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Tang J, Wang P, Liu C, Peng J, Liu Y, Ma Q. Pharmacotherapy in patients with heart failure with reduced ejection fraction: A systematic review and meta-analysis. Chin Med J (Engl) 2024:00029330-990000000-01087. [PMID: 38811344 DOI: 10.1097/cm9.0000000000003118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Angiotensin receptor neprilysin inhibitors (ARNIs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers (BBs), and mineralocorticoid receptor antagonists (MRAs) are the cornerstones in treating heart failure with reduced ejection fraction (HFrEF). Sodium-glucose cotransporter 2 inhibitors (SGLT-2is) are included in HFrEF treatment guidelines. However, the effect of SGLT-2i and the five drugs on HFrEF have not yet been systematically evaluated. METHODS PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) from inception dates to September 23, 2022. Additional trials from previous relevant reviews and references were also included. The primary outcomes were changes in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter/dimension (LVEDD), left ventricular end-systolic diameter/dimension (LVESD), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV), left ventricular end-systolic volume index (LVESVI), and left ventricular end-diastolic volume index (LVEDVI). Secondary outcomes were New York Heart Association (NYHA) class, 6-min walking distance (6MWD), B-type natriuretic peptide (BNP) level, and N-terminal pro-BNP (NT-proBNP) level. The effect sizes were presented as the mean difference (MD) with 95% confidence interval (CI). RESULTS We included 68 RCTs involving 16,425 patients. Compared with placebo, ARNI + BB + MRA + SGLT-2i was the most effective combination to improve LVEF (15.63%, 95% CI: 9.91% to 21.68%). ARNI + BB + MRA + SGLT-2i (5.83%, 95% CI: 0.53% to 11.14%) and ARNI + BB + MRA (3.83%, 95% CI: 0.72% to 6.90%) were superior to the traditional golden triangle "ACEI + BB + MRA" in improving LVEF. ACEI + BB + MRA + SGLT-2i was better than ACEI + BB + MRA (-8.05 mL/m2, 95% CI: -14.88 to -1.23 mL/m2) and ACEI + BB + SGLT-2i (-18.94 mL/m2, 95% CI: -36.97 to -0.61 mL/m2) in improving LVEDVI. ACEI + BB + MRA + SGLT-2i (-3254.21 pg/mL, 95% CI: -6242.19 to -560.47 pg/mL) was superior to ARB + BB + MRA in reducing NT-proBNP. CONCLUSIONS Adding SGLT-2i to ARNI/ACEI + BB + MRA is beneficial for reversing cardiac remodeling. The new quadruple drug "ARNI + BB + MRA + SGLT-2i" is superior to the golden triangle "ACEI + BB + MRA" in improving LVEF. REGISTRATION PROSPERO; No. CRD42022354792.
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Affiliation(s)
- Jia Tang
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Ping Wang
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Chenxi Liu
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Jia Peng
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Yubo Liu
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Qilin Ma
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
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Jiao M, Zhang Y, Song X, Xu B. The role and mechanism of TXNDC5 in disease progression. Front Immunol 2024; 15:1354952. [PMID: 38629066 PMCID: PMC11019510 DOI: 10.3389/fimmu.2024.1354952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Thioredoxin domain containing protein-5 (TXNDC5), also known as endothelial protein-disulfide isomerase (Endo-PDI), is confined to the endoplasmic reticulum through the structural endoplasmic reticulum retention signal (KDEL), is a member of the PDI protein family and is highly expressed in the hypoxic state. TXNDC5 can regulate the rate of disulfide bond formation, isomerization and degradation of target proteins through its function as a protein disulfide isomerase (PDI), thereby altering protein conformation, activity and improving protein stability. Several studies have shown that there is a significant correlation between TXNDC5 gene polymorphisms and genetic susceptibility to inflammatory diseases such as rheumatoid, fibrosis and tumors. In this paper, we detail the expression characteristics of TXNDC5 in a variety of diseases, summarize the mechanisms by which TXNDC5 promotes malignant disease progression, and summarize potential therapeutic strategies to target TXNDC5 for disease treatment.
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Affiliation(s)
- Mingxia Jiao
- Department of Urology, The First Affiliated Hospital of Shandong First Medical University & Shandong Province Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Organ Transplantation and Nephrosis, Shandong Institute of Nephrology, Jinan, Shandong, China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Yeyong Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, Shandong, China
| | - Xie Song
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Bing Xu
- Department of Urology, The First Affiliated Hospital of Shandong First Medical University & Shandong Province Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Organ Transplantation and Nephrosis, Shandong Institute of Nephrology, Jinan, Shandong, China
- Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
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Oraii A, Healey JS, Kowalik K, Pandey AK, Benz AP, Wong JA, Conen D, McIntyre WF. Mineralocorticoid receptor antagonists and atrial fibrillation: a meta-analysis of clinical trials. Eur Heart J 2024; 45:756-774. [PMID: 38195054 DOI: 10.1093/eurheartj/ehad811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/05/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND AND AIMS Mineralocorticoid receptor antagonists (MRAs) improve cardiovascular outcomes in a variety of settings. This study aimed to assess whether cardioprotective effects of MRAs are modified by heart failure (HF) and atrial fibrillation (AF) status and to study their impact on AF events. METHODS MEDLINE, Embase, and Cochrane Central databases were searched to 24 March 2023 for randomized controlled trials evaluating the efficacy of MRAs as compared with placebo or usual care in reducing cardiovascular outcomes and AF events in patients with or at risk for cardiovascular diseases. Random-effects models and interaction analyses were used to test for effect modification. RESULTS Meta-analysis of seven trials (20 741 participants, mean age: 65.6 years, 32% women) showed that the efficacy of MRAs, as compared with placebo, in reducing a composite of cardiovascular death or HF hospitalization remains consistent across patients with HF [risk ratio = 0.81; 95% confidence interval (CI): 0.67-0.98] and without HF (risk ratio = 0.84; 95% CI: 0.75-0.93; interaction P = .77). Among patients with HF, MRAs reduced cardiovascular death or HF hospitalization in patients with AF (hazard ratio = 0.95; 95% CI: 0.54-1.66) to a similar extent as in those without AF (hazard ratio = 0.82; 95% CI: 0.63-1.07; interaction P = .65). Pooled data from 20 trials (21 791 participants, mean age: 65.2 years, 31.3% women) showed that MRAs reduce AF events (risk ratio = 0.76; 95% CI: 0.67-0.87) in both patients with and without prior AF. CONCLUSIONS Mineralocorticoid receptor antagonists are similarly effective in preventing cardiovascular events in patients with and without HF and most likely retain their efficacy regardless of AF status. Mineralocorticoid receptor antagonists may also be moderately effective in preventing incident or recurrent AF events.
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Affiliation(s)
- Alireza Oraii
- Population Health Research Institute, McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2, Canada
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2, Canada
- Division of Cardiology, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | - Krzysztof Kowalik
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Avinash K Pandey
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexander P Benz
- Population Health Research Institute, McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2, Canada
| | - Jorge A Wong
- Population Health Research Institute, McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2, Canada
- Division of Cardiology, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | - David Conen
- Population Health Research Institute, McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2, Canada
- Division of Cardiology, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | - William F McIntyre
- Population Health Research Institute, McMaster University, 237 Barton St East, DBVSRI C3-13A, Hamilton, ON L8L 2X2, Canada
- Division of Cardiology, Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
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Tingen HSA, Berends M, Tubben A, Bijzet J, Houwerzijl EJ, Muntinghe FLH, Kroesen BJ, van der Zwaag PA, van der Meer P, Slart RHJA, Hazenberg BPC, Nienhuis HLA. High-Sensitivity Cardiac Troponin T to Exclude Cardiac Involvement in TTR Variant Carriers and ATTRv Amyloidosis Patients. J Clin Med 2024; 13:810. [PMID: 38337504 PMCID: PMC10856062 DOI: 10.3390/jcm13030810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Individuals carrying a pathogenic transthyretin gene variant (TTRv) are at high risk for developing hereditary transthyretin (ATTRv) amyloidosis and are routinely screened for the development of cardiomyopathy (ATTRv-CM). This study aims to evaluate whether the cardiac biomarkers N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) can be used to rule out ATTRv-CM. (2) Methods: In this retrospective case-control study, data from 46 ATTRv-CM patients and 101 TTRv carriers and ATTRv amyloidosis patients without cardiomyopathy were included. Binary logistic regression models were used to assess the ability of NT-proBNP and hs-cTnT to predict the diagnosis of ATTRv-CM. An optimal cutoff for the relevant biomarker(s) was determined based on a sensitivity of ≥99% and the highest possible percentage of additional tests avoided (%ATA) in the index dataset. (3) Results: Hs-cTnT demonstrated the highest predictive capabilities for ATTRv-CM. The addition of NT-proBNP did not improve the predictive model. A hs-cTnT cutoff of <6 ng/L resulted in a 97% sensitivity and a negative predictive value of 95% with a %ATA of 30% in the validation dataset. (4) Conclusion: In conclusion, hs-cTnT is a useful biomarker for excluding cardiac involvement in TTRv carriers and ATTRv amyloidosis patients and it has the potential to prevent unnecessary diagnostic procedures.
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Affiliation(s)
- Hendrea S. A. Tingen
- Department of Nuclear Medicine and Molecular Imaging, Groningen Amyloidosis Centre of Expertise, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Milou Berends
- Department of Internal Medicine, Groningen Amyloidosis Centre of Expertise, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands (H.L.A.N.)
| | - Alwin Tubben
- Department of Cardiology, Groningen Amyloidosis Centre of Expertise, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Johan Bijzet
- Department of Laboratory Medicine, Groningen Amyloidosis Centre of Expertise, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Ewout J. Houwerzijl
- Department of Internal Medicine, Groningen Amyloidosis Centre of Expertise, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands (H.L.A.N.)
| | - Friso L. H. Muntinghe
- Department of Internal Medicine, Groningen Amyloidosis Centre of Expertise, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands (H.L.A.N.)
| | - Bart-Jan Kroesen
- Department of Laboratory Medicine, Groningen Amyloidosis Centre of Expertise, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Paul A. van der Zwaag
- Department of Genetics, Groningen Amyloidosis Centre of Expertise, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, Groningen Amyloidosis Centre of Expertise, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Riemer H. J. A. Slart
- Department of Nuclear Medicine and Molecular Imaging, Groningen Amyloidosis Centre of Expertise, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Bouke P. C. Hazenberg
- Department of Rheumatology & Clinical Immunology, Groningen Amyloidosis Centre of Expertise, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Hans L. A. Nienhuis
- Department of Internal Medicine, Groningen Amyloidosis Centre of Expertise, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands (H.L.A.N.)
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Sacharczuk W, Dankowski R, Ożegowski S, Rojna M, Szyszka A. Evaluation of early left-sided cardiac reverse remodeling under combined therapy of sacubitril-valsartan and spironolactone compared with angiotensin-converting enzyme inhibitors and spironolactone. Front Cardiovasc Med 2023; 10:1103688. [PMID: 37077749 PMCID: PMC10106719 DOI: 10.3389/fcvm.2023.1103688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
We aimed to compare therapies of sacubitril/valsartan + spironolactone (S/V + S) with angiotensin-converting enzyme inhibitors + spironolactone (ACEI + S) on the left-sided cardiac reverse remodeling (L-CRR). The second objective was to analyze the usefulness of GLS and LVEF in response to therapy. Methods 78 patients (mean age 63.4 years, 20 females) with symptomatic heart failure with reduced ejection fraction were randomized to groups of equal numbers, i.e., 39 patients, and started on therapy of S/V + S or ACEI + S. Second evaluations were made after 6-8 weeks of therapy. Results GLS changed from -7.4% to -9.4% (18% improvement) in both arms equally. More than 50% of patients, initially with very severe systolic dysfunction (GLS > -8%), were reclassified to severe (GLS -8% to -12%). LVEF did not improve in any of the groups. The quality of life measured by MLHFQ and walking distance by 6-MWT increased. Positive correlations between GLS and 6MWT (r = 0.41, p = 0.02) and GLS and MHFLQ (r = 0.42, p = 0.03) were found. The S/V + S subgroup demonstrated improvements in LVEDV (Δ16.7 vs. 4.5 ml), E/e ratio (Δ 2.8 vs. 1.4), and LAVI (Δ 9.4 vs. 8.4 ml/m2) as compared to ACEI + S. Conclusion GLS, unlike LVEF, detects early changes in LV systolic function after 6-8 weeks of combined therapy, i.e., SV + S and ACE + S. GLS is more useful than LVEF in assessing early response to treatment. The effect of S/V + S and ACEI + S on LV systolic function was comparable, but the improvement in diastolic function as expressed by E/e', LAVI, and LVEDV was more pronounced with S/V + S.
