for Journals by Title or ISSN
for Articles by Keywords
help
Followed Journals
Journal you Follow: 0
 
Sign Up to follow journals, search in your chosen journals and, optionally, receive Email Alerts when new issues of your Followed Journals are published.
Already have an account? Sign In to see the journals you follow.
Journal Cover JACC : Heart Failure
  [SJR: 4.318]   [H-I: 18]   [11 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Online) 2213-1779
   Published by Elsevier Homepage  [3177 journals]
  • Integrative Assessment of Congestion in Heart Failure Throughout the
           Patient Journey
    • Authors: Nicolas Girerd; Marie-France Seronde; Stefano Coiro; Tahar Chouihed; Pascal Bilbault; François Braun; David Kenizou; Bruno Maillier; Pierre Nazeyrollas; Gérard Roul; Ludivine Fillieux; William T. Abraham; James Januzzi; Laurent Sebbag; Faiez Zannad; Alexandre Mebazaa; Patrick Rossignol
      Pages: 273 - 285
      Abstract: Publication date: April 2018
      Source:JACC: Heart Failure, Volume 6, Issue 4
      Author(s): Nicolas Girerd, Marie-France Seronde, Stefano Coiro, Tahar Chouihed, Pascal Bilbault, François Braun, David Kenizou, Bruno Maillier, Pierre Nazeyrollas, Gérard Roul, Ludivine Fillieux, William T. Abraham, James Januzzi, Laurent Sebbag, Faiez Zannad, Alexandre Mebazaa, Patrick Rossignol
      Congestion is one of the main predictors of poor patient outcome in patients with heart failure. However, congestion is difficult to assess, especially when symptoms are mild. Although numerous clinical scores, imaging tools, and biological tests are available to assist physicians in ascertaining and quantifying congestion, not all are appropriate for use in all stages of patient management. In recent years, multidisciplinary management in the community has become increasingly important to prevent heart failure hospitalizations. Electronic alert systems and communication platforms are emerging that could be used to facilitate patient home monitoring that identifies congestion from heart failure decompensation at an earlier stage. This paper describes the role of congestion detection methods at key stages of patient care: pre-admission, admission to the emergency department, in-hospital management, and lastly, discharge and continued monitoring in the community. The multidisciplinary working group, which consisted of cardiologists, emergency physicians, and a nephrologist with both clinical and research backgrounds, reviewed the current literature regarding the various scores, tools, and tests to detect and quantify congestion. This paper describes the role of each tool at key stages of patient care and discusses the advantages of telemedicine as a means of providing true integrated patient care.
      Graphical abstract image

      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2017.09.023
       
  • The Effect of Door-to-Diuretic Time on Clinical Outcomes in
           Patients With Acute Heart Failure
    • Authors: Jin Joo Park; Sun-Hwa Kim; Il-Young Oh; Dong-Ju Choi; Hyun-Ah Park; Hyun-Jai Cho; Hae-Young Lee; Jae-Yeong Cho; Kye Hun Kim; Jung-Woo Son; Byung-Su Yoo; Jaewon Oh; Seok-Min Kang; Sang Hong Baek; Ga Yeon Lee; Jin Oh Choi; Eun-Seok Jeon; Sang Eun Lee; Jae-Joong Kim; Ju-Hee Lee; Myeong-Chan Cho; Se Yong Jang; Shung Chull Chae; Byung-Hee Oh
      Pages: 286 - 294
      Abstract: Publication date: April 2018
      Source:JACC: Heart Failure, Volume 6, Issue 4
      Author(s): Jin Joo Park, Sun-Hwa Kim, Il-Young Oh, Dong-Ju Choi, Hyun-Ah Park, Hyun-Jai Cho, Hae-Young Lee, Jae-Yeong Cho, Kye Hun Kim, Jung-Woo Son, Byung-Su Yoo, Jaewon Oh, Seok-Min Kang, Sang Hong Baek, Ga Yeon Lee, Jin Oh Choi, Eun-Seok Jeon, Sang Eun Lee, Jae-Joong Kim, Ju-Hee Lee, Myeong-Chan Cho, Se Yong Jang, Shung Chull Chae, Byung-Hee Oh
      Objectives This study sought to examine the impact of door-to-diuretic (D2D) time on mortality in patients with acute heart failure (AHF) who were presenting to an emergency department (ED). Background Most patients with AHF present with congestion. Early decongestion with diuretic agents could improve their clinical outcomes. Methods The Korea Acute Heart Failure registry enrolled 5,625 consecutive patients hospitalized for AHF. For this analysis, the study included patients who received intravenous diuretic agents within 24 h after ED arrival. Early and delayed groups were defined as D2D time ≤60 min and D2D time >60 min, respectively. The primary outcomes were in-hospital death and post-discharge death at 1 month and 1 year on the basis of D2D time. Results A total of 2,761 patients met the inclusion criteria. The median D2D time was 128 min (interquartile range: 63 to 243 min), and 663 (24%) patients belonged to the early group. The baseline characteristics were similar between the groups. The rate of in-hospital death did not differ between the groups (5.0% vs. 5.1%; p > 0.999), nor did the post-discharge 1-month (4.0% vs. 3.0%; log-rank p = 0.246) and 1-year (20.6% vs. 19.3%; log-rank p = 0.458) mortality rates. Get With the Guidelines-Heart Failure risk score was calculated for each patient. In multivariate analyses with adjustment for Get With the Guidelines-Heart Failure risk score and other significant clinical covariates and propensity-matched analyses, D2D time was not associated with clinical outcomes. Conclusions The D2D time was not associated with clinical outcomes in a large prospective cohort of patients with AHF who were presenting to an ED. (Registry [Prospective Cohort] for Heart Failure in Korea [KorAHF]; NCT01389843)
      Graphical abstract image

      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2017.12.017
       
  • “Time Is Muscle” in Acute Heart Failure
    • Authors: G. Michael Felker; James L. Januzzi
      Pages: 295 - 297
      Abstract: Publication date: April 2018
      Source:JACC: Heart Failure, Volume 6, Issue 4
      Author(s): G. Michael Felker, James L. Januzzi
      Graphical abstract image

      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2018.01.011
       
  • Indications for Cardiac Resynchronization Therapy
    • Authors: Camilla Normand; Cecilia Linde; Jagmeet Singh; Kenneth Dickstein
      Pages: 308 - 316
      Abstract: Publication date: April 2018
      Source:JACC: Heart Failure, Volume 6, Issue 4
      Author(s): Camilla Normand, Cecilia Linde, Jagmeet Singh, Kenneth Dickstein
      Objectives This study compares and contrasts the recommended indications for cardiac resynchronization therapy (CRT) according to the most recent guidelines from international cardiology societies. Background CRT has been shown to reduce morbidity and mortality in selected patients with systolic heart failure. Cardiology societies provide guidelines regarding the indications for CRT. As evidence evolves, it is challenging for the guideline committees to review the impact of newer evidence in a timely fashion. Methods Six of the most recent international guidelines providing recommendation concerning CRT implantation ranging from 2011 to 2017 were reviewed. These included guidelines from 2 European, 1 North American, 1 Canadian, and 1 Australian/New Zealand societies and the National Institute for Health and Care Excellence guidelines, specific to the United Kingdom. Results Although international societies provide consistent recommendations for most CRT indications, differences are found in recommendations for several important patient populations. Specifically, divergent recommendations exist regarding QRS duration, bundle branch morphology, patients in atrial fibrillation, choice of device type (CRT pacemakers vs. CRT defibrillators), and selected patients who are likely to be dependent on right ventricular pacing. The timing of publication of specific guidelines appears to play an essential role in explaining these disparities. Conclusions Despite general consistency in international guideline recommendations, there remain certain patient populations for whom there are variations in recommendations concerning eligibility for CRT and selection of the most appropriate device in the individual patient.

