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Journal Cover JACC : Heart Failure
  [SJR: 4.318]   [H-I: 18]   [8 followers]  Follow
    
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   ISSN (Online) 2213-1779
   Published by Elsevier Homepage  [3042 journals]
  • Angiotensin Receptor Neprilysin Inhibition in Heart Failure With
           Preserved Ejection Fraction
    • Authors: Scott D. Solomon; Adel R. Rizkala; Jianjian Gong; Wenyan Wang; Inder S. Anand; Junbo Ge; Carolyn S.P. Lam; Aldo P. Maggioni; Felipe Martinez; Milton Packer; Marc A. Pfeffer; Burkert Pieske; Margaret M. Redfield; Jean L. Rouleau; Dirk J. Van Veldhuisen; Faiez Zannad; Michael R. Zile; Akshay S. Desai; Victor C. Shi; Martin P. Lefkowitz; John J.V. McMurray
      Pages: 471 - 482
      Abstract: Publication date: July 2017
      Source:JACC: Heart Failure, Volume 5, Issue 7
      Author(s): Scott D. Solomon, Adel R. Rizkala, Jianjian Gong, Wenyan Wang, Inder S. Anand, Junbo Ge, Carolyn S.P. Lam, Aldo P. Maggioni, Felipe Martinez, Milton Packer, Marc A. Pfeffer, Burkert Pieske, Margaret M. Redfield, Jean L. Rouleau, Dirk J. Van Veldhuisen, Faiez Zannad, Michael R. Zile, Akshay S. Desai, Victor C. Shi, Martin P. Lefkowitz, John J.V. McMurray
      Objectives The PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF With Preserved Ejection Fraction) trial is designed to determine the efficacy and safety of the angiotensin receptor neprilysin inhibitor sacubitril/valsartan compared with valsartan in patients with chronic heart failure and preserved ejection fraction (HFpEF). Background HFpEF is highly prevalent, associated with substantial morbidity and mortality, and in need of effective therapies that improve outcomes. The angiotensin receptor neprilysin inhibitor (ARNI) sacubitril/valsartan, which has been shown to benefit patients with heart failure (HF) and reduced ejection fraction, demonstrated favorable physiologic effects in a phase II HFpEF trial. Methods The PARAGON-HF trial is a randomized, double-blind, parallel group, active-controlled, event-driven trial comparing the long-term efficacy and safety of valsartan and sacubitril/valsartan in patients with chronic HFpEF (left ventricular ejection fraction ≥45%), New York Heart Association functional class II to IV symptoms, elevated natriuretic peptides, and evidence of structural heart disease. Before randomization, all patients entered sequential single-blind run-in periods to ensure tolerability of both drugs at half the target doses (i.e., valsartan titrated to 80 mg bid followed by sacubitril/valsartan 49/51 mg [100 mg] bid). The primary outcome is the composite of cardiovascular death and total (first and recurrent) HF hospitalizations. Conclusions PARAGON-HF will determine whether sacubitril/valsartan is superior to angiotensin receptor blockade alone in patients with chronic symptomatic HFpEF. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711)
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      PubDate: 2017-07-03T20:48:19Z
      DOI: 10.1016/j.jchf.2017.04.013
       
  • A History of Asthma From Childhood and Left Ventricular Mass in
           Asymptomatic Young Adults
    • Authors: Dianjianyi Sun; Tiange Wang; Yoriko Heianza; Jun Lv; Liyuan Han; Felicia Rabito; Tanika Kelly; Shengxu Li; Jiang He; Lydia Bazzano; Wei Chen; Lu Qi
      Pages: 497 - 504
      Abstract: Publication date: July 2017
      Source:JACC: Heart Failure, Volume 5, Issue 7
      Author(s): Dianjianyi Sun, Tiange Wang, Yoriko Heianza, Jun Lv, Liyuan Han, Felicia Rabito, Tanika Kelly, Shengxu Li, Jiang He, Lydia Bazzano, Wei Chen, Lu Qi
      Objectives This study aimed to examine whether a history of asthma from childhood is associated with left ventricular (LV) mass in adulthood. Background Asthma has been related to various cardiovascular risk factors affecting LV hypertrophy. The authors saw a need for a prospective study to analyze the relationship between a history of asthma from childhood and markers of LV mass among asymptomatic young adults. Methods Prospective analyses were performed among 1,118 Bogalusa Heart Study participants (average age at follow-up 36.7 ± 5.1 years), with a baseline history of self-reported asthma collected since childhood (average age at baseline 26.8 ± 10.1 years). LV mass (g) was assessed using 2-dimensional guided M-mode echocardiography and was indexed for body height (m2.7) as LV mass index (LVMI; g/m2.7). A multivariate linear mixed model was fitted for the repeated measures. Results After an average of 10.4 ± 7.5 years of follow-up, participants with a history of asthma from childhood had a greater LV mass (167.6 vs. 156.9; p = 0.01) and LVMI (40.7 vs. 37.7; p < 0.01) with adjustment for age, sex, race, smoking status, antihypertensive medication, heart rate, and systolic blood pressure (SBP). The difference of LVMI between group with asthma and the group without asthma remained significant after additional adjustment for body mass index (39.0 vs. 37.1; p = 0.03) and high-sensitivity C-reactive protein (38.4 vs. 36.6; p = 0.04). In addition, the authors found significant interactions between SBP and asthma on LV mass and LVMI (p for interaction <0.01, respectively). The associations between asthma and LV measures appeared to be stronger among pre-hypertensive and hypertensive participants (SBP ≥130 mm Hg) compared with participants with normal SBP (<130 mm Hg) (regression coefficient: 39.5 vs. 2.3 for LV mass and 9.0 vs. 0.9 for LVMI). Conclusions The findings of this study indicate that a history of asthma is associated with higher LVMI, and this association is stronger among participants with pre-hypertension and hypertension.
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      PubDate: 2017-07-03T20:48:19Z
      DOI: 10.1016/j.jchf.2017.03.009
       
  • Intersection of 2 Epidemics
    • Authors: John S. Gottdiener
      Pages: 505 - 506
      Abstract: Publication date: July 2017
      Source:JACC: Heart Failure, Volume 5, Issue 7
      Author(s): John S. Gottdiener
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      PubDate: 2017-07-03T20:48:19Z
      DOI: 10.1016/j.jchf.2017.05.003
       
  • Clinical Characteristics, Histopathological Features, and Clinical Outcome
           of Methamphetamine-Associated Cardiomyopathy
    • Authors: Stephan Schürer; Karin Klingel; Marcus Sandri; Nicolas Majunke; Christian Besler; Reinhard Kandolf; Philipp Lurz; Michael Luck; Pia Hertel; Gerhard Schuler; Axel Linke; Norman Mangner
      Pages: 435 - 445
      Abstract: Publication date: June 2017
      Source:JACC: Heart Failure, Volume 5, Issue 6
      Author(s): Stephan Schürer, Karin Klingel, Marcus Sandri, Nicolas Majunke, Christian Besler, Reinhard Kandolf, Philipp Lurz, Michael Luck, Pia Hertel, Gerhard Schuler, Axel Linke, Norman Mangner
      Objectives This study aimed to assess characteristics including endomyocardial biopsy and outcome of patients with methamphetamine (MA)-associated cardiomyopathy in a series of patients treated in Germany. Background MA abuse is an increasing problem worldwide. Methods The cases of 30 consecutive MA-abusing patients with a left ventricular (LV) ejection fraction of <40% and endomyocardial biopsy performed at initial diagnosis were analyzed. Baseline characteristics were collected retrospectively, whereas follow-up was prospective. The primary endpoint was a composite of death, nonfatal stroke, and rehospitalization for heart failure. Results Patients were 30.3 ± 1.9 years of age, predominantly male (93.3%), and highly symptomatic; 83.3% had New York Heart Association functional class III or IV dyspnea. Echocardiography revealed marked LV dilatation (mean LV end-diastolic diameter 67.1 ± 7.4 mm) and impaired LV ejection fraction (mean 19 ± 6%). One-third of the patients had intraventricular thrombi. Endomyocardial biopsy revealed markers of inflammation and fibrosis; the fibrosis correlated with the duration of MA abuse. At follow-up, discontinuation of MA abuse together with medical therapy partially improved cardiac function (LV ejection fraction, 19 ± 6 vs. 43 ± 13; p < 0.001) and symptoms (p = 0.056), whereas patients with continued abuse did not show any improvement. The improvement in cardiac function was independently associated with the extent of fibrosis. The primary endpoint occurred more often in patients with continued MA abuse (57.1% vs. 13.0%; p = 0.037). Conclusions MA-associated cardiomyopathy is characterized by severe heart failure and depressed cardiac function. The extent of myocardial fibrosis seems to predict the recoverability of LV function. Cessation of MA abuse is associated with improvement in cardiac function and symptoms, whereas continued MA abuse leads to ongoing heart failure and worse outcome.
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      PubDate: 2017-06-03T15:09:09Z
      DOI: 10.1016/j.jchf.2017.02.017
       