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Affiliation(s)
- Wioletta Sacharczuk
- Second Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
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Naser N, Durak–Nalbantic A, Sabanovic-Bajramovic N, Karic A. The Effectiveness of Eplerenone vs Spironolactone on Left Ventricular Systolic Function, Hospitalization and Cardiovascular Death in Patients With Chronic Heart Failure-HFrEF. Med Arch 2023; 77:105-111. [PMID: 37260796 PMCID: PMC10227849 DOI: 10.5455/medarh.2023.77.105-111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/19/2023] [Indexed: 06/02/2023] Open
Abstract
Background Heart failure remains one of the most prevalent clinical syndromes associated with significant morbidity and mortality. According to current guidelines, the prescription of a MRA is recommended to reduce the risk of HF hospitalization and death in all patients with symptomatic heart failure and no contraindications for this therapy. Objective The aim of our study was to determine the efficacy of eplerenone vs. spironolactone on left ventricular systolic function by measuring left ventricle ejection fraction (LVEF) in patients with chronic heart failure, especially their effect on preventing hospitalization, reducing mortality, and improving clinical status among patients with chronic HF. Methods From June 2021 to June 2022, the study was a randomized, prospective clinical trial single blind study. A total of 142 patients of chronic heart failure with reduced ejection fraction were selected by random sampling. Each patient was randomly allocated into either of the two groups and was continued receiving treatment with either spironolactone (Spiron-HF group) or eplerenone (Epler-HF group). Patients in Epler-HF group were compared with an arm of the same size and matched by age and gender patients in Spiron-HF group for management of chronic HFrEF. Each patient was evaluated clinically, biochemically, and echocardiographically at the beginning of treatment (baseline) after 6 months and at the end of 12th month. Echocardiography was performed to find out change in left ventricular systolic function. Results After 12 months of treatment, significant improvement of left ventricular ejection fraction was observed in eplerenone treated arm (37.9 ± 3.8 ± 4.6 in Spiron-HF group versus 40.1 ± 5.7 in Epler-HF group; P < 0.05). A significant reduction in left ventricular end-systolic volume (6.3 ± 2.5ml in Spiron-HF versus 17.8± 4.4ml in Epler-HF group; P < 0.05) and left ventricular systolic diameter volume (2.7 ± 0.5ml in Spiron-HF versus 6.7 ± 0.2ml in Epler-HF group; P < 0.05), occurred after 12 months of treatment. Left ventricular global longitudinal strain (LV GLS) was significantly improved in Epler-HF group compared with Spiron-HF group (0.6 ± 0.4 versus 3.4 ± 0.9; P < 0.05). There were no significant differences observed in reduction of left ventricular end-diastolic volume (2.2 ± 0.5 ml versus 4.7 ± 1.1ml; P =0.103) and left ventricular diastolic diameter (1.2 ± 0.6 versus 1.7 ± 0.3; P=0.082) in both arms. The effects of both MRA agents spironolactone and eplerenone on the primary composite outcome, each of the individual mortality and hospital admission outcomes are shown in Figure 1 and 2. Patients of the Epler-HF group showed statistically significant lower cardiovascular mortality (HR 0.53; 95% CI 0.34-0.82; p= 0.007) and all-cause mortality (HR 0.64; 95% CI 0.44-0.93; p= 0.022) than patients of the Spiron-HF group. The statistical analysis did not show a statistically significant difference between Epler -HF and Spiron-HF study groups regarding the risk of the primary composite outcome; cardiovascular death or hospitalization due to HF (Hazard Ratio (HR) eplerenone vs. spironolactone = 0.95; 95% Confidence Interval (CI) 0.73- 1.27; p= 0.675). Conclusion Our study has demonstrated favorable effects of eplerenone on cardiac remodeling parameters and reduction of cardiovascular mortality and all-cause mortality compared with spironolactone in the treatment of HFrEF. The ability of eplerenone to effectively block the mineralocorticoid receptor while minimizing side effects and a significant reduction in the risk of hospitalization and cardiovascular death confirms its key role in the treatment of patients with chronic HFrEF.
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Affiliation(s)
- Nabil Naser
- Polyclinic „Dr. Nabil”, Sarajevo, Bosnia and Herzegovina
- Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Azra Durak–Nalbantic
- Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
- Clinic for Heart Disease, University Clinical Center Sarajevo. Sarajevo, Bosnia and Herzegovina
| | | | - Alen Karic
- Department of Cardiac Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
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Hiraiwa H, Okumura T, Murohara T. Amino acid profiling to predict prognosis in patients with heart failure: an expert review. ESC Heart Fail 2022; 10:32-43. [PMID: 36300549 PMCID: PMC9871678 DOI: 10.1002/ehf2.14222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/05/2022] [Accepted: 10/14/2022] [Indexed: 01/27/2023] Open
Abstract
Heart failure is a complex disease with a poor prognosis. A number of widely used prognostic tools have limitations, so efforts to identify novel predictive markers and measures are important. As a metabolomics tool, amino acid profiling has shown promise in predicting heart failure prognosis; however, the evidence has not yet been sufficiently evaluated. We describe the utilization of amino acids in the healthy heart and in heart failure before reviewing the literature on amino acid profiling for prognostic prediction. We expertly interpret the findings and provide suggestions for future research to advance the understanding of the prognostic potential of amino acid profiling in heart failure. Our analysis revealed correlations between amino acid biomarkers and traditional prognostic factors, the additional prognostic value of amino acid biomarkers over traditional prognostic factors, and the successful use of amino acid biomarkers to distinguish heart failure aetiology. Although certain amino acid biomarkers have demonstrated additional prognostic value over traditional measures, such as New York Heart Association functional class, these measures are deeply rooted in clinical practice; thus, amino acid biomarkers may be best placed as additional prognostic tools to improve current risk stratification rather than as surrogate tools. Once the metabolic profiles of different heart failure aetiologies have been clearly delineated, the amino acid biomarkers with the most value in prognostic prediction should be determined. Amino acid profiling could be useful to evaluate the pathophysiology and metabolic status of different heart failure cohorts, distinguish heart failure aetiologies, and improve risk stratification and prognostic prediction.
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Affiliation(s)
- Hiroaki Hiraiwa
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Takahiro Okumura
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
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Hung CT, Tsai YW, Wu YS, Yeh CF, Yang KC. The novel role of ER protein TXNDC5 in the pathogenesis of organ fibrosis: mechanistic insights and therapeutic implications. J Biomed Sci 2022; 29:63. [PMID: 36050716 PMCID: PMC9438287 DOI: 10.1186/s12929-022-00850-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Fibrosis-related disorders account for an enormous burden of disease-associated morbidity and mortality worldwide. Fibrosis is defined by excessive extracellular matrix deposition at fibrotic foci in the organ tissue following injury, resulting in abnormal architecture, impaired function and ultimately, organ failure. To date, there lacks effective pharmacological therapy to target fibrosis per se, highlighting the urgent need to identify novel drug targets against organ fibrosis. Recently, we have discovered the critical role of a fibroblasts-enriched endoplasmic reticulum protein disulfide isomerase (PDI), thioredoxin domain containing 5 (TXNDC5), in cardiac, pulmonary, renal and liver fibrosis, showing TXNDC5 is required for the activation of fibrogenic transforming growth factor-β signaling cascades depending on its catalytic activity as a PDI. Moreover, deletion of TXNDC5 in fibroblasts ameliorates organ fibrosis and preserves organ function by inhibiting myofibroblasts activation, proliferation and extracellular matrix production. In this review, we detailed the molecular and cellular mechanisms by which TXNDC5 promotes fibrogenesis in various tissue types and summarized potential therapeutic strategies targeting TXNDC5 to treat organ fibrosis.
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Affiliation(s)
- Chen-Ting Hung
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, No. 1, Sec. 1, Ren-Ai Rd, 1150R, Taipei, 100, Taiwan
| | - Yi-Wei Tsai
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, No. 1, Sec. 1, Ren-Ai Rd, 1150R, Taipei, 100, Taiwan
| | - Yu-Shuo Wu
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, No. 1, Sec. 1, Ren-Ai Rd, 1150R, Taipei, 100, Taiwan
| | - Chih-Fan Yeh
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Kai-Chien Yang
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, No. 1, Sec. 1, Ren-Ai Rd, 1150R, Taipei, 100, Taiwan. .,Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan. .,Research Center for Developmental Biology & Regenerative Medicine, National Taiwan University, Taipei, Taiwan. .,Center for Frontier Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
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Milwidsky A, Mathai SV, Topilsky Y, Jorde UP. Medical Therapy for Functional Mitral Regurgitation. Circ Heart Fail 2022; 15:e009689. [PMID: 35862021 DOI: 10.1161/circheartfailure.122.009689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Functional mitral regurgitation (FMR) can be broadly categorized into 2 main groups: ventricular and atrial, which often coexist. The former is secondary to left ventricular remodeling usually in the setting of heart failure with reduced ejection fraction or less frequently due to ischemic papillary muscle remodeling. Atrial FMR develops due to atrial and annular dilatation related to atrial fibrillation/flutter or from increased atrial pressures in the setting of heart failure with preserved ejection fraction. Guideline-directed medical therapy is the first step and prevails as the mainstay in the treatment of FMR. In this review, we address the medical therapeutic options for FMR management and highlight a targeted approach for each FMR category. We further address important clinical and echocardiographic characteristics to aid in determining when medical therapy is expected to have a low yield and an appropriate window for effective interventional approaches exists.
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Affiliation(s)
- Assi Milwidsky
- Department of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (A.M., U.P.J.).,Department of Cardiology, Tel-Aviv Sourasky Medical Center (affiliated with the Sackler School of Medicine), Tel-Aviv University, Israel (A.M., Y.T.)
| | - Sheetal Vasundara Mathai
- Department of Medicine, Jacobi Medical Center and Albert Einstein College of Medicine, Bronx, NY (S.V.M.)
| | - Yan Topilsky
- Department of Cardiology, Tel-Aviv Sourasky Medical Center (affiliated with the Sackler School of Medicine), Tel-Aviv University, Israel (A.M., Y.T.)
| | - Ulrich P Jorde
- Department of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (A.M., U.P.J.)
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10
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Espinoza Romero C, Lima ICV, Hotta VT, Bocchi EA, Salemi VMC. Endomyocardial fibrosis of the right ventricle in a patient with schistosomiasis: a case report. Eur Heart J Case Rep 2022; 6:ytac312. [PMID: 35949701 PMCID: PMC9356724 DOI: 10.1093/ehjcr/ytac312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/11/2022] [Accepted: 07/22/2022] [Indexed: 11/14/2022]
Abstract
Background Endomyocardial fibrosis (EMF) is a rare and underdiagnosed cause of restrictive cardiomyopathy. Its aetiology is not yet defined and could be caused by the influence of different clinical factors that seem to combine with genetic aspects of individuals susceptible to an inflammatory process that leads to formation of fibrosis. Case summary We describe a case of a 50-year-old man from the northeastern region of Brazil, where there is high prevalence of schistosomiasis. He presented to our centre with symptoms of right heart failure. The echocardiogram showed normal left ventricular ejection fraction. Right ventricular had normal systolic function but in the apical region was filled with a homogeneous and hypoechoic image causing obliteration and restriction of the apex. The late gadolinium enhancement with cardiac magnetic resonance showed diffuse and heterogeneous subendocardial fibrosis in the right ventricle apex consistent with EMF, but declined endocardiectomy. Discussion This report presents an interesting case of EMF and schistosomiasis simultaneously. The hypothesis of parasitosis as a probable cause of EMF was raised by helminth-induced hypereosinophilia. Complementary imaging tests such as magnetic resonance imaging and echocardiography, in addition to clinical and epidemiological suspicion, are essential for its diagnosis. Early surgical resolution becomes crucial for long-term survival.
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Affiliation(s)
- Cristhian Espinoza Romero
- Heart failure deparment.Heart Institute (InCor). Hospital das Clinicas da Universidade de São Paulo , São Paulo , Brazil
| | - Ivna Cunha Vieira Lima
- Heart failure deparment.Heart Institute (InCor). Hospital das Clinicas da Universidade de São Paulo , São Paulo , Brazil
| | - Viviane Tiemi Hotta
- Heart failure deparment.Heart Institute (InCor). Hospital das Clinicas da Universidade de São Paulo , São Paulo , Brazil
| | - Edimar Alcides Bocchi
- Heart failure deparment.Heart Institute (InCor). Hospital das Clinicas da Universidade de São Paulo , São Paulo , Brazil
| | - Vera Maria Cury Salemi
- Heart failure deparment.Heart Institute (InCor). Hospital das Clinicas da Universidade de São Paulo , São Paulo , Brazil
- Coronary Deparment. Hospital Sírio Libanês , São Paulo , Brazil
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11
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Petty HJ, Barrett JE, Kosmowski EG, Amos DS, Ryan SM, Jones LD, Lassiter CS. Spironolactone affects cardiovascular and craniofacial development in zebrafish embryos (Danio rerio). ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2022; 92:103848. [PMID: 35288337 DOI: 10.1016/j.etap.2022.103848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
Spironolactone, a potassium-sparing diuretic and aldosterone antagonist, is a mineralocorticoid hormone commonly prescribed to patients suffering from heart failure, hirsutism, dermatological afflictions, and hypertension. Interestingly, relatively little work has been done on the development of vertebrate embryos after exposure to this compound. Here, we treat zebrafish embryos with spironolactone at 10-6 M, 10-7 M, or 10-8 M, and observe them after three to seven days of exposure. While no effect was observed in mortality, we did detect differences in cardiovascular development at 3 dpf and craniofacial development at 5 dpf. At 10-6 M, smaller atria, ventricles, and blood vessels were observed. The highest concentrations also caused a longer ceratohyal/Meckel's distance, longer palatoquadrate, and smaller angles between the palatoquadrate and both the ceratohyal and Meckel's. Further research of spironolactone's effects on embryonic development could lead to a better understanding of the compound resulting in improved public and environmental health.
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Affiliation(s)
- Hannah J Petty
- Department of Biology, Roanoke College, 221 College Lane, Salem, VA 24153, USA
| | - Jacob E Barrett
- Department of Biology, Roanoke College, 221 College Lane, Salem, VA 24153, USA
| | - Erin G Kosmowski
- Department of Biology, Roanoke College, 221 College Lane, Salem, VA 24153, USA
| | - Dandre S Amos
- Department of Biology, Roanoke College, 221 College Lane, Salem, VA 24153, USA
| | - Sean M Ryan
- Department of Biology, Roanoke College, 221 College Lane, Salem, VA 24153, USA
| | - Lucas D Jones
- Department of Biology, Roanoke College, 221 College Lane, Salem, VA 24153, USA
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12
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Hnat T, Veselka J, Honek J. Left ventricular reverse remodelling and its predictors in non-ischaemic cardiomyopathy. ESC Heart Fail 2022; 9:2070-2083. [PMID: 35437948 PMCID: PMC9288763 DOI: 10.1002/ehf2.13939] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/16/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
Adverse remodelling following an initial insult is the hallmark of heart failure (HF) development and progression. It is manifested as changes in size, shape, and function of the myocardium. While cardiac remodelling may be compensatory in the short term, further neurohumoral activation and haemodynamic overload drive this deleterious process that is associated with impaired prognosis. However, in some patients, the changes may be reversed. Left ventricular reverse remodelling (LVRR) is characterized as a decrease in chamber volume and normalization of shape associated with improvement in both systolic and diastolic function. LVRR might occur spontaneously or more often in response to therapeutic interventions that either remove the initial stressor or alleviate some of the mechanisms that contribute to further deterioration of the failing heart. Although the process of LVRR in patients with new‐onset HF may take up to 2 years after initiating treatment, there is a significant portion of patients who do not improve despite optimal therapy, which has serious clinical implications when considering treatment escalation towards more aggressive options. On the contrary, in patients that achieve delayed improvement in cardiac function and architecture, waiting might avoid untimely implantable cardioverter‐defibrillator implantation. Therefore, prognostication of successful LVRR based on clinical, imaging, and biomarker predictors is of utmost importance. LVRR has a positive impact on prognosis. However, reverse remodelled hearts continue to have abnormal features. In fact, most of the molecular, cellular, interstitial, and genome expression abnormalities remain and a susceptibility to dysfunction redevelopment under biomechanical stress persists in most patients. Hence, a distinction should be made between reverse remodelling and true myocardial recovery. In this comprehensive review, current evidence on LVRR, its predictors, and implications on prognostication, with a specific focus on HF patients with non‐ischaemic cardiomyopathy, as well as on novel drugs, is presented.