      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2018.01.022
       
  • My LVAD Gave Me a New Lease on Life
    • Authors: Joe Dolan
      First page: 343
      Abstract: Publication date: April 2018
      Source:JACC: Heart Failure, Volume 6, Issue 4
      Author(s): Joe Dolan


      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2017.11.007
       
  • Changing the Research Culture in the United States
    • Authors: Christopher M. O’Connor; Michael R. Bristow
      Pages: 344 - 345
      Abstract: Publication date: April 2018
      Source:JACC: Heart Failure, Volume 6, Issue 4
      Author(s): Christopher M. O’Connor, Michael R. Bristow


      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2018.03.001
       
  • There Should Not Be Much Doubt That Neurogenic Stress Cardiomyopathy in
           Cardiac Donors Is a Phenotype of Takotsubo Syndrome
    • Authors: John E. Madias
      Pages: 346 - 347
      Abstract: Publication date: April 2018
      Source:JACC: Heart Failure, Volume 6, Issue 4
      Author(s): John E. Madias


      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2017.12.002
       
  • Takotsubo Common Pathways and SNRI Medications
    • Authors: Daniel Woronow; Courtney Suggs; Robert L. Levin; Ida-Lina Diak; Cindy Kortepeter
      Pages: 347 - 348
      Abstract: Publication date: April 2018
      Source:JACC: Heart Failure, Volume 6, Issue 4
      Author(s): Daniel Woronow, Courtney Suggs, Robert L. Levin, Ida-Lina Diak, Cindy Kortepeter


      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2017.12.011
       
  • Solid Organ Transplantation
    • Authors: Larry A. Weinrauch; John A. D’Elia
      Pages: 348 - 349
      Abstract: Publication date: April 2018
      Source:JACC: Heart Failure, Volume 6, Issue 4
      Author(s): Larry A. Weinrauch, John A. D’Elia


      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2017.12.015
       
  • Heart Rate in Heart Failure With Preserved Ejection Fraction
    • Authors: Patricia Palau; Eloy Domínguez; Juan Sanchis; Antoni Bayés-Genis; Julio Núñez
      Pages: 350 - 351
      Abstract: Publication date: April 2018
      Source:JACC: Heart Failure, Volume 6, Issue 4
      Author(s): Patricia Palau, Eloy Domínguez, Juan Sanchis, Antoni Bayés-Genis, Julio Núñez


      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2017.12.003
       
  • Post-Myocardial Infarction Heart Failure
    • Authors: M. Cecilia Bahit; Ajar Kochar; Christopher B. Granger
      Pages: 179 - 186
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): M. Cecilia Bahit, Ajar Kochar, Christopher B. Granger
      Heart failure (HF) complicating myocardial infarction (MI) is common and may be present at admission or develop during the hospitalization. Among patients with MI, there is a strong relationship between degree of HF and mortality. The optimal management of the patient with HF complicating MI varies according to time since the onset of infarction. Medical therapy for HF after MI includes early (within 24 h) initiation of angiotensin-converting enzyme inhibitors and early (within 7 days) use of aldosterone antagonists. Alternatively, in patients with MI and ongoing HF, early use (<24 h) of beta-blockers is associated with an increased risk of cardiogenic shock and death. Long-term beta-blocker use after MI is associated with a reduced risk of reinfarction and death. Thus, it is critical to frequently re-evaluate beta-blocker eligibility among patients after MI with HF. Cardiogenic shock is an extreme presentation of HF after MI and is a leading cause of death in the MI setting. The only therapy proven to reduce mortality for patients with cardiogenic shock is early revascularization. Several studies are examining new approaches to mitigate the occurrence and adverse impact of post-MI HF. These studies are testing drugs for HF and diabetes and are evaluating mechanical support devices to bridge patients to recovery or transplantation.
      Graphical abstract image

      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2017.09.015
       
  • Anemia in Heart Failure
    • Authors: Niels Grote Beverborg; Dirk J. van Veldhuisen; Peter van der Meer
      Pages: 201 - 208
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): Niels Grote Beverborg, Dirk J. van Veldhuisen, Peter van der Meer
      One-third of all patients with heart failure have anemia, and its presence is associated with more symptoms, increased rates of hospitalization, and increased mortality. The etiology of anemia is multifactorial, complex, and varies between patients. The most important factors leading to anemia in heart failure are inadequate erythropoietin production resulting from renal failure, intrinsic bone marrow defects, medication use, and nutritional deficiencies such as iron deficiency. Erythropoiesis-stimulating agents (ESAs) have been proven to successfully correct hemoglobin levels, albeit without significant improvement in clinical outcome. On the contrary, the use of ESAs has led to increased rates of thromboembolic events and ischemic stroke. This use of ESAs for the treatment of anemia in heart failure, therefore, cannot be recommended. In addition, these results question whether anemia is a therapeutic target or merely a marker of disease severity. Other therapies are being studied and include agents targeting the erythropoietin receptor, hepcidin pathway, or iron availability. This review focuses on the pathophysiology of anemia in heart failure, explains why investigated therapies might not have led to the desired results, and discusses promising future therapies.
      Graphical abstract image