  • Breaking Bad
    • Authors: Tariq Ahmad; Jacob N. Schroder; James L. Januzzi
      Pages: 446 - 448
      Abstract: Publication date: June 2017
      Source:JACC: Heart Failure, Volume 5, Issue 6
      Author(s): Tariq Ahmad, Jacob N. Schroder, James L. Januzzi
      Graphical abstract image

      PubDate: 2017-06-03T15:09:09Z
      DOI: 10.1016/j.jchf.2017.03.008
       
  • Patients Not Meeting PARADIGM-HF Enrollment Criteria Are Eligible for
           Sacubitril/Valsartan on the Basis of FDA Approval
    • Authors: Antonio L. Perez; Veraprapas Kittipibul; W.H. Wilson Tang; Randall C. Starling
      Pages: 460 - 463
      Abstract: Publication date: June 2017
      Source:JACC: Heart Failure, Volume 5, Issue 6
      Author(s): Antonio L. Perez, Veraprapas Kittipibul, W.H. Wilson Tang, Randall C. Starling


      PubDate: 2017-06-03T15:09:09Z
      DOI: 10.1016/j.jchf.2017.03.007
       
  • Decreased Mortality With Beta-Blockers in Patients With Heart Failure and
           Coexisting Atrial Fibrillation
    • Authors: Bart A. Mulder; Dirk J. Van Veldhuisen; Michiel Rienstra
      Pages: 466 - 467
      Abstract: Publication date: June 2017
      Source:JACC: Heart Failure, Volume 5, Issue 6
      Author(s): Bart A. Mulder, Dirk J. Van Veldhuisen, Michiel Rienstra


      PubDate: 2017-06-03T15:09:09Z
      DOI: 10.1016/j.jchf.2017.03.010
       
  • All Roads Lead to Rome
    • Authors: Levent Cerit
      First page: 468
      Abstract: Publication date: June 2017
      Source:JACC: Heart Failure, Volume 5, Issue 6
      Author(s): Levent Cerit


      PubDate: 2017-06-03T15:09:09Z
      DOI: 10.1016/j.jchf.2017.02.010
       
  • Is Left Ventricular Ejection Fraction by Echo in Patients With Atrial
           Fibrillation Reliable'
    • Authors: Gang Huang; Junbo Xu; Tingjie Zhang
      Pages: 468 - 469
      Abstract: Publication date: June 2017
      Source:JACC: Heart Failure, Volume 5, Issue 6
      Author(s): Gang Huang, Junbo Xu, Tingjie Zhang


      PubDate: 2017-06-03T15:09:09Z
      DOI: 10.1016/j.jchf.2017.02.014
       
  • Long-Term Effect of Endothelin Receptor Antagonism With Bosentan on the
           Morbidity and Mortality of Patients With Severe Chronic Heart Failure
    • Authors: Milton Packer; John J.V. McMurray; Henry Krum; Wolfgang Kiowski; Barry M. Massie; Avi Caspi; Craig M. Pratt; Mark C. Petrie; David DeMets; Isaac Kobrin; Sebastien Roux; Karl Swedberg; Milton Packer; Avi Caspi; Wolfgang Kiowski; Henry Krum; Craig Pratt; Karl Swedberg; Barry Massie; John McMurray; John McMurray; Eugene Connally; Mark Petrie; David DeMets; Susan Anderson; Jody Barnet; Robert Cody; Henry Dargie; Gary Francis; Barry Greenberg; Juerg Reichen; J. Karrasch; H. Krum; J. Horowitz; J. Amerena; A. Sindone; P. MacDonald; I. Jeffrey; I. Button; E. DeAngelis; R. Pacher; R. Davies; F. McAlister; P. Tanser; B. Sussex; G. Baumann; E. Fleck; H.-G. Olbrich; K. Werdan; H. Klein; F. Staffeld; A.M. Zeiher; C. Roediger; A. Caspi; A. Marmor; L. Reisin; Z. Vered; E. Klainman; N. Roguin; D. Tzivoni; D. David; B. Lewis; E. Abinader; M. Omary; Y. Rosenman; E. Kaluski; R.W. Breedveld; P.H. van der Burgh; P.H.J.M. Dunselman; H.J. Schaafsma; D.P. Hertzberger; N.J. Holwerda; J.A. Kragten; J. van Wijngaarden; J.L. Posma; S.A.M. Said; L.C. Slegers; R.M. Tjon Joe Gin; F.N. Wempe; J.C.L. Wesdorp; A.R. Willems; A.J.A.M. Withagen; J.M. Cornel; L.H.J. van Kempen; W. Kiowski; O. Bertel; T. Moccetti; J.J.V. McMurray; R.A. Greenbaum; P. Bennett; J. Swan; G. Davies; I. Findlay; B. Gould; S. Ball; P. Hubner; A. Lahiri; J. McLay; R. Northcote; S. Saltissi; I. Squire; J. Stephens; M. Stewart; G. Bridgen; J. Walsh; D.J. Webb; Z. Ansari; S. Baron; R. Bellinger; W. Bennet; D. Benvenuti; D. Dawley; L.C. Egbujiobi; I. Eisenstein; T. Little; A. Hertsberg; M. Greenspan; R.J. Grossman; P. Hanley; M. Jesrani; H. Kashou; R. Levites; R. Malik; B. Marmorstein; M. Schwartz; A. Nisar; R. Perelman; M.L. Schwarz; S. Sedlis; J. Srebro; M. Taveras; R. Weiss; P. Weitzman; G.K. Wetherley; M. El Shahawy; D. Kereiakes; L. Campos; G. Peterson; R.S. Small; W.R. Davis; M.-T. Olivari; W. Meengs; M. Koren; P. Slagona; S. Jennison; R. Hershberger; K.F. Browne; D.J. Farnham; S. Zelenkofske; C. Lawless; M. Nathan; T. Meyer; M. Kukin; H. Parekh; R. Berkowitz; J. Boehmer; S. Brozena; P. Dandona; G.W. Dec; V. DeQuattro; P. Fenster; M. Fowler; S. Ellaham; M. Geller; M. Gheorgiade; J. Ghali; S. Murali; S. Katz; C. Bott-Silverman; B. Singh; U. Thadani; G. Torre; J. Teerlink; T. Chandraratna; M. Kesselbrenner; A. Mukherjee; C. Che-Pin Tsai; K. Abbo; M. Goldberg; T. Smith; R.T. Martin
      Pages: 317 - 326
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Milton Packer, John J.V. McMurray, Henry Krum, Wolfgang Kiowski, Barry M. Massie, Avi Caspi, Craig M. Pratt, Mark C. Petrie, David DeMets, Isaac Kobrin, Sebastien Roux, Karl Swedberg
      Objectives The objective of this clinical trial was to evaluate the long-term effect of endothelin receptor antagonism with bosentan on the morbidity and mortality of patients with severe chronic heart failure. Background Endothelin may play a role in heart failure, but short-term clinical trials with endothelin receptor antagonists have reported disappointing results. Long-term trials are lacking. Methods In 2 identical double-blind trials, we randomly assigned 1,613 patients with New York Heart Association functional class IIIb to IV heart failure and an ejection fraction <35% to receive placebo or bosentan (target dose 125 mg twice daily) for a median of 1.5 years. The primary outcome for each trial was clinical status at 9 months (assessed by the hierarchical clinical composite); the primary outcome across the 2 trials was death from any cause or hospitalization for heart failure. Results Bosentan did not influence clinical status at 9 months in either trial (p = 0.928 and p = 0.263). In addition, 321 patients in the placebo group and 312 patients in the bosentan group died or were hospitalized for heart failure (hazard ratio [HR]: 1.01; 95% confidence interval [CI]: 0.86 to 1.18; p = 0.90). The bosentan group experienced fluid retention within the first 2 to 4 weeks, as evidenced by increased peripheral edema, weight gain, decreases in hemoglobin, and an increased risk of hospitalization for heart failure, despite intensification of background diuretics. During follow-up, 173 patients died in the placebo group and 160 patients died in the bosentan group (HR: 0.94; 95% CI: 0.75 to 1.16). About 10% of the bosentan group showed meaningful increases in hepatic transaminases, but none had acute or chronic liver failure. Conclusions Bosentan did not improve the clinical course or natural history of patients with severe chronic heart failure and but caused early and important fluid retention.
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      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.02.021
       