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Affiliation(s)
- Tomas Hnat
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84/1, Prague, 15006, Czech Republic
| | - Josef Veselka
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84/1, Prague, 15006, Czech Republic
| | - Jakub Honek
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84/1, Prague, 15006, Czech Republic
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13
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DeVore AD, Hellkamp AS, Thomas L, Albert NM, Butler J, Patterson JH, Spertus JA, Williams FB, Shen X, Hernandez AF, Fonarow GC. The Association of Improvement in Left Ventricular Ejection Fraction with Outcomes in Patients with Heart Failure with Reduced Ejection Fraction: Data from CHAMP-HF. Eur J Heart Fail 2022; 24:762-770. [PMID: 35293088 DOI: 10.1002/ejhf.2486] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/07/2022] Open
Abstract
AIMS We assessed for an association between improvements in left ventricular ejection fraction (LVEF) and future outcomes, including health status, in routine clinical practice. METHODS AND RESULTS CHAMP-HF was a registry of outpatients with heart failure (HF) and LVEF <40%. Enrolled participants completed the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) at regular intervals and were followed as part of routine care. We assessed for associations between improvements in LVEF (>10%) over time and concurrent changes in KCCQ-12, as well as the subsequent risk of poor outcomes. We included 2092 participants in the study. They had the following characteristics: median age 67 years (25th , 75th percentile 58, 75), 29% female, median duration of HF 2.7 years (0.6, 6.8), and median baseline LVEF 30% (23, 35). Of the study participants, 689 (34%) had a >10% absolute improvement in LVEF. Participants with an LVEF improvement also had an improvement in KCCQ-12 overall summary score compared with participants without an LVEF improvement (+7.6 vs +3.5, adjusted effect estimate +4.1 [95% CI 2.3 to 5.7]). Similarly, subsequent all-cause death or HF hospitalization occurred in 12% in the LVEF improvement group vs 25% in the group without an LVEF improvement (adjusted HR 0.50, 95% CI 0.41 to 0.61). CONCLUSION In a large cohort of outpatients with chronic HF, improvements in LVEF were associated with improved health status and a reduced risk for future clinical events. These data underscore the importance of improvement in LVEF as a treatment target for medical interventions for patients with chronic HF.
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Affiliation(s)
- Adam D DeVore
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Laine Thomas
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS, USA
| | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO, USA
| | | | - Xian Shen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
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14
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Na SJ, Youn JC, Lee HS, Jeon S, Lee HY, Cho HJ, Choi JO, Jeon ES, Lee SE, Kim MS, Kim JJ, Hwang KK, Cho MC, Chae SC, Kang SM, Choi DJ, Yoo BS, Kim KH, Oh BH, Baek SH. The Prescription Characteristics, Efficacy and Safety of Spironolactone in Real-World Patients With Acute Heart Failure Syndrome: A Prospective Nationwide Cohort Study. Front Cardiovasc Med 2022; 9:791446. [PMID: 35274010 PMCID: PMC8902170 DOI: 10.3389/fcvm.2022.791446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/31/2022] [Indexed: 11/14/2022] Open
Abstract
Background Randomized clinical trials of spironolactone showed significant mortality reduction in patients with heart failure with reduced ejection fraction. However, its role in acute heart failure syndrome (AHFS) is largely unknown. Aim To investigate the prescription characteristics, efficacy and safety of spironolactone in real-world patients with AHFS. Methods 5,136 AHFS patients who survived to hospital discharge using a nationwide prospective registry in Korea were analyzed. The primary efficacy outcome was 3-year all-cause mortality. Results Spironolactone was prescribed in 2,402 (46.8%) at discharge: <25 mg in 890 patients (37.1%), ≥25 mg, and <50 mg in 1,154 patients (48.0%), and ≥50 mg in 358 patients (14.9%). Patients treated with spironolactone had a lower proportion of chronic renal failure and renal replacement therapy during hospitalization and had lower serum creatinine level than those who did not. In overall patients, 3-year mortality was not different in both groups (35.9 vs. 34.5%, P = 0.279). The incidence of renal injury and hyperkalemia was 2.2% and 4.3%, respectively, at the first follow-up visit. The treatment effect of spironolactone on mortality was different across subpopulations according to LVEF. The use of spironolactone was associated with a significant reduction in 3-year morality in patients with LVEF ≤ 26% (33.8 vs. 44.3%, P < 0.001; adjusted HR 0.79, 95% CI 0.64–0.97, P = 0.023), but not in patients with LVEF > 26%. Conclusions Although spironolactone was frequently used at lower doses in real-world practice, use of spironolactone significantly reduced 3-year mortality in patients with severely reduced LVEF with acceptable safety profile. However, our findings remain prone to various biases and further prospective randomized controlled studies are needed to confirm these findings.
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Affiliation(s)
- Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Medicine, Catholic University Graduate School, Seoul, South Korea
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- *Correspondence: Jong-Chan Youn
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Soyoung Jeon
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jin-Oh Choi
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Eun-Seok Jeon
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min-Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae-Joong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, South Korea
| | - Seok-Min Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byung-Su Yoo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Byung-Hee Oh
- Department of Internal Medicine, Mediplex Sejong Hospital, Incheon, South Korea
| | - Sang Hong Baek
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Sang Hong Baek
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15
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Safdar Z, Cho E. Effect of spironolactone use in pulmonary arterial hypertension - analysis from pivotal trial databases. Pulm Circ 2021; 11:20458940211045618. [PMID: 34790347 PMCID: PMC8591657 DOI: 10.1177/20458940211045618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 08/24/2021] [Indexed: 11/30/2022] Open
Abstract
Spironolactone, a common diuretic used in the treatment of pulmonary arterial hypertension (PAH), improves cardiopulmonary hemodynamics by attenuating the adverse effects of hyperaldosteronism on endothelin type-B receptor function within pulmonary endothelial cells. Spironolactone has demonstrated vascular remodeling properties and reduced all-cause mortality in patients with severe heart failure. Despite widespread use, however, its effect on morbidity and mortality in PAH has not been fully explored. A large cohort of PAH patients from a harmonized dataset from four pivotal trials were analyzed to characterize the patient population and outcomes associated with spironolactone treatment. Of 1229 evaluable patients, 74% were female, mean age of 47 ± 15 years, baseline six-minute walk distance (6MWD) 345 ± 74 m and 75% were World health Organization (WHO) functional class (FC) III/IV. Of the patients receiving spironolactone, 43% were on subcutaneous treprostinil, compared to 29.9% of those patients who were not receiving spironolactone. Long-term spironolactone-treated PAH patients were older (p = 0.01), had lower baseline 6MWD (p = 0.01) and cardiac index (p < 0.01), higher baseline Borg dyspnea score (p = 0.01), WHO functional class, and right arterial pressure (p < 0.01). Additionally, spironolactone-treated patients tended to have higher hazard of clinical worsening (p < 0.01). A propensity analysis was performed and when controlled for disease severity, revealed that spironolactone-treated patients did not demonstrate improved outcomes in terms of survival and clinical worsening. Across studies, the current analysis has demonstrated that the actions of spironolactone within the context of the PAH disease process may differ from its action in CHF patients. Despite reported outcomes of spironolactone use in patients with left heart disease, these findings may not translate to right heart failure and pulmonary vascular pathology, as similar outcomes have not necessarily been recognized in the PAH patient population. Future studies are needed to explore these findings further.
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Affiliation(s)
- Zeenat Safdar
- Pulmonary Hypertension Center at Houston Methodist Lung Center, Houston Methodist Hospital, Weill Cornell College of Medicine, Houston, TX, USA
| | - Eunah Cho
- United Therapeutics Corporation, Research Triangle Park, NC, USA.,Department of Statistics, NC State University, Raleigh, NC, USA
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16
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Di Bella G, Aquaro GD, Bogaert J, Piaggi P, Micari A, Pizzino F, Camastra G, Carerj S, Campisi M, Bracco A, Carerj ML, Emdin M, Khandheria BK, Pingitore A. Non-transmural myocardial infarction associated with regional contractile function is an independent predictor of positive outcome: an integrated approach to myocardial viability. J Cardiovasc Magn Reson 2021; 23:121. [PMID: 34719402 PMCID: PMC8559354 DOI: 10.1186/s12968-021-00818-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance permits assessment of irreversible myocardial fibrosis and contractile function in patients with previous myocardial infarction. We aimed to assess the prognostic value of myocardial fibrotic tissue with preserved/restored contractile activity. METHODS In 730 consecutive myocardial infarction patients (64 ± 11 years), we quantified left ventricular (LV) end-diastolic (EDV) and end-systolic (ESV) volumes, ejection fraction (EF), regional wall motion (WM) (1 normal, 2 hypokinetic, 3 akinetic, 4 dyskinetic), and WM score index (WMSI), and measured the transmural (1-50 and 51-100) and global extent of the infarct scar by late gadolinium enhancement (LGE). Contractile fibrotic (CT-F) segments were identified as those showing WM-1 and WM-2 with LGE ≤ or ≥ 50%. RESULTS During follow-up (median 2.5, range 1-4.7 years), cardiac events (cardiac death or appropriate implantable defibrillator shocks) occurred in 123 patients (17%). At univariate analysis, age, LVEDV, LVESV, LVEF, WMSI, extent of LGE, segments with transmural extent > 50%, and CT-F segments were associated with cardiac events. At multivariate analysis, age > 65 years, LVEF < 30%, WMSI > 1.7, and dilated LVEDV independently predicted cardiac events, while CT-F tissue was the only independent predictor of better outcome. After adjustment for LVEF < 30% and LVEDV dilatation, the presence of CT-F tissue was associated with good prognosis. CONCLUSIONS In addition to CMR imaging parameters associated with adverse outcome (severe LV dysfunction, poor WM, and dilated EDV), the presence of fibrotic myocardium showing contractile activity in patients with previous myocardial infarction yields a beneficial effect on patient survival.
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Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy
| | | | - Jan Bogaert
- Department of Radiology, KU Leuven - UZ Leuven, Gasthuisberg Campus. Herestraat 49, 3000, Leuven, Belgium
| | - Paolo Piaggi
- Department of Information Engineering, University of Pisa, via G. Caruso 16, 56122, Pisa, Italy
| | - Antonio Micari
- Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy
| | - Fausto Pizzino
- Department of Cardiology, "Santa Maria Dei Battuti" Hospital, Conegliano - ULSS2 Marca Trevigiana, Via Brigata Bisagno 2, 31015, Conegliano, Treviso, Italy
| | - Giovanni Camastra
- Cardiac Department, Vannini Hospital Rome, via Acqua Bullicante 4, 00177, Roma, Italy
| | - Scipione Carerj
- Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy
| | - Mariapaola Campisi
- Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy
| | - Antonio Bracco
- Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy
- Department of Cardiology, ISMETT" Hospital, via Ernesto Tricomi, 5, 90127, Palermo, Province of Palermo, Italy
| | - Maria Ludovica Carerj
- Clinical and Experimental Department of Medicine, University of Messina, via Consolare Valeria 1, 98100, Messina, Italy
| | - Michele Emdin
- Fondazione Toscana G. Monasterio, via Giuseppe Moruzzi 1, 56124, Pisa, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Advocate Aurora Health, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA.
| | - Alessandro Pingitore
- C.N.R. Clinical Physiology Institute, via Giuseppe Moruzzi 1, 56124, Pisa, Italy
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17
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Khan MS, Kristensen SL, Vaduganathan M, Kober L, Abraham WT, Desai AS, Solomon SD, Swedberg K, Dickstein K, Zile MR, Packer M, McMurray JJ, Butler J. Natriuretic peptide plasma concentrations and risk of cardiovascular versus non-cardiovascular events in heart failure with reduced ejection fraction: Insights from the PARADIGM-HF and ATMOSPHERE trials. Am Heart J 2021; 237:45-53. [PMID: 33621540 DOI: 10.1016/j.ahj.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/17/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND N-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma concentrations are independent prognostic markers in patients with heart failure and reduced ejection fraction (HFrEF). Whether a differential risk association between NT-proBNP plasma concentrations and risk of cardiovascular (CV) vs non-CV adverse events exists is not well known. OBJECTIVE To assess if there is a differential proportional risk of CV vs non-CV adverse events by NT-proBNP plasma concentrations. METHODS In this post hoc combined analysis of PARADIGM-HF and ATMOSPHERE trials, proportion of CV vs non-CV mortality and hospitalizations were assessed by NT-proBNP levels (<400, 400-999, 1000-1999, 2000-2999, and >3000 pg/mL) at baseline using Cox regression adjusting for traditional risk factors. RESULTS A total of 14,737 patients with mean age of 62 ± 8 years (24% history of atrial fibrillation [AF]) were studied. For CV deaths, the event rates per 1000 patient-years steeply increased from 33.8 in the ≤400 pg/mL group to 142.3 in the ≥3000 pg/mL group, while the non-CV death event rates modestly increased from 9.0 to 22.7, respectively. Proportion of non-CV deaths decreased across the 5 NT-proBNP groups (21.1%, 18.4%, 17.9%, 17.4%, and 13.7% respectively). Similar trend was observed for non-CV hospitalizations (46.4%, 42.6%, 42.9%, 42.0%, and 36.9% respectively). These results remained similar when stratified according to the presence of AF at baseline and prior HF hospitalization within last 12 months. CONCLUSIONS The absolute CV event rates per patient years of follow-up were greater and had higher stepwise increases than non-CV event rates across a broad range of NT-proBNP plasma concentrations indicating a differential risk of CV events at varying baseline NT-proBNP values. These results have implications for future design of clinical trials.
