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Ferreira JP, Claggett BL, Liu J, Sharma A, Desai AS, Anand IS, O'Meara E, Rouleau JL, De Denus S, Pitt B, Pfeffer MA, Zannad F, Solomon SD. High-sensitivity C-reactive protein in heart failure with preserved ejection fraction: Findings from TOPCAT. Int J Cardiol 2024; 402:131818. [PMID: 38307421 DOI: 10.1016/j.ijcard.2024.131818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/22/2024] [Accepted: 01/28/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Inflammation plays a central role in the genesis and progression of heart failure with preserved ejection fraction (HFpEF). C-reactive protein (CRP) is widely used as means to assess systemic inflammation, and elevated levels of CRP have been associated with poor HF prognosis. Identification of chronic low-grade inflammation in outpatients can be performed measuring high-sensitivity CRP (hsCRP). The clinical characteristics and outcome associations of a pro-inflammatory state among outpatients with HFpEF requires further study. AIMS Using a biomarker subset of TOPCAT-Americas (NCT00094302), we aim to characterize HFpEF patients according to hsCRP levels and study the prognostic associations of hsCRP. METHODS hsCRP was available in a subset of 232 participants. Comparisons were performed between patients with hsCRP <2 mg/L and ≥ 2 mg/L. Cox regression models were used to study the association between hsCRP and the study outcomes. RESULTS Compared to patients with hsCRP <2 mg/L (n = 89, 38%), those with hsCRP ≥2 mg/L (n = 143, 62%) had more frequent HF hospitalizations prior to randomization, chronic obstructive pulmonary disease, orthopnea, higher body mass index, and worse health-related quality-of-life. A hsCRP level ≥ 2 mg/L was associated with an increased risk of cardiovascular death and HF hospitalizations: hsCRP ≥2 mg/L vs <2 mg/L adjusted HR 2.36, 95%CI 1.27-4.38, P = 0.006. Spironolactone did not influence hsCRP levels from baseline to month 12: gMean ratio = 1.11, 95%CI 0.87-1.42, P = 0.39. CONCLUSIONS A hsCRP ≥2 mg/L identified HFpEF patients with a high risk of HF events and cardiovascular mortality. Spironolactone did not influence hsCRP levels at 12 months.
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Affiliation(s)
- João Pedro Ferreira
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Centre - UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal; Université de Lorraine, Inserm, Centre d'Investigation Clinique Plurithématique 1433, U1116, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France.
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jiankang Liu
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Abhinav Sharma
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre & DREAM-CV Lab, McGill University Health Centre & Division of Cardiology, McGill University, Montreal, Quebec, Canada
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Inder S Anand
- Department of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Eileen O'Meara
- Montreal Heart Institute and Université de Montréal, Montreal, QC, Canada
| | - Jean L Rouleau
- Montreal Institute of Cardiology, University of Montreal, Montreal, QC, Canada
| | - Simon De Denus
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Bertram Pitt
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigation Clinique Plurithématique 1433, U1116, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Pabón MA, Wang X, Lam CSP, O'Meara E, Vaduganathan M, Claggett BL, Foà A, Lu H, Langkilde AM, De Boer RA, Desai AS, Hernandez AF, Inzucchi SE, Jhund PS, Kosiborod MN, Martinez FA, Shah SJ, Petersson M, McMurray JJV, Solomon SD, Vardeny O. Sex Differences in Heart Failure With Improved Ejection Fraction: The DELIVER Trial. JACC Heart Fail 2024:S2213-1779(24)00265-8. [PMID: 38661586 DOI: 10.1016/j.jchf.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Maria A Pabón
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Xiaowen Wang
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | - Eileen O'Meara
- Montreal Heart Institute/Université de Montréal, Montreal, Quebec, Canada
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Claggett
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alberto Foà
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Henri Lu
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Vaud, Switzerland
| | | | | | - Akshay S Desai
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, Minnesota, USA
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Newman JD, O'Meara E, Böhm M, Savarese G, Kelly PR, Vardeny O, Allen LA, Lancellotti P, Gottlieb SS, Samad Z, Morris AA, Desai NR, Rosano GMC, Teerlink JR, Giraldo CS, Lindenfeld J. Implications of Atrial Fibrillation for Guideline-Directed Therapy in Patients With Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:932-950. [PMID: 38418008 DOI: 10.1016/j.jacc.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 03/01/2024]
Abstract
Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular conditions that frequently coexist. Among patients with HF, more than one-half also have AF. Both are associated with significant morbidity and mortality. Moreover, the prevalence of each is increasing globally, and this trend is expected to continue owing to an aging population and increased life expectancy. Diagnosis of AF in a patient with HF is associated with greater symptom burden, more frequent hospitalizations, and a worse prognosis. Guideline-directed medical therapy (GDMT) for HF can affect the incidence of AF. Once present, AF can influence the efficacy of some components of GDMT for HF. In this review, we discuss the effect of GDMT for HF across the spectrum of ejection fraction on prevention of AF as well as the benefit of GDMT in patients with vs without AF.
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Affiliation(s)
| | - Eileen O'Meara
- Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Michael Böhm
- University of the Saarland, Homberg/Saar, Germany
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Orly Vardeny
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA; Baltimore Veterans Administration Medical Center, Baltimore, Maryland, USA
| | | | | | - Nihar R Desai
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Giuseppe M C Rosano
- Center for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | | | | | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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4
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Minamisawa M, Inciardi RM, Claggett B, Cikes M, Liu L, Prasad N, Biering-Sørensen T, Lam CSP, Shah SJ, Zile MR, O'Meara E, Redfield MM, McMurray JJV, Solomon SD, Shah AM. Clinical implications of subclinical left ventricular dysfunction in heart failure with preserved ejection fraction: The PARAGON-HF study. Eur J Heart Fail 2024. [PMID: 38369856 DOI: 10.1002/ejhf.3167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
AIMS Left ventricular (LV) subclinical impairment has been described in heart failure with preserved ejection fraction (HFpEF). We assessed the relationship between LV myocardial deformation by strain imaging and recurrent hospitalization for heart failure (HF) or cardiovascular death in a large international HFpEF population. METHODS AND RESULTS We assessed two-dimensional speckle-tracking based global longitudinal strain (GLS) in 790 patients (mean age 74 ± 8 years, 54% female) with adequate image quality enrolled in the PARAGON-HF echocardiography study. We examined the relationship of GLS with total HF hospitalizations and cardiovascular death (the primary composite outcome) after accounting for clinical confounders. Approximately 47% of the population had evidence of LV subclinical dysfunction, defined as absolute GLS <16%. Impaired GLS was significantly associated with higher values of circulating baseline N-terminal pro-B-type-natriuretic peptide. After a median follow-up of 3.0 years, there were 407 total HF hospitalizations and cardiovascular deaths. After multivariable adjustment, worse GLS was associated with a greater risk for the primary composite outcome (adjusted hazard ratio per 1% decrease: 1.06; 95% confidence interval 1.02-1.11; p = 0.008). GLS did not modify the treatment effect of sacubitril/valsartan compared with valsartan for the composite outcome (p for interaction >0.1). CONCLUSIONS In a large HFpEF population, impaired LV function was observed even among patients with preserved ejection fraction, and was associated with an increased risk of total HF hospitalizations or cardiovascular death, accounting for clinical confounders. These findings highlight the key role of subtle LV systolic impairment in the pathophysiology of HFpEF.