  • Theory and Fact
    • Authors: Stephen S. Gottlieb
      Pages: 327 - 328
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Stephen S. Gottlieb
      Graphical abstract image

      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.03.005
       
  • The Influence of Age on Hemodynamic Parameters During Rest and Exercise
           in Healthy Individuals
    • Authors: Emil Wolsk; Rine Bakkestrøm; Jacob H. Thomsen; Louise Balling; Mads J. Andersen; Jordi S. Dahl; Christian Hassager; Jakob E. Møller; Finn Gustafsson
      Pages: 337 - 346
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Emil Wolsk, Rine Bakkestrøm, Jacob H. Thomsen, Louise Balling, Mads J. Andersen, Jordi S. Dahl, Christian Hassager, Jakob E. Møller, Finn Gustafsson
      Objectives In this study, the authors sought to obtain hemodynamic estimates across a wide age span and in both sexes for future reference and compare these estimates with current guideline diagnostic hemodynamic thresholds for abnormal filling pressure and pulmonary hypertension. Background At present, the influence of age on hemodynamic function is largely unknown. Because many diseases with proposed cardiac impact are more prevalent in the older population, it is pivotal to know how hemodynamic parameters are affected by age itself to discern the influence of disease from that of physiological aging. Methods Sixty-two healthy participants, evenly distributed with respect to age (20 to 80 years) and sex (32 women/30 men), were prospectively enrolled in the study. Participants were all deemed healthy by medical history, echocardiography, exercise test, spirometry, blood tests, and electrocardiogram. Participants had hemodynamic parameters measured using right heart catheterization during rest, passive leg raise, and incremental exercise. Results During rest, all hemodynamic parameters were similar between age groups, apart from blood pressure. During leg raise and incremental exercise, there was augmented filling pressure (p < 0.0001) and diminished cardiac output (p = 0.001) and hence a higher pressure:flow ratio (pulmonary artery pressure/capillary wedge pressure to cardiac output) with progressive age, evident from the earliest ages. All indexed hemodynamic measures were similar between sexes. The diagnostic threshold (pulmonary capillary wedge pressure ≥25 mm Hg) currently used during exercise testing to diagnose abnormal left ventricular filling pressure was measured in 30% of our healthy elderly participants. Conclusions Cardiac aging was progressive without sex differences in healthy participants. The hemodynamic reference values obtained suggest that the diagnostic threshold for abnormal filling pressure should be individually determined according to age of the patient.
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      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2016.10.012
       
  • Physical Activity, Obesity, and Subclinical Myocardial Damage
    • Authors: Roberta Florido; Chiadi E. Ndumele; Lucia Kwak; Yuanjie Pang; Kunihiro Matsushita; Jennifer A. Schrack; Mariana Lazo; Vijay Nambi; Roger S. Blumenthal; Aaron R. Folsom; Josef Coresh; Christie M. Ballantyne; Elizabeth Selvin
      Pages: 377 - 384
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Roberta Florido, Chiadi E. Ndumele, Lucia Kwak, Yuanjie Pang, Kunihiro Matsushita, Jennifer A. Schrack, Mariana Lazo, Vijay Nambi, Roger S. Blumenthal, Aaron R. Folsom, Josef Coresh, Christie M. Ballantyne, Elizabeth Selvin
      Objectives This study sought to evaluate the association of physical activity with chronic myocardial damage, assessed by elevated high-sensitivity cardiac troponin T (hs-cTnT), in individuals with and without obesity. Background Physical activity is associated with reduced risk of heart failure (HF), particularly among obese people. The role of chronic myocardial damage in this association is uncertain. Methods We studied 9,427 participants in the Atherosclerosis Risk in Communities Study without cardiovascular disease, with body mass index >18.5 kg/m2. Physical activity was categorized per American Heart Association guidelines as recommended, intermediate, or poor. We evaluated cross-sectional associations of physical activity and obesity with elevated hs-cTnT (≥14 ng/l). In prospective analyses, we quantified the association of elevated hs-cTnT with HF risk within cross-categories of baseline physical activity and obesity. Results People with poor physical activity were more likely to have elevated hs-cTnT than those with recommended levels (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 1.15 to 1.68). In cross-categories of physical activity and obesity, using the non-obese/recommended activity group as the reference, individuals with obesity and poor activity were most likely to have elevated hs-cTnT (OR: 2.46; 95% CI: 1.91 to 3.19), whereas the obese/recommended activity group had a weaker association (OR: 1.68; 95% CI: 1.28 to 2.21; p < 0.001 for interaction between physical activity and obesity). In prospective analyses, elevated hs-cTnT was strongly associated (p < 0.001) with incident HF in all obesity/physical activity cross-categories (p > 0.20 for interaction). Conclusions Physical activity is inversely associated with chronic subclinical myocardial damage. Physical activity might lessen the association between obesity and subclinical myocardial damage, which could represent a mechanism by which physical activity reduces HF risk.
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      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.02.002
       
  • Physical Activity Prevents Obesity and Heart Failure
    • Authors: Tariq Ahmad; Jeffrey M. Testani
      Pages: 385 - 387
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Tariq Ahmad, Jeffrey M. Testani
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      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.03.006
       
  • Impact of Current Versus Previous Cardiac Resynchronization Therapy
           Guidelines on the Proportion of Patients With Heart Failure Eligible for
           Therapy
    • Authors: Kristin J. Lyons; Justin A. Ezekowitz; Li Liang; Paul A. Heidenreich; Clyde W. Yancy; Adam D. DeVore; Adrian F. Hernandez; Gregg C. Fonarow
      Pages: 388 - 392
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Kristin J. Lyons, Justin A. Ezekowitz, Li Liang, Paul A. Heidenreich, Clyde W. Yancy, Adam D. DeVore, Adrian F. Hernandez, Gregg C. Fonarow
      Objectives This study sought to ascertain the impact of heart failure (HF) guideline change on the number of patients eligible to undergo cardiac resynchronization therapy (CRT). Background The 2013 HF guideline of the American College of Cardiology Foundation and American Heart Association (ACCF/AHA) narrowed the recommendations for CRT. The impact of this guideline change on the number of eligible patients for CRT has not been described. Methods Using data from Get With The Guidelines–Heart Failure between 2012 and 2015, this study evaluated the proportion of hospitalized patients with HF who were eligible for CRT on the basis of historical and current guideline recommendations. The authors identified 25,102 hospitalizations for HF that included patients with a left ventricular ejection fraction (LVEF) ≤35% from 283 hospitals. Patients with a medical, system-related, or patient-related reason for not undergoing CRT were excluded. Results Overall, 49.1% (n = 12,336) of patients with HF, an LVEF ≤35%, and no documented contraindication were eligible for CRT on the basis of historical guidelines, and 33.1% (n = 8,299) of patients were eligible for CRT on the basis of current guidelines, a 16.1% absolute reduction in eligibility (p < 0.0001). Patients eligible for CRT on the basis of current guidelines were more likely to have CRT with an implantable cardioverter-defibrillator or CRT with pacing only placed or prescribed at discharge (57.8% vs. 54.9%; p < 0.0001) compared with patients eligible for CRT on the basis of historical guidelines. Conclusions In this population of patients with HF, an LVEF ≤35%, and no documented contraindication for CRT, the current ACCF/AHA HF guidelines reduce the proportion of patients eligible for CRT by approximately 15%.
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      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.02.018
       
  • High Heart Failure Readmission Rates
    • Authors: Christopher M. O’Connor
      First page: 393
      Abstract: Publication date: May 2017
      Source:JACC: Heart Failure, Volume 5, Issue 5
      Author(s): Christopher M. O’Connor


      PubDate: 2017-04-28T16:43:11Z
      DOI: 10.1016/j.jchf.2017.03.011
       
  • Atrial Fibrillation in Heart Failure∗
    • Authors: Carolyn S.P. Lam; Michiel Rienstra; Wan Ting Tay; Licette C.Y. Liu; Yoran M. Hummel; Peter van der Meer; Rudolf A. de Boer; Isabelle C. Van Gelder; Dirk J. van Veldhuisen; Adriaan A. Voors; Elke S. Hoendermis
      Pages: 92 - 98
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Carolyn S.P. Lam, Bernadet T. Santema, Adriaan A. Voors
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      PubDate: 2017-07-12T21:18:38Z
      DOI: 10.1016/j.jchf.2016.10.005
       