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Affiliation(s)
| | | | | | - Lars Kober
- Division of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - William T Abraham
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH
| | - Akshay S Desai
- Brigham and Women's Hospital Heart & Vascular Center, Boston, MA
| | - Scott D Solomon
- Brigham and Women's Hospital Heart & Vascular Center, Boston, MA
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Kenneth Dickstein
- Department of Cardiology, University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | - Michael R Zile
- Division of Cardiology, Medical University of South Carolina, and Ralph H Johnson Veterans Administration Medical Centre, Charleston, SC
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX
| | - John Jv McMurray
- BHF Cardiovascular Research Center, University of Glasgow, Glasgow, United Kingdom
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS
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18
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Martin N, Manoharan K, Davies C, Lumbers RT. Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction. Cochrane Database Syst Rev 2021; 5:CD012721. [PMID: 34022072 PMCID: PMC8140651 DOI: 10.1002/14651858.cd012721.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Beta-blockers and inhibitors of the renin-angiotensin-aldosterone system improve survival and reduce morbidity in people with heart failure with reduced left ventricular ejection fraction (LVEF); a review of the evidence is required to determine whether these treatments are beneficial for people with heart failure with preserved ejection fraction (HFpEF). OBJECTIVES To assess the effects of beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, and mineralocorticoid receptor antagonists in people with HFpEF. SEARCH METHODS We updated searches of CENTRAL, MEDLINE, Embase, and one clinical trial register on 14 May 2020 to identify eligible studies, with no language or date restrictions. We checked references from trial reports and review articles for additional studies. SELECTION CRITERIA: We included randomised controlled trials with a parallel group design, enrolling adults with HFpEF, defined by LVEF greater than 40%. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 41 randomised controlled trials (231 reports), totalling 23,492 participants across all comparisons. The risk of bias was frequently unclear and only five studies had a low risk of bias in all domains. Beta-blockers (BBs) We included 10 studies (3087 participants) investigating BBs. Five studies used a placebo comparator and in five the comparator was usual care. The mean age of participants ranged from 30 years to 81 years. A possible reduction in cardiovascular mortality was observed (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.62 to 0.99; number needed to treat for an additional benefit (NNTB) 25; 1046 participants; three studies), however, the certainty of evidence was low. There may be little to no effect on all-cause mortality (RR 0.82, 95% CI 0.67 to 1.00; 1105 participants; four studies; low-certainty evidence). The effects on heart failure hospitalisation, hyperkalaemia, and quality of life remain uncertain. Mineralocorticoid receptor antagonists (MRAs) We included 13 studies (4459 participants) investigating MRA. Eight studies used a placebo comparator and in five the comparator was usual care. The mean age of participants ranged from 54.5 to 80 years. Pooled analysis indicated that MRA treatment probably reduces heart failure hospitalisation (RR 0.82, 95% CI 0.69 to 0.98; NNTB = 41; 3714 participants; three studies; moderate-certainty evidence). However, MRA treatment probably has little or no effect on all-cause mortality (RR 0.91, 95% CI 0.78 to 1.06; 4207 participants; five studies; moderate-certainty evidence) and cardiovascular mortality (RR 0.90, 95% CI 0.74 to 1.11; 4070 participants; three studies; moderate-certainty evidence). MRA treatment may have little or no effect on quality of life measures (mean difference (MD) 0.84, 95% CI -2.30 to 3.98; 511 participants; three studies; low-certainty evidence). MRA treatment was associated with a higher risk of hyperkalaemia (RR 2.11, 95% CI 1.77 to 2.51; number needed to treat for an additional harmful outcome (NNTH) = 11; 4291 participants; six studies; high-certainty evidence). Angiotensin-converting enzyme inhibitors (ACEIs) We included eight studies (2061 participants) investigating ACEIs. Three studies used a placebo comparator and in five the comparator was usual care. The mean age of participants ranged from 70 to 82 years. Pooled analyses with moderate-certainty evidence suggest that ACEI treatment likely has little or no effect on cardiovascular mortality (RR 0.93, 95% CI 0.61 to 1.42; 945 participants; two studies), all-cause mortality (RR 1.04, 95% CI 0.75 to 1.45; 1187 participants; five studies) and heart failure hospitalisation (RR 0.86, 95% CI 0.64 to 1.15; 1019 participants; three studies), and may result in little or no effect on the quality of life (MD -0.09, 95% CI -3.66 to 3.48; 154 participants; two studies; low-certainty evidence). The effects on hyperkalaemia remain uncertain. Angiotensin receptor blockers (ARBs) Eight studies (8755 participants) investigating ARBs were included. Five studies used a placebo comparator and in three the comparator was usual care. The mean age of participants ranged from 61 to 75 years. Pooled analyses with high certainty of evidence suggest that ARB treatment has little or no effect on cardiovascular mortality (RR 1.02, 95% 0.90 to 1.14; 7254 participants; three studies), all-cause mortality (RR 1.01, 95% CI 0.92 to 1.11; 7964 participants; four studies), heart failure hospitalisation (RR 0.92, 95% CI 0.83 to 1.02; 7254 participants; three studies), and quality of life (MD 0.41, 95% CI -0.86 to 1.67; 3117 participants; three studies). ARB was associated with a higher risk of hyperkalaemia (RR 1.88, 95% CI 1.07 to 3.33; 7148 participants; two studies; high-certainty evidence). Angiotensin receptor neprilysin inhibitors (ARNIs) Three studies (7702 participants) investigating ARNIs were included. Two studies used ARBs as the comparator and one used standardised medical therapy, based on participants' established treatments at enrolment. The mean age of participants ranged from 71 to 73 years. Results suggest that ARNIs may have little or no effect on cardiovascular mortality (RR 0.96, 95% CI 0.79 to 1.15; 4796 participants; one study; moderate-certainty evidence), all-cause mortality (RR 0.97, 95% CI 0.84 to 1.11; 7663 participants; three studies; high-certainty evidence), or quality of life (high-certainty evidence). However, ARNI treatment may result in a slight reduction in heart failure hospitalisation, compared to usual care (RR 0.89, 95% CI 0.80 to 1.00; 7362 participants; two studies; moderate-certainty evidence). ARNI treatment was associated with a reduced risk of hyperkalaemia compared with valsartan (RR 0.88, 95% CI 0.77 to 1.01; 5054 participants; two studies; moderate-certainty evidence). AUTHORS' CONCLUSIONS There is evidence that MRA and ARNI treatment in HFpEF probably reduces heart failure hospitalisation but probably has little or no effect on cardiovascular mortality and quality of life. BB treatment may reduce the risk of cardiovascular mortality, however, further trials are needed. The current evidence for BBs, ACEIs, and ARBs is limited and does not support their use in HFpEF in the absence of an alternative indication. Although MRAs and ARNIs are probably effective at reducing the risk of heart failure hospitalisation, the treatment effect sizes are modest. There is a need for improved approaches to patient stratification to identify the subgroup of patients who are most likely to benefit from MRAs and ARNIs, as well as for an improved understanding of disease biology, and for new therapeutic approaches.
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Affiliation(s)
- Nicole Martin
- Institute of Health Informatics Research, University College London, London, UK
| | | | - Ceri Davies
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - R Thomas Lumbers
- Institute of Health Informatics, University College London, London, UK
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19
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Bao J, Kan R, Chen J, Xuan H, Wang C, Li D, Xu T. Combination pharmacotherapies for cardiac reverse remodeling in heart failure patients with reduced ejection fraction: A systematic review and network meta-analysis of randomized clinical trials. Pharmacol Res 2021; 169:105573. [PMID: 33766629 DOI: 10.1016/j.phrs.2021.105573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 12/22/2022]
Abstract
Pharmacotherapies, including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor II blockers (ARBs), β-blockers (BBs), mineralocorticoid receptor antagonists (MRAs) and angiotensin receptor blocker-neprilysin inhibitor (ARNI), have played a pivotal role in reducing in-hospital and mortality in heart failure patients with reduced ejection fraction (HFrEF). However, effects of the five drug categories used alone or in combination for cardiac reverse remodeling (CRR) in these patients have not been systematically evaluated. A Bayesian network meta-analysis was conducted based on 55 randomized controlled trials published between 1989 and 2019 involving 12,727 patients from PubMed, EMBASE, Cochrane Library, and Clinicaltrials.gov. The study is registered with PROSPERO (CRD42020170457). Our primary outcomes were CRR indicators, including changes of left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV) and end-systolic volume (LVESV), indexed LVEDV (LVEDVI) and LVESV (LVESVI), and left ventricular end-diastolic dimension (LVEDD) and end-systolic dimension (LVESD); Secondary outcomes were functional capacity comprising New York Heart Association (NYHA) class and 6-min walking distance (6MWD); cardiac biomarkers involving B type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP). The effect sizes were presented as the mean difference with 95% credible intervals. According to the results, all dual-combination therapies except ACEI+ARB were significantly more associated with LVEF or NYHA improvement than placebo, ARB+BB and ARNI+BB were the top two effective dual-combinations in LVEF improvement (+7.59% [+4.27, +11.25] and +7.31% [+3.93, +10.97] respectively); ACEI+BB was shown to be superior to ACEI in reducing LVEDVI and LVESVI (-6.88 mL/m2 [-13.18, -1.89] and -10.64 mL/m2 [-18.73, -3.54] respectively); ARNI+BB showed superiority over ACEI+BB in decreasing the level of NT-proBNP (-240.11 pg/mL [-456.57, -6.73]). All tri-combinations were significantly more effective than placebo in LVEF improvement, and ARNI+BB+MRA ranked first (+21.13% [+14.34, +28.13]); ACEI+BB+MRA was significantly more associated with a decrease in LVEDD than ACEI (-6.57 mm [-13.10, -0.84]). A sensitivity analysis ignoring concomitant therapies for LVEF illustrated that all the five drug types except ARB were shown to be superior to placebo, and ARNI ranked first (+4.83% [+1.75, +7.99]). In conclusion, combination therapies exert more benefits on CRR for patients with HFrEF. Among them, ARNI+BB, ARB+BB, ARNI+BB+MRA and ARB+BB+MRA were the top two effective dual and triple combinations in LVEF improvement, respectively; The new "Golden Triangle" of ARNI+BB+MRA was shown to be superior to ACEI+BB+MRA or ARB+BB+MRA in LVEF improvement.
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Affiliation(s)
- Jieli Bao
- The Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, PR China; The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, PR China
| | - Rongsheng Kan
- The Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, PR China
| | - Junhong Chen
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, PR China
| | - Haochen Xuan
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, PR China
| | - Chaofan Wang
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, PR China
| | - Dongye Li
- The Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, PR China; The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, PR China.
| | - Tongda Xu
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, PR China
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20
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Frankenstein L, Seide S, Täger T, Jensen K, Fröhlich H, Clark AL, Seiz M, Katus HA, Nee P, Uhlmann L, Naci H, Atar D. Relative Efficacy of Spironolactone, Eplerenone, and cAnRenone in patients with Chronic Heart failure (RESEARCH): a systematic review and network meta-analysis of randomized controlled trials. Heart Fail Rev 2021; 25:161-171. [PMID: 31364027 DOI: 10.1007/s10741-019-09832-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study aims to assess the comparative benefit and risk profile of treatment with mineralocorticoid receptor antagonists (MRAs) with regard to all-cause mortality (primary endpoint), cardiovascular mortality, or heart failure (HF)-related hospitalization (secondary endpoints) and the safety endpoints hyperkalemia, acute renal failure, and gynecomastia in patients with chronic HF. We conducted a systematic review and network meta-analysis following PRISMA-P and PRISMA-NMA guidelines. From 16 different sources, 14 randomized controlled trials totaling 12,213 patients testing an active treatment of either spironolactone, eplerenone, or canrenone/potassium-canreonate in adults with symptomatic HF due to systolic dysfunction reporting any of the above endpoints were retained. Efficacy in comparison to placebo/standard medical care with respect to all-cause mortality was confirmed for spironolactone and eplerenone while no conclusion could be drawn for canrenone (HR 0.69 (0.62; 0.77), 0.82 (0.75; 0.91), and 0.50 (0.17; 1.45), respectively). Indirect comparisons hint a potential (non-significant) preference of spironolactone over eplerenone (HR 0.84 (0.68; 1.03)). The overall risk of bias was low to intermediate. Results for secondary endpoints as well as sensitivity analyses essentially mirrored these findings. The beta-blocker adjusted meta-analysis for the primary endpoint showed the same tendency as the unadjusted one (HR 0.39 (0.07; 2.03)). Results need to be interpreted with caution, though, as the resultant mix of patient- and study-level covariates produced unstable statistical modeling. We found no significant and systematic superiority of either MRA regarding efficacy toward all endpoints considered in both direct and indirect comparisons.
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Affiliation(s)
- Lutz Frankenstein
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Svenja Seide
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Tobias Täger
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Hanna Fröhlich
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Andrew L Clark
- Hull York Medical School at Castle Hill Hospital, Hull, UK
| | - Mirjam Seiz
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Paul Nee
- Marketing Group, Gamida-Cell, Cambridge, MA, USA
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ulleval and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
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21
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Salzano A, D'Assante R, Israr MZ, Eltayeb M, D'Agostino A, Bernieh D, De Luca M, Rega S, Ranieri B, Mauro C, Bossone E, Squire IB, Suzuki T, Marra AM. Biomarkers in Heart Failure: Clinical Insights. Heart Fail Clin 2021; 17:223-243. [PMID: 33673947 DOI: 10.1016/j.hfc.2021.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Andrea Salzano
- IRCCS SDN Nuclear and Diagnostic Research Institute, Naples, Italy.
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Mohamed Eltayeb
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Anna D'Agostino
- IRCCS SDN Nuclear and Diagnostic Research Institute, Naples, Italy
| | - Dennis Bernieh
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Mariarosaria De Luca
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Salvatore Rega
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Brigida Ranieri
- IRCCS SDN Nuclear and Diagnostic Research Institute, Naples, Italy
| | - Ciro Mauro
- AORN A Cardarelli, Cardiac Rehabilitation Unit, Naples, Italy
| | - Eduardo Bossone
- AORN A Cardarelli, Cardiac Rehabilitation Unit, Naples, Italy
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Toru Suzuki
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Alberto M Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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22
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Tao P, Zhitao T, Jiming L. A retrospective study on the short-term effect of high-dose spironolactone (80 mg/d) on chronic congestive heart failure. Medicine (Baltimore) 2021; 100:e23188. [PMID: 33592818 PMCID: PMC7870209 DOI: 10.1097/md.0000000000023188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/15/2020] [Indexed: 01/05/2023] Open
Abstract
To explore the short-term effect of high-dose spironolactone (80 mg/d) on chronic congestive heart failure (CHF).The general clinical data of 211 patients with CHF from February 2016 to August 2019 were collected and analyzed. Patients were divided into Low-dose group (taking 40 mg/d spironolactone) and High-dose group (taking 80 mg/d spironolactone) according to the patient's previous dose of spironolactone. The changes of B-type brain natriuretic peptide (BNP), NT-pro BNP (N terminal pro B type natriuretic peptide), echocardiography, 6-minute walking test (6MWT), and comprehensive cardiac function assessment data were collected for analysis.Compared with before treatment, the blood potassium of the two groups increased significantly (P < .05), but the blood potassium did not exceed the normal range. Compared with before treatment, BNP, NT-pro BNP, LVEDD, LVEDV and NYHA grading were significantly decreased (P < .05), LVEF and 6-MWT were significantly increased (P < .05). Compared with the Low-dose group, the high-dose group BNP (117.49 ± 50.32 vs 195.76 ± 64.62, P < .05), NT-pro BNP (312.47 ± 86.28 vs 578.47 ± 76.73, P < .05), LVEDD (45.57 ± 5.69 vs 51.96 ± 5.41, P <.05), LVEDV (141.63 ± 51.14 vs 189.85 ± 62.49, P < .05) and NYHA grading (1.29 ± 0.41 vs 1.57 ± 0.49, P < .05) were significantly reduced, but, 6-MWT (386.57 ± 69.72 vs 341.73 ± 78.62, P < .05), LVEF (41.62 ± 2.76 vs 36.02 ± 2.18, P < .05) and total effective rate (92.68% vs 81.39%, P < .05) increased significantly.Compared with 40 mg spironolactone, 80 mg spironolactone can rapidly reduce BNP and NT-pro BNP concentration, enhance exercise tolerance, improve clinical signs and cardiac function classification, and has better efficacy.
