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  JACC : Heart Failure
   Full-text available via subscription Subscription journal
   ISSN (Online) 2213-1779
   Published by American College of Cardiology Foundation Homepage  [1 journal]
  • Phrenic Nerve Stimulation for Central Sleep Apnea Wiping Out Apnea or
           Whipping the Muscles' ∗
    • Authors: Naughton MT.
      Abstract: Central sleep apnea (CSA) occurs in about one-third of patients with advanced heart failure (HF) (1). It is characterized by a waxing and waning respiratory pattern, usually of about 60 s cycle length during non–rapid eye movement sleep (2). In contrast to most sleep-related breathing disorders, CSA is associated with hyperventilation (3).
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Cardiovascular Reactivity to Mental Stress and Mortality in Patients With
           Heart Failure
    • Authors: Kupper N; Denollet J, Widdershoven J, et al.
      Abstract: ObjectivesThis study examined whether blood pressure (BP) and heart rate responses to acute mental stress were associated with mortality in patients with heart failure (HF).BackgroundHF is characterized by reduced contractility and impaired BP reactivity. Compared to exercise-induced physiological changes, the effects of mental stress on BP and heart rate in HF are not well understood.MethodsPatients with systolic HF (N = 100, 26% female, mean 65 ± 12 years of age) underwent a structured public speech task, during which BP and heart rate were recorded. Stress-induced BP and heart rate reactivity were categorized as high (>75%), intermediate (25% to 75%), or low (6.3 beats/min) to acute mental stress was associated with a reduced mortality risk (HR: 0.40; 95% CI: 0.16 to 1.00; p = 0.051) compared to patients with intermediate responses.ConclusionsLow diastolic BP reactivity to mental stress is independently associated with all-cause mortality in patients with HF. Larger studies need to replicate this finding and examine the role of psychosocial variables.
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Race and Vitamin D Binding Protein Gene Polymorphisms Modify the
           Association of 25-Hydroxyvitamin D and Incident Heart Failure The ARIC
           (Atherosclerosis Risk in Communities) Study
    • Authors: Lutsey PL; Michos ED, Misialek JR, et al.
      Abstract: ObjectivesThis study sought to determine if low serum 25-hydroxyvitamin D (25[OH]D) is associated with incident heart failure (HF) and if the association is: 1) partly mediated by traditional cardiovascular risk factors; 2) stronger among whites than blacks; and 3) stronger among those genetically predisposed to having high levels of vitamin D binding protein (DBP).BackgroundSuboptimal 25(OH)D is a potential cardiovascular risk factor.MethodsA total of 12,215 ARIC (Atherosclerosis Risk in Communities) study participants free of HF at baseline (1990 to 1992; median age, 56; 24% black) were followed through 2010. Total serum 25(OH)D was measured at baseline using liquid chromatography–mass spectrometry. Incident HF events were identified by a hospital discharge code of ICD9-428 and parallel International Classification of Diseases codes for HF deaths.ResultsDuring 21 years of follow-up, 1,799 incident HF events accrued. The association between 25(OH)D and HF varied by race (p-interaction = 0.02). Among whites, risk was 2-fold higher for those in the lowest (≤17 ng/ml) versus highest (≥31 ng/ml) quintile of 25(OH)D. The association was attenuated but remained significant with covariate adjustment. In blacks there was no overall association. In both races, those with low 25(OH)D and the rs7041 G allele, which predisposes to high DBP, were at greater risk (p-interaction = 0.01).ConclusionsLow serum 25(OH)D was independently associated with incident HF among whites, but not among blacks. However, in both races, low 25(OH)D was associated with HF risk among those genetically predisposed to high DBP. These findings provide novel insight into metabolic differences that may underlie racial variation in the association between 25(OH)D and cardiovascular risk.
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Vitamin D Deficiency and Heart Failure Risk Not so Black and White'
    • Authors: Wang TJ; Wells QS.