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Affiliation(s)
- Masatoshi Minamisawa
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Riccardo M Inciardi
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maja Cikes
- Department for Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb, Zagreb, Croatia
| | - Li Liu
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Narayana Prasad
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tor Biering-Sørensen
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore, Singapore
- University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Michael R Zile
- The Medical University of South Carolina and the Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Eileen O'Meara
- Montreal Heart Institute and Université de Montréal, Montreal, QC, Canada
| | | | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ali MU, Mancini GBJ, Fitzpatrick-Lewis D, Connelly KA, O'Meara E, Zieroth S, Sherifali D. The effectiveness of sodium-glucose co-transporter 2 inhibitors on cardiorenal outcomes: an updated systematic review and meta-analysis. Cardiovasc Diabetol 2024; 23:72. [PMID: 38360604 PMCID: PMC10870515 DOI: 10.1186/s12933-024-02154-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/04/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The 2022 Canadian Cardiovascular Society (CCS) cardiorenal guideline provided clinical recommendations on sodium-glucose co-transport 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) use. Since then, additional trials of relevance for SGLT2i have been published. This update re-evaluates the clinical recommendations for using SGLTi and their indirect comparison with existing evidence on GLP-1RA as compared to the standard of care to reduce cardiorenal morbidity and mortality. METHODS We updated our existing search and screening of the literature from September 2021 to April 2023 for randomized controlled trials of SGLT2i and GLP-1RA with placebo control. We conducted risk of bias assessment, data extraction and updated our meta-analysis of studies with similar interventions and components. The certainty of the evidence was determined using GRADE. RESULTS Evidence from three new trials and additional results from an updated existing trial on SGLT2i met our inclusion criteria after an updated search. Across all the included studies, the total sample size was 151,023 adults, with 90,943 in SGLT2i trials and 60,080 in GLP-1 RA trials. The mean age ranged from 59.9 to 68.4 years. Compared with standard care, the use of SGLT2i and GLP-1 RA showed significant reductions in the outcomes of cardiovascular (CV) mortality (14% & 13%), any-cause mortality (12% & 12%), major adverse CV events (MACE) (11% & 14%), heart failure (HF) hospitalization (30% & 9%), CV death or HF hospitalization (23% & 11%), and kidney composite outcome (32% & 22%). In participants with T2D, both classes demonstrated significant cardiorenal protection. But, only GLP-1RA showed a reduction in non-fatal stroke (16%) and only SGLT2i showed a reduction in HF hospitalization (30%) in this population of people living with T2D. CONCLUSIONS This updated and comprehensive meta-analysis substantiates and strengthens the clinical recommendations of the CCS cardiorenal guidelines.
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Affiliation(s)
- Muhammad Usman Ali
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - G B John Mancini
- Division of Cardiology, Centre for Cardiovascular Innovation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Kim A Connelly
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada
| | - Eileen O'Meara
- Division of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Shelley Zieroth
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Parent M, Leclerc J, O'Meara E, Barrette R, Lévesque S, Parent MC, Brouillette D, Garceau P, Liszkowski M, Rouleau J, Ducharme A. Clinical Heart fAilure Management Program: Changing the practice by partnering primary care and specialists (CHAMP-HF). Int J Cardiol Heart Vasc 2024; 50:101330. [PMID: 38298468 PMCID: PMC10827585 DOI: 10.1016/j.ijcha.2023.101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 02/02/2024]
Abstract
Background While significant gains were made in the management of heart failure (HF), most patients are still diagnosed when they are acutely ill in hospital, often with advanced disease. Earlier diagnosis in the community could lead to improved outcomes. Whether a partnership and an educational program for primary care providers (PCP) increase HF awareness and management is unknown. Methods We conducted an observational study between March 2019 and June 2020 during which HF specialists gave monthly HF conferences to PCP. Using a pre-post design, medical charts and administrative databases were reviewed and a questionnaire was completed by participating PCP. Primary and secondary endpoints included: 1) the number of patients diagnosed with HF, 2) implementation of GDMT for patients with HFrEF; 3) PCPs' experience and confidence. Results Six PCP agreed to participate. Amongst the 11,909 patients of the clinic, 70 (0.59 %) patients met the criteria for HF. This number increased by 28.6 % (n = 90) after intervention. Increased use of GDMT for HFrEF patients at baseline (n = 35) was observed for all class of agents, with doubling of patients on triple therapies, from 8 (22.9 %) to 16 (45.7 %), p = 0.0047. Self-confidence on HF management was low (1, 16.7 %) but increased after the educational intervention of physicians (3, 50 %). Conclusion An educational and collaborative approach between HF specialists and community PCP increased the number of new HF cases diagnosed, enhanced implementation of GDMT in patients with HFrEF and increase PCPs' confidence in treating HF, despite being conducted during the COVID-19 pandemic.