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Affiliation(s)
- Pan Tao
- Department of Critical Medicine
| | | | - Liu Jiming
- Emergency Department, Chongqing Bishan District People's Hospital, Chongqing, China
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23
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Mineralocorticoid Receptor Antagonist Use in Heart Failure With Reduced Ejection Fraction and End-Stage Renal Disease Patients on Dialysis: A Literature Review. Cardiol Rev 2021; 28:107-115. [PMID: 31985521 DOI: 10.1097/crd.0000000000000286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Mineralocorticoid receptor antagonists (MRAs) are known to have a proven mortality benefit in heart failure with reduced ejection fraction (HFrEF) without kidney disease. As patients with end-stage renal disease (ESRD) requiring either peritoneal dialysis or hemodialysis were excluded in clinical trials of HFrEF, the data are scant on the appropriate use of MRAs in this population. The unknown efficacy, along with concerns of adverse effects such as hyperkalemia, has limited the willingness of clinicians to consider using MRAs in these patients. However, it is unclear whether the risk of hyperkalemia is present if a patient is oliguric or anuric. Current guidelines recommend against the use of MRAs in patients with chronic kidney disease, but do not address the use of MRAs in patients requiring dialysis. This article will review the epidemiology of heart failure in ESRD, the pathophysiological derangements of the renin-angiotensin-aldosterone system in patients with kidney disease, and the results from case series and trials of the use of MRAs in ESRD with HFrEF. Although limited to several small trials using MRAs in peritoneal and hemodialysis patients with or without HFrEF, the current literature appears to show the potential for clinical benefits with little risk.
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24
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Lawson MA, Hansen DE, Gupta DK, Bell SP, Adkisson DW, Mallugari RR, Sawyer DB, Ooi H, Kronenberg MW. Modification of ventriculo-arterial coupling by spironolactone in nonischemic dilated cardiomyopathy. ESC Heart Fail 2021; 8:1156-1166. [PMID: 33403831 PMCID: PMC8006677 DOI: 10.1002/ehf2.13161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/23/2020] [Accepted: 11/20/2020] [Indexed: 01/19/2023] Open
Abstract
Aims We sought to clarify the role of ventriculo–arterial (V–A) coupling in the treatment of nonischemic dilated cardiomyopathy (NIDCM) by adding a mineralocorticoid receptor antagonist (MRA) to conventional anti‐failure therapy. Methods and results We employed cardiac magnetic resonance imaging to quantify left ventricular (LV) contractility and V–A coupling in normal subjects at rest (n = 11) and in patients with NIDCM (n = 12) before and after long term anti‐failure therapy, in which MRA was added to conventional anti‐failure therapy. After ≥6 months' treatment in NIDCM patients, LV volumes and mass decreased, and the LV ejection fraction increased from a median of 24% (17, 27) (interquartile range IQR) to 47 (42, 52) (P < 0.002), with a marked reduction in arterial elastance (Ea) from 2.89 mmHg/mL (2.34, 4.0) to 1.50 (1.29, 1.95) (P < 0.002), similar to Ea of normal subjects, 1.53 (1.34, 1.67) (P > 0.05). The V–A coupling ratio, Ea/end‐systolic elastance (single‐beat method), decreased by −1.08 (−1.96, −0.55), (P = 0.003), as did Ea/end‐systolic pressure/end‐systolic pressure ratio, −0.54 (0.35, 0.87), (P = 0.002). The preload recruitable stroke work (PRSW) increased as did PRSW indexed for Ea (both P = 0.002), which reflected ‘total circulatory performance’. Conclusions In NIDCM, adding MRA to conventional anti‐failure therapy markedly improved LV ejection fraction and reduced peripheral vascular resistance, due to both improved LV contractility and especially to enhanced V–A coupling, as Ea decreased to normal. Total circulatory performance was a sensitive indicator of both LV pump performance and the arterial loading conditions.
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Affiliation(s)
- Mark A Lawson
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - David E Hansen
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Deepak K Gupta
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Susan P Bell
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Douglas W Adkisson
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Ravinder R Mallugari
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Douglas B Sawyer
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Henry Ooi
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Marvin W Kronenberg
- VA Tennessee Valley Health Care System, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
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25
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Lotfi F, Jafari M, Rezaei Hemami M, Salesi M, Nikfar S, Behnam Morshedi H, Kojuri J, Keshavarz K. Evaluation of the effectiveness of infusion of bone marrow derived cell in patients with heart failure: A network meta-analysis of randomized clinical trials and cohort studies. Med J Islam Repub Iran 2020; 34:178. [PMID: 33816377 PMCID: PMC8004572 DOI: 10.47176/mjiri.34.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Indexed: 11/21/2022] Open
Abstract
Background: The aim of this study was to investigate the effectiveness of bone marrow-derived cells (BMC) technology in patients with heart failure and compare it with alternative therapies, including drug therapy, cardiac resynchronization therapy pacemaker (CRT-P), cardiac resynchronization therapy defibrillator (CRT-D).
Methods: A systematic review study was conducted to identify all clinical studies published by 2017. Using keywords such as "Heart Failure, BMC, Drug Therapy, CRT-D, CRT-P" and combinations of the mentioned words, we searched electronic databases, including Scopus, Cochrane Library, and PubMed. The quality of the selected studies was assessed using the Cochrane Collaboration's tool and the Newcastle-Ottawa. The primary and secondary end-points were left ventricular ejection fraction (LVEF) (%), failure cases (Number), left ventricular end-systolic volume (LVES) (ml), and left ventricular end-diastolic volume (LVED) (ml). Random-effects network meta-analyses were used to conduct a systematic comparison. Statistical analysis was done using STATA.
Results: This network meta-analysis covered a total of 57 final studies and 6694 patients. The Comparative effectiveness of BMC versus CRT-D, Drug, and CRT-P methods indicated the statistically significant superiority of BMC over CRT-P (6.607, 95% CI: 2.92, 10.29) in LVEF index and overall CRT-P (-13.946, 95% CI: -18.59, -9.29) and drug therapy (-4.176, 95% CI: -8.02, -.33) in LVES index. In addition, in terms of LVED index, the BMC had statistically significant differences with CRT-P (-10.187, 95% CI: -18.85, -1.52). BMC was also dominant to all methods in failure cases as a final outcome and the difference was statistically significant i.e. BMC vs CRT-D: 0.529 (0.45, 0.62) and BMC vs Drug: 0.516 (0.44, 0.60). In none of the outcomes, the other methods were statistically more efficacious than BMC. The BMC method was superior or similar to the other methods in all outcomes.
Conclusion: The results of this study showed that the BMC method, in general, and especially in terms of failure cases index, had a higher level of clinical effectiveness. However, due to the lack of data asymmetry, insufficient data and head-to-head studies, BMC in this meta-analysis might be considered as an alternative to existing treatments for heart failure.
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Affiliation(s)
- Farhad Lotfi
- Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Jafari
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy and Evidence-Based Medicine Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Javad Kojuri
- Department of Cardiology, School of Medicine, Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
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26
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Ejiri K, Miyoshi T, Kihara H, Hata Y, Nagano T, Takaishi A, Toda H, Nanba S, Nakamura Y, Akagi S, Sakuragi S, Minagawa T, Kawai Y, Nishii N, Fuke S, Yoshikawa M, Nakamura K, Ito H. Effect of Luseogliflozin on Heart Failure With Preserved Ejection Fraction in Patients With Diabetes Mellitus. J Am Heart Assoc 2020; 9:e015103. [PMID: 32805185 PMCID: PMC7660815 DOI: 10.1161/jaha.119.015103] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Effects of sodium‐glucose cotransporter 2 inhibitors on reducing hospitalization for heart failure have been reported in randomized controlled trials, but their effects on patients with heart failure with preserved ejection fraction (HFpEF) are unknown. This study aimed to evaluate the drug efficacy of luseogliflozin, a sodium‐glucose cotransporter 2 inhibitor, in patients with type 2 diabetes mellitus and HFpEF. Methods and Results We performed a multicenter, open‐label, randomized, controlled trial for comparing luseogliflozin 2.5 mg once daily with voglibose 0.2 mg 3 times daily in patients with type 2 diabetes mellitus suffering from HFpEF (left ventricular ejection fraction >45% and BNP [B‐type natriuretic peptide] concentrations ≥35 pg/mL) in a 1:1 randomization fashion. The primary outcome was the difference from baseline in BNP levels after 12 weeks of treatment between the 2 drugs. A total of 173 patients with diabetes mellitus and HFpEF were included. Of these, 83 patients were assigned to receive luseogliflozin and 82 to receive voglibose. There was no significant difference in the reduction in BNP concentrations after 12 weeks from baseline between the 2 groups. The ratio of the mean BNP value at week 12 to the baseline value was 0.79 in the luseogliflozin group and 0.87 in the voglibose group (percent change, −9.0% versus −1.9%; ratio of change with luseogliflozin versus voglibose, 0.93; 95% CI, 0.78–1.10; P=0.26). Conclusion In patients with type 2 diabetes mellitus and HFpEF, there is no significant difference in the degree of reduction in BNP concentrations after 12 weeks between luseogliflozin and voglibose. Registration URL: https://www.umin.ac.jp/ctr/index.htm; Unique identifier: UMIN000018395.
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Affiliation(s)
- Kentaro Ejiri
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Okayama Japan.,Department of Internal Medicine Tamano City Hospital Okayama Japan
| | - Toru Miyoshi
- Department of Internal Medicine Tamano City Hospital Okayama Japan
| | - Hajime Kihara
- Department of Internal Medicine Kihara Cardiovascular Clinic Asahikawa Japan
| | - Yoshiki Hata
- Department of Cardiology Minamino Cardiovascular Hospital Hachioji Japan
| | | | | | - Hironobu Toda
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Okayama Japan.,Department of Internal Medicine Okayama East Neurosurgery Hospital Okayama Japan
| | - Seiji Nanba
- Department of Cardiology Okayama Rosai Hospital Okayama Japan
| | - Yoichi Nakamura
- Department of Cardiovascular Medicine Specified Clinic of Soyokaze Cardiovascular Medicine and Diabetes Care Matsuyama Japan
| | - Satoshi Akagi
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Okayama Japan.,Department of Internal Medicine Akaiwa Medical Association Hospital Okayama Japan
| | - Satoru Sakuragi
- Department of Cardiovascular Medicine Iwakuni Clinical Center Iwakuni Japan
| | - Taro Minagawa
- Department of Internal Medicine Minagawa Cardiovascular Clinic Gifu Japan
| | - Yusuke Kawai
- Department of Cardiovascular Medicine Okayama City Hospital Okayama Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Okayama Japan.,Department of Internal Medicine Yoshinaga Hospital Okayama Japan
| | - Soichiro Fuke
- Department of Cardiovascular Medicine Japanese Red Cross Okayama Hospital Okayama Japan
| | | | - Kazufumi Nakamura
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Okayama Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Okayama Japan
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Brener MI, Uriel N, Burkhoff D. Left Ventricular Volume Reduction and Reshaping as a Treatment Option for Heart Failure. STRUCTURAL HEART 2020. [DOI: 10.1080/24748706.2020.1777359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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DeVore AD, Hellkamp AS, Thomas L, Albert NM, Butler J, Patterson JH, Spertus JA, Williams FB, Duffy CI, Hernandez AF, Fonarow GC. Improvement in Left Ventricular Ejection Fraction in Outpatients With Heart Failure With Reduced Ejection Fraction: Data From CHAMP-HF. Circ Heart Fail 2020; 13:e006833. [PMID: 32580657 DOI: 10.1161/circheartfailure.119.006833] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Among patients with heart failure (HF) with reduced ejection fraction (EF), improvements in left ventricular EF (LVEF) are associated with better outcomes and remain an important treatment goal. Patient factors associated with LVEF improvement in routine clinical practice have not been clearly defined. METHODS CHAMP-HF (Change the Management of Patients with Heart Failure) is a prospective registry of outpatients with HF with reduced EF. Assessments of LVEF are recorded when performed for routine care. We analyzed patients with both baseline and ≥1 follow-up LVEF assessments to describe factors associated with LVEF improvement. RESULTS In CHAMP-HF, 2623 patients had a baseline and follow-up LVEF assessment. The median age was 67 (interquartile range, 58-75) years, 40% had an ischemic cardiomyopathy, and median HF duration was 2.8 years (0.7-6.8). Median LVEF was 30% (23-35), and median change on follow-up was 4% (-2 to -13); 19% of patients had a decrease in LVEF, 31% had no change, 49% had a ≥5% increase, and 34% had a ≥10% increase. In a multivariable model, the following factors were associated with ≥5% LVEF increase: shorter HF duration (odds ratio [OR], 1.21 [95% CI, 1.17-1.25]), no implantable cardioverter defibrillator (OR, 1.46 [95% CI, 1.34-1.55]), lower LVEF (OR, 1.15 [95% CI, 1.10-1.19]), nonischemic cardiomyopathy (OR, 1.24 [95% CI, 1.09-1.36]), and no coronary disease (OR, 1.20 [95% CI, 1.03-1.35]). CONCLUSIONS In a large cohort of outpatients with chronic HF with reduced EF, improvements in LVEF were common. Common baseline cardiac characteristics identified a population that was more likely to respond over time. These data may inform clinical decision making and should be the basis for future research on myocardial recovery.
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Affiliation(s)
- Adam D DeVore
- Duke Clinical Research Institute, Durham, NC (A.D.D., A.S.H., L.T., A.F.H.).,Department of Medicine, Duke University School of Medicine, Durham, NC (A.D.D., A.F.H.)
| | - Anne S Hellkamp
- Duke Clinical Research Institute, Durham, NC (A.D.D., A.S.H., L.T., A.F.H.)
| | - Laine Thomas
- Duke Clinical Research Institute, Durham, NC (A.D.D., A.S.H., L.T., A.F.H.)
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson (J.B.)
| | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO (J.A.S.)
| | | | - Carol I Duffy
- Novartis Pharmaceuticals Corporation, East Hanover, NJ (C.I.D.)
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, NC (A.D.D., A.S.H., L.T., A.F.H.).,Department of Medicine, Duke University School of Medicine, Durham, NC (A.D.D., A.F.H.)
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.)