      Abstract: In the past decade, interest in vitamin D has blossomed, driven in large part by epidemiologic studies linking low vitamin D status with a variety of adverse health outcomes. The association of vitamin D deficiency with cardiovascular disease has generated particular attention, and for good reason, because the public health implications of a new, easily modifiable risk factor for cardiovascular disease are enormous. Because vitamin D deficiency is more common among blacks and individuals in developed countries, it has even been speculated that vitamin D supplementation could address some of the well-documented racial/ethnic and geographic disparities in cardiovascular risk.
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Phrenic Nerve Stimulation for the Treatment of Central Sleep Apnea
    • Authors: Abraham WT; Jagielski D, Oldenburg O, et al.
      Abstract: ObjectivesThe aim of this study was to evaluate chronic, transvenous, unilateral phrenic nerve stimulation to treat central sleep apnea (CSA) in a prospective, multicenter, nonrandomized study.BackgroundCSA occurs predominantly in patients with heart failure and increases the risk for morbidity and mortality. Established therapies for CSA are lacking, and those available are limited by poor patient adherence.MethodsFifty-seven patients with CSA underwent baseline polysomnography followed by transvenous phrenic nerve stimulation system implantation and follow-up. Feasibility was assessed by implantation success rate and therapy delivery. Safety was evaluated by monitoring of device- and procedure-related adverse events. Efficacy was evaluated by changes in the apnea-hypopnea index at 3 months. Quality of life at 6 months was evaluated using a sleepiness questionnaire, patient global assessment, and, in patients with heart failure at baseline, the Minnesota Living With Heart Failure Questionnaire.ResultsThe study met its primary end point, demonstrating a 55% reduction in apnea-hypopnea index from baseline to 3 months (49.5 ± 14.6 episodes/h vs. 22.4 ± 13.6 episodes/h of sleep; p < 0.0001; 95% confidence interval for change: −32.3 to −21.9). Central apnea index, oxygenation, and arousals significantly improved. Favorable effects on quality of life and sleepiness were noted. In patients with heart failure, the Minnesota Living With Heart Failure Questionnaire score significantly improved. Device- or procedure-related serious adverse events occurred in 26% of patients through 6 months post therapy initiation, predominantly due to lead repositioning early in the study. Therapy was well tolerated. Efficacy was maintained at 6 months.ConclusionsTransvenous, unilateral phrenic nerve stimulation appears safe and effective for treating CSA. These findings should be confirmed in a prospective, randomized, controlled trial. (Chronic Evaluation of Respicardia Therapy; NCT01124370)
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Inside This Issue
    • PubDate: Fri, 01 May 2015 00:00:00 GMT
  • The Autonomic Nervous System and Cardiovascular Health and Disease A
           Complex Balancing Act ∗
    • Authors: Bairey Merz C; Elboudwarej O, Mehta P.
      Abstract: The cardiac autonomic nervous system (ANS) is a crucial component in physiological and pathological responses of the cardiovascular system. Through its 2 branches, the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS) nervous systems, as well as effector molecules including norepinephrine (NE) and acetylcholine, the ANS orchestrates many events that allow for appropriate blood pressure (BP), heart rate (HR), and vasoregulatory responses to routine daily stimuli. Dysregulation of this system due to aging, acute and chronic stress, organic and idiopathic and other causes contributes to cardiovascular pathology, including hypertension, ischemic heart disease, arrhythmias, and congestive heart failure, and often contributes to fatal outcomes.
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Assessing the Use of International Classification of Diseases-10th
           Revision Codes From the Emergency Department for the Identification of
           Acute Heart Failure
    • Authors: Frolova N; Bakal JA, McAlister FA, et al.