      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2017.08.023
       
  • Clinical Characteristics and Outcome of Methamphetamine-Associated
           Pulmonary Arterial Hypertension and Dilated Cardiomyopathy
    • Authors: Susan X. Zhao; Calvin Kwong; Aravind Swaminathan; Amit Gohil; Michael H. Crawford
      Pages: 209 - 218
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): Susan X. Zhao, Calvin Kwong, Aravind Swaminathan, Amit Gohil, Michael H. Crawford
      Objectives This study sought to characterize patients with methamphetamine-associated pulmonary arterial hypertension (MA-PAH) and cardiomyopathy (MA-CMP), to compare with MA controls (MA-CTL), users with structurally normal hearts, with the aim of identifying risk factors for these conditions. Background MA-PAH and MA-CMP are 2 poorly understood cardiac complications in MA users. Methods We retrospectively studied the clinical characteristics and outcomes of 50 MA-PAH, 296 MA-CMP, and 356 MA-CTL patients, whom we evaluated between 2010 and 2017. Results After a median follow-up of 20.0 months (interquartile range [IQR]: 7.6 to 42.6 months), all-cause mortality was 18.0% for MA-PAH, 15.2% for MA-CMP, and 4.5% for MA-CTL group (p < 0.001). More women (58%) were in the MA-PAH group than in the MA-CMP (14%; p < 0.001) and MA-CTL (42%; p = 0.028) groups, whereas the MA-CMP group was predominantly male (86% vs. 58% in the MA-CTL group; p < 0.001). More MA-CMP patients had hypertension (p < 0.001) or alcoholism (p < 0.001) than MA-CTL patients. Logistic regression analyses identified male sex, alcoholism, and hypertension as independent factors associated with MA-CMP with the following respective adjusted odds ratios (OR) of 3.791 (95% confidence interval [CI]: 2.508 to 5.730), OR of 2.959 (95% CI: 2.084 to 4.203), and OR of 2.111 (95% CI: 1.486 to 2.999), whereas female sex was the only factor associated with MA-PAH. Conclusions Both MA-PAH and MA-CMP patients carried significant disease burden and mortality risk. Male sex, hypertension, and alcoholism were strongly associated with MA-CMP, whereas female sex and other unknown factors may influence development of MA-PAH. This study adds to the understanding of MA-associated cardiac complications and highlights directions for future investigation.
      Graphical abstract image

      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2017.10.006
       
  • Crystal Methamphetamine
    • Authors: Ori Ben-Yehuda; Neil Siecke
      Pages: 219 - 221
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): Ori Ben-Yehuda, Neil Siecke
      Graphical abstract image

      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2018.01.004
       
  • No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy
    • Authors: Chesney D. Castleberry; John L. Jefferies; Ling Shi; James D. Wilkinson; Jeffrey A. Towbin; Ryan W. Harrison; Joseph W. Rossano; Elfriede Pahl; Teresa M. Lee; Linda J. Addonizio; Melanie D. Everitt; Justin Godown; Joseph Mahgerefteh; Paolo Rusconi; Charles E. Canter; Steven D. Colan; Paul F. Kantor; Hiedy Razoky; Steven E. Lipshultz; Tracie L. Miller
      Pages: 222 - 230
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): Chesney D. Castleberry, John L. Jefferies, Ling Shi, James D. Wilkinson, Jeffrey A. Towbin, Ryan W. Harrison, Joseph W. Rossano, Elfriede Pahl, Teresa M. Lee, Linda J. Addonizio, Melanie D. Everitt, Justin Godown, Joseph Mahgerefteh, Paolo Rusconi, Charles E. Canter, Steven D. Colan, Paul F. Kantor, Hiedy Razoky, Steven E. Lipshultz, Tracie L. Miller
      Objectives This study aimed to examine the role of nutrition in pediatric dilated cardiomyopathy (DCM). Background In adults with DCM, malnutrition is associated with mortality, whereas obesity is associated with survival. Methods The National Heart, Lung, and Blood Institute–funded Pediatric Cardiomyopathy Registry was used to identify patients with DCM and categorized by anthropometric measurements: malnourished (MN) (body mass index [BMI] <5% for age ≥2 years or weight-for-length <5% for <2 years), obesity (BMI >95% for age ≥2 years or weight-for-length >95% for <2 years), or normal bodyweight (NB). Of 904 patients with DCM, 23.7% (n = 214) were MN, 13.3% (n=120) were obese, and 63.1% (n=570) were NB. Results Obese patients were older (9.0 vs. 5.7 years for NB; p < 0.001) and more likely to have a family history of DCM (36.1% vs. 23.5% for NB; p = 0.023). MN patients were younger (2.7 years vs. 5.7 years for NB; p < 0.001) and more likely to have heart failure (79.9% vs. 69.7% for NB; p = 0.012), cardiac dimension z-scores >2, and higher ventricular mass compared with NB. In multivariable analysis, MN was associated with increased risk of death (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.66 to 3.65; p < 0.001); whereas obesity was not (HR: 1.49; 95% CI: 0.72 to 3.08). Competing outcomes analysis demonstrated increased risk of mortality for MN compared with NB (p = 0.03), but no difference in transplant rate (p = 0.159). Conclusions Malnutrition is associated with increased mortality and other unfavorable echocardiographic and clinical outcomes compared with those of NB. The same effect of obesity on survival was not observed. Further studies are needed investigating the long-term impact of abnormal anthropometric measurements on outcomes in pediatric DCM. (Pediatric Cardiomyopathy Registry; NCT00005391)
      Graphical abstract image

      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2017.11.015
       
  • Obesity and Prognosis in Pediatric Dilated Cardiomyopathy
    • Authors: Carl J. Lavie; Hector O. Ventura
      Pages: 231 - 232
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): Carl J. Lavie, Hector O. Ventura
      Graphical abstract image

      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2017.11.013
       
  • Impact of Body Mass Index on Heart Failure by Race/Ethnicity From the Get
           With The Guidelines–Heart Failure (GWTG–HF) Registry
    • Authors: Tiffany M. Powell-Wiley; Julius Ngwa; Selomie Kebede; Di Lu; Phillip J. Schulte; Deepak L. Bhatt; Clyde Yancy; Gregg C. Fonarow; Michelle A. Albert
      Pages: 233 - 242
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): Tiffany M. Powell-Wiley, Julius Ngwa, Selomie Kebede, Di Lu, Phillip J. Schulte, Deepak L. Bhatt, Clyde Yancy, Gregg C. Fonarow, Michelle A. Albert
      Objectives This study sought to evaluate the influence of race/ethnicity on the relationship between body mass index (BMI) and mortality in heart failure with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF) patients. Background Prior studies demonstrated an “obesity paradox” among overweight and obese patients, where they have a better HF prognosis than normal weight patients. Less is known about the relationship between BMI and mortality among diverse patients with HF, particularly given disparities in obesity and HF prevalence. Methods The authors used Get With The Guidelines–Heart Failure data to assess the relationship between BMI and in-hospital mortality by using logistic regression modeling. The authors assessed 30-day and 1-year rates of all-cause mortality following discharge by using Cox regression modeling. Results A total of 39,647 patients with HF were included (32,434 [81.8%] white subjects; 3,809 [9.6%] black subjects; 1,928 [4.9%] Hispanic subjects; 544 [1.4%] Asian subjects; and 932 [2.3%] other subjects); 59.7% of subjects had HFpEF, and 30.7% were obese. More black and Hispanic patients had Class I or higher obesity (BMI ≥30 kg/m2) than whites, Asians, or other racial/ethnic groups (p < 0.0001). Among subjects with HFpEF, higher BMI was associated with lower 30-day mortality, up to 30 kg/m2 with a small risk increase above 30 kg/m2 (BMI: 30 vs. 18.5 kg/m2), hazard ratio (HR) of 0.63 (95% confidence interval [CI]: 0.54 to 0.73). A modest relationship was observed in HFrEF subjects (BMI: 30 vs. 18.5 kg/m2; HR: 0.73; 95% CI: 0.60 to 0.89), with no risk increase above 30 kg/m2. There were no significant interactions between BMI and race or ethnicity related to 30-day mortality (p > 0.05). Conclusions This work is one of the first suggesting the obesity paradox for 30-day mortality exists at all BMI levels in HFrEF but not in patients with HFpEF. Higher BMI was associated with lower 30-day mortality across racial/ethnic groups in a manner inconsistent with the J-shaped relationship noted for coronary artery disease. The differential slope of obesity and mortality among HFpEF and patients with HFrEF potentially suggests differing mechanistic factors, requiring further exploration.
      Graphical abstract image