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Affiliation(s)
- Marianne Parent
- Faculty of Medicine, University of Montreal, Montreal, Canada
- Department of Medicine, Montreal Heart Institute, Montreal, Canada
| | - Jacinthe Leclerc
- Faculty of Pharmacy, Université Laval, Quebec, Canada
- Research Center, Quebec Heart and Lung Institute, Université Laval, Quebec, Canada
| | - Eileen O'Meara
- Faculty of Medicine, University of Montreal, Montreal, Canada
- Department of Medicine, Montreal Heart Institute, Montreal, Canada
| | | | - Sylvie Lévesque
- Montreal Health Innovation Coordinating Center, Biostatistics, Montreal, Canada
| | - Marie-Claude Parent
- Faculty of Medicine, University of Montreal, Montreal, Canada
- Department of Medicine, Montreal Heart Institute, Montreal, Canada
| | | | - Patrick Garceau
- Faculty of Medicine, University of Montreal, Montreal, Canada
- Department of Medicine, Montreal Heart Institute, Montreal, Canada
| | - Mark Liszkowski
- Faculty of Medicine, University of Montreal, Montreal, Canada
- Department of Medicine, Montreal Heart Institute, Montreal, Canada
| | - Jean Rouleau
- Faculty of Medicine, University of Montreal, Montreal, Canada
- Department of Medicine, Montreal Heart Institute, Montreal, Canada
| | - Anique Ducharme
- Faculty of Medicine, University of Montreal, Montreal, Canada
- Department of Medicine, Montreal Heart Institute, Montreal, Canada
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7
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Pabon M, Cunningham J, Claggett B, Felker GM, McMurray JJV, Metra M, Diaz R, Wang X, Arias-Mendoza A, Bonderman D, Crespo-Leiro M, Fonseca C, Goncalvesova E, Lund M, O'Meara E, Sliwa-Hahnle K, Malik FI, Solomon SD, Teerlink JR. Sex Differences in Heart Failure With Reduced Ejection Fraction in the GALACTIC-HF Trial. JACC Heart Fail 2023; 11:1729-1738. [PMID: 37831045 DOI: 10.1016/j.jchf.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Women with heart failure with reduced ejection fraction (HFrEF) receive less guideline-recommended therapy and experience worse quality of life than men. OBJECTIVES The authors sought to assess differences in baseline characteristics, outcomes, efficacy, and safety of omecamtiv mecarbil between men and women enrolled in the GALACTIC-HF (Registrational Study With Omecamtiv Mecarbil [AMG 423] to Treat Chronic Heart Failure With Reduced Ejection Fraction) study. METHODS In GALACTIC-HF, patients with symptomatic heart failure with EF of 35% or less, recent heart failure event, and elevated natriuretic peptides were randomized to omecamtiv mecarbil or placebo. The current analysis investigated differences in baseline characteristics, clinical outcomes, and efficacy and safety of omecamtiv mecarbil between men and women. RESULTS Of 8,232 patients analyzed, 21.2% were women. Women more likely self-identified as being Black, had worse symptoms (lower Kansas City Cardiomyopathy Questionnaire Total Symptom Score [KCCQ-TSS]), and were less likely to be treated with angiotensin receptor/neprilysin inhibitor and devices at baseline. Compared with men, women had lower rates of the primary endpoint (adjusted HR: 0.80, 95% CI: 0.73-0.88). Sex did not significantly modify omecamtiv mecarbil's treatment effect (P interaction = 0.68). Women also had 20% less risk of cardiovascular death, heart failure event, and all-cause death. Women participants had lower rates of serious adverse events. CONCLUSIONS Women participants of the GALACTIC-HF trial had worse quality of life and were less likely to be treated with guideline-based therapies at baseline. Despite KCCQ-TSS being predictive of poor outcomes in this population, women had a 20% lower risk of an HF event or cardiovascular death compared with men. The beneficial effect of omecamtiv mecarbil did not significantly differ by sex. (Registrational Study With Omecamtiv Mecarbil [AMG 423] to Treat Chronic Heart Failure With Reduced Ejection Fraction [GALACTIC-HF]; NCT02929329).
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Affiliation(s)
- Maria Pabon
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jon Cunningham
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Brian Claggett
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, Glasgow, United Kingdom
| | | | - Rafael Diaz
- Estudios Clínicos Latino América, Rosario, Argentina
| | - Xiaowen Wang
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Maria Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna, CHUAC, INIBIC, UDC, CIBERCV, La Coruna, Spain
| | - Cândida Fonseca
- Department of Internal Medicine, Hospital São Francisco Xavier, Lisbon, Portugal
| | | | | | - Eileen O'Meara
- Montreal Heart Institute and Université de Montréal, Montreal, QC, Canada
| | | | - Fady I Malik
- Cytokinetics Inc, South San Francisco, California, USA
| | - Scott D Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
| | - John R Teerlink
- San Francisco Veterans Affairs Medical Center and School of Medicine, University of California-San Francisco, San Francisco, California, USA
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8
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Harrington J, Mentz RJ, Rockhold FW, Garg J, Butler J, De Pasquale CG, Ezekowitz JA, Lewis GD, O'Meara E, Ponikowski P, Troughton RW, Wong YW, Adamczyk R, Blackman N, Hernandez AF. Baseline characteristics of patients in the randomized study to investigate the efficacy and safety of ferric carboxymaltose as treatment for heart failure with iron deficiency: HEART-FID trial. Am Heart J 2023; 266:25-31. [PMID: 37598795 DOI: 10.1016/j.ahj.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Prior clinical trials have investigated intravenous iron in patients with heart failure (HF) and iron deficiency, but the safety and efficacy of this therapy remains unclear. METHODS We report the baseline demographics and clinical characteristics of patients enrolled in the HEART-FID study and compare HEART-FID participants with patients within other contemporary clinical trials of patients with HF with reduced ejection fraction (HFrEF), including other intravenous iron trials. RESULTS In the 3,065 participants randomized in HEART-FID, median (IQR) age was 69.7 (62.0-76.5) years, 1,037 (33.8%) were female, 322 (10.5%) were Black, median ejection fraction was 32% (25%-37%), 1,837 (60.0%) had ischemic etiology, and baseline median NT-proBNP was 1,462 (721-2,966) pg/mL. Median baseline hemoglobin was 12.6 (11.6-13.6) g/dL, and median 6-minute walk test distance was 272 (196-350) m, similar to prior intravenous iron HFrEF trials. Common comorbidities included atrial fibrillation/flutter (43.7%), and type 2 diabetes (45.2%). Compared with several recent HFrEF trials, patients enrolled in HEART-FID had similar baseline demographics and clinical characteristics, though a greater proportion of women and Black participants were recruited in HEART-FID. In HEART-FID, HFrEF therapy included a beta-blocker in 92.5%, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitors (ARNI) in 86.1% (with 29.7% ARNI), and a mineralocorticoid antagonist (MRA) in 55.6%. CONCLUSIONS Patients enrolled in HEART-FID were similar to those enrolled in other contemporary HFrEF trials and registries, including trials of intravenous iron in HFrEF. However, the HEART-FID cohort is substantially larger and more racially diverse than prior trials of intravenous iron in HFrEF. TRIAL REGISTRATION ClinicalTrials.gov (NCT03037931).