      Abstract: ObjectivesThe objective of this study was to compare administrative codes with chart review for patients with acute heart failure (AHF).BackgroundAdministrative databases are used in population health research; however, the validity of codes in the emergency department (ED) for AHF compared with chart review is uncertain.MethodsA cohort of 952 patients with suspected AHF were prospectively recruited from 4 EDs in Edmonton, Alberta, Canada, from 2009 to 2012. Patients had their diagnoses adjudicated by expert physicians using a standardized scoring system and detailed chart review. ED and hospital discharge International Classification of Diseases-10th Revision (ICD-10) codes were captured in the main diagnosis or in any diagnostic field.ResultsThe 897 patients had a median age of 77 years (interquartile range: 67 to 85 years), and 806 (90%) were admitted to the hospital. Overall, 809 patients (90.2%) had AHF by adjudication and 660 (73.6%) had ICD-10 code I50.x as a main diagnosis in the ED administrative data, respectively. The positive predictive value of an AHF main diagnosis in the ED administrative data was 93.3% (95% confidence interval [CI]: 92.0% to 94.7%), with sensitivity of 76.1% (95% CI: 75.0% to 77.2%) and specificity of 50.0% (95% CI: 39.8% to 60.1%). The positive predictive value for AHF in any diagnostic field of the ED administrative data was 92.0% (95% CI: 91.1% to 93.0%), with a sensitivity of 89.4% (95% CI: 88.5% to 90.4%) and specificity of 28.4% (95% CI: 20.1% to 37.9%).ConclusionsAn ICD-10 I50.x diagnosis in the ED is highly predictive of AHF compared with chart-level adjudication using a validated score. Thus, the use of these codes in ED administrative databases could identify AHF for clinical and epidemiological studies.
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Assessing the Accuracy of Emergency Department International
           Classification of Diseases Coding ∗
    • Authors: Storrow AB; Collins SP.
      Abstract: Describing emergency department (ED) care has increasingly relied on multiple, large national data sources and, in particular, accurate International Classification of Diseases (ICD) coding. Although such data are contained in impressively large and longitudinal datasets, they were mostly intended for billing, not research, purposes (1). Until recently, epidemiological study of ICD coding for heart failure has largely been limited to hospitalized patients, has not distinguished between acute and chronic disease, and has not addressed coding accuracy within the ED. In this issue of JACC: Heart Failure, Frolova et al. (2) assess how ED discharge ICD-10th Revision (ICD-10) codes for acute heart failure (AHF) compared with expert physician adjudication, including both patients admitted to the hospital and those discharged from the ED. Such a report is important and timely; stakeholders often rely on coding accuracy to improve ED operations and health care policy decisions.
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Worsening Heart Failure Following Admission for Acute Heart Failure A
           Pooled Analysis of the PROTECT and RELAX-AHF Studies
    • Authors: Davison BA; Metra M, Cotter G, et al.
      Abstract: ObjectivesThese studies conducted analyses to examine patient characteristics and outcomes associated with worsening heart failure (WHF).BackgroundWHF during an admission for acute heart failure (AHF) represents treatment failure and is a potential therapeutic target for clinical trials of AHF.MethodsIndividual patient data from the PROTECT (Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function) and RELAX-AHF (Relaxin in Acute Heart Failure) phase II and III studies were pooled for analysis.ResultsOf 3,691 patients, death or WHF through day 5 occurred in 12.4%, ranging from 9.5% to 14.5% among studies. A multivariable model provided modest discrimination between patients who did or did not develop WHF (C-index = 0.68). After multivariable adjustment, WHF was associated with a mean increase in length of stay of 5.2 days (95% confidence interval [CI]: 4.6 to 5.8 days) and increased risks of 60-day HF or renal failure readmission or cardiovascular death (hazard ratio [HR]: 1.64, 95% CI: 1.34 to 2.01) and 180-day mortality (HR: 1.93, 95% CI: 1.55 to 2.41) (all p < 0.001). The risk of mortality was higher in patients whose WHF required intravenous inotropes or mechanical therapy (HR: 3.03, 95% CI: 2.11 to 4.36) compared with patients whose WHF was treated with intravenous loop diuretic alone (HR: 1.80, 95% CI: 1.36 to 2.36) (both p < 0.001). WHF was associated with larger increases in markers of renal and hepatic dysfunction during the first days of admission, but remained significantly associated with adverse outcomes after adjustment for these changes.ConclusionsWHF during the first 5 days of admission for AHF occurred in approximately 10% to 15% of patients and was associated with longer length of stay and higher risk for readmission and death.
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Worsening Heart Failure Challenges as a Therapeutic Target ∗
    • Authors: Tang W; Grodin JL.