      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2017.11.011
       
  • Body Mass Index and Heart Failure Mortality
    • Authors: Michael E. Hall
      Pages: 243 - 245
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): Michael E. Hall
      Graphical abstract image

      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2017.12.013
       
  • Utilizing NT-proBNP for Eligibility and Enrichment in Trials in HFpEF,
           HFmrEF, and HFrEF
    • Authors: Gianluigi Savarese; Nicola Orsini; Camilla Hage; Ola Vedin; Francesco Cosentino; Giuseppe M.C. Rosano; Ulf Dahlström; Lars H. Lund
      Pages: 246 - 256
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): Gianluigi Savarese, Nicola Orsini, Camilla Hage, Ola Vedin, Francesco Cosentino, Giuseppe M.C. Rosano, Ulf Dahlström, Lars H. Lund
      Objectives The purpose of this study was to assess the association between N-terminal pro–B-type natriuretic peptide (NT-proBNP) and cardiovascular (CV) versus non-CV events and between NT-proBNP and potential treatment effects in heart failure (HF) with preserved, mid-range, and reduced ejection fraction (HFpEF, HFmrEF, and HFrEF, respectively) and clinically relevant subgroups. Background Optimizing patient eligibility criteria in HF trials requires biomarkers that enrich for CV but not for non-CV events and select patients most likely to respond to the tested intervention. Methods In the Swedish HF registry population stratified by EF category, we used Kaplan-Meier curves to estimate unadjusted CV and non-CV risks (mortality or hospitalization); Poisson regressions to calculate crude event rates of CV and non-CV events according to NT-proBNP levels; and Cox regressions to calculate the adjusted hazard ratios for HF therapies according to NT-proBNP ≤ or > median. Results In a cohort of 15,849 patients (23% HFpEF, 21% HFmrEF, 56% HFrEF), median NT-proBNP was 2,037, 2,192, and 3,141 pg/ml, respectively. With increasing NT-proBNP, CV event rates increased more steeply than non-CV rates (range 20 to 160 and 30 to 100 per 100 patient-years in HFpEF; 20 to 130 and 20 to 100 in HFmrEF; and 20 to 110 and 20 to 50 in HFrEF, respectively). The CV-to-non-CV ratio increased with increasing NT-proBNP in HFpEF and HFrEF, but only in the lower range in HFmrEF. The association between treatments (e.g., angiotensin-converting enzyme-inhibitor, angiotensin II receptor blockers, and beta-blockers) and outcomes was consistent in NT-proBNP ≤ and > median. Conclusions In HF trial design in different EF categories, NT-proBNP may be a useful tool for eligibility and enrichment for CV events, but its role in predicting a potential treatment response remains unclear.
      Graphical abstract image

      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2017.12.014
       
  • Sense and Sensibility of the Use of NT-proBNP for Eligibility in Clinical
           Trials∗
    • Authors: Adriaan A. Voors
      Pages: 257 - 259
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): Adriaan A. Voors
      Graphical abstract image

      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2018.01.003
       
  • Heart Failure Health Care 2018
    • Authors: Christopher M. O’Connor
      Pages: 262 - 263
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): Christopher M. O’Connor


      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2018.01.013
       
  • The Mediterranean Diet to Treat Heart Failure
    • Authors: Salvatore Carbone; Hayley E. Billingsley; Antonio Abbate
      First page: 264
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): Salvatore Carbone, Hayley E. Billingsley, Antonio Abbate


      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2017.12.008
       
  • Renal Effects and Associated Outcomes During Angiotensin-Neprilysin
           Inhibition in Heart Failure
    • Authors: Kevin Damman; Mauro Gori; Brian Claggett; Pardeep S. Jhund; Michele Senni; Martin P. Lefkowitz; Margaret F. Prescott; Victor C. Shi; Jean L. Rouleau; Karl Swedberg; Michael R. Zile; Milton Packer; Akshay S. Desai; Scott D. Solomon; John J.V. McMurray
      Abstract: Publication date: Available online 11 April 2018
      Source:JACC: Heart Failure
      Author(s): Kevin Damman, Mauro Gori, Brian Claggett, Pardeep S. Jhund, Michele Senni, Martin P. Lefkowitz, Margaret F. Prescott, Victor C. Shi, Jean L. Rouleau, Karl Swedberg, Michael R. Zile, Milton Packer, Akshay S. Desai, Scott D. Solomon, John J.V. McMurray
      Objectives The purpose of this study was to evaluate the renal effects of sacubitril/valsartan in patients with heart failure and reduced ejection fraction. Background Renal function is frequently impaired in patients with heart failure with reduced ejection fraction and may deteriorate further after blockade of the renin–angiotensin system. Methods In the PARADIGM-HF (Prospective Comparison of ARNI with ACE inhibition to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial, 8,399 patients with heart failure with reduced ejection fraction were randomized to treatment with sacubitril/valsartan or enalapril. The estimated glomerular filtration rate (eGFR) was available for all patients, and the urinary albumin/creatinine ratio (UACR) was available in 1872 patients, at screening, randomization, and at fixed time intervals during follow-up. We evaluated the effect of study treatment on change in eGFR and UACR, and on renal and cardiovascular outcomes, according to eGFR and UACR. Results At screening, the eGFR was 70 ± 20 ml/min/1.73 m2 and 2,745 patients (33%) had chronic kidney disease; the median UACR was 1.0 mg/mmol (interquartile range: 0.4 to 3.2 mg/mmol) and 24% had an increased UACR. The decrease in eGFR during follow-up was less with sacubitril/valsartan compared with enalapril (−1.61 ml/min/1.73 m2/year; [95% confidence interval: −1.77 to −1.44 ml/min/1.73 m2/year] vs. −2.04 ml/min/1.73 m2/year [95% CI: −2.21 to −1.88 ml/min/1.73 m2/year ]; p < 0.001) despite a greater increase in UACR with sacubitril/valsartan than with enalapril (1.20 mg/mmol [95% CI: 1.04 to 1.36 mg/mmol] vs. 0.90 mg/mmol [95% CI: 0.77 to 1.03 mg/mmol]; p < 0.001). The effect of sacubitril/valsartan on cardiovascular death or heart failure hospitalization was not modified by eGFR, UACR (p interaction = 0.70 and 0.34, respectively), or by change in UACR (p interaction = 0.38). Conclusions Compared with enalapril, sacubitril/valsartan led to a slower rate of decrease in the eGFR and improved cardiovascular outcomes, even in patients with chronic kidney disease, despite causing a modest increase in UACR.
      Graphical abstract image

