2).
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Prolonged QRS in Heart Failure With Preserved Ejection Fraction Risk
           Marker and Therapeutic Target' ∗
    • Authors: Kelly JP; Daubert JP.
      Abstract: Clinical trials of therapeutic agents for heart failure with preserved ejection fraction (HFpEF) have yielded little beyond disappointment for physicians caring for these ubiquitous patients who comprise over one-half of the annual 1,000,000 heart failure (HF) discharges in the United States (1). The most recent and largest HFpEF trial, TOPCAT (Treatment Of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist), although nominally negative, may reveal insights into the risk of different patient subgroups. HFpEF has changed names, has struggled with identity crises, and likely reflects several different processes (2). Recently, the application of computerized analysis and grouping of phenotypic variables has suggested 3 subsets of patients with HFpEF (3). Phenotypically characterizing the heterogeneous constituents of the HFpEF syndrome into clinically meaningful groups may allow researchers and clinicians to move toward a future of precision medicine.
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Impaired Pulmonary Diffusion in Heart Failure With Preserved Ejection
    • Authors: Olson TP; Johnson BD, Borlaug BA.
      Abstract: ObjectivesThe purpose of this study was to compare measures of gas exchange at rest and during exercise in patients with heart failure and preserved ejection fraction (HFpEF) with age- and sex-matched control subjects.BackgroundPatients with HFpEF display elevation in left heart pressures, but it is unclear how this affects pulmonary gas transfer or its determinants at rest and during exercise.MethodsPatients with HFpEF (n = 20) and control subjects (n = 26) completed a recumbent cycle ergometry exercise test with simultaneous measurement of ventilation and gas exchange. Diffusion of the lungs for carbon monoxide (DLCO) and its subcomponents, pulmonary capillary blood volume (VC) and alveolar-capillary membrane conductance (DM), were measured at rest, and matched for low-intensity (20 W) and peak exercise. Stroke volume was measured by transthoracic echocardiography to calculate cardiac output.ResultsCompared with control subjects, patients with HFpEF displayed impaired diastolic function and reduced exercise capacity. Patients with HFpEF demonstrated a 24% lower DLCO at rest (11.0 ± 2.3 ml/mm Hg/min vs. 14.4 ± 3.3 ml/mm Hg/min; p < 0.01) related to reductions in both DM (18.1 ± 4.9 ml/mm Hg/min vs. 23.1 ± 9.1 ml/mm Hg/min; p = 0.04), and VC (45.9 ± 15.2. ml vs. 58.9 ± 16.2 ml; p = 0.01). DLCO was lower in patients with HFpEF compared with control subjects in all stages of exercise, yet its determinants showed variable responses. With low-level exercise, patients with HFpEF demonstrated greater relative increases in VC, coupled with heightened ventilatory drive and more severe symptoms of dyspnea compared with control subjects. At 20-W exercise, DM was markedly reduced in patients with HFpEF compared with control subjects. From 20 W to peak exercise, there was no further increase in VC in patients with HFpEF, which in tandem with reduced DM, led to a 30% reduction in DLCO at peak exercise (17.3 ± 4.2 ml/mm Hg/min vs. 24.7 ± 7.1 ml/mm Hg/min; p < 0.01).ConclusionsSubjects with HFpEF display altered pulmonary function and gas exchange at rest and especially during exercise, which contributes to exercise intolerance. Novel therapies that improve gas diffusion may be effective to improve exercise tolerance in patients with HFpEF.
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • QRS Duration Is a Predictor of Adverse Outcomes in Heart Failure
           With Preserved Ejection Fraction
    • Authors: Joseph J; Claggett BC, Anand IS, et al.
      Abstract: ObjectivesThis study examined the relationship between baseline QRS duration and clinical outcomes in subjects enrolled in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial.BackgroundHeart failure with preserved ejection fraction (HFPEF) is a heterogeneous clinical syndrome. Whether QRS duration identifies HFPEF subjects at an increased risk of adverse outcomes has not been well studied.MethodsQRS duration was analyzed as a dichotomous variable (≥120 ms or 
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Understanding Heart Failure With Mid-Range Ejection Fraction ∗
    • Authors: Lam CP; Teng T.
      Abstract: Heart failure (HF) with borderline or mid-range ejection fraction (HFmEF; 40% ≤EF 
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
  • Precipitating Clinical Factors, Heart Failure Characterization,
           and Outcomes in Patients Hospitalized With Heart Failure With
           Reduced, Borderline, and Preserved Ejection Fraction
    • Authors: Kapoor JR; Kapoor R, Ju C, et al.
      Abstract: ObjectivesThis study assessed the comparative frequency of precipitating clinical factors leading to hospitalization among heart failure (HF) patients with reduced, borderline, and preserved ejection fraction (EF)BackgroundThere are few data assessing the comparative frequency of clinical factors leading to HF among hospitalized among patients with reduced, borderline, and preserved EF.MethodsWe analyzed the factors potentially contributing to HF hospitalization among 99,825 HF admissions from 305 hospitals in the Get With The Guidelines-HF (GWTG-HF) database between January 2005 and September 2013 and assessed their association with length of stay and in-hospital mortality.ResultsMean patient age was 72.6 ± 14.2 years, 49% were female, and mean EF was 39.3 ± 17.2%. Common factors included pneumonia/respiratory process (28.2%), arrhythmia (21.7%), medication noncompliance (15.8%), worsening renal failure (14.7%), and uncontrolled hypertension (14.5%). In patients with borderline EF (EF 40% to 49%), pneumonia was associated with longer hospital stay, whereas dietary and medication noncompliance were associated with reduced length of stay. In patients with preserved EF (EF ≥50% or qualitative assessment of normal or mild dysfunction), pneumonia, weight gain, and worsening renal function were independently associated with longer lengths of stay. Worsening renal function and pneumonia were independently associated with higher in-hospital mortality in all HF groups, and acute pulmonary edema was associated with higher mortality in reduced EF. Dietary noncompliance (14.7%) was associated with reduced mortality for all groups but reached statistical significance in the subgroups of reduced (odds ratio [OR]: 0.65; 95% confidence interval [CI]: 0.46 to 0.91) and preserved systolic function (OR: 0.52; 95% CI: 0.33 to 0.83). Patients presenting with ischemia had a higher mortality rate (OR: 1.31; 95% CI: 1.02 to 1.69; and 1.72; 95% CI: 1.27 to 2.33, respectively, in the 2 groups).ConclusionsPotential precipitating factors among patients hospitalized with HF vary by EF group and are independently associated with clinical outcomes.
      PubDate: Wed, 01 Jun 2016 00:00:00 GMT
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