      Abstract: Worsening heart failure (WHF) has been proposed over the years as a clinically relevant endpoint in assessing therapies for acute decompensated heart failure (ADHF) (1). Although varied across different studies, WHF was often defined as “either failure to improve (persistent symptoms and signs of HF during treatment) or worsening symptoms and signs of HF, pulmonary edema, or cardiogenic shock after initial stabilization and treatment of at least 24 h any of which requires rescue therapy” (1). This short-term endpoint (often within 7 days of admission) parallels early reinfarction after myocardial infarction as an indicator of initial treatment failure (2). As such, WHF has been used as a component of a primary or secondary endpoint in many clinical trials testing both novel medications (3–7) and new methods for established therapies for ADHF (8–10) as summarized in Table 1. In this issue of JACC: Heart Failure, Davison et al. (11) added another analysis to this growing body of literature on WHF during treatment for ADHF. They retrospectively analyzed a pooled contemporary ADHF cohort to identify baseline predictors of WHF and its associated outcomes. As with the previous studies (1,12–15), respiratory status, increased neurohormonal activation, and other familiar (and some less familiar such as “Western-like country”) baseline markers of clinical severity were found to be significant, but modest, predictors in a multivariable model for incident WHF (C-statistic: 0.67, 95% confidence interval: 0.65 to 0.70). After adjusting for baseline risk factors, laboratory values with their changes, and physical examination changes, WHF was associated with increased length of stay, cardiovascular death, or heart failure/renal failure rehospitalization by 60 days, and death by 180 days (p < 0.0001 for all). When stratified by treatment type—additional intravenous loop diuretic drugs or inotropes or mechanical therapies—WHF remained associated with death by 180 days. As with other studies, the investigators concluded that WHF is an important clinical event during the clinical course of ADHF that is not fully explained by baseline risk factors and can track with adverse outcomes after ADHF.
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Cardiopulmonary Responses and Prognosis in Hypertrophic Cardiomyopathy A
           Potential Role for Comprehensive Noninvasive Hemodynamic Assessment
    • Authors: Finocchiaro G; Haddad F, Knowles JW, et al.
      Abstract: ObjectivesThis study sought to discover the key determinants of exercise capacity, maximal oxygen consumption (oxygen uptake [Vo2]), and ventilatory efficiency (ventilation/carbon dioxide output [VE/Vco2] slope) and assess the prognostic potential of metabolic exercise testing in hypertrophic cardiomyopathy (HCM).BackgroundThe intrinsic mechanisms leading to reduced functional tolerance in HCM are unclear.MethodsThe study sample included 156 HCM patients consecutively enrolled from January 1, 2007 to January 1, 2012 with a complete clinical assessment, including rest and stress echocardiography and cardiopulmonary exercise test (CPET) with impedance cardiography. Patients were also followed for the composite outcome of cardiac-related death, heart transplant, and functional deterioration leading to septal reduction therapy (myectomy or septal alcohol ablation).ResultsAbnormalities in CPET responses were frequent, with 39% (n = 61) of the sample showing a reduced exercise tolerance (Vo2 max 34). The variables most strongly associated with exercise capacity (expressed in metabolic equivalents), were peak cardiac index (r = 0.51, p < 0.001), age (r = –0.25, p < 0.01), male sex (r = 0.24, p = 0.02), and indexed right ventricular end-diastolic area (r = 0.31, p = 0.002), resulting in an R2 of 0.51, p < 0.001. Peak cardiac index was the main predictor of peak Vo2 (r = 0.61, p < 0.001). The variables most strongly related to VE/VCO2 slope were E/E′ (r = 0.23, p = 0.021) and indexed left atrial volume index (LAVI) (r = 0.34, p = 0.005) (model R2 = 0.15). The composite endpoint occurred in 21 (13%) patients. In an exploratory analysis, 3 variables were independently associated with the composite outcome (mean follow-up 27 ± 11 months): peak Vo2 34 (hazard ratio: 3.14; 95% CI: 1.26 to 7.87; p = 0.014), and LAVI >40 ml/m2 (hazard ratio: 3.32; 95% CI: 1.08 to 10.16; p = 0.036).ConclusionsIn HCM, peak cardiac index is the main determinant of exercise capacity, but it is not significantly related to ventilatory efficiency. Peak Vo2, ventilatory inefficiency, and LAVI are associated with an increased risk of major events in the short-term follow-up.