      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2018.02.004
       
  • Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock
    • Authors: Mary E. Keebler; Elias V. Haddad; Chun W. Choi; Stuart McGrane; Sandip Zalawadiya; Kelly H. Schlendorf; D. Marshall Brinkley; Matthew R. Danter; Mark Wigger; Jonathan N. Menachem; Ashish Shah; JoAnn Lindenfeld
      Abstract: Publication date: Available online 11 April 2018
      Source:JACC: Heart Failure
      Author(s): Mary E. Keebler, Elias V. Haddad, Chun W. Choi, Stuart McGrane, Sandip Zalawadiya, Kelly H. Schlendorf, D. Marshall Brinkley, Matthew R. Danter, Mark Wigger, Jonathan N. Menachem, Ashish Shah, JoAnn Lindenfeld
      Venoarterial extracorporeal membrane oxygenation has emerged as a viable treatment for patients in cardiogenic shock with biventricular failure and pulmonary dysfunction. Advances in pump and oxygenator technology, cannulation strategies, patient selection and management, and durable mechanical circulatory support have contributed to expanded utilization of this technology. However, challenges remain that require investigation to improve outcomes.
      Graphical abstract image

      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2017.11.017
       
  • Heart Failure Costs, Minority Populations, and Outcomes
    • Authors: Marvin A. Konstam
      Abstract: Publication date: Available online 11 April 2018
      Source:JACC: Heart Failure
      Author(s): Marvin A. Konstam
      Graphical abstract image

      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2018.02.005
       
  • Traveling the Interstices of Data Sharing
    • Authors: Paul W. Armstrong; Robert J. Mentz; Cynthia M. Westerhout
      Abstract: Publication date: Available online 11 April 2018
      Source:JACC: Heart Failure
      Author(s): Paul W. Armstrong, Robert J. Mentz, Cynthia M. Westerhout
      Graphical abstract image

      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2018.02.003
       
  • Opening Opportunities With Open Data
    • Authors: Alexander R. Zheutlin; James Brian Byrd
      Abstract: Publication date: Available online 11 April 2018
      Source:JACC: Heart Failure
      Author(s): Alexander R. Zheutlin, James Brian Byrd


      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2017.12.019
       
  • Exploiting the Natriuretic Peptide Pathway to Preserve Glomerular
           Filtration in Heart Failure∗
    • Authors: Wilfried Mullens; Pieter Martens
      Abstract: Publication date: Available online 11 April 2018
      Source:JACC: Heart Failure
      Author(s): Wilfried Mullens, Pieter Martens
      Graphical abstract image

      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2018.02.017
       
  • Hypertrophic Cardiomyopathy
    • Authors: Jeffrey B. Geske; Steve R. Ommen; Bernard J. Gersh
      Abstract: Publication date: Available online 11 April 2018
      Source:JACC: Heart Failure
      Author(s): Jeffrey B. Geske, Steve R. Ommen, Bernard J. Gersh
      Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiomyopathy, manifesting as left ventricular hypertrophy in the absence of a secondary cause. The genetic underpinnings of HCM arise largely from mutations of sarcomeric proteins; however, the specific underlying mutation often remains undetermined. Patient presentation is phenotypically diverse, ranging from asymptomatic to heart failure or sudden cardiac death. Left ventricular hypertrophy and abnormal ventricular configuration result in dynamic left ventricular outflow obstruction in most patients. The goal of therapeutic interventions is largely to reduce dynamic obstruction, with treatment modalities spanning lifestyle modifications, pharmacotherapies, and septal reduction therapies. A small subset of patients with HCM will experience sudden cardiac death, and risk stratification remains a clinical challenge. This paper presents a clinical update for diagnosis, family screening, clinical imaging, risk stratification, and management of symptoms in patients with HCM.
      Graphical abstract image

      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2018.02.010
       
  • Clinical Spectrum and Management of Heart Failure
           in Hypertrophic Cardiomyopathy
    • Authors: Barry J. Maron; Ethan J. Rowin; James E. Udelson; Martin S. Maron
      Abstract: Publication date: Available online 11 April 2018
      Source:JACC: Heart Failure
      Author(s): Barry J. Maron, Ethan J. Rowin, James E. Udelson, Martin S. Maron
      Heart failure (HF), characterized by excessive exertional dyspnea, is a common complication within the broad clinical spectrum of hypertrophic cardiomyopathy (HCM). HF has become an increasingly prominent management issue with the reduction in sudden deaths due to use of implantable defibrillators in this disease. Exertional dyspnea ranges in severity from mild to severe (New York Heart Association functional classes II to IV) and not uncommonly becomes refractory to medical management, leading to progressive disability, but largely in the absence of pulmonary congestion and volume overload requiring hospitalization. HCM-related HF is most commonly due to dynamic mechanical impedance to left ventricular outflow produced by mitral valve systolic anterior motion, leading to high intracavity pressures. Surgical septal myectomy with low operative mortality (<1%) produces HF reversal and symptom relief in 90% to 95% of patients, while also conveying a survival benefit. Exercise echocardiography has assumed an important role in the evaluation of patients with HCM, i.e., by identifying candidates for septal reduction therapy with refractory HF when outflow gradients are present only with physiological exercise, distinguishing highly symptomatic nonobstructive patients as heart transplant candidates, and predicting future development of progressive HF. Notably, mortality directly attributable to HF has become exceedingly uncommon in HCM (<0.5%/year) in contrast with HF in non-HCM diseases (by 20-fold). In conclusion, HF in HCM is associated with diverse and complex pathophysiology, but a substantially more favorable prognosis than conventional non–HCM HF, and highly amenable to effective treatment options in the vast majority of patients.
      Graphical abstract image

      PubDate: 2018-04-15T21:50:26Z
      DOI: 10.1016/j.jchf.2017.09.011
       
  • Reply
    • Authors: Guido Tavazzi; Gabriele Giorgio Iotti
      Abstract: Publication date: April 2018
      Source:JACC: Heart Failure, Volume 6, Issue 4
      Author(s): Guido Tavazzi, Gabriele Via, Giorgio Iotti