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Affiliation(s)
- Josephine Harrington
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Robert J Mentz
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC.
| | - Frank W Rockhold
- Duke Clinical Research Institute, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | | | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX; Department of Medicine, University of Mississippi, Jackson, MS
| | | | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Gregory D Lewis
- Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Eileen O'Meara
- Montreal Heart Institute and Université de Montréal, Montréal, Canada
| | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland
| | - Richard W Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Yee Weng Wong
- The Prince Charles Hospital and University of Queensland, Queensland, Australia; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Adrian F Hernandez
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
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Vardeny O, Fang JC, Desai AS, Jhund PS, Claggett B, Vaduganathan M, de Boer RA, Hernandez AF, Lam CSP, Inzucchi SE, Martinez FA, Kosiborod MN, DeMets D, O'Meara E, Zieroth S, Comin-Colet J, Drozdz J, Chiang CE, Kitakaze M, Petersson M, Lindholm D, Langkilde AM, McMurray JJV, Solomon SD. Author Correction: Dapagliflozin in heart failure with improved ejection fraction: a prespecified analysis of the DELIVER trial. Nat Med 2023; 29:3269. [PMID: 36932245 PMCID: PMC10719083 DOI: 10.1038/s41591-023-02302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, MN, USA.
| | - James C Fang
- University of Utah Medical Center, Salt Lake City, UT, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore, Singapore
| | | | | | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | | | - Eileen O'Meara
- Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Shelley Zieroth
- St. Boniface Hospital & University of Manitoba, Winnipeg, Manitoba, Canada
| | - Josep Comin-Colet
- Cardiology Department, Bellvitge University Hospital, Bio-Heart Bellvitge Institute for Biomedical Research, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Jaroslaw Drozdz
- Department Cardiology, Medical University Lodz, Lodz, Poland
| | - Chern-En Chiang
- General Clinical Research Center and Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Daniel Lindholm
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - John J V McMurray
- BHF Glasgow Cardiovascular Research Center, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Parkash R, O'Meara E, Tang ASL. The Role of Ablation-Based Rhythm Control in the Tangled Web of Atrial Fibrillation and Heart Failure. Circulation 2023; 148:933-935. [PMID: 37721977 DOI: 10.1161/circulationaha.123.065329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Affiliation(s)
- Ratika Parkash
- Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (R.P.)
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Mentz RJ, Garg J, Rockhold FW, Butler J, De Pasquale CG, Ezekowitz JA, Lewis GD, O'Meara E, Ponikowski P, Troughton RW, Wong YW, She L, Harrington J, Adamczyk R, Blackman N, Hernandez AF. Ferric Carboxymaltose in Heart Failure with Iron Deficiency. N Engl J Med 2023; 389:975-986. [PMID: 37632463 DOI: 10.1056/nejmoa2304968] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
BACKGROUND Ferric carboxymaltose therapy reduces symptoms and improves quality of life in patients who have heart failure with a reduced ejection fraction and iron deficiency. Additional evidence about the effects of ferric carboxymaltose on clinical events is needed. METHODS In this double-blind, randomized trial, we assigned ambulatory patients with heart failure, a left ventricular ejection fraction of 40% or less, and iron deficiency, in a 1:1 ratio, to receive intravenous ferric carboxymaltose or placebo, in addition to standard therapy for heart failure. Ferric carboxymaltose or placebo was given every 6 months as needed on the basis of iron indexes and hemoglobin levels. The primary outcome was a hierarchical composite of death within 12 months after randomization, hospitalizations for heart failure within 12 months after randomization, or change from baseline to 6 months in the 6-minute walk distance. The significance level was set at 0.01. RESULTS We enrolled 3065 patients, of whom 1532 were randomly assigned to the ferric carboxymaltose group and 1533 to the placebo group. Death by month 12 occurred in 131 patients (8.6%) in the ferric carboxymaltose group and 158 (10.3%) in the placebo group; a total of 297 and 332 hospitalizations for heart failure, respectively, occurred by month 12; and the mean (±SD) change from baseline to 6 months in the 6-minute walk distance was 8±60 and 4±59 m, respectively (Wilcoxon-Mann-Whitney P = 0.02; unmatched win ratio, 1.10; 99% confidence interval, 0.99 to 1.23). Repeated dosing of ferric carboxymaltose appeared to be safe with an acceptable adverse-event profile in the majority of patients. The number of patients with serious adverse events occurring during the treatment period was similar in the two groups (413 patients [27.0%] in the ferric carboxymaltose group and 401 [26.2%] in the placebo group). CONCLUSIONS Among ambulatory patients who had heart failure with a reduced ejection fraction and iron deficiency, there was no apparent difference between ferric carboxymaltose and placebo with respect to the hierarchical composite of death, hospitalizations for heart failure, or 6-minute walk distance. (Funded by American Regent, a Daiichi Sankyo Group company; HEART-FID ClinicalTrials.gov number, NCT03037931.).
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Affiliation(s)
- Robert J Mentz
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Jyotsna Garg
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Frank W Rockhold
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Javed Butler
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Carmine G De Pasquale
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Justin A Ezekowitz
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Gregory D Lewis
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Eileen O'Meara
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Piotr Ponikowski
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Richard W Troughton
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Yee Weng Wong
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Lilin She
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Josephine Harrington
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Robert Adamczyk
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Nicole Blackman
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
| | - Adrian F Hernandez
- From the Division of Cardiology, Department of Medicine (R.J.M., J.H., A.F.H.), and the Department of Biostatistics and Bioinformatics (F.W.R.), Duke University School of Medicine, and Duke Clinical Research Institute (R.J.M., J.G., F.W.R., L.S., J.H., A.F.H.) - both in Durham, NC; Baylor Scott and White Research Institute, Dallas (J.B.); the Department of Medicine, University of Mississippi, Jackson (J.B.); Flinders Medical Centre, Flinders University, Adelaide, SA (C.G.D.P.), and the Department of Cardiology, Prince Charles Hospital and Faculty of Medicine, University of Queensland, Brisbane (Y.W.W.) - both in Australia; Canadian VIGOUR Centre, University of Alberta, Edmonton (J.A.E.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L.); the Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland (P.P.); Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.); the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.W.W.); and American Regent, Shirley, NY (R.A., N.B.)