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Tantisattamo E, Molnar MZ, Ho BT, Reddy UG, Dafoe DC, Ichii H, Ferrey AJ, Hanna RM, Kalantar-Zadeh K, Amin A. Approach and Management of Hypertension After Kidney Transplantation. Front Med (Lausanne) 2020; 7:229. [PMID: 32613001 PMCID: PMC7310511 DOI: 10.3389/fmed.2020.00229] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/04/2020] [Indexed: 12/14/2022] Open
Abstract
Hypertension is one of the most common cardiovascular co-morbidities after successful kidney transplantation. It commonly occurs in patients with other metabolic diseases, such as diabetes mellitus, hyperlipidemia, and obesity. The pathogenesis of post-transplant hypertension is complex and is a result of the interplay between immunological and non-immunological factors. Post-transplant hypertension can be divided into immediate, early, and late post-transplant periods. This classification can help clinicians determine the etiology and provide the appropriate management for these complex patients. Volume overload from intravenous fluid administration is common during the immediate post-transplant period and commonly contributes to hypertension seen early after transplantation. Immunosuppressive medications and donor kidneys are associated with post-transplant hypertension occurring at any time point after transplantation. Transplant renal artery stenosis (TRAS) and obstructive sleep apnea (OSA) are recognized but common and treatable causes of resistant hypertension post-transplantation. During late post-transplant period, chronic renal allograft dysfunction becomes an additional cause of hypertension. As these patients develop more substantial chronic kidney disease affecting their allografts, fibroblast growth factor 23 (FGF23) increases and is associated with increased cardiovascular and all-cause mortality in kidney transplant recipients. The exact relationship between increased FGF23 and post-transplant hypertension remains poorly understood. Blood pressure (BP) targets and management involve both non-pharmacologic and pharmacologic treatment and should be individualized. Until strong evidence in the kidney transplant population exists, a BP of <130/80 mmHg is a reasonable target. Similar to complete renal denervation in non-transplant patients, bilateral native nephrectomy is another treatment option for resistant post-transplant hypertension. Native renal denervation offers promising outcomes for controlling resistant hypertension with no significant procedure-related complications. This review addresses the epidemiology, pathogenesis, and specific etiologies of post-transplant hypertension including TRAS, calcineurin inhibitor effects, OSA, and failed native kidney. The cardiovascular and survival outcomes related to post-transplant hypertension and the utility of 24-h blood pressure monitoring will be briefly discussed. Antihypertensive medications and their mechanism of actions relevant to kidney transplantation will be highlighted. A summary of guidelines from different professional societies for BP targets and antihypertensive medications as well as non-pharmacological interventions, including bilateral native nephrectomy and native renal denervation, will be reviewed.
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Affiliation(s)
- Ekamol Tantisattamo
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, VA Long Beach Healthcare System, Long Beach, CA, United States.,Section of Nephrology, Department of Internal Medicine, Multi-Organ Transplant Center, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States
| | - Miklos Z Molnar
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, United States.,Methodist University Hospital Transplant Institute, Memphis, TN, United States.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Bing T Ho
- Division of Nephrology and Hypertension, Department of Medicine, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Uttam G Reddy
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, VA Long Beach Healthcare System, Long Beach, CA, United States
| | - Donald C Dafoe
- Division of Transplantation, Department of Surgery, University of California Irvine School of Medicine, Orange, CA, United States
| | - Hirohito Ichii
- Division of Transplantation, Department of Surgery, University of California Irvine School of Medicine, Orange, CA, United States
| | - Antoney J Ferrey
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, VA Long Beach Healthcare System, Long Beach, CA, United States
| | - Ramy M Hanna
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA, United States.,Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, VA Long Beach Healthcare System, Long Beach, CA, United States
| | - Alpesh Amin
- Department of Medicine, University of California Irvine School of Medicine, Orange, CA, United States
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Safdar Z, Frost A, Basant A, Deswal A, O'Brian Smith E, Entman M. Spironolactone in pulmonary arterial hypertension: results of a cross-over study. Pulm Circ 2020; 10:2045894019898030. [PMID: 32426108 PMCID: PMC7219009 DOI: 10.1177/2045894019898030] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/07/2019] [Indexed: 11/15/2022] Open
Abstract
The renin-angiotensin-aldosterone system is implicated in the pathophysiology of pulmonary arterial hypertension. We undertook this study to determine the effects of spironolactone, a mineralocorticoid receptor blocker, on collagen metabolism in pulmonary arterial hypertension patients. After obtaining institutional review board approval and informed consent, 42 pulmonary arterial hypertension patients were prospectively enrolled and 35 patients completed the 16-week randomized double-blinded crossover clinical trial. Subjects received 50 mg spironolactone or placebo and at the end of week 8, treatment arm was switched. Circulating levels of collagen biomarkers, brain natriuretic peptide, and aldosterone levels were measured, and six-minute walk distance, liver function tests, and echocardiogram data were collected at weeks 0, 8, and 16. Mean age was 45 ± 15 years and 87% were females. At baseline, brain natriuretic peptide and aldosterone levels were 74 ± 95 pg/ml and 7 ± 8 pg/ml, respectively. There was no change in the levels of amino-terminal propeptide of procollagen type III (PIIINP), MMP-9, TIMP-1, and MMP-9/TIMP-1 ratio at weeks 8 and 16 compared to baseline values in placebo arm and treatment arm. The baseline six-min walk distance was 436 ± 115 meters at baseline and no change in walk distance was noted at weeks 8 and 16 (P = 0.372). None of the patients developed hyperkalemia or liver function test abnormalities at weeks 8 and 16 requiring discontinuation of study drug. Our study showed no change in collagen metabolite levels in pulmonary arterial hypertension patients treated with spironolactone. Spironolactone was safe and well tolerated by pulmonary arterial hypertension patients with no increased hyperkalemia or liver function test abnormalities.
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Affiliation(s)
- Zeenat Safdar
- Division of Pulmonary-Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Adaani Frost
- Division of Pulmonary-Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Arya Basant
- Division of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Anita Deswal
- Division of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - E O'Brian Smith
- Division of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Mark Entman
- Division of Cardiology, Baylor College of Medicine, Houston, TX, USA
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Visit-to-visit blood pressure variation and outcomes in heart failure with reduced ejection fraction: findings from the Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms trial. J Hypertens 2020; 38:420-425. [DOI: 10.1097/hjh.0000000000002275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Withdrawal of Neurohumoral Blockade After Cardiac Resynchronization Therapy. J Am Coll Cardiol 2020; 75:1426-1438. [DOI: 10.1016/j.jacc.2020.01.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 01/14/2023]
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Januzzi JL, Prescott MF, Butler J, Felker GM, Maisel AS, McCague K, Camacho A, Piña IL, Rocha RA, Shah AM, Williamson KM, Solomon SD. Association of Change in N-Terminal Pro-B-Type Natriuretic Peptide Following Initiation of Sacubitril-Valsartan Treatment With Cardiac Structure and Function in Patients With Heart Failure With Reduced Ejection Fraction. JAMA 2019; 322:1085-1095. [PMID: 31475295 PMCID: PMC6724151 DOI: 10.1001/jama.2019.12821] [Citation(s) in RCA: 369] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE In patients with heart failure and reduced ejection fraction (HFrEF), treatment with sacubitril-valsartan reduces N-terminal pro-b-type natriuretic peptide (NT-proBNP) concentrations. The effect of sacubitril-valsartan on cardiac remodeling is uncertain. OBJECTIVE To determine whether NT-proBNP changes in patients with HFrEF treated with sacubitril-valsartan correlate with changes in measures of cardiac volume and function. DESIGN, SETTING, AND PARTICIPANTS Prospective, 12-month, single-group, open-label study of patients with HFrEF enrolled in 78 outpatient sites in the United States. Sacubitril-valsartan was initiated and the dose adjusted. Enrollment commenced on October 25, 2016, and follow-up was completed on October 22, 2018. EXPOSURES NT-proBNP concentrations among patients treated with sacubitril-valsartan. MAIN OUTCOMES AND MEASURES The primary outcome was the correlation between changes in log2-NT-proBNP concentrations and left ventricular (LV) EF, LV end-diastolic volume index (LVEDVI), LV end-systolic volume index (LVESVI), left atrial volume index (LAVI), and ratio of early transmitral Doppler velocity/early diastolic annular velocity (E/e') at 12 months. RESULTS Among 794 patients (mean age, 65.1 years; 226 women [28.5%]; mean LVEF = 28.2%), 654 (82.4%) completed the study. The median NT-proBNP concentration at baseline was 816 pg/mL (interquartile range [IQR], 332-1822) and 455 pg/mL (IQR, 153-1090) at 12 months (difference, P < .001). At 12 months, the change in log2-NT-proBNP concentration was correlated with changes in LVEF (r = -0.381 [IQR, -0.448 to -0.310]; P < .001), LVEDVI (r = 0.320 [IQR, 0.246 to 0.391]; P < .001), LVESVI (r = 0.405 [IQR, 0.335 to 0.470]; P < .001), LAVI (r = 0.263 [IQR, 0.186 to 0.338]; P < .001), and E/e' (r = 0.269 [IQR, 0.182 to 0.353]; P < .001). At 12 months, LVEF increased from 28.2% to 37.8% (difference, 9.4% [95% CI, 8.8% to 9.9%]; P < .001), while LVEDVI decreased from 86.93 to 74.15 mL/m2 (difference, -12.25 mL/m2 [IQR, -12.92 to -11.58]; P < .001) and LVESVI decreased from 61.68 to 45.46 mL/m2 (difference, -15.29 mL/m2 [95% CI, -16.03 to -14.55]; P < .001). LAVI and E/e' ratio also decreased significantly. The most frequent adverse events were hypotension (17.6%), dizziness (16.8%), hyperkalemia (13.2%), and worsening kidney function (12.3%). CONCLUSIONS AND RELEVANCE In this exploratory study of patients with HFrEF treated with sacubitril-valsartan, reduction in NT-proBNP concentration was weakly yet significantly correlated with improvements in markers of cardiac volume and function at 12 months. The observed reverse cardiac remodeling may provide a mechanistic explanation for the effects of sacubitril-valsartan in patients with HFrEF. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02887183.
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Affiliation(s)
- James L. Januzzi
- Massachusetts General Hospital, Boston
- Baim Institute for Clinical Research, Boston, Massachusetts
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson
| | - G. Michael Felker
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - Alan S. Maisel
- University of California, San Diego School of Medicine, San Diego
| | | | | | | | | | - Amil M. Shah
- Brigham and Women’s Hospital, Boston, Massachusetts
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35
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Lam CSP, Li YH, Bayes-Genis A, Ariyachaipanich A, Huan DQ, Sato N, Kahale P, Cuong TM, Dong Y, Li X, Zhou Y. The role of N-terminal pro-B-type natriuretic peptide in prognostic evaluation of heart failure. J Chin Med Assoc 2019; 82:447-451. [PMID: 31180944 DOI: 10.1097/jcma.0000000000000102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Heart failure (HF) is a growing challenge in the Asia Pacific region. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a well-established tool for diagnosis of HF; however, it is relatively underutilized in predicting adverse outcomes in HF. Multiple studies have demonstrated the prognostic role of NT-proBNP in HF. A single value of NT-proBNP >5000 pg/mL predicts a worse outcome in hospitalized patients with HF with reduced ejection fraction (HFrEF). In stable outpatients with HFrEF, NT-proBNP > 1000 pg/mL predicts a poorer prognosis. NT-proBNP provides the same prognostic information in patients with HF with preserved ejection fraction (HFpEF) as in those with HFrEF. An expert panel composed of cardiologists mainly from Asia Pacific region was convened to discuss the utility of NT-proBNP in HF prognostication. This article summarizes available scientific evidence and consensus recommendations from the meeting.
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Affiliation(s)
- Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
- University Medical Centre Groningen, Groningen, The Netherlands
- The George Institute for Global Health, Newtown New South Wales, Australia
| | - Yi-Heng Li
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | | | | | - Do Quang Huan
- Heart Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Naoki Sato
- Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
| | | | - Ta Manh Cuong
- Vietnam Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Xinli Li
- Jiangsu Province Hospital, Nanjing, China
| | - Yanli Zhou
- Jiangsu Province Hospital, Nanjing, China
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Ejiri K, Miyoshi T, Nakamura K, Sakuragi S, Munemasa M, Namba S, Takaishi A, Ito H. The effect of luseogliflozin and alpha-glucosidase inhibitor on heart failure with preserved ejection fraction in diabetic patients: rationale and design of the MUSCAT-HF randomised controlled trial. BMJ Open 2019; 9:e026590. [PMID: 30928954 PMCID: PMC6475163 DOI: 10.1136/bmjopen-2018-026590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a strong risk factor for coronary artery disease and heart failure, particularly heart failure with preserved ejection fraction (HFpEF). The aim of the ongoing MUSCAT-HF (It stands for Prospective Comparison of Luseogliflozin and Alpha-glucosidase on the Management of Diabetic Patients with Chronic Heart Failure and Preserved Ejection Fraction) trial is to evaluate the efficacy of luseogliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, versus voglibose, an alpha-glucosidase inhibitor, using brain natriuretic peptide (BNP) as the index of therapeutic effect in T2DM patients with HFpEF. METHODS AND ANALYSIS A total of 190 patients with T2DM and HFpEF (ejection fraction >45%) who are drug-naïve or taking any anti-diabetic agents will be randomised (1:1) to receive luseogliflozin 2.5 mg one time per day or voglibose 0.2 mg three times per day. The patients will be stratified by age (<65 years, ≥65 years), baseline haemoglobin A1c (<8.0%, ≥8.0%), baseline BNP (<100 pg/mL, ≥100 pg/mL), baseline renal function (estimated glomerular filtration rate ≥60 mL/min/1.73 m2, <60 mL/min/1.73 m2), use of thiazolidine or not and presence or absence of atrial fibrillation and flutter at screening. After randomisation, participants will receive the study drug for 12 weeks in addition to their background therapy. The primary endpoint is the proportional change in baseline BNP after 12 weeks of treatment. The key secondary endpoints are the change from baseline in the ratio of early mitral inflow velocity to mitral annular early diastolic velocity, body weight and glycaemic control after 12 weeks of treatment. ETHICS AND DISSEMINATION The study has been approved by the ethics committee and the patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER UMIN000018395.