      PubDate: 2018-04-15T21:50:26Z
       
  • Reply
    • Authors: Richa Gupta; Kelly Schlendorf JoAnn Lindenfeld
      Abstract: Publication date: April 2018
      Source:JACC: Heart Failure, Volume 6, Issue 4
      Author(s): Richa Gupta, Kelly Schlendorf, JoAnn Lindenfeld


      PubDate: 2018-04-15T21:50:26Z
       
  • Worsening Heart Failure During the Use of DPP-4 Inhibitors
    • Authors: Milton Packer
      Abstract: Publication date: Available online 7 March 2018
      Source:JACC: Heart Failure
      Author(s): Milton Packer
      Although dipeptidyl peptidase (DPP)-4 inhibitors have been reported to have a neutral effect on thromboembolic vaso-occlusive events in large-scale trials, they act to potentiate several endogenous peptides that can exert deleterious cardiovascular effects. Experimentally, DPP-4 inhibitors may augment the ability of glucagon-like peptide-1 to stimulate cyclic adenosine monophosphate in cardiomyocytes, and potentiation of the effects of stromal cell–derived factor-1 by DPP-4 inhibitors may aggravate cardiac fibrosis. These potentially deleterious actions of DPP-4 inhibitors might not become clinically apparent if these drugs were to promote sodium excretion. However, the natriuretic effect of DPP-4 inhibitors is modest, because they act on the distal (rather than proximal) renal tubules. Accordingly, both clinical trials and observational studies have reported an increase in the risk of heart failure in patients with type 2 diabetes who were receiving DPP-4 inhibitors. This risk may be muted in trials with a high prevalence of metformin use or with low and declining background use of insulin and thiazolidinediones. Still, the most vulnerable patients (i.e., those with established heart failure) were not well represented in these studies. The only trial that specifically evaluated patients with pre-existing left ventricular dysfunction observed important drug-related adverse structural and clinical effects. In conclusion, an increased risk of worsening heart failure appears to be a class effect of DPP-4 inhibitors, even in patients without a history of heart failure. Additional clinical trials are urgently needed to elucidate the benefits and risks of DPP-4 inhibitors in patients with established left ventricular dysfunction.
      Graphical abstract image

      PubDate: 2018-03-17T19:19:32Z
      DOI: 10.1016/j.jchf.2017.12.016
       
  • Narrowing the Disparities in Heart Failure
    • Authors: Hena Patel; Kim Allan Williams
      Abstract: Publication date: Available online 7 March 2018
      Source:JACC: Heart Failure
      Author(s): Hena Patel, Kim Allan Williams
      Graphical abstract image Highlights

      PubDate: 2018-03-17T19:19:32Z
      DOI: 10.1016/j.jchf.2018.01.019
       
  • “Recovering” the Recognition for VO2 Kinetics During Exercise
           Recovery in Heart Failure
    • Authors: Marco Guazzi
      Abstract: Publication date: Available online 7 March 2018
      Source:JACC: Heart Failure
      Author(s): Marco Guazzi
      Graphical abstract image

      PubDate: 2018-03-17T19:19:32Z
      DOI: 10.1016/j.jchf.2018.01.020
       
  • Comorbidities and Cardiometabolic Disease
    • Authors: Matthew Nayor; Danielle M. Enserro; Vanessa Xanthakis; Martin G. Larson; Emelia J. Benjamin; Jayashri Aragam; Gary F. Mitchell; Ramachandran S. Vasan
      Abstract: Publication date: Available online 7 March 2018
      Source:JACC: Heart Failure
      Author(s): Matthew Nayor, Danielle M. Enserro, Vanessa Xanthakis, Martin G. Larson, Emelia J. Benjamin, Jayashri Aragam, Gary F. Mitchell, Ramachandran S. Vasan
      Objectives This study sought to evaluate the course, correlates, and prognosis of longitudinal changes in left ventricular (LV) diastolic dysfunction (DD) in the community-based Framingham Heart Study. Background Relationships of clinical risk factors to longitudinal progression of DD are incompletely understood. Methods Diastolic function was assessed by echocardiography performed at consecutive examinations (visits 1 and 2, mean interval 5.6 years) in 1,740 participants (64 ± 8 years of age at visit 1, 59% women) with normal LV systolic function and no atrial fibrillation. Results Of 1,615 individuals with normal-to-mild DD at visit 1, 198 (12%) progressed to ≥ moderate DD at visit 2. Progression was more likely in women and with advancing age (p < 0.0001). Of 125 individuals with ≥ moderate DD at visit 1, 25 (20%) regressed to normal-to-mild DD by visit 2. Regression of DD was associated with younger age (p < 0.03). In stepwise regression models, age, female sex, baseline and changes in systolic blood pressure, diastolic blood pressure, body mass index, serum triglycerides, and diabetes were positively associated with worsening diastolic function (all p < 0.05). Noncardiac comorbidity tracked with progressive DD. Cardiovascular disease (CVD) or death events occurred in 44 of 1,509 participants free of CVD at visit 2, during 2.7 ± 0.6 years of post-visit 2 follow-up. Presence of ≥ moderate DD was associated with higher risk (age- and sex-adjusted hazard ratio for CVD or death: 2.14; 95% confidence interval: 1.06 to 4.32; p = 0.03). Conclusions In a community-based cohort of middle-aged to older adults, cardiometabolic risk factors and noncardiac comorbidities were associated with DD progression. Moderate or worse DD was associated with higher risk of CVD or death.
      Graphical abstract image

      PubDate: 2018-03-17T19:19:32Z
      DOI: 10.1016/j.jchf.2017.12.018
       
  • Obesity-Related Heart Failure With a Preserved Ejection Fraction
    • Authors: Milton Packer; Dalane W. Kitzman
      Abstract: Publication date: Available online 7 March 2018
      Source:JACC: Heart Failure
      Author(s): Milton Packer, Dalane W. Kitzman
      Obesity-related heart failure with a preserved ejection fraction (HFpEF) is an important phenotype prevalent in the community, especially in people with metabolic disorders (e.g., dyslipidemia, diabetes). These individuals exhibit a marked expansion of plasma volume, but ventricular distensibility is limited, most likely as a result of cardiac microvascular rarefaction acting in concert with myocardial and pericardial fibrosis. Consequently, the increase in plasma volume causes a disproportionate increase in cardiac filling pressures, leading to heart failure, even though systolic ejection is not impaired. The features of this syndrome appear to be related (in part) to the overproduction of adipocyte-derived cell-signaling molecules, including aldosterone and neprilysin. The resulting sodium retention and plasma volume expansion is exacerbated by their mutual actions to promote cardiac and systemic inflammation and fibrosis. Inhibitors of aldosterone, neprilysin and the sodium-glucose transporter-2 (SGLT2) can ameliorate the plasma volume expansion and pro-inflammatory and profibrotic pathways, potentially opposing the action of diverse adipocytokines. All 3 classes of drugs can reduce the quantity of visceral adipose tissue and ameliorate its abnormal biological properties. This mechanistic framework is supported by the results of large-scale randomized trials with mineralocorticoid receptor antagonists and SGLT2 inhibitors and is being further tested in an ongoing large-scale trial of neprilysin inhibition. The promise of using mineralocorticoid receptor antagonists, neprilysin inhibitors, and SGLT2 inhibitors (alone or in combination) in the management of obesity-related HFpEF suggests that physicians might finally have a phenotype of HFpEF that they can understand and treat.
      Graphical abstract image