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Ducharme A, Zieroth S, Ahooja V, Anderson K, Andrade J, Boivin-Proulx LA, Ezekowitz J, Howlett J, Lepage S, Leong D, McDonald MA, O'Meara E, Poon S, Swiggum E, Virani S. Canadian Cardiovascular Society-Canadian Heart Failure Society Focused Clinical Practice Update of Patients With Differing Heart Failure Phenotypes. Can J Cardiol 2023; 39:1030-1040. [PMID: 37169222 DOI: 10.1016/j.cjca.2023.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023] Open
Abstract
A number of societies produce heart failure (HF) management guidelines, comprising official recommendations on the basis of recent research discoveries, but their applicability to specific situations encountered in daily practice might be difficult. In this clinical practice update we aim to provide responses to fundamental questions that face health care providers, like appropriate timing for the introduction and optimization of different classes of medication according to specific patient phenotypes, when second-line therapies and valvular interventions should be considered, and management of difficult clinical scenarios such as cardiorenal syndrome and frailty. A consensus-based methodology was used. Approaches to 5 different phenotypes are presented: (1) The wet HF phenotype is the easiest to manage, decongestion being performed alongside introduction of guideline-directed medical therapy (GDMT); (2) The de novo HF phenotype requires the introduction of the 4 pillars of GDMT, personalizing the order on the basis of the individuals' biological and physiological characteristics; (3) The worsening HF phenotype is a marker of poor prognosis, and therefore should motivate optimization of GDMT, start second-line therapies, and/or reevaluate goals of care/advanced HF therapies; (4) The cardiorenal phenotypes require correct volume assessment, because renal function usually improves with decongestion; and (5) The frail HF phenotype require special attention, careful drug titration, and consideration of cardiac rehabilitation programs. In conclusion, specific common HF phenotypes call for a personalized approach to improve adoption of the HF guidelines into clinical practice.
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Affiliation(s)
- Anique Ducharme
- Department of Medicine, Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada.
| | - Shelley Zieroth
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vineeta Ahooja
- Department of Medicine, The Heart Health Institute, Scarborough, Ontario, Canada
| | - Kim Anderson
- Department of Medicine, Dalhousie University QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Jason Andrade
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Justin Ezekowitz
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan Howlett
- Department of Medicine, Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Serge Lepage
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Derek Leong
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michael A McDonald
- Department of Medicine, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Eileen O'Meara
- Department of Medicine, Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Stephanie Poon
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Swiggum
- Department of Medicine, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada
| | - Sean Virani
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Docherty KF, McDowell K, Welsh P, Osmanska J, Anand I, de Boer RA, Køber L, Kosiborod MN, Martinez FA, O'Meara E, Ponikowski P, Schou M, Berg DD, Sabatine MS, Morrow DA, Jarolim P, Hammarstedt A, Sjöstrand M, Langkilde AM, Solomon SD, Sattar N, Jhund PS, McMurray JJV. Association of Carbohydrate Antigen 125 on the Response to Dapagliflozin in Patients With Heart Failure. J Am Coll Cardiol 2023; 82:142-157. [PMID: 37407113 DOI: 10.1016/j.jacc.2023.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Elevated circulating carbohydrate antigen 125 (CA125) is a marker of congestion and a predictor of outcomes in acute heart failure (HF). Less is known about CA125 in chronic ambulatory HF with reduced ejection fraction. OBJECTIVES This study examined the association between baseline CA125 (and changes in CA125) and outcomes in patients with HF with reduced ejection fraction in the DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure; NCT03036124) trial and its relationship with the effect of dapagliflozin. METHODS The primary outcome was a composite of a first episode of worsening HF or cardiovascular death. CA125 was measured at baseline and 12 months following randomization. RESULTS Median baseline CA125 was 13.04 U/mL (IQR: 8.78-21.13 U/mL) in 3,123 of 4,774 patients with available data. Compared with CA125 ≤35 U/mL (upper limit of normal), patients with CA125 >35 U/mL were at a higher risk of the primary outcome (adjusted HR: 1.59; 95% CI: 1.29-1.96). The adjusted risks of the primary outcome relative to quartile 1 (Q1) (≤8.78 U/mL) were as follow: Q2, 8.79-13.04 U/mL (HR: 0.94; 95% CI: 0.71-1.24); Q3, 13.05-21.13 U/mL (HR: 1.22; 95% CI: 0.94-1.59); Q4, ≥21.14 U/mL (HR: 1.63; 95% CI: 1.28-2.09). The beneficial effect of dapagliflozin compared with placebo on the primary outcome was consistent whether CA125 was analyzed in quartiles (interaction P = 0.13) or as a continuous variable (interaction P = 0.75). The placebo-corrected relative change in CA125 at 12 months was -5.2% (95% CI: -10.6% to 0.5%; P = 0.07). CONCLUSIONS In DAPA-HF, elevated CA125 levels were an independent predictor of the risk of worsening HF or cardiovascular death. Dapagliflozin reduced the risk of worsening HF or cardiovascular death regardless of baseline CA125.
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Affiliation(s)
- Kieran F Docherty
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Kirsty McDowell
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Paul Welsh
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Joanna Osmanska
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom. https://twitter.com/Kieranfdocherty
| | - Inder Anand
- Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota, USA
| | - Rudolf A de Boer
- Erasmus Medical Center, Department of Cardiology, Rotterdam, the Netherlands. https://twitter.com/UoGHeartFailure
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Felipe A Martinez
- Instituto Docencia Asistencia Médica e Investigación Clinica, Cordoba National University, Cordoba, Argentina
| | - Eileen O'Meara
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | | | - Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - David D Berg
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; TIMI Study Group, Boston, Massachusetts, USA
| | - Marc S Sabatine
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; TIMI Study Group, Boston, Massachusetts, USA
| | - David A Morrow
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; TIMI Study Group, Boston, Massachusetts, USA
| | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ann Hammarstedt
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Mikaela Sjöstrand
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Naveed Sattar
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom.
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14
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McMurray JJ, Docherty KF, Welsh P, Anand IS, Berg D, De Boer RA, Jarolim P, Kober L, Kosiborod M, Martinez FA, O'Meara E, Morrow DA, Ponikowski P, Sabatine MS, Sattar N, Schou M, Hammarstedt A, Langkilde AM, Sjoestrand M, Solomon SD, Jhund P. CA125 IN PATIENTS WITH HFREF AND THE EFFECT OF DAPAGLIFLOZIN: INSIGHTS FROM DAPA-HF. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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15
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O'Meara E, Zannad F. Fibrosis Biomarkers Predict Cardiac Reverse Remodeling. JACC Heart Fail 2023; 11:73-75. [PMID: 36599552 DOI: 10.1016/j.jchf.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Eileen O'Meara
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montréal, Canada.