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Cardiopulmonary Limitation in Hypertrophic Cardiomyopathy Unscrambling the
           Rubik’s Cube ∗
    • Authors: Geske JB; Allison TG, Gersh BJ.
      Abstract: In this issue of JACC: Heart Failure, Finocchiaro et al. (1) present a single-center analysis of 156 patients with hypertrophic cardiomyopathy (HCM) who underwent noninvasive hemodynamic assessment inclusive of rest and stress transthoracic echocardiography as well as cardiopulmonary exercise testing (CPET) with impedance cardiography. The authors correlate functional assessment (exercise capacity, maximal oxygen consumption [Vo2], and ventilatory efficiency [VE/Vco2 slope]) with demographic, echocardiographic, and impedance variables. Furthermore, they assess the impact of measured variables on a short-term (mean 27 months) combined outcome of death, transplant, and need for septal reduction therapy (SRT). The authors conclude that peak cardiac index is the primary driver of exercise capacity and that peak Vo2, VE/Vco2 slope, and left atrial volume index are adverse predictors of the specified outcome.
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Medical Editors’ Grand Rounds A Discussion of Timely Topics and
           Editorial Emergencies
    • Authors: O’Connor CM.
      Abstract: Each year we devote one Cardiology Grand Rounds to the topic of medical journals and cardiology section editors. In this capacity, we discuss, analyze, and thoroughly review the role, processes, and effect that medical editors have on the advancement of scientific knowledge. This year we had an exciting panel discussion among 6 top medical editors, including Stuart Spencer, Executive Editor, The Lancet; Eric Peterson, Associate Editor for Cardiology, JAMA; Howard Rockman, Editor-in-Chief, Journal of Clinical Investigation; Daniel Mark, Editor-in-Chief, American Heart Journal; Galen Wagner, Editor-in-Chief, Journal of Electrocardiology; and myself for JACC: Heart Failure. We asked the editors to discuss 6 critical topics in the field of publishing that they faced on a daily basis. The topics were:1.Impact Factor. The collective opinion of this group of editors was that the impact factor is not an especially useful tool in evaluating journals and papers. There are methods to game the analysis by reducing the number of papers accepted to augment the impact factor. Some journals increased their impact factor 2-fold, from 20 to 40, and some have doubled their impact factor from 0.6 to 1.2. What does this really mean' The editors commented that it is not the impact factor, but instead the concept, value, and science of the paper that is most important. It is important to note, for example, that a Nobel Prize winner published his signature paper in a journal with an impact factor of 3.0. I noted that, despite its significant imperfection, it is better to be higher, rather than lower, in this imperfect world of comparing journals. Additionally, the panel discussed the role of impact factors for individual papers and citations, and expressed concern about the use of the impact factor for promotion and payment of investigators throughout the world. Such an imperfect metric is easier to assess than actually delving into the paper, the science, and the value of the experiment itself. Overall, we agreed that the impact factor should be re-evaluated and that we must look for better metrics of evaluation such as the H-index, or the adjusted impact factors minus guidelines and review papers.2.Integrity of scientific papers. This poses an even greater threat, as the number of publications throughout the world increases. There is pressure on faculty members to publish in highly-prestigious journals. It is possible to subtract a few observations here and there to get a positive result. The panel agreed that there is a bias that papers with positive results are often published in more prestigious journals than papers with negative results, and this may influence the pressure on the investigators to have positive results. The panel strongly recommended that it would be useful to have the actual datasets for review. Although tedious, difficult to analyze, and burdensome, a cursory review and inquiry of the dataset may actually allow for examination of the total integrity of the submitted paper. For example, we had a case of a randomized controlled trial of an investigational drug which improved peak oxygen uptake to an extensive degree in a small number of patients. Upon requesting the dataset, the investigators retracted the paper and went elsewhere. In addition, it has been noted, if more than several errors exist between the tables and figures, the likelihood that the data could be fraudulent is significantly increased. Thus, the panel agreed that we need to have better methods for ensuring the integrity of data. One proposed method was providing the primary data, and another method was eliminating the financial impetus for publishing papers.3.Ghostwriters. There was unanimous agreement that ghostwriting needs to be eliminated and that all authors and coauthors should declare their contributions to the paper. Investigators who make no contribution should not be listed as coauthors. We cited the enormous irregularities of some papers where there could be 40 to 50 coauthors, and it is seemingly impossible that many of these investigators could be contributing significantly to the report.4.Open access. Although the group of medical editors believed that this was a good process due to the increased transparency, it could also cause peer review to deteriorate, which would allow the publication of papers and experiments that could be erroneous and fraudulent.5.Peer review. The panel felt that continued efforts to have rigorous peer review was perceived to be an important role of the editorial process. The editors discussed the role of peer review and whether payment should be made for peer review. We agreed that reviewers should not be paid, but reviewers should be recognized for the process and excellence in this area. For example, JACC recognizes excellent peer review with the Simon Dack Award at its annual meeting. Indeed, this award and letters from the editor have supported these reviewers in their promotion and tenure process. In addition, excellent review metrics have been used to evaluate candidacy for associate editors and editors, and the panel believed that this recommendation should be standardized across journals. Finally, reviewers are often asked to write editorial comments, which are highly recognized and cited. The group of editors fe...