  • The Transition From Hypertension to Heart Failure
    • Authors: Franz H Messerli; Urs Fischer; Stefano F Rimoldi; Sripal Bangalore
      First page: 153
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Franz H. Messerli, Stefano F. Rimoldi, Sripal Bangalore
      Longstanding hypertension ultimately leads to heart failure (HF), and as a consequence most patients with HF have a history of hypertension. Conversely, absence of hypertension in middle age is associated with lower risks for incident HF across the remaining life course. Cardiac remodeling to a predominant pressure overload consists of diastolic dysfunction and concentric left ventricular (LV) hypertrophy. When pressure overload is sustained, diastolic dysfunction progresses, filling of the concentric remodeled LV decreases, and HF with preserved ejection fraction ensues. Diastolic dysfunction and HF with preserved ejection fraction are the most common cardiac complications of hypertension. The end stage of hypertensive heart disease results from pressure and volume overload and consists of dilated cardiomyopathy with both diastolic dysfunction and reduced ejection fraction. “Decapitated hypertension” is a term used to describe the decrease in blood pressure resulting from reduced pump function in HF. Progressive renal failure, another complication of longstanding hypertension, gives rise to the cardiorenal syndrome (HF and renal failure). The so-called Pickering syndrome, a clinical entity consisting of flash pulmonary edema and bilateral atheromatous renovascular disease, is a special form of the cardiorenal syndrome. Revascularization of renal arteries is the treatment of choice. Most antihypertensive drug classes when used as initial therapy decelerate the transition from hypertension to HF, although not all of them are equally efficacious. Low-dose, once daily hydrochlorothiazide should be avoided, but long-acting thiazide-like diuretics chlorthalidone and indapamide seem to have an edge over other antihypertensive drugs in preventing HF.
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      PubDate: 2017-07-12T21:18:38Z
      DOI: 10.1016/s0140-6736(17)30017-x
       
  • Development of Acute Decompensated Heart Failure Therapies
    • Authors: Paul D. Smith; Paul Mross; Nate Christopher
      Pages: 118 - 126
      Abstract: Publication date: June 2017
      Source:JACC: Heart Failure, Volume 5, Issue 6
      Author(s): Christopher M. O’Connor


      PubDate: 2017-06-03T15:09:09Z
      DOI: 10.1016/j.ctim.2017.01.007
       
  • The Fastest Way to the Failing Heart Is Through the Kidneys∗
    • Authors: Jozine M. ter Maaten; Aldo Pietro Maggioni; Roberto Latini; Serge Masson; Gianni Tognoni; Luigi Tavazzi; Stefano Signorini; Adriaan A. Voors; Kevin Damman
      Pages: 189 - 195
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Kevin Damman, Adriaan A. Voors
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      PubDate: 2017-07-12T21:18:38Z
      DOI: 10.1016/j.ahj.2017.01.017
       
  • Intrarenal Flow Alterations During Transition From Euvolemia to
           Intravascular Volume Expansion in Heart Failure Patients
    • Authors: Petra Nijst; Frederik H. Verbrugge; Pieter Martens; Matthias Dupont; W.H. Wilson Tang; Wilfried Mullens
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Petra Nijst, Pieter Martens, Matthias Dupont, W.H. Wilson Tang, Wilfried Mullens
      Objectives The goal of this study was to assess: 1) the intrarenal flow in heart failure (HF) patients during the transition from euvolemia to intravascular volume overload; and 2) the relationship between intrarenal flow and diuretic efficiency. Background Intrarenal blood flow alterations may help to better understand impaired volume handling in HF. Methods Resistance index (RI) and venous impedance index (VII) were assessed in 6 healthy subjects, 40 euvolemic HF patients with reduced ejection fraction (HFrEF) and 10 HF patients with preserved ejection fraction (HFpEF). Assessments were performed by using Doppler ultrasonography at baseline, during 3 h of intravascular volume expansion with 1 l of hydroxyethyl starch 6%, and 1 h after the administration of a loop diuretic. Clinical parameters, echocardiography, and biochemistry were assessed. Urine output was collected after 3 and 24 h. Results In response to volume expansion, VII increased significantly in HFrEF patients (0.4 ± 0.3 to 0.7 ± 0.2; p < 0.001) and in HFpEF patients (0.4 ± 0.3 to 0.7 ± 0.2; p = 0.002) but not in healthy subjects (0.2 ± 0.2 to 0.3 ± 0.1; p = 0.622). This outcome was reversed after loop diuretic administration. In contrast, RI did not change significantly after volume expansion. Echocardiographic-estimated filling pressures did not change significantly. VII during volume expansion was significantly correlated with diuretic response in HF patients independent of baseline renal function (R2 = 0.35; p < 0.001). Conclusions In HF patients, intravascular volume expansion resulted in significant blunting of venous flow before a significant increase in cardiac filling pressures could be demonstrated. The observed impaired renal venous flow is correlated with less diuretic efficiency. Intrarenal venous flow patterns may be of interest for evaluating renal congestion.
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      PubDate: 2017-07-12T21:18:38Z
      DOI: 10.1016/j.ijcard.2017.05.041
       
  • Atrial Fibrillation in Heart Failure With Preserved, Mid-Range, and
           Reduced Ejection Fraction
    • Authors: Ulrik Sartipy; Ulf Michael Lars Lund
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Ulrik Sartipy, Ulf Dahlström, Michael Fu, Lars H. Lund
      Objectives The study sought to assess the independent risk factors for, consequences of, and outcomes with atrial fibrillation (AF) compared with sinus rhythm (SR) in heart failure (HF) with preserved ejection fraction (HFpEF) versus HF with mid-range ejection fraction (HFmrEF) versus HF with reduced ejection fraction (HFrEF). Background AF is common in HF, but most data are from HFrEF. The importance of AF in HFpEF and MFmrEF is less well known. Methods In patients from 2000 to 2012 in the SwedeHF (Swedish Heart Failure Registry) registry, enriched with patient-level data from national health care registries, the authors assessed prevalence of, associations with and prognostic impact of AF in HFpEF versus HFmrEF versus HFrEF. Results Of 41,446 patients, 23% had HFpEF, 22% had HFmrEF, and 55% had HFrEF. The prevalence of AF was 65%, 60%, and 53% in HFpEF, HFmrEF, and HFrEF, respectively. Independent associations with AF were similar in HFpEF, HFmrEF, and HFrEF and included greater age, male, duration of HF, prior myocardial infarction, and prior stroke or transient ischemic attack (TIA). The adjusted hazard ratios for AF versus SR in HFpEF, HFmrEF, and HFrEF were the following: for death, 1.11 (95% confidence interval [CI]: 1.02 to 1.21), 1.22 (95% CI: 1.12 to 1.33), and 1.17 (95% CI: 1.11 to 1.23); for HF hospitalization or death, 1.17 (95% CI: 1.09 to 1.26), 1.29 (95% CI: 1.20 to 1.40), and 1.15 (95% CI: 1.10 to 1.20); and for stroke or TIA or death, 1.15 (95% CI: 1.07 to 1.25), 1.23 (95% CI: 1.13 to 1.34), and 1.19 (95% CI: 1.14 to 1.26). Conclusions AF was progressively more common with increasing ejection fraction, but was associated with similar clinical characteristics in HFpEF, HFmrEF, and HFrEF. AF was associated with similarly increased risk of death, HF hospitalization, and stroke or TIA in all ejection fraction groups. In contrast, AF and SR populations were considerably different regarding associated patient characteristics and outcomes.
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      PubDate: 2017-07-12T21:18:38Z
       
  • The Paradox in Demonstrating Hydralazine-Nitrate Efficacy∗
    • Authors: Jay Cohn
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Jay N. Cohn
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      PubDate: 2017-07-12T21:18:38Z
       