| | - Faiez Zannad
- Université de Lorraine, Inserm CIC 1433 and CHRU, Nancy, France
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16
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Basmadjian L, Bouabdallaoui N, Simard F, O'Meara E, Ducharme A, Rouleau JL, Racine N, White M, Sirois MG, Asgar A, Ibrahim R, Dorval JF, Bonan R, Cartier R, Forcillo J, El-Hamamsy I, Henri C. Growth Differentiation Factor-15 as a Predictor of Functional Capacity, Frailty, and Ventricular Dysfunction in Patients With Aortic Stenosis and Preserved Left Ventricular Ejection Fraction. Am J Cardiol 2023; 186:11-16. [PMID: 36334433 DOI: 10.1016/j.amjcard.2022.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/25/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
In aortic stenosis (AS), left ventricular (LV) remodeling often occurs before symptom onset, and early intervention may be beneficial. Risk stratification remains challenging and identification of biomarkers may be useful. We evaluated the association between growth differentiation factor-15 (GDF-15) and soluble suppression of tumorigenicity 2 (sST2) and known markers of poor prognosis in AS. Baseline plasma GDF-15 and sST2 levels were measured in 70 patients with moderate-severe AS (aortic valve area <1.5 cm2) and preserved LV ejection fraction (>45%). Patients were categorized into "low GDF-15" versus "high GDF-15" and "low sST2" versus "high sST2" groups. Groups were compared for differences in cardiovascular risk factors, 6-minute walk test, 5 m gait speed, cognitive function (Montreal Cognitive Assessment), and echocardiographic parameters. Overall, 44% of patients were deemed asymptomatic by New York Heart Association class, 61% had severe AS (aortic valve area <1 cm2) and all patients had preserved LV ejection fraction. GDF-15 levels were not predictive of AS severity. However, high GDF-15 (>1,050 pg/ml) was associated with LV dysfunction as shown by lower indexed stroke volume (p <0.01), worse LV global longitudinal strain (p = 0.04), greater mean E/e' (p = 0.02) and indexed left atrial volume (p <0.01). It was also associated with decreased functional capacity with shorter 6-minute walk test (p = 0.01) and slower 5 m gait speed (p = 0.02). Associations between sST2 levels and markers of poor prognosis were less compelling. In this study of patients with moderate to severe AS, elevated GDF-15 levels are associated with impaired functional capacity, poorer performance on fragility testing, and LV dysfunction. In conclusion, GDF-15 may integrate these markers of adverse outcomes into a single biomarker of poor prognosis.
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Affiliation(s)
- Lauren Basmadjian
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Nadia Bouabdallaoui
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - François Simard
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Eileen O'Meara
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anique Ducharme
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Lucien Rouleau
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Normand Racine
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Michel White
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Martin G Sirois
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anita Asgar
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Reda Ibrahim
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-François Dorval
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Raoul Bonan
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Raymond Cartier
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jessica Forcillo
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Ismail El-Hamamsy
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Christine Henri
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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17
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Ali MU, Mancini GBJ, Fitzpatrick-Lewis D, Lewis R, Jovkovic M, Zieroth S, O'Meara E, Connelly KA, Sherifali D. Reply to Du et al.-Obvious Differences Between GLP1RAs and SGLT2is in the Outcomes of Heart Failure, Renal Failure, and Stroke. Can J Cardiol 2023; 39:90. [PMID: 36152771 DOI: 10.1016/j.cjca.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 01/10/2023] Open
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18
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Butt JH, Docherty KF, Claggett BL, Desai AS, Fang JC, Petersson M, Langkilde AM, de Boer RA, Cabrera Honorio JW, Hernandez AF, Inzucchi SE, Kosiborod MN, Køber L, Lam CSP, Martinez FA, Ponikowski P, Sabatine MS, Vardeny O, O'Meara E, Saraiva JFK, Shah SJ, Vaduganathan M, Jhund PS, Solomon SD, McMurray JJV. Dapagliflozin in Black and White Patients With Heart Failure Across the Ejection Fraction Spectrum. JACC Heart Fail 2022; 11:375-388. [PMID: 36881399 DOI: 10.1016/j.jchf.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Black people have a higher incidence and prevalence of heart failure (HF) than White people, and once HF has developed, they may have worse outcomes. There is also evidence that the response to several pharmacologic therapies may differ between Black and White patients. OBJECTIVES The authors sought to examine the outcomes and response to treatment with dapagliflozin according to Black or White race in a pooled analysis of 2 trials comparing dapagliflozin to placebo in patients with heart failure with reduced ejection fraction (DAPA-HF [Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure]) and heart failure with Mildly reduced ejection fraction/heart failure with preserved ejection fraction (DELIVER [Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure]). METHODS Because most self-identified Black patients were enrolled in the Americas, the comparator group was White patients randomized in the same regions. The primary outcome was the composite of worsening HF or cardiovascular death. RESULTS Of the 3,526 patients randomized in the Americas, 2,626 (74.5%) identified as White and 381 (10.8%) as Black. The primary outcome occurred at a rate of 16.8 (95% CI: 13.8-20.4) in Black patients compared with 11.6 (95% CI: 10.6-12.7) per 100 person-years in White patients (adjusted HR: 1.27; 95% CI: 1.01-1.59). Compared with placebo, dapagliflozin decreased the risk of the primary endpoint to the same extent in Black (HR: 0.69; 95% CI: 0.47-1.02) and White patients (HR: 0.73 [95% CI: 0.61-0.88]; Pinteraction = 0.73). The number of patients needed to treat with dapagliflozin to prevent one event over the median follow-up was 17 in White and 12 in Black patients. The beneficial effects and favorable safety profile of dapagliflozin were consistent across the range of left ventricular ejection fractions in both Black and White patients. CONCLUSIONS The relative benefits of dapagliflozin were consistent in Black and White patients across the range of left ventricular ejection fraction, with greater absolute benefits in Black patients. (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure [DAPA-HF]; NCT03036124) (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213).