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Affiliation(s)
- Kentaro Ejiri
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Satoru Sakuragi
- Department of Cardiovascular Medicine, Iwakuni Clinical Centre, Iwakuni, Japan
| | - Mitsuru Munemasa
- Department of Cardiology, Okayama Medical Center, Okayama, Japan
| | - Seiji Namba
- Department of Cardiology, Okayama Rosai Hospital, Okayama, Japan
| | - Atsushi Takaishi
- Department of Cardiology, Mitoyo General Hospital, Kan-onji, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Begic E, Hadzidedic S, Kulaglic A, Ramic-Brkic B, Begic Z, Causevic M. SOMAscan-based proteomic measurements of plasma brain natriuretic peptide are decreased in mild cognitive impairment and in Alzheimer's dementia patients. PLoS One 2019; 14:e0212261. [PMID: 30763368 PMCID: PMC6375605 DOI: 10.1371/journal.pone.0212261] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/30/2019] [Indexed: 12/18/2022] Open
Abstract
Alzheimer's disease represents the most common age-related neurodegenerative disorder and a leading cause of progressive cognitive impairment. Predicting cognitive decline is challenging but would be invaluable in an increasingly aging population which also experiences a rising cardiovascular risk. In order to examine whether plasma measurements of one of the established biomarkers of heart failure, brain natriuretic peptide (BNP), reflect a decline in cognitive function, associated with Alzheimer's disease neurodegeneration, BNP levels were analysed, by using a novel assay called a SOMAscan, in 1. cognitively healthy, control subjects; 2. subjects with mild cognitive impairment, and 3. subjects with Alzheimer's disease. The results of our study show that the levels of the BNP were significantly different between the three types of diagnoses (p < 0.05), whereby subjects with mild cognitive impairment had the lowest mean BNP value, and healthy subjects had the highest BNP value. Importantly, our results show that the levels of the BNP are influenced by the presence of at least one APOE4 allele in the healthy (p < 0.05) and in the Alzheimer's disease groups of subjects (p < 0.1). As the levels of the BNP appear to be independent of the APOE4 genotype in subjects with mild cognitive impairment, the results of our study support inclusion of measurements of plasma levels of the BNP in the list of the core Alzheimer's disease biomarkers for identification of the mild cognitive impairment group of patients. In addition, the results of our study warrant further investigations into molecular links between Alzheimer's disease-type cognitive decline and cardiovascular disorders.
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Affiliation(s)
- Edin Begic
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
- Department of Cardiology, General Hospital "Prim.Dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina
| | - Suncica Hadzidedic
- Computer Science and Information Systems Department, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Ajla Kulaglic
- Computer Science and Information Systems Department, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Belma Ramic-Brkic
- Computer Science and Information Systems Department, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Zijo Begic
- Department of Pediatric Cardiology, University Clinical Center, Sarajevo, Bosnia and Herzegovina
| | - Mirsada Causevic
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
- * E-mail:
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Chahal D, Yau A, Casciato P, Marquez V. B-type peptides to predict post–liver transplant mortality: systematic review and meta-analysis. CANADIAN LIVER JOURNAL 2019; 2:4-18. [DOI: 10.3138/canlivj.2018-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/14/2018] [Indexed: 11/20/2022]
Abstract
Background: Cirrhotic patients undergoing liver transplantation are at risk of cardiac complications. Brain natriuretic peptide (BNP) and amino terminal brain natriuretic peptide (NT-BNP) are used in cardiac risk stratification. Their significance in predicting mortality risk in cirrhotic patients during or after liver transplantation is unknown. We conducted a systematic review and meta-analysis to answer this question. Methods: An electronic search of EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews (2005–September 2016), Google Scholar, and study bibliographies was conducted. Study quality was determined, and demographic and outcome data were gathered. Random effects meta-analyses of mortality-based BNP and NT-BNP level or presence of post-transplant heart failure were conducted. Results: Seven studies including 2,010 patients were identified. Demographics were similar between patients with high or low BNP or NT-BNP levels. Hepatitis C was the most prevalent etiology of cirrhosis (38%). Meta-analysis revealed a pooled relative risk of 3.1 (95% CI 1.9% to 5.0%) for post-transplant mortality based on elevated BNP or NT-BNP level. Meta-analysis also revealed a pooled relative risk of 1.6 (95% CI 1.3% to 2.1%) for post-transplant mortality if patients had demonstrated post-transplant heart failure. Conclusions: Our analysis suggests that BNP or NT-BNP measurement may help in risk stratification and provides data on post-operative mortality in cirrhotic patients undergoing liver transplantation. Discriminatory thresholds are higher in cirrhotic patients relative to prior studies with non-cirrhotic patients. However, the number of analyzed studies is limited, and our findings should be validated further through larger, prospective studies.
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Affiliation(s)
- Daljeet Chahal
- Postgraduate Medicine Program, University of British Columbia, Vancouver, British Columbia
| | - Alan Yau
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia
| | | | - Vladimir Marquez
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia
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Marti CN, Fonarow GC, Anker SD, Yancy C, Vaduganathan M, Greene SJ, Ahmed A, Januzzi JL, Gheorghiade M, Filippatos G, Butler J. Medication dosing for heart failure with reduced ejection fraction - opportunities and challenges. Eur J Heart Fail 2018; 21:286-296. [PMID: 30537163 DOI: 10.1002/ejhf.1351] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/18/2018] [Accepted: 08/23/2018] [Indexed: 12/11/2022] Open
Abstract
Multiple drug classes have shown incremental benefits in heart failure with reduced ejection fraction. Most of these trials were designed to achieve specific doses of the investigational agent. Clinical practice guidelines recommend using the same target dosing of therapies, as tolerated. However, with the increasing number of available therapies, clinicians face the challenge of simultaneously using several drugs, achieving target doses, and managing side effects that are often overlapping. Blood pressure, renal function, hyperkalaemia, and other factors may impede achieving target doses of all medications, leaving clinicians with dilemmas as to how to sequence and dose these various classes of drugs. The guideline-directed eligibility for certain drugs and devices requires stability on maximally tolerated doses of background therapies. However, significant variability exists in dosing achieved in clinical practice. We discuss the existing background data regarding the doses of heart failure medications in clinical trials and in practice, and provide recommendations on how to navigate this complex therapeutic decision-making.
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Affiliation(s)
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Stefan D Anker
- Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine, Berlin, Germany
| | - Clyde Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Stephen J Greene
- Duke Clinical Research Institute and Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Ali Ahmed
- Veterans Affairs Medical Center and George Washington University, Washington, DC, USA
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, and the Baim Institute for Clinical Research, Boston, MA, USA
| | - Mihai Gheorghiade
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Weinmann K, Werner J, Koenig W, Rottbauer W, Walcher D, Keßler M. Add-on Immunoadsorption Shortly-after Optimal Medical Treatment Further Significantly and Persistently Improves Cardiac Function and Symptoms in Recent-Onset Heart Failure-A Single Center Experience. Biomolecules 2018; 8:biom8040133. [PMID: 30400209 PMCID: PMC6315717 DOI: 10.3390/biom8040133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/17/2018] [Accepted: 10/29/2018] [Indexed: 12/28/2022] Open
Abstract
Background: Immunoadsorption and intravenous immunoglobulin (IVIG) administration may have beneficial effects in patients with dilated cardiomyopathy with end-stage heart failure. We investigated the effect of immunoadsorption with subsequent IVIG administration on cardiac function and symptoms in patients on optimal medical treatment (OMT) for heart failure (HF) with recent-onset cardiomyopathy during long-term follow-up. Methods: Thirty-five patients with recent-onset of HF symptoms received intensive guideline-recommended medical HF therapy for 5.2 months. Subsequently, all patients received a single cycle of immunoadsorption for five days followed by IVIG administration. During the 29-month follow-up period, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF) and N-terminal pro brain natriuretic peptide (NT-proBNP) were evaluated. Changes in quality of life (QoL) were assessed using the Minnesota Living with HF Questionnaire. Results: Three months after immunoadsorption, NYHA functional class improved from 2.0 to 1.5 (p < 0.005) and LVEF significantly increased from 27.0% to 39.0% (p < 0.0001). Long-term follow-up of 29 months showed stable NYHA functional class and a further moderate increase in LVEF from 39.0% to 42.0% (p < 0.0001) accompanied by a significant improvement in NT-proBNP and QoL scores. Conclusion: Immunoadsorption followed by IVIG administration further enhances LVEF, HF symptoms, QoL and biomarkers in patients with recent-onset HF on OMT.
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Affiliation(s)
- Karolina Weinmann
- Department of Internal Medicine II, University Hospital Ulm, 89081 Ulm, Germany.
| | - Jakob Werner
- Department of Internal Medicine II, University Hospital Ulm, 89081 Ulm, Germany.
| | - Wolfgang Koenig
- Department of Internal Medicine II, University Hospital Ulm, 89081 Ulm, Germany.
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital Ulm, 89081 Ulm, Germany.
| | - Daniel Walcher
- Department of Internal Medicine II, University Hospital Ulm, 89081 Ulm, Germany.
| | - Mirjam Keßler
- Department of Internal Medicine II, University Hospital Ulm, 89081 Ulm, Germany.
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Tanabe K, Sakamoto T. Heart failure with recovered ejection fraction. J Echocardiogr 2018; 17:5-9. [PMID: 30218436 DOI: 10.1007/s12574-018-0396-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 01/06/2023]
Abstract
Substantial or complete myocardial recovery occurs in many patients with heart failure (HF). HF patients with myocardial recovery or recovered left ventricular (LV) ejection fraction (EF; HFrecEF) are a distinct population of HF patients with different underlying etiologies, comorbidities, response to therapies, and outcomes compared with HF patients with persistent reduced or preserved EF. Improvement in LVEF has been systematically linked to improved quality of life, and lower rehospitalization rates and mortality. However, the mortality and morbidity in HFrecEF patients remain higher than those in the normal population. Currently, data to guide the management of HFrecEF patients are lacking. This review discusses specific characteristics, pathophysiology, and clinical implications for HFrecEF.
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Affiliation(s)
- Kazuaki Tanabe
- Division of Cardiology, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, 693-8501, Japan.
| | - Takahiro Sakamoto
- Division of Cardiology, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, 693-8501, Japan
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Abstract
Although much remains unknown regarding the pathophysiology of acute heart failure (AHF), precipitating events are thought to involve a complex set of interactions between the heart, kidneys, and peripheral vasculature. In addition to these interactions, which are considered the primary abnormalities in patients with AHF, several other organ systems may also be affected and contribute to disease progression. Currently available scientific literature suggests that the natural history and pathophysiology of AHF consists of two phases: (1) an "initiation phase" involving a series of triggering events, and (2) an "amplification phase," in which multiple mechanisms contribute to worsening HF and exacerbate end-organ damage. Biomarkers of cardiac, renal, pulmonary, and other organ function have been identified during episodes of AHF, including brain natriuretic peptide, troponin I, and troponin T; biomarkers associated with AHF have proven to be useful tools for studying the pathophysiology of the syndrome, predicting clinical outcomes, and identifying patient management strategies. Despite considerable advances in recent years, AHF continues to be a leading cause of hospitalization and death in patients with chronic HF. Moreover, AHF remains a major healthcare issue exacting a considerable cost burden. Addressing this ongoing unmet need requires prioritizing efforts to better understand the natural history and pathophysiology of AHF; only then can targeted therapies be developed to prevent rehospitalization in patients with AHF, or at least alter the trajectory of disease progression toward improved clinical outcomes.
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Affiliation(s)
- Hani N Sabbah
- Department of Medicine, Division of Cardiovascular Medicine, Henry Ford Health System, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, 48202, USA.
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Gardner RS, Singh JP, Stancak B, Nair DG, Cao M, Schulze C, Thakur PH, An Q, Wehrenberg S, Hammill EF, Zhang Y, Boehmer JP. HeartLogic Multisensor Algorithm Identifies Patients During Periods of Significantly Increased Risk of Heart Failure Events. Circ Heart Fail 2018; 11:e004669. [DOI: 10.1161/circheartfailure.117.004669] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/06/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Roy S. Gardner
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, United Kingdom (R.S.G.)
| | | | - Branislav Stancak
- Eastern Slovakia Institute for Cardiac and Vascular Diseases, Kosice, Slovakia (B.S.)
| | - Devi G. Nair
- St. Bernards Heart and Vascular Center, Jonesboro, AR (D.G.N.)
| | | | | | | | - Qi An
- Boston Scientific, Marlborough, MA (P.H.T., Q.A., S.W., E.F.H., Y.Z.)
| | - Scott Wehrenberg
- Boston Scientific, Marlborough, MA (P.H.T., Q.A., S.W., E.F.H., Y.Z.)
| | - Eric F. Hammill
- Boston Scientific, Marlborough, MA (P.H.T., Q.A., S.W., E.F.H., Y.Z.)
| | - Yi Zhang
- Boston Scientific, Marlborough, MA (P.H.T., Q.A., S.W., E.F.H., Y.Z.)
| | - John P. Boehmer
- Penn State Milton S. Hershey Medical Center, Hershey, PA (J.P.B.)