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Characterization of Pulmonary Hypertension in Heart Failure Using the
           Diastolic Pressure Gradient The Conundrum of High and Low Diastolic
           Pulmonary Gradient
    • Authors: Gerges C; Gerges M, Lang IM.
      Abstract: We read with interest the paper by Tampakakis et al. (1) and accompanying editorial by Chatterjee and Lewis (2) in a recent issue of JACC: Heart Failure refuting the prognostic value of the diastolic pulmonary gradient (DPG) (3). In addition to numerous limitations that are acknowledged both in the original paper and the editorial, it is important to point out details regarding the prognostic relevance of DPG.
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Measurement to Predict Survival: The Case of Diastolic Pulmonary Gradient
    • Authors: Naeije R.
      Abstract: When I revived the diastolic pressure gradient (DPG), I never thought of introducing a new prognostic marker (1). The purpose was only to improve the diagnosis of pulmonary vascular disease in heart failure (HF). However, a subsequent report by Gerges et al. (2) showed that an increased DPG is associated with a shorter survival in these patients. Thus Gerges et al. (2) comforted the notion that a high DPG phenotypes a subset of patients with HF and severe pulmonary vascular disease evolving much alike pulmonary arterial hypertension.
      PubDate: Fri, 01 May 2015 00:00:00 GMT
  • Reply Characterization of Pulmonary Hypertension in Heart Failure Using
           the Diastolic Pressure Gradient: The Conundrum of High and Low Diastolic
           Pulmonary Gradient
    • Authors: Tampakakis E; Tedford RJ.
      Abstract: We appreciate the important comments made by Dr. Gerges and colleagues and Dr. Naeije in their respective letters regarding our article (1). First, we agree with Dr. Gerges and colleagues that the patient characteristics of our respective cohorts are different: ours were younger, with more diverse heart failure (HF) pathologies and a relatively small percentage (7%) of ischemic cardiomyopathy. Importantly, our results were maintained after excluding patients with human immunodeficiency virus, infiltrative disease, and restrictive cardiomyopathy (60 of 469 [13%]). Another key difference is that the patients in our study had preexisting clinical HF diagnosis. In the study by Gerges et al. (2), patients were categorized with left heart disease based solely on a pulmonary capillary wedge pressure (PCWP) >15 mm Hg. Compared with our cohort, these patients may have been more likely to have pulmonary arterial hypertension or at least significant pulmonary arteriopathy (e.g., mean pulmonary artery pressure of 50 to 60 mm Hg with a PCWP of 16 mm Hg). Despite these diferences, the percentage of patients with pulmonary hypertension and diastolic pulmonary gradient (DPG) ≥7 mm Hg were similar between our 2 studies (62 of 469 [13%] vs. 179 of 1,094 [16%]). Moreover, although statistically significant, the absolute difference in survival curves between the high and low DPG groups in the study by Dr. Gerges and colleagues was small.
      PubDate: Fri, 01 May 2015 00:00:00 GMT
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