      PubDate: 2018-03-17T19:19:32Z
      DOI: 10.1016/j.jchf.2018.01.009
       
  • Is Time of the Essence' The Impact of Time of Hospital Presentation
           in Acute Heart Failure
    • Authors: Lukasz P. Cerbin; Andrew P. Ambrosy; Stephen J. Greene; Paul W. Armstrong; Javed Butler; Adrian Coles; Adam D. DeVore; Justin A. Ezekowitz; Adrian F. Hernandez; Marco Metra; Randall C. Starling; Wilson Tang; John R. Teerlink; Adriaan A. Voors; Angie Wu; Christopher M. O’Connor; Robert J. Mentz
      Abstract: Publication date: Available online 7 March 2018
      Source:JACC: Heart Failure
      Author(s): Lukasz P. Cerbin, Andrew P. Ambrosy, Stephen J. Greene, Paul W. Armstrong, Javed Butler, Adrian Coles, Adam D. DeVore, Justin A. Ezekowitz, Adrian F. Hernandez, Marco Metra, Randall C. Starling, Wilson Tang, John R. Teerlink, Adriaan A. Voors, Angie Wu, Christopher M. O’Connor, Robert J. Mentz
      Objectives As the largest acute heart failure (AHF) trial conducted to date, the global ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial database presented an opportunity to systematically describe the relationship among time of hospital presentation, clinical profile, inpatient management, and outcomes among patients admitted with AHF. Background Time of hospital presentation has been shown to impact outcomes among patients hospitalized with many conditions. However, the association among time of presentation and patient characteristics, management, and clinical outcomes among patients hospitalized with AHF has not been well characterized. Methods A post hoc analysis of the ASCEND-HF trial was performed, which enrolled 7,141 patients hospitalized for AHF. Patients were divided based on when they presented to the hospital; regular hours were defined as 9 am to 5 pm, Monday through Friday, and off hours were defined as 5 pm to 9 am, Monday through Friday and weekends. Clinical characteristics and outcomes were compared by time of presentation. Results Overall, 3,298 patients (46%) presented during off hours. Off-hour patients were more likely to have orthopnea (80% vs. 74%, respectively) and rales (56% vs. 49%, respectively) than regular-hour patients. Off-hour patients were more likely to receive intravenous (IV) nitroglycerin (18% vs. 11%, respectively) and IV loop diuretics (92% vs. 86%, respectively) as initial therapy and reported greater relief from dyspnea at 24 h (odds ratio [OR]: 1.14; 95% confidence interval [CI]: 1.04 to 1.24; p = 0.01) than regular-hour patients. After adjustment, off-hour presentation was associated with significantly lower 30-day mortality (OR: 0.74; 95% CI: 0.57 to 0.96; p = 0.03) and 180-day mortality (hazard ratio [HR]: 0.82; 95% CI: 0.72 to 0.94; p = 0.01) but similar 30-day rehospitalization rates (p = 0.40). Conclusions In this AHF trial, patients admitted during off hours exhibited a distinct clinical profile, experienced greater dyspnea relief, and had lower post-discharge mortality than regular-hour patients. These findings have implications for future AHF trials.
      Graphical abstract image

      PubDate: 2018-03-17T19:19:32Z
      DOI: 10.1016/j.jchf.2018.01.018
       
  • Diastole Tracks Cardiometabolic Risk∗
    • Authors: Walter J. Paulus; Elisa Dal Canto
      Abstract: Publication date: Available online 7 March 2018
      Source:JACC: Heart Failure
      Author(s): Walter J. Paulus, Elisa Dal Canto
      Graphical abstract image

      PubDate: 2018-03-17T19:19:32Z
      DOI: 10.1016/j.jchf.2018.01.008
       
  • Post-Exercise Oxygen Uptake Recovery Delay
    • Authors: Cole S. Bailey; Luke T. Wooster; Mary Buswell; Sarvagna Patel; Paul P. Pappagianopoulos; Kristian Bakken; Casey White; Melissa Tanguay; Jasmine B. Blodgett; Aaron L. Baggish; Rajeev Malhotra; Gregory D. Lewis
      Abstract: Publication date: Available online 7 March 2018
      Source:JACC: Heart Failure
      Author(s): Cole S. Bailey, Luke T. Wooster, Mary Buswell, Sarvagna Patel, Paul P. Pappagianopoulos, Kristian Bakken, Casey White, Melissa Tanguay, Jasmine B. Blodgett, Aaron L. Baggish, Rajeev Malhotra, Gregory D. Lewis
      Objectives This study sought to characterize the functional and prognostic significance of oxygen uptake (VO2) kinetics following peak exercise in individuals with heart failure (HF). Background It is unknown to what extent patterns of VO2 recovery following exercise reflect circulatory response during exercise in HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). Methods We investigated patients (30 HFpEF, 20 HFrEF, and 22 control subjects) who underwent cardiopulmonary exercise testing with invasive hemodynamic monitoring and a second distinct HF cohort (n = 106) who underwent noninvasive cardiopulmonary exercise testing with assessment of long-term outcomes. Fick cardiac output (CO) and cardiac filling pressures were measured at rest and throughout exercise in the initial cohort. A novel metric, VO2 recovery delay (VO2RD), defined as time until post-exercise VO2 falls permanently below peak VO2, was measured to characterize VO2 recovery kinetics. Results VO2RD in patients with HFpEF (median 25 s [interquartile range (IQR): 9 to 39 s]) and HFrEF (28 s [IQR: 2 to 52 s]) was in excess of control subjects (5 s [IQR: 0 to 7 s]; p < 0.0001 and p = 0.003, respectively). VO2RD was inversely related to cardiac output augmentation during exercise in HFpEF (ρ = −0.70) and HFrEF (ρ = −0.73, both p < 0.001). In the second cohort, VO2RD predicted transplant-free survival in univariate and multivariable Cox regression analysis (Cox hazard ratios: 1.49 and 1.37 per 10-s increase in VO2RD, respectively; both p < 0.005). Conclusions Post-exercise VO2RD is an easily recognizable, noninvasively derived pattern that signals impaired cardiac output augmentation during exercise and predicts outcomes in HF. The presence and duration of VO2RD may complement established exercise measurements for assessment of cardiac reserve capacity.
      Graphical abstract image