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Martin N, Manoharan K, Thomas J, Davies C, Lumbers RT. Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction. Cochrane Database Syst Rev 2018; 6:CD012721. [PMID: 29952095 PMCID: PMC6513293 DOI: 10.1002/14651858.cd012721.pub2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Beta-blockers and inhibitors of the renin-angiotensin aldosterone system improve survival and reduce morbidity in people with heart failure with reduced left ventricular ejection fraction. There is uncertainty whether these treatments are beneficial for people with heart failure with preserved ejection fraction and a comprehensive review of the evidence is required. OBJECTIVES To assess the effects of beta-blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, and mineralocorticoid receptor antagonists in people with heart failure with preserved ejection fraction. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trial registries on 25 July 2017 to identify eligible studies. Reference lists from primary studies and review articles were checked for additional studies. There were no language or date restrictions. SELECTION CRITERIA We included randomised controlled trials with a parallel group design enrolling adult participants with heart failure with preserved ejection fraction, defined by a left ventricular ejection fraction of greater than 40 percent. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion and extracted data. The outcomes assessed included cardiovascular mortality, heart failure hospitalisation, hyperkalaemia, all-cause mortality and quality of life. Risk ratios (RR) and, where possible, hazard ratios (HR) were calculated for dichotomous outcomes. For continuous data, mean difference (MD) or standardised mean difference (SMD) were calculated. We contacted trialists where neccessary to obtain missing data. MAIN RESULTS 37 randomised controlled trials (207 reports) were included across all comparisons with a total of 18,311 participants.Ten studies (3087 participants) investigating beta-blockers (BB) were included. A pooled analysis indicated a reduction in cardiovascular mortality (15% of participants in the intervention arm versus 19% in the control arm; RR 0.78; 95% confidence interval (CI) 0.62 to 0.99; number needed to treat to benefit (NNTB) 25; 1046 participants; 3 studies). However, the quality of evidence was low and no effect on cardiovascular mortality was observed when the analysis was limited to studies with a low risk of bias (RR 0.81; 95% CI 0.50 to 1.29; 643 participants; 1 study). There was no effect on all-cause mortality, heart failure hospitalisation or quality of life measures, however there is uncertainty about these effects given the limited evidence available.12 studies (4408 participants) investigating mineralocorticoid receptor antagonists (MRA) were included with the quality of evidence assessed as moderate. MRA treatment reduced heart failure hospitalisation (11% of participants in the intervention arm versus 14% in the control arm; RR 0.82; 95% CI 0.69 to 0.98; NNTB 41; 3714 participants; 3 studies; moderate-quality evidence) however, little or no effect on all-cause and cardiovascular mortality and quality of life measures was observed. MRA treatment was associated with a greater risk of hyperkalaemia (16% of participants in the intervention group versus 8% in the control group; RR 2.11; 95% CI 1.77 to 2.51; 4291 participants; 6 studies; high-quality evidence).Eight studies (2061 participants) investigating angiotensin converting enzyme inhibitors (ACEI) were included with the overall quality of evidence assessed as moderate. The evidence suggested that ACEI treatment likely has little or no effect on cardiovascular mortality, all-cause mortality, heart failure hospitalisation, or quality of life. Data for the effect of ACEI on hyperkalaemia were only available from one of the included studies.Eight studies (8755 participants) investigating angiotensin receptor blockers (ARB) were included with the overall quality of evidence assessed as high. The evidence suggested that treatment with ARB has little or no effect on cardiovascular mortality, all-cause mortality, heart failure hospitalisation, or quality of life. ARB was associated with an increased risk of hyperkalaemia (0.9% of participants in the intervention group versus 0.5% in the control group; RR 1.88; 95% CI 1.07 to 3.33; 7148 participants; 2 studies; high-quality evidence).We identified a single ongoing placebo-controlled study investigating the effect of angiotensin receptor neprilysin inhibitors (ARNI) in people with heart failure with preserved ejection fraction. AUTHORS' CONCLUSIONS There is evidence that MRA treatment reduces heart failure hospitalisation in heart failure with preserverd ejection fraction, however the effects on mortality related outcomes and quality of life remain unclear. The available evidence for beta-blockers, ACEI, ARB and ARNI is limited and it remains uncertain whether these treatments have a role in the treatment of HFpEF in the absence of an alternative indication for their use. This comprehensive review highlights a persistent gap in the evidence that is currently being addressed through several large ongoing clinical trials.
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Affiliation(s)
- Nicole Martin
- University College LondonFarr Institute of Health Informatics Research222 Euston RoadLondonUKNW1 2DA
| | - Karthick Manoharan
- John Radcliffe HospitalEmergency Department3 Sherwood AvenueLondonMiddlesexUKUb6 0pg
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of EducationLondonUK
| | - Ceri Davies
- Barts Heart Centre, St Bartholomew's HospitalDepartment of CardiologyWest SmithfieldLondonUKEC1A 7BE
| | - R Thomas Lumbers
- University College LondonInstitute of Health InformaticsLondonUK
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Bradham WS, Bell SP, Huang S, Harrell FE, Adkisson DW, Lawson MA, Sawyer DB, Ooi H, Kronenberg MW. Timing of Left Ventricular Remodeling in Nonischemic Dilated Cardiomyopathy. Am J Med Sci 2018; 356:262-267. [PMID: 30286821 DOI: 10.1016/j.amjms.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Mineralocorticoid receptor antagonist (MRA) treatment produces beneficial left ventricular (LV) remodeling in nonischemic dilated cardiomyopathy (NIDCM). This study addressed the timing of maximal beneficial LV remodeling in NIDCM when adding MRA. MATERIALS AND METHODS We studied 12 patients with NIDCM on stable β-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor-blocking therapy who underwent cardiac magnetic resonance imaging before and after 6-31 months of continuous MRA therapy. RESULTS At baseline, the LV ejection fraction (LVEF) was 24% (19-27); median [interquartile range]. The LV end-systolic volume index (LVESVI) was 63 ml (57-76) and the LV stroke volume index (LVSVI) was 19 ml (14-21), all depressed. After adding MRA to the HF regimen, the LVEF increased to 47% (42-52), with a decrease in LVESVI to 36 ml (33-45) and increase in LVSVI to 36 ml (28-39) (for each, P < 0 .0001). Using generalized least squares analysis, the maximal beneficial remodeling (defined by maximal increase in LVEF, the maximal decrease in LVESVI and maximal increase in LVSVI) was achieved after approximately 12-16 months of MRA treatment. CONCLUSIONS Adding MRA to a standard medical regimen for NIDCM resulted in beneficial LV remodeling. The maximal beneficial remodeling was achieved with 12-16 months of MRA therapy. These results have implications for the timing of other advanced therapies, such as placing internal cardioverter-defibrillators.
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Affiliation(s)
| | | | - Shi Huang
- Department of Biostatistics, Vanderbilt University School of Medicine, and the Cardiology Section, VA Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Frank E Harrell
- Department of Biostatistics, Vanderbilt University School of Medicine, and the Cardiology Section, VA Tennessee Valley Healthcare System, Nashville, Tennessee
| | | | | | | | - Henry Ooi
- Division of Cardiovascular Medicine and
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Is the PARADIGM-HF cohort representative of the real-world heart failure patient population? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Rodrigues G, Tralhão A, Aguiar C, Freitas P, Ventosa A, Mendes M. Is the PARADIGM-HF cohort representative of the real-world heart failure patient population? Rev Port Cardiol 2018; 37:491-496. [PMID: 29779951 DOI: 10.1016/j.repc.2017.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 09/29/2017] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION A new drug with prognostic impact on heart failure, sacubitril/valsartan, has been introduced in current guidelines. However, randomized trial results can be compromised by lack of representativeness. We aimed to assess the representativeness of the PARADIGM-HF trial in a real-world population of patients with heart failure. METHODS We reviewed the records of 196 outpatients followed in a heart failure clinic between January 2013 and December 2014. After exclusion of 44 patients with preserved ejection fraction, the inclusion and exclusion criteria of the trial were applied. RESULTS Of the 152 patients with systolic heart failure, 106 lacked one or more inclusion criteria and 45 had at least one exclusion criterion. Considering only patients with ejection fraction ≤35% (HFrEF) (n=88), 43 patients lacked at least one inclusion criterion and 25 patients had at least one exclusion criterion. Combining the inclusion and exclusion criteria, 24.3% of patients with systolic HF (ejection fraction ≤50%) and 42% of patients with HFrEF would be eligible for the PARADIGM-HF trial. CONCLUSION One in four patients with systolic HF followed in a heart failure outpatient clinic would fulfill the reference study criteria for treatment with the new drug, sacubitril/valsartan.
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Vanezis AP, Arnold JR, Rodrigo G, Lai FY, Debiec R, Nazir S, Khan JN, Ng LL, Chitkara K, Coghlan JG, Hetherington SL, McCann GP, Samani NJ. Daily remote ischaemic conditioning following acute myocardial infarction: a randomised controlled trial. Heart 2018; 104:1955-1962. [PMID: 29748420 PMCID: PMC6252375 DOI: 10.1136/heartjnl-2018-313091] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Remote ischaemic conditioning (rIC) is a cardioprotective tool which has shown promise in preclinical and clinical trials in the context of acute ischaemia. Repeated rIC post myocardial infarction may provide additional benefits which have not previously been tested clinically. METHODS The trial assessed the role of daily rIC in enhancing left ventricular ejection fraction (LVEF) recovery in patients with impaired LVEF (<45%) after ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (P-PCI). Patients were recruited from four UK hospitals and randomised to receive either 4 weeks of daily rIC or sham conditioning using the autoRIC Device (CellAegis) starting on day 3 post P-PCI. The primary endpoint was the improvement in LVEF over 4 months assessed by cardiac MRI (CMR). Seventy-three patients (38 cases, 35 controls) completed the study. RESULTS The treatment and control groups were well matched at baseline including for mean LVEF (42.8% vs 44.3% respectively, p=0.952). There was no difference in the improvement in LVEF over 4 months between the treatment and control groups (4.8%±7.8% vs 4.6%±5.9% respectively, p=0.924). No differences were seen in the secondary outcome measures including changes in infarct size and left ventricular end-diastolic and systolic volumes, major adverse cardiac and cerebral event, mean Kansas City Cardiomyopathy Questionnaire score and change in N-terminal pro-brain natriuretic peptide levels. CONCLUSIONS Daily rIC starting on day 3 and continued for 4 weeks following successful P-PCI for STEMI did not improve LVEF as assessed by CMR after 4 months when compared with a matched control group. TRIAL REGISTRATION NUMBER NCT0166461.
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Affiliation(s)
- Andrew Peter Vanezis
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Jayanth Ranjit Arnold
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Glenn Rodrigo
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Florence Y Lai
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Radek Debiec
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Sheraz Nazir
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Jamal Nasir Khan
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | | | | | | | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
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Shih YC, Chen CL, Zhang Y, Mellor RL, Kanter EM, Fang Y, Wang HC, Hung CT, Nong JY, Chen HJ, Lee TH, Tseng YS, Chen CN, Wu CC, Lin SL, Yamada KA, Nerbonne JM, Yang KC. Endoplasmic Reticulum Protein TXNDC5 Augments Myocardial Fibrosis by Facilitating Extracellular Matrix Protein Folding and Redox-Sensitive Cardiac Fibroblast Activation. Circ Res 2018. [PMID: 29535165 DOI: 10.1161/circresaha.117.312130] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
RATIONALE Cardiac fibrosis plays a critical role in the pathogenesis of heart failure. Excessive accumulation of extracellular matrix (ECM) resulting from cardiac fibrosis impairs cardiac contractile function and increases arrhythmogenicity. Current treatment options for cardiac fibrosis, however, are limited, and there is a clear need to identify novel mediators of cardiac fibrosis to facilitate the development of better therapeutics. Exploiting coexpression gene network analysis on RNA sequencing data from failing human heart, we identified TXNDC5 (thioredoxin domain containing 5), a cardiac fibroblast (CF)-enriched endoplasmic reticulum protein, as a potential novel mediator of cardiac fibrosis, and we completed experiments to test this hypothesis directly. OBJECTIVE The objective of this study was to determine the functional role of TXNDC5 in the pathogenesis of cardiac fibrosis. METHODS AND RESULTS RNA sequencing and Western blot analyses revealed that TXNDC5 mRNA and protein were highly upregulated in failing human left ventricles and in hypertrophied/failing mouse left ventricle. In addition, cardiac TXNDC5 mRNA expression levels were positively correlated with those of transcripts encoding transforming growth factor β1 and ECM proteins in vivo. TXNDC5 mRNA and protein were increased in human CF (hCF) under transforming growth factor β1 stimulation in vitro. Knockdown of TXNDC5 attenuated transforming growth factor β1-induced hCF activation and ECM protein upregulation independent of SMAD3 (SMAD family member 3), whereas increasing expression of TXNDC5 triggered hCF activation and proliferation and increased ECM protein production. Further experiments showed that TXNDC5, a protein disulfide isomerase, facilitated ECM protein folding and that depletion of TXNDC5 led to ECM protein misfolding and degradation in CF. In addition, TXNDC5 promotes hCF activation and proliferation by enhancing c-Jun N-terminal kinase activity via increased reactive oxygen species, derived from NAD(P)H oxidase 4. Transforming growth factor β1-induced TXNDC5 upregulation in hCF was dependent on endoplasmic reticulum stress and activating transcription factor 6-mediated transcriptional control. Targeted disruption of Txndc5 in mice (Txndc5-/-) revealed protective effects against isoproterenol-induced cardiac hypertrophy, reduced fibrosis (by ≈70%), and markedly improved left ventricle function; post-isoproterenol left ventricular ejection fraction was 59.1±1.5 versus 40.1±2.5 (P<0.001) in Txndc5-/- versus wild-type mice, respectively. CONCLUSIONS The endoplasmic reticulum protein TXNDC5 promotes cardiac fibrosis by facilitating ECM protein folding and CF activation via redox-sensitive c-Jun N-terminal kinase signaling. Loss of TXNDC5 protects against β agonist-induced cardiac fibrosis and contractile dysfunction. Targeting TXNDC5, therefore, could be a powerful new therapeutic approach to mitigate excessive cardiac fibrosis, thereby improving cardiac function and outcomes in patients with heart failure.
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Affiliation(s)
- Ying-Chun Shih
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Chao-Ling Chen
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Yan Zhang
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Rebecca L Mellor
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Evelyn M Kanter
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Yun Fang
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Hua-Chi Wang
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Chen-Ting Hung
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Jing-Yi Nong
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Hui-Ju Chen
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Tzu-Han Lee
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Yi-Shuan Tseng
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Chiung-Nien Chen
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Chau-Chung Wu
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Shuei-Liong Lin
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Kathryn A Yamada
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Jeanne M Nerbonne
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei
| | - Kai-Chien Yang
- From the Department and Graduate Institute of Pharmacology (Y.-C.S., C.-L.C., H.-C.W., C.-T.H., J.-Y.N., H.-J.C., T.-H.L., Y.-S.T., K.-C.Y.), Department and Graduate Institute of Medical Education and Bioethics (C.-C.W.), and Department and Graduate Institute of Physiology (S.-L.L.), National Taiwan University College of Medicine, Taipei; Department of Developmental Biology (J.M.N.) and Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine (Y.Z., R.L.M., E.M.K., K.A.Y., J.M.N.), Washington University School of Medicine, St Louis, MO; Department of Medicine, University of Chicago, IL (Y.F.); Department of Surgery (C.-N.C.), Division of Nephrology, Department of Internal Medicine (S.-L.L.), and Division of Cardiology, Department of Internal Medicine (C.-C.W., K.-C.Y.), National Taiwan University Hospital, Taipei.
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Chen B, Geng J, Gao SX, Yue WW, Liu Q. Eplerenone Modulates Interleukin-33/sST2 Signaling and IL-1β in Left Ventricular Systolic Dysfunction After Acute Myocardial Infarction. J Interferon Cytokine Res 2018; 38:137-144. [PMID: 29565745 DOI: 10.1089/jir.2017.0067] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bo Chen
- Department of Cardiology, The Fourth People's Hospital of Jinan, Medical School, Tai Shan Medical College, Jinan, P.R. China
| | - Jing Geng
- Department of Cardiology, The Fourth People's Hospital of Jinan, Medical School, Tai Shan Medical College, Jinan, P.R. China
| | - Shao-Xi Gao
- Department of Cardiology, The Fourth People's Hospital of Jinan, Medical School, Tai Shan Medical College, Jinan, P.R. China
| | - Wen-Wei Yue
- Department of Cardiology, The Fourth People's Hospital of Jinan, Medical School, Tai Shan Medical College, Jinan, P.R. China
| | - Qiang Liu
- Department of Cardiology, The Fourth People's Hospital of Jinan, Medical School, Tai Shan Medical College, Jinan, P.R. China
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