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Affiliation(s)
- Jawad H Butt
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Kieran F Docherty
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James C Fang
- University of Utah Medical Center, Salt Lake City, Utah, USA
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R and D, AstraZeneca, Gothenburg, Sweden
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R and D, AstraZeneca, Gothenburg, Sweden
| | | | | | | | | | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Lars Køber
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | | | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Orly Vardeny
- The Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, USA
| | - Eileen O'Meara
- Institut de Cardiologie de Montréal, Université de Montréal, Québec, Canada
| | - Jose F K Saraiva
- Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
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19
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Ostrominski JW, Vaduganathan M, Claggett BL, de Boer RA, Desai AS, Dobreanu D, Hernandez AF, Inzucchi SE, Jhund PS, Kosiborod M, Lam CSP, Langkilde AM, Lindholm D, Martinez FA, O'Meara E, Petersson M, Shah SJ, Thierer J, McMurray JJV, Solomon SD. Dapagliflozin and New York Heart Association functional class in heart failure with mildly reduced or preserved ejection fraction: the DELIVER trial. Eur J Heart Fail 2022; 24:1892-1901. [PMID: 36054231 DOI: 10.1002/ejhf.2652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/01/2022] [Accepted: 08/06/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS This pre-specified analysis of the DELIVER trial examined whether clinical benefits of dapagliflozin in heart failure (HF) with left ventricular ejection fraction (LVEF) >40% varied by baseline New York Heart Association (NYHA) class and examined the treatment effects on NYHA class over time. METHODS AND RESULTS Treatment effects of dapagliflozin by baseline NYHA class II (n = 4713) versus III/IV (n = 1549) were examined on the primary endpoint (cardiovascular death or worsening HF event) and key secondary endpoints. Effects of dapagliflozin on change in NYHA class at 4, 16, and 32 weeks were also evaluated. Higher baseline NYHA class was associated with older age, female sex, greater comorbidity burden, lower LVEF, and higher natriuretic peptide levels. Participants with baseline NYHA class III/IV, as compared with II, were independently more likely to experience the primary endpoint (adjusted hazard ratio [HR] 1.16 [95% confidence interval, 1.02-1.33]) and all-cause death (adjusted HR 1.22 [1.06-1.40]). Dapagliflozin consistently reduced the risk of the primary endpoint compared with placebo, irrespective of baseline NYHA class (HR 0.81 [0.70-0.94] for NYHA class II vs. HR 0.80 [0.65-0.98] for NYHA class III/IV; pinteraction = 0.921). Participants with NYHA class III/IV had greater improvement in Kansas City Cardiomyopathy Questionnaire total symptom scores between baseline and 32 weeks (+4.8 [2.5-7.1]) versus NYHA class II (+1.8 [0.7-2.9]; pinteraction = 0.011). Dapagliflozin was associated with higher odds of any improvement in NYHA class (odds ratio [OR] 1.32 [1.16-1.51]), as well as improvement to NYHA class I (OR 1.43 [1.17-1.75]), versus placebo at 32 weeks, with benefits seen as early as 4 weeks. CONCLUSIONS Among symptomatic patients with HF and LVEF >40%, treatment with dapagliflozin provided clinical benefit irrespective of baseline NYHA class and was associated with early and sustained improvements in NYHA class over time.
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Affiliation(s)
- John W Ostrominski
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dan Dobreanu
- University of Medicine, Pharmacy, Science and Technology "G.E. Palade", Târgu Mures, Romania
| | - Adrian F Hernandez
- Department of Medicine, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, CT, USA
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Mikhail Kosiborod
- St Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MI, USA
| | - Carolyn S P Lam
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore, Singapore
| | - Anna M Langkilde
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, Gothenburg, Sweden
| | - Daniel Lindholm
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, Gothenburg, Sweden
| | | | - Eileen O'Meara
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Magnus Petersson
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, Gothenburg, Sweden
| | - Sanjiv J Shah
- Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jorge Thierer
- Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educatión Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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20
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Solomon SD, McMurray JJV, Claggett B, de Boer RA, DeMets D, Hernandez AF, Inzucchi SE, Kosiborod MN, Lam CSP, Martinez F, Shah SJ, Desai AS, Jhund PS, Belohlavek J, Chiang CE, Borleffs CJW, Comin-Colet J, Dobreanu D, Drozdz J, Fang JC, Alcocer-Gamba MA, Al Habeeb W, Han Y, Cabrera Honorio JW, Janssens SP, Katova T, Kitakaze M, Merkely B, O'Meara E, Saraiva JFK, Tereshchenko SN, Thierer J, Vaduganathan M, Vardeny O, Verma S, Pham VN, Wilderäng U, Zaozerska N, Bachus E, Lindholm D, Petersson M, Langkilde AM. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med 2022; 387:1089-1098. [PMID: 36027570 DOI: 10.1056/nejmoa2206286] [Citation(s) in RCA: 728] [Impact Index Per Article: 364.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure and cardiovascular death among patients with chronic heart failure and a left ventricular ejection fraction of 40% or less. Whether SGLT2 inhibitors are effective in patients with a higher left ventricular ejection fraction remains less certain. METHODS We randomly assigned 6263 patients with heart failure and a left ventricular ejection fraction of more than 40% to receive dapagliflozin (at a dose of 10 mg once daily) or matching placebo, in addition to usual therapy. The primary outcome was a composite of worsening heart failure (which was defined as either an unplanned hospitalization for heart failure or an urgent visit for heart failure) or cardiovascular death, as assessed in a time-to-event analysis. RESULTS Over a median of 2.3 years, the primary outcome occurred in 512 of 3131 patients (16.4%) in the dapagliflozin group and in 610 of 3132 patients (19.5%) in the placebo group (hazard ratio, 0.82; 95% confidence interval [CI], 0.73 to 0.92; P<0.001). Worsening heart failure occurred in 368 patients (11.8%) in the dapagliflozin group and in 455 patients (14.5%) in the placebo group (hazard ratio, 0.79; 95% CI, 0.69 to 0.91); cardiovascular death occurred in 231 patients (7.4%) and 261 patients (8.3%), respectively (hazard ratio, 0.88; 95% CI, 0.74 to 1.05). Total events and symptom burden were lower in the dapagliflozin group than in the placebo group. Results were similar among patients with a left ventricular ejection fraction of 60% or more and those with a left ventricular ejection fraction of less than 60%, and results were similar in prespecified subgroups, including patients with or without diabetes. The incidence of adverse events was similar in the two groups. CONCLUSIONS Dapagliflozin reduced the combined risk of worsening heart failure or cardiovascular death among patients with heart failure and a mildly reduced or preserved ejection fraction. (Funded by AstraZeneca; DELIVER ClinicalTrials.gov number, NCT03619213.).