  • Clinical Effectiveness of Hydralazine–Isosorbide Dinitrate in
           African-American Patients With Heart Failure
    • Authors: Boback Ziaeian; Gregg Fonarow Paul Heidenreich
      Abstract: Publication date: Available online 12 July 2017
      Source:JACC: Heart Failure
      Author(s): Boback Ziaeian, Gregg C. Fonarow, Paul A. Heidenreich
      Objectives This study sought to evaluate the effectiveness of hydralazine–isosorbide dinitrate (H-ISDN) in African Americans with heart failure (HF) with reduced ejection fraction (HFrEF). Background Among African-American patients with HFrEF, H-ISDN was found to improve quality of life and lower HF-related hospitalization and mortality rates in the A-HEFT (African-American Heart Failure Trial). Few studies have evaluated the effectiveness of this therapy in clinical practice. Methods Veterans Affairs patients with a hospital admission for HF between 2007 and 2013 were screened. Inclusion criteria included African-American race, left ventricular ejection fraction <40%, and receipt of Veterans Affairs medications. Exclusions were documented contraindications to H-ISDN, creatinine >2.0 mg/dl, or intolerance to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Adjusted hazard ratios were calculated for patients who received H-ISDN 6-months before admission compared with patients who did not receive H-ISDN, by using inverse probability weighting of propensity scores and a time to death analysis for 18 months of follow-up. Propensity scores were generated using patients’ characteristics, left ventricular ejection fraction, laboratory values, and hospital characteristics. Results The final cohort included 5,168 African-American patients with HF (mean age 65.2 years), with 15.2% treated with H-ISDN before index admission. After 18 months, there were 1,275 reported deaths (24.7%). The adjusted mortality rate at 18 months was 22.1% for patients receiving H-ISDN treatment and 25.2% for untreated patients (p = 0.009); adjusted hazard ratio: 0.85 (95% confidence interval: 0.73 to 1.00; p = 0.057). Conclusions H-ISDN remains underused in African-American patients with HFrEF. In this cohort, the study found that H-ISDN use was associated with lower mortality rates in African-American patients with HFrEF when controlling for patient selection by using an inverse probability weighting of propensity scores.

      PubDate: 2017-07-12T21:18:38Z
       
  • Instructions For Authors
    • Abstract: Publication date: July 2017
      Source:JACC: Heart Failure, Volume 5, Issue 7


      PubDate: 2017-07-03T20:48:19Z
       
  • A Decade With Editorial Mentors
    • Authors: Christopher
      Abstract: Publication date: July 2017
      Source:JACC: Heart Failure, Volume 5, Issue 7
      Author(s): Christopher M. O’Connor


      PubDate: 2017-07-03T20:48:19Z
       
  • Biomarker Profiles of Acute Heart Failure Patients With a Mid-Range
           Ejection Fraction
    • Authors: Jasper Tromp; Mohsin A.F. Khan; Robert J. Mentz; Christopher M. O’Connor; Marco Metra; Howard C. Dittrich; Piotr Ponikowski; John R. Teerlink; Gad Cotter; Beth Davison; John G.F. Cleland; Michael M. Givertz; Daniel M. Bloomfield; Dirk J. van Veldhuisen; Hans L. Hillege; Adriaan A. Voors; Peter van der Meer
      Abstract: Publication date: Available online 14 June 2017
      Source:JACC: Heart Failure
      Author(s): Jasper Tromp, Mohsin A.F. Khan, Robert J. Mentz, Christopher M. O’Connor, Marco Metra, Howard C. Dittrich, Piotr Ponikowski, John R. Teerlink, Gad Cotter, Beth Davison, John G.F. Cleland, Michael M. Givertz, Daniel M. Bloomfield, Dirk J. van Veldhuisen, Hans L. Hillege, Adriaan A. Voors, Peter van der Meer
      Objectives In this study, the authors used biomarker profiles to characterize differences between patients with acute heart failure with a midrange ejection fraction (HFmrEF) and compare them with patients with a reduced (heart failure with a reduced ejection fraction [HFrEF]) and preserved (heart failure with a preserved ejection fraction [HFpEF]) ejection fraction. Background Limited data are available on biomarker profiles in acute HFmrEF. Methods A panel of 37 biomarkers from different pathophysiological domains (e.g., myocardial stretch, inflammation, angiogenesis, oxidative stress, hematopoiesis) were measured at admission and after 24 h in 843 acute heart failure patients from the PROTECT trial. HFpEF was defined as left ventricular ejection fraction (LVEF) of ≥50% (n = 108), HFrEF as LVEF of <40% (n = 607), and HFmrEF as LVEF of 40% to 49% (n = 128). Results Hemoglobin and brain natriuretic peptide levels (300 pg/ml [HFpEF]; 397 pg/ml [HFmrEF] 521 pg/ml [HFrEF]; ptrend <0.001) showed an upward trend with decreasing LVEF. Network analysis showed that in HFrEF interactions between biomarkers were mostly related to cardiac stretch, whereas in HFpEF, biomarker interactions were mostly related to inflammation. In HFmrEF, biomarker interactions were both related to inflammation and cardiac stretch. In HFpEF and HFmrEF (but not in HFrEF), remodeling markers at admission and changes in levels of inflammatory markers across the first 24 h were predictive for all-cause mortality and rehospitalization at 60 days (pinteraction <0.05). Conclusions Biomarker profiles in patients with acute HFrEF were mainly related to cardiac stretch and in HFpEF related to inflammation. Patients with HFmrEF showed an intermediate biomarker profile with biomarker interactions between both cardiac stretch and inflammation markers. (PROTECT-1: A Study of the Selective A1 Adenosine Receptor Antagonist KW-3902 for Patients Hospitalized With Acute HF and Volume Overload to Assess Treatment Effect on Congestion and Renal Function; NCT00328692)
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      PubDate: 2017-06-18T16:00:19Z
      DOI: 10.1016/j.jchf.2017.04.007
       
  • Modifiable Risk Factors for Incident Heart Failure in Atrial
           Fibrillation
    • Authors: Neal A. Chatterjee; Claudia U. Chae; Eunjung Kim; M. Vinayaga Moorthy; David Conen; Roopinder K. Sandhu; Nancy R. Cook; I-Min Lee; Christine M. Albert
      Abstract: Publication date: Available online 14 June 2017
      Source:JACC: Heart Failure
      Author(s): Neal A. Chatterjee, Claudia U. Chae, Eunjung Kim, M. Vinayaga Moorthy, David Conen, Roopinder K. Sandhu, Nancy R. Cook, I-Min Lee, Christine M. Albert
      Objectives This study sought to identify modifiable risk factors and estimate the impact of risk factor modification on heart failure (HF) risk in women with new-onset atrial fibrillation (AF). Background Incident HF is the most common nonfatal event in patients with AF, although strategies for HF prevention are lacking. Methods We assessed 34,736 participants in the Women’s Health Study who were free of prevalent cardiovascular disease at baseline. Cox models with time-varying assessment of risk factors after AF diagnosis were used to identify significant modifiable risk factors for incident HF. Results Over a median follow-up of 20.6 years, 1,495 women developed AF without prevalent HF. In multivariable models, new-onset AF was associated with an increased risk of HF (hazard ratio [HR]: 9.03; 95% confidence interval [CI]: 7.52 to 10.85). Once women with AF developed HF, all-cause (HR: 1.83; 95% CI: 1.37 to 2.45) and cardiovascular mortality (HR: 2.87; 95% CI: 1.70 to 4.85) increased. In time-updated, multivariable models accounting for changes in risk factors after AF diagnosis, systolic blood pressure >120 mm Hg, body mass index ≥30 kg/m2, current tobacco use, and diabetes mellitus were each associated with incident HF. The combination of these 4 modifiable risk factors accounted for an estimated 62% (95% CI: 23% to 83%) of the population-attributable risk of HF. Compared with women with 3 or 4 risk factors, those who maintained or achieved optimal risk factor control had a progressive decreased risk of HF (HR for 2 risk factors: 0.60; 95% CI: 0.37 to 0.95; 1 risk factor: 0.40; 95% CI: 0.25 to 0.63; and 0 risk factors: 0.14; 95% CI: 0.07 to 0.29). Conclusions In women with new-onset AF, modifiable risk factors including obesity, hypertension, smoking, and diabetes accounted for the majority of the population risk of HF. Optimal levels of modifiable risk factors were associated with decreased HF risk. Prospective assessment of risk factor modification at the time of AF diagnosis may warrant future investigation.
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      PubDate: 2017-06-18T16:00:19Z
      DOI: 10.1016/j.jchf.2017.04.004
       
  • Time to Take the Failure Out of Heart Failure
    • Authors: John G.F. Cleland; Pierpaolo Pellicori; Andrew L. Clark; Mark C. Petrie
      Abstract: Publication date: Available online 14 June 2017
      Source:JACC: Heart Failure
      Author(s): John G.F. Cleland, Pierpaolo Pellicori, Andrew L. Clark, Mark C. Petrie
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      PubDate: 2017-06-18T16:00:19Z
      DOI: 10.1016/j.jchf.2017.04.003
       