      PubDate: 2018-03-17T19:19:32Z
      DOI: 10.1016/j.jchf.2018.01.007
       
  • Sudden Death in Heart Failure with Preserved Ejection Fraction: A
           Competing Risks Analysis from the TOPCAT Trial
    • Authors: Muthiah Vaduganathan; Brian L. Claggett; Neal A. Chatterjee; Inder S. Anand; Nancy K. Sweitzer; James C. Fang; Eileen O'Meara; Sanjiv J. Shah; Sheila M. Hegde; Akshay S. Desai; Eldrin F. Lewis; Jean Rouleau; Bertram Pitt; Marc A. Pfeffer; Scott D. Solomon
      Abstract: Publication date: Available online 4 March 2018
      Source:JACC: Heart Failure
      Author(s): Muthiah Vaduganathan, Brian L. Claggett, Neal A. Chatterjee, Inder S. Anand, Nancy K. Sweitzer, James C. Fang, Eileen O'Meara, Sanjiv J. Shah, Sheila M. Hegde, Akshay S. Desai, Eldrin F. Lewis, Jean Rouleau, Bertram Pitt, Marc A. Pfeffer, Scott D. Solomon
      Background Sudden death (SD) may be an important mode of death in heart failure with preserved ejection fraction (HFpEF). Objectives To investigate rates and predictors of SD or aborted cardiac arrest (ACA) in HFpEF. Methods We studied 1,767 patients with HFpEF (EF≥45%) enrolled in the Americas region of the TOPCAT trial. We identified independent predictors of composite SD/ACA with step-wise backward selection using competing risks regression analysis accounting for non-sudden causes of death. Results During median 3.0 (1.9-4.4) year follow-up, 77 patients experienced SD/ACA and 312 experienced non-SD/ACA. Corresponding incidence rates were 1.4 (1.1-1.8) and 5.8 (5.1-6.4) events/100 patient-years. SD/ACA was numerically lower but not statistically reduced in those randomized to spironolactone: 1.2 (0.9-1.7) vs. 1.6 (1.2-2.2) events/100 patient-years; subdistributional HR 0.74 95% CI 0.47-1.16; P=0.19. After accounting for competing risks of non-sudden death, male sex and insulin-treated diabetes mellitus were independently predictive of composite SD/ACA (C-statistic 0.65). Covariates—including eligibility criteria, age, ejection fraction, coronary artery disease, LBBB, and baseline therapies—were not independently associated with SD/ACA. Sex and diabetes mellitus status remained independent predictors in sensitivity analyses excluding patients with implantable cardioverter-defibrillators and when predicting SD alone. Conclusions SD accounted for ∼20% of deaths in HFpEF. Male sex and insulin-treated diabetes mellitus identify patients at higher risk for SD/ACA with modest discrimination. These data may guide future SD-preventative efforts in HFpEF. Clinical Trials Registration TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist); ClinicalTrials.gov Unique Identifier: NCT00094302.

      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2018.02.014
       
  • Will biomarkers succeed as a surrogate endpoint in heart failure
           trials'
    • Authors: James L. Januzzi
      Abstract: Publication date: Available online 4 March 2018
      Source:JACC: Heart Failure
      Author(s): James L. Januzzi


      PubDate: 2018-03-06T10:14:04Z
      DOI: 10.1016/j.jchf.2018.02.008
       
  • My Heart Failure Journey
    • Authors: Covert
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): Ed Covert


      PubDate: 2018-03-06T10:14:04Z
       
  • Reply
    • Authors: Estruch Victor; Gil Pere Llorens
      Abstract: Publication date: March 2018
      Source:JACC: Heart Failure, Volume 6, Issue 3
      Author(s): Òscar Miró, Ramón Estruch, Victor Gil, Pere Llorens


      PubDate: 2018-03-06T10:14:04Z
       
  • Meta-Analyses and Interpretation of Troponin Values in Heart
           Failure∗
    • Authors: Allan S. Jaffe; Wayne L. Miller
      Abstract: Publication date: Available online 10 January 2018
      Source:JACC: Heart Failure
      Author(s): Allan S. Jaffe, Wayne L. Miller
      Graphical abstract image

      PubDate: 2018-02-02T07:29:35Z
      DOI: 10.1016/j.jchf.2017.12.001
       
  • High-Sensitivity Cardiac Troponin and New-Onset Heart Failure
    • Authors: Jonathan D.W. Evans; Stephen J.H. Dobbin; Stephen J. Pettit; Emanuele Di Angelantonio; Peter Willeit
      Abstract: Publication date: Available online 10 January 2018
      Source:JACC: Heart Failure
      Author(s): Jonathan D.W. Evans, Stephen J.H. Dobbin, Stephen J. Pettit, Emanuele Di Angelantonio, Peter Willeit
      Objectives The aim of this study was to systematically collate and appraise the available evidence regarding the association between high-sensitivity cardiac troponin (hs-cTn) and incident heart failure (HF) and the added value of hs-cTn in HF prediction. Background Identification of subjects at high risk for HF and early risk factor modification with medications such as angiotensin-converting enzyme inhibitors may delay the onset of HF. Hs-cTn has been suggested as a prognostic marker for the incidence of first-ever HF in asymptomatic subjects. Methods PubMed, Embase, and Web of Science were systematically searched for prospective cohort studies published before January 2017 that reported associations between hs-cTn and incident HF in subjects without baseline HF. Study-specific multivariate-adjusted hazard ratios (HRs) were pooled using random-effects meta-analysis. Results Data were collated from 16 studies with a total of 67,063 subjects and 4,165 incident HF events. The average age was 57 years, and 47% were women. Study quality was high (Newcastle-Ottawa score 8.2 of 9). In a comparison of participants in the top third with those in the bottom third of baseline values of hs-cTn, the pooled multivariate-adjusted HR for incident HF was 2.09 (95% confidence interval [CI]: 1.76 to 2.48; p < 0.001). Between-study heterogeneity was high, with an I2 value of 80%. HRs were similar in men and women (2.29 [95% CI: 1.64 to 3.21] vs. 2.18 [95% CI: 1.68 to 2.81]) and for hs-cTnI and hs-cTnT (2.09 [95% CI: 1.53 to 2.85] vs. 2.11 [95% CI: 1.69 to 2.63]) and across other study-level characteristics. Further adjustment for B-type natriuretic peptide yielded a similar HR of 2.08 (95% CI: 1.64 to 2.65). Assay of hs-cTn in addition to conventional risk factors provided improvements in the C index of 1% to 3%. Conclusions Available prospective studies indicate a strong association of hs-cTn with the risk of first-ever HF and significant improvements in HF prediction.
      Graphical abstract image

      PubDate: 2018-02-02T07:29:35Z
      DOI: 10.1016/j.jchf.2017.11.003
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
 
Home (Search)
Subjects A-Z
Publishers A-Z
Customise
APIs
Your IP address: 23.20.240.193
 
About JournalTOCs
API
Help
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-