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Affiliation(s)
- Scott D Solomon
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - John J V McMurray
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Brian Claggett
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Rudolf A de Boer
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - David DeMets
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Adrian F Hernandez
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Silvio E Inzucchi
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Mikhail N Kosiborod
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Carolyn S P Lam
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Felipe Martinez
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Sanjiv J Shah
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Akshay S Desai
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Pardeep S Jhund
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Jan Belohlavek
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Chern-En Chiang
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - C Jan Willem Borleffs
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Josep Comin-Colet
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Dan Dobreanu
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Jaroslaw Drozdz
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - James C Fang
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Marco Antonio Alcocer-Gamba
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Waleed Al Habeeb
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Yaling Han
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Jose Walter Cabrera Honorio
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Stefan P Janssens
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Tzvetana Katova
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Masafumi Kitakaze
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Béla Merkely
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Eileen O'Meara
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Jose Francisco Kerr Saraiva
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Sergey N Tereshchenko
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Jorge Thierer
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Muthiah Vaduganathan
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Orly Vardeny
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Subodh Verma
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Vinh Nguyen Pham
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Ulrica Wilderäng
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Natalia Zaozerska
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Erasmus Bachus
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Daniel Lindholm
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Magnus Petersson
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
| | - Anna Maria Langkilde
- From the Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston (S.D.S., B.C., A.S.D., M.V.); the British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, United Kingdom (J.J.V.M., P.S.J.); the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen (R.A.B., C.S.P.L.), and Haga Teaching Hospital, the Hague (C.J.W.B.) - both in the Netherlands; the University of Wisconsin, Madison (D. DeMets); Duke University Medical Center, Durham, NC (A.F.H.); Yale School of Medicine, New Haven, CT (S.E.I.); Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Kansas City (M.N.K.); National Heart Center Singapore and Duke-National University of Singapore, Singapore (C.S.P.L.); National University of Cordoba, Cordoba (F.M.), and Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires (J.T.) - both in Argentina; Northwestern University Feinberg School of Medicine, Chicago (S.J.S.); General University Hospital, Charles University, Prague, Czech Republic (J.B.); General Clinical Research Center and the Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-E.C.); the Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute, University of Barcelona, L'Hospitalet de Llobregat, Barcelona (J.C.-C.); George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania (D. Dobreanu); the Department of Cardiology, Medical University Lodz, Lodz, Poland (J.D.); University of Utah Medical Center, Salt Lake City (J.C.F.); Centro de Estudios Clínicos de Querétaro, Querétaro, Mexico (M.A.A.-G.); the Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia (W.A.H.); the Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China (Y.H.); Clínica Vesalio, San Borja, Peru (J.W.C.H.); the Department of Cardiovascular Diseases, Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium (S.P.J.); the Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.); Kinshukai Hanwa Daini Senboku Hospital, Osaka, Japan (M.K.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.); Institut de Cardiologie de Montréal, Université de Montréal, Montreal (E.O.), and the Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto (S.V.) - both in Canada; the Cardiovascular Division, Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil (J.F.K.S.); the Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow (S.N.T.); the Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis (O.V.); Cardiovascular Center, Tam Anh Hospital, Tan Tao University, Tan Duc, Vietnam (V.N.P.); and Late-Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (U.W., N.Z., E.B., D.L., M.P., A.M.L.)
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21
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Cunningham JW, Vaduganathan M, Claggett BL, Kulac IJ, Desai AS, Jhund PS, de Boer RA, DeMets D, Hernandez AF, Inzucchi SE, Kosiborod MN, Lam CSP, Martinez F, Shah SJ, McGrath MM, O'Meara E, Wilderäng U, Lindholm D, Petersson M, Langkilde AM, McMurray JJV, Solomon SD. Dapagliflozin in Patients Recently Hospitalized With Heart Failure and Mildly Reduced or Preserved Ejection Fraction. J Am Coll Cardiol 2022; 80:1302-1310. [PMID: 36041912 DOI: 10.1016/j.jacc.2022.07.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients recently hospitalized for heart failure (HF) are at high risk for rehospitalization and death. OBJECTIVES The purpose of this study was to investigate clinical outcomes and response to dapagliflozin in patients with HF with mildly reduced or preserved left ventricular ejection fraction (LVEF) who were enrolled during or following hospitalization. METHODS The DELIVER (Dapagliflozin Evaluation to Improve the LIVES of Patients With PReserved Ejection Fraction Heart Failure) trial randomized patients with HF and LVEF >40% to dapagliflozin or placebo. DELIVER permitted randomization during or shortly after hospitalization for HF in clinically stable patients off intravenous HF therapies. This prespecified analysis investigated whether recent HF hospitalization modified risk of clinical events or response to dapagliflozin. The primary outcome was worsening HF event or cardiovascular death. RESULTS Of 6,263 patients in DELIVER, 654 (10.4%) were randomized during HF hospitalization or within 30 days of discharge. Recent HF hospitalization was associated with greater risk of the primary outcome after multivariable adjustment (HR: 1.88; 95% CI: 1.60-2.21; P < 0.001). Dapagliflozin reduced the primary outcome by 22% in recently hospitalized patients (HR: 0.78; 95% CI: 0.60-1.03) and 18% in patients without recent hospitalization (HR: 0.82; 95% CI: 0.72-0.94; Pinteraction = 0.71). Rates of adverse events, including volume depletion, diabetic ketoacidosis, or renal events, were similar with dapagliflozin and placebo in recently hospitalized patients. CONCLUSIONS Dapagliflozin safely reduced risk of worsening HF or cardiovascular death similarly in patients with and without history of recent HF hospitalization. Starting dapagliflozin during or shortly after HF hospitalization in patients with mildly reduced or preserved LVEF appears safe and effective. (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213).
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Affiliation(s)
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Claggett
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ian J Kulac
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Akshay S Desai
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | | | - David DeMets
- University of Wisconsin, Madison, Wisconsin, USA
| | | | | | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore, Singapore
| | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Martina M McGrath
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eileen O'Meara
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Ulrica Wilderäng
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Daniel Lindholm
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Scott D Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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22
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Ali MU, Mancini GBJ, Fitzpatrick-Lewis D, Lewis R, Jovkovic M, Zieroth S, O'Meara E, Connelly KA, Sherifali D. The Effectiveness of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-like Peptide-1 Receptor Agonists on Cardiorenal Outcomes: Systematic Review and Meta-analysis. Can J Cardiol 2022; 38:1201-1210. [PMID: 35961756 DOI: 10.1016/j.cjca.2022.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Evidence for the cardiorenal risk reduction properties of antihyperglycemic medications originally prescribed for type 2 diabetes, sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) is rapidly emerging. We completed a meta-analysis of recent literature to provide evidence-based estimates of benefit across various populations and outcomes. METHODS We searched Medline and Cochrane databases from 2015 to September 2021 for randomized controlled trials of SGLT2i and GLP-1RA with placebo control. Reviewers screened citations, extracted data, and assessed the risk of bias and certainty of evidence. We assessed statistical and methodological heterogeneity and performed a meta-analysis