  • The Changing Landscape of Atrial Fibrillation
    • Authors: Darae Ko; Renate B. Schnabel; Ludovic Trinquart; Emelia J. Benjamin
      Abstract: Publication date: Available online 14 June 2017
      Source:JACC: Heart Failure
      Author(s): Darae Ko, Renate B. Schnabel, Ludovic Trinquart, Emelia J. Benjamin
      Graphical abstract image

      PubDate: 2017-06-18T16:00:19Z
      DOI: 10.1016/j.jchf.2017.05.002
       
  • Progression to Stage D Heart Failure Among Outpatients With Stage C Heart
           Failure and Reduced Ejection Fraction
    • Authors: Andreas P. Kalogeropoulos; Ayman Samman-Tahhan; Jeffrey S. Hedley; Andrew A. McCue; Jonathan B. Bjork; David W. Markham; Kunal N. Bhatt; Vasiliki V. Georgiopoulou; Andrew L. Smith; Javed Butler
      Abstract: Publication date: Available online 14 June 2017
      Source:JACC: Heart Failure
      Author(s): Andreas P. Kalogeropoulos, Ayman Samman-Tahhan, Jeffrey S. Hedley, Andrew A. McCue, Jonathan B. Bjork, David W. Markham, Kunal N. Bhatt, Vasiliki V. Georgiopoulou, Andrew L. Smith, Javed Butler
      Objectives This study sought to estimate the rate of progression to Stage D heart failure (HF) among outpatients with Stage C HF and to identify risk factors for progression. Background The pool of patients who may be candidates for advanced HF therapies is growing. Methods We estimated 3-year progression to clinically determined Stage D HF and competing mortality among 964 outpatients with Stage C heart failure with reduced ejection fraction (HFrEF), where ejection fraction is ≤40%. Results The mean age of patients was 62 ± 15 years; 35% were women; 47% were white; 46% were black, and 7% were of other races; median baseline ejection fraction was 28% (25th to 75th percentile: 20% to 35%); and 47% had ischemic heart disease. After 3.0 years (25th to 75th percentile: 1.7 to 3.2 years), 112 patients progressed to Stage D (3-year incidence: 12.2%; 95% confidence interval [CI]: 10.2% to 14.6%; annualized: 4.5%; 95% CI: 3.8% to 5.5%), and 116 patients died before progression (3-year competing mortality: 12.9%; annualized: 4.7%; 95% CI: 3.9% to 5.6%). By 3 years, 25.1% of patients (95% CI: 22.2% to 28.1%) had either progressed to Stage D or died (annualized: 9.2%; 95% CI: 8.1% to 10.5%). Annualized progression rates were higher in black versus white patients (6.3% vs. 2.7%, respectively; p < 0.001), nonischemic versus ischemic patients (6.1% vs. 2.9%, respectively; p < 0.001), and in New York Heart Association functional class III to IV versus I to II patients (7.5% vs. 1.9%, respectively; p < 0.001) but were similar for men and women (4.7% vs. 4.2%, respectively; p = 0.53). Lower ejection fraction and blood pressure, renal and hepatic dysfunction, and chronic lung disease rates were additional predictors of progression. Predictors of competing mortality were different from those of disease progression. Conclusions Among patients with Stage C HFrEF receiving care in a referral center, 4.5% progressed to Stage D HF each year, with earlier progression among black and nonischemic patients. These findings have implications for healthcare planning and resource allocation for these patients.
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      PubDate: 2017-06-18T16:00:19Z
      DOI: 10.1016/j.jchf.2017.02.020
       
  • Reply
    • Authors: Julia Cadrin-Tourigny; Azadeh Shohoudi Denis Roy Paul Khairy
      Abstract: Publication date: June 2017
      Source:JACC: Heart Failure, Volume 5, Issue 6
      Author(s): Julia Cadrin-Tourigny, Azadeh Shohoudi, Denis Roy, Paul Khairy


      PubDate: 2017-06-03T15:09:09Z
       
  • Tetralogy of Fallow
    • Authors: Milton Packer
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Milton Packer
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      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.03.004
       
  • Do We Need Another Walking Test?∗
    • Authors: Clinton A. Brawner; Steven J. Keteyian
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Clinton A. Brawner, Steven J. Keteyian
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      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.03.001
       
  • Holding the Readmission Gates
    • Authors: Gregg C. Fonarow; Boback Ziaeian
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Gregg C. Fonarow, Boback Ziaeian
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      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.04.002
       
  • Can Heart Failure With Preserved Ejection Fraction Shed Light on the
           Mortality-Readmissions Paradox?∗
    • Authors: Jennifer
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Jennifer E. Ho
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      PubDate: 2017-05-14T19:07:41Z
       
  • Race/Ethnic Differences in Outcomes Among Hospitalized Medicare Patients
           With Heart Failure and Preserved Ejection Fraction
    • Authors: Boback Ziaeian; Paul A. Heidenreich; Haolin Xu; Adam D. DeVore; Roland A. Matsouaka; Adrian F. Hernandez; Deepak L. Bhatt; Clyde W. Yancy; Gregg C. Fonarow
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Boback Ziaeian, Paul A. Heidenreich, Haolin Xu, Adam D. DeVore, Roland A. Matsouaka, Adrian F. Hernandez, Deepak L. Bhatt, Clyde W. Yancy, Gregg C. Fonarow
      Objectives This study analyzed HFpEF patient characteristics and clinical outcomes according to race/ethnicity and adjusted for patient and hospital characteristics along with socioeconomic status (SES). Background The proportion of hospitalizations for heart failure with preserved ejection fraction (HFpEF) has increased over the last decade. Whether the short- and long-term outcomes differ between racial/ethnic groups is not well described. Methods The Get With The Guidelines–Heart Failure registry was linked to Medicare administrative data to identify hospitalized patients with HFpEF ≥65 years of age with left ventricular ejection fraction ≥50% between 2006 and 2014. Cox proportional hazards models were used to report hazard ratios (HRs) for 30-day and 1-year readmission and mortality rates with sequential adjustments for patient characteristics, hospital characteristics, and SES. Results The final cohort included 53,065 patients with HFpEF. Overall 30-day mortality was 5.87%; at 1 year, it was 33.1%. The 30-day all-cause readmission rate was 22.2%, and it was 67.0% at 1 year. After adjusting for patient characteristics, hospital characteristics, and SES, 30-day mortality was lower for black patients (HR: 0.84; 95% confidence interval [CI]: 0.71 to 0.98; p = 0.031) and Hispanic patients (HR: 0.78; 95% CI: 0.64 to 0.96; p = 0.017) compared with white patients. One-year mortality was lower for black patients (HR: 0.93; 95% CI: 0.87 to 0.99; p = 0.031), Hispanic patients (HR: 0.83; 95% CI: 0.75 to 0.91; p < 0.001), and Asian patients (HR: 0.76; 95% CI: 0.66 to 0.88; p < 0.001) compared with white patients. Black patients had a higher risk of readmission at 30 days (HR: 1.09; 95% CI: 1.02 to 1.16; p = 0.012) and 1 year (HR: 1.14; 95% CI: 1.09 to 1.20; p < 0.001) compared with white patients. Conclusions Black, Hispanic, and Asian patients had a lower mortality risk after a hospitalization for HFpEF compared with white patients; black patients had higher readmission rates. These differences in mortality and readmission risk according to race/ethnicity persisted after adjusting for patient characteristics, SES, and hospital factors.
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      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.02.012
       
  • Associations Between Short or Long Length of Stay and 30-Day Readmission
           and Mortality in Hospitalized Patients With Heart Failure
    • Authors: Maneesh Sud; Bing Yu; Harindra C. Wijeysundera; Peter C. Austin; Dennis T. Ko; Juarez Braga; Peter Cram; John A. Spertus; Michael Domanski; Douglas S. Lee
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Maneesh Sud, Bing Yu, Harindra C. Wijeysundera, Peter C. Austin, Dennis T. Ko, Juarez Braga, Peter Cram, John A. Spertus, Michael Domanski, Douglas S. Lee
      Objectives This study sought to examine the associations between heart failure (HF)-related hospital length of stay and 30-day readmissions and HF hospital length of stay and mortality rates. Background Although reducing HF readmission and mortality rates are health care priorities, how HF-related hospital length of stay affects these outcomes is not fully known. Methods A population-level, multicenter cohort study of 58,230 patients with HF (age >65 years) was conducted in Ontario, Canada between April 1, 2003 and March 31, 2012. Results When length of stay was modeled as continuous variable, its association with the rate of cardiovascular readmission was nonlinear (p < 0.001 for nonlinearity) and U-shaped. When analyzed as a categorical variable, there was a higher rate of cardiovascular readmission for short (1 to 2 days; adjusted hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 1.04 to 1.21; p = 0.003) and long (9 to 14 days; HR: 1.11; 95% CI: 1.04 to 1.19; p = 0.002) lengths of stay as compared with 5 to 6 days (reference). Hospital readmissions for HF demonstrated a similar nonlinear (p = 0.005 for nonlinearity) U-shaped relationship with increased rates for short (HR: 1.15; 95% CI: 1.04 to 1.27; p = 0.006) and long (HR: 1.14; 95% CI: 1.04 to 1.25; p = 0.004) lengths of stay. Noncardiovascular readmissions demonstrated increased rates with long (HR: 1.17; 95% CI: 1.07 to 1.29; p < 0.001) and decreased rates with short (HR: 0.87; 95% CI: 0.79 to 0.96; p = 0.006) lengths of stay (p = 0.53 for nonlinearity). The 30-day mortality risk was highest after a long length of stay (HR: 1.28; 95% CI: 1.14 to 1.43; p < 0.001). Conclusions A short length of stay after hospitalization for HF is associated with increased rates of cardiovascular and HF readmissions but lower rates of noncardiovascular readmissions. A long length of stay is associated with increased rates of all types of readmission and mortality.
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      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.03.012
       
  • A New Clinically Applicable Measure of Functional Status in Patients With
           Heart Failure
    • Authors: Kristie M. Harris; David S. Krantz; Willem J. Kop; Joanne Marshall; Shawn W. Robinson; Jennifer M. Marshall; Stephen S. Gottlieb
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Kristie M. Harris, David S. Krantz, Willem J. Kop, Joanne Marshall, Shawn W. Robinson, Jennifer M. Marshall, Stephen S. Gottlieb
      Objectives This study reports the development and predictive value of the 60-foot walk test (60ftWT), a brief functional status measure for patients with heart failure (HF). The goal was to develop a test suitable for clinical settings and appropriate for patients with walking impairments. Background The 6-min walk test (6MWT) has considerable predictive value, but requires a long walking course and has limited utility in patients with mobility-related comorbidities. A shorter, more clinically practical test is therefore needed. Methods A total of 144 patients (age 57.4 ± 11.4 years; 111 males) with symptomatic HF received baseline assessments using the 60ftWT, 6MWT, and self-reported symptom and health status. Patients were tested 3 months later to determine stability of assessments. HF hospitalizations or death from any cause were recorded for 3.5 years following baseline. Results Median 60ftWT completion time was 26 seconds (interquartile range: 22 to 31). Longer 60ftWT time was associated with shorter 6MWT distance (r = -0.75; p < 0.001), and with higher symptom severity at baseline (r = –0.40; p < 0.001). Longer 60ftWT times also predicted increases in 6MWT and symptoms from baseline to 3 months (p < 0.01). Both WTs predicted long-term clinical outcomes, with patients taking longer than 31 seconds to complete the 60ftWT at greatest risk for HF hospitalization or death (hazard ratio: 2.13; 95% confidence interval: 1.18 to 3.84; p = 0.01). Conclusions The 60ftWT is an easily administered functional status measure that predicts adverse events, symptoms, and health status. It has the potential for considerable clinical utility to help identify patients at risk for future events and to calibrate treatments designed to improve functional status and quality of life.
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      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.02.005
       
  • Long-Term Effects of Flosequinan on the Morbidity and Mortality of
           Patients With Severe Chronic Heart Failure
    • Authors: Milton Packer; Bertram Pitt; Jean-Lucien Rouleau; Karl Swedberg; David L. DeMets; Lloyd Fisher
      Abstract: Publication date: Available online 10 May 2017
      Source:JACC: Heart Failure
      Author(s): Milton Packer, Bertram Pitt, Jean-Lucien Rouleau, Karl Swedberg, David L. DeMets, Lloyd Fisher
      Objectives The objective of this clinical trial was to evaluate the long-term effects of flosequinan on the morbidity and mortality of patients with severe chronic heart failure. Background Flosequinan was the first oral vasodilator to be used in the clinic to augment the effects of digitalis, diuretics, and angiotensin-converting enzyme inhibitors in heart failure. However, the drug activated neurohormonal systems and exerted both positive inotropic and chronotropic effects, raising concerns about its safety during long-term use. Methods Following a run-in period designed to minimize the risk of tachycardia, we randomly assigned 2,354 patients in New York Heart functional class III to IV heart failure and with an ejection fraction ≤35% to receive long-term treatment with placebo or flosequinan (75 or 100 mg/day) in addition to their usual therapy. The primary outcome was all-cause mortality. Results The trial was terminated after a recommendation of the Data and Safety Monitoring Board, because during an average of 10 months of follow-up, 192 patients died in the placebo group and 255 patients died in the flosequinan group (hazard ratio: 1.39, 95% confidence interval: 1.15 to 1.67; p = 0.0006). Flosequinan also increased the risk of disease progression, which was paralleled by drug-related increases in heart rate and neurohormonal activation. However, during the first month, patients in the flosequinan group were more likely to report an improvement in well-being and less likely to experience worsening heart failure. Similarly, during the month following drug withdrawal at the end of the trial, patients withdrawn from flosequinan were more likely than those withdrawn from placebo to report symptoms of or to require treatment for worsening heart failure. Conclusions Although flosequinan produced meaningful symptomatic benefits during short- and long-term treatment, the drug increased the risk of death in patients with severe chronic heart failure.
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      PubDate: 2017-05-14T19:07:41Z
      DOI: 10.1016/j.jchf.2017.03.003
       
  • Promise of a New Role for Heart Rate Variability in the Clinical
           Management of Patients With Heart Failure∗
    • Authors: Philip F. Binkley
      Abstract: Publication date: Available online 5 April 2017
      Source:JACC: Heart Failure
      Author(s): Philip F. Binkley
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      PubDate: 2017-04-08T14:29:58Z
      DOI: 10.1016/j.jchf.2017.02.008
       
  • Risk Assessment and Comparative Effectiveness of Left Ventricular Assist
           Device and Medical Management in Ambulatory Heart Failure Patients
    • Authors: Randall C. Starling; Jerry D. Estep; Douglas A. Horstmanshof; Carmelo A. Milano; Josef Stehlik; Keyur B. Shah; Brian A. Bruckner; Sangjin Lee; James W. Long; Craig H. Selzman; Vigneshwar Kasirajan; Donald C. Haas; Andrew J. Boyle; Joyce Chuang; David J. Farrar; Joseph G. Rogers
      Abstract: Publication date: Available online 5 April 2017
      Source:JACC: Heart Failure
      Author(s): Randall C. Starling, Jerry D. Estep, Douglas A. Horstmanshof, Carmelo A. Milano, Josef Stehlik, Keyur B. Shah, Brian A. Bruckner, Sangjin Lee, James W. Long, Craig H. Selzman, Vigneshwar Kasirajan, Donald C. Haas, Andrew J. Boyle, Joyce Chuang, David J. Farrar, Joseph G. Rogers
      Objectives The authors sought to provide the pre-specified primary endpoint of the ROADMAP (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients) trial at 2 years. Background The ROADMAP trial was a prospective nonrandomized observational study of 200 patients (97 with a left ventricular assist device [LVAD], 103 on optimal medical management [OMM]) that showed that survival with improved functional status at 1 year was better with LVADs compared with OMM in a patient population of ambulatory New York Heart Association functional class IIIb/IV patients. Methods The primary composite endpoint was survival on original therapy with improvement in 6-min walk distance ≥75 m. Results Patients receiving LVAD versus OMM had lower baseline health-related quality of life, reduced Seattle Heart Failure Model 1-year survival (78% vs. 84%; p = 0.012) predominantly INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile 4 (65% vs. 34%; p < 0.001) versus profiles 5 to 7. More LVAD patients met the primary endpoint at 2 years: 30% LVAD versus 12% OMM (odds ratio 3.2 [95% confidence interval 1.3 to 7.7]; p = 0.012). Survival as treated on original therapy at 2 years was greater for LVAD versus OMM (70 ± 5% vs. 41 ± 5%; p < 0.001), but there was no difference in intent-to-treat survival (70 ± 5% vs. 63 ± 5%; p = 0.307). In the OMM arm, 23 of 103 (22%) received delayed LVADs (18 within 12 months; 5 from 12 to 24 months). LVAD adverse events declined after year 1 for bleeding (primarily gastrointestinal) and arrhythmias. Conclusions Survival on original therapy with improvement in 6-min walk distance was superior with LVAD compared with OMM at 2 years. Reduction in key adverse events beyond 1 year was observed in the LVAD group. The ROADMAP trial provides risk-benefit information to guide patient- and physician-shared decision making for elective LVAD therapy as a treatment for heart failure. (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients [ROADMAP]; NCT01452802).
      Graphical abstract image

      PubDate: 2017-04-08T14:29:58Z
      DOI: 10.1016/j.jchf.2017.02.016
       
  • Association of Holter-Derived Heart Rate Variability Parameters With the
           Development of Congestive Heart Failure in the Cardiovascular Health Study
           
    • Authors: Vaiibhav N. Patel; Brian R. Pierce; Rohan K. Bodapati; David L. Brown; Diane G. Ives; Phyllis K. Stein
      Abstract: Publication date: Available online 5 April 2017
      Source:JACC: Heart Failure
      Author(s): Vaiibhav N. Patel, Brian R. Pierce, Rohan K. Bodapati, David L. Brown, Diane G. Ives, Phyllis K. Stein
      Objectives This study sought to determine whether Holter-based parameters of heart rate variability (HRV) are independently associated with incident heart failure among older adults in the CHS (Cardiovascular Health Study) as evidenced by an improvement in the predictive power of the Health Aging and Body Composition Heart Failure (Health ABC) score. Background Abnormal HRV, a marker of autonomic dysfunction, has been associated with multiple adverse cardiovascular outcomes but not the development of congestive heart failure (CHF). Methods Asymptomatic CHS participants with interpretable 24-h baseline Holter recordings were included (n = 1,401). HRV measures and premature ventricular contraction (PVC) counts were compared between participants with (n = 260) and without (n = 1,141) incident CHF on follow-up. Significantly different parameters between groups were added to the components of the Health ABC score, a validated CHF prediction tool, using stepwise Cox regression. Results The final model included components of the Health ABC score, In PVC counts (adjusted hazard ratio [aHR]: 1.12; 95% confidence interval [CI]: 1.07 to 1.19; p < 0.001) and the following HRV measures: abnormal heart rate turbulence onset (aHR: 1.52; 95% CI: 1.11 to 2.08; p = 0.009), short-term fractal scaling exponent (aHR: 0.27; 95% CI: 0.14 to 0.53; p < 0.001), in very low frequency power (aHR: 1.28; 95% CI: 1.02 to 1.60; p = 0.037), and coefficient of variance of N-N intervals (aHR: 0.94; 95% CI: 0.90 to 0.99; p = 0.009). The C-statistic for the final model was significantly improved over the Health ABC model alone (0.77 vs. 0.73; p = 0.0002). Conclusions Abnormal HRV parameters were significantly and independently associated with incident CHF in asymptomatic, older adults. When combined with increased PVCs, HRV improved the predictive power of the Health ABC score.
      Graphical abstract image

      PubDate: 2017-04-08T14:29:58Z
      DOI: 10.1016/j.jchf.2016.12.015
       
  • Body Mass Index and Cardiorespiratory Fitness in Mid-Life and Risk of
           Heart Failure Hospitalization in Older Age
    • Authors: Ambarish Pandey; William K. Cornwell; Benjamin Willis; Ian J. Neeland; Ang Gao; David Leonard; Laura DeFina; Jarett D. Berry
      Abstract: Publication date: Available online 5 April 2017
      Source:JACC: Heart Failure
      Author(s): Ambarish Pandey, William K. Cornwell, Benjamin Willis, Ian J. Neeland, Ang Gao, David Leonard, Laura DeFina, Jarett D. Berry
      Objectives This study evaluated the contributions of obesity and changes in body mass index (BMI) in mid-life to long-term heart failure (HF) risk independent of cardiorespiratory fitness (CRF) levels. Background Obesity and low CRF are well-established risk factors for HF. However, given the inverse association between CRF and obesity, the independent contributions of BMI toward HF risk are not fully understood. Methods We included 19,485 participants from the Cooper Center Longitudinal Study who survived to receive Medicare coverage, from 1999 to 2009. CRF was estimated in metabolic equivalents (METS) according to Balke treadmill time. Associations of BMI and BMI change with HF hospitalization after age 65 were assessed by applying a proportional hazards recurrent events model to the failure time data. Results After 127,110 person-years of follow-up, we observed 1,038 HF hospitalization events. Higher mid-life BMI was significantly associated with greater risk of HF hospitalization after adjusting for established HF risk factors (hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 1.12 to 1.26) per 3 kg/m2 higher BMI). This association was attenuated after adjusting for CRF (HR: 1.10; 95% CI: 1.03 to 1.17 per 3 kg/m2 higher BMI). CRF accounted for 47% of the HF risk associated with BMI. BMI change was not significantly associated with risk of HF in older age after adjustment for CRF change. Conclusions Higher BMI-associated risk of HF is explained largely by differences in CRF levels. Furthermore, BMI change is not significantly associated with HF risk after adjusting for CRF changes. These findings highlight the importance of CRF in mediating BMI-associated HF risk.
      Graphical abstract image

      PubDate: 2017-04-08T14:29:58Z
      DOI: 10.1016/j.jchf.2016.12.021
       
  • Therapeutic Cardiorespiratory Fitness to Prevent and Treat Heart
           Failure∗
    • Authors: Carl J. Lavie; Steven J. Keteyian; Hector O. Ventura
      Abstract: Publication date: Available online 5 April 2017
      Source:JACC: Heart Failure
      Author(s): Carl J. Lavie, Steven J. Keteyian, Hector O. Ventura
      Graphical abstract image

      PubDate: 2017-04-08T14:29:58Z
      DOI: 10.1016/j.jchf.2017.01.007
       
  • A Novel Rehabilitation Intervention for Older Patients With Acute
           Decompensated Heart Failure
    • Authors: Gordon R. Reeves; David J. Whellan; Christopher M. O'Connor; Pamela Duncan; Joel D. Eggebeen; Timothy M. Morgan; Leigh Ann Hewston; Amy Pastva; Mahesh J. Patel; Dalane W. Kitzman
      Abstract: Publication date: Available online 8 March 2017
      Source:JACC: Heart Failure
      Author(s): Gordon R. Reeves, David J. Whellan, Christopher M. O'Connor, Pamela Duncan, Joel D. Eggebeen, Timothy M. Morgan, Leigh Ann Hewston, Amy Pastva, Mahesh J. Patel, Dalane W. Kitzman
      Objectives This study sought to assess a novel physical rehabilitation intervention in older patients hospitalized for acute decompensated heart failure (ADHF). Background After ADHF, older patients, who are frequently frail with multiple comorbidities, have prolonged and incomplete recovery of physical function and remain at high risk for poor outcomes. Methods The REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) pilot study was a 3-site, randomized, attention-controlled pilot study of a tailored, progressive, multidomain physical rehabilitation intervention beginning in the hospital and continuing for 12 weeks post-discharge in patients ≥60 years hospitalized with ADHF. The primary purpose was to assess the feasibility and reasonableness of the hypothesis that the novel rehabilitation intervention would improve physical function (Short Physical Performance Battery [SPPB]) over 3 months and reduce all-cause rehospitalizations over 6 months. Results The study enrolled 27 patients with ADHF (ages 60 to 98 years; 59% women; 56% African American; 41% with preserved ejection fraction [≥45%]). At baseline, participants had marked impairments in physical function, multiple comorbidities, and frailty. Study retention (89%) and intervention adherence (93%) were excellent. At 3 months, an intervention effect size was measured for the SPPB score of +1.1 U (7.4 ± 0.5 U vs. 6.3 ± 0.5 U), and at 6 months an effect size was observed for an all-cause rehospitalization rate of −0.48 (1.16 ± 0.35 vs. 1.64 ± 0.39). The change in SPPB score was strongly related to all-cause rehospitalizations, explaining 91% of change. Conclusions These findings support the feasibility and rationale for a recently launched, National Institutes of Health–funded trial to test the safety and efficacy of this novel multidomain physical rehabilitation intervention to improve physical function and reduce rehospitalizations in older, frail patients with ADHF with multiple comorbidities. (Rehabilitation and Exercise Training After Hospitalization [REHAB-HF]; NCT01508650; A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [REHAB-HF]; NCT02196038)
      Graphical abstract image

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

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

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

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

      PubDate: 2017-03-27T12:18:44Z
      DOI: 10.1016/j.jchf.2016.12.014
       
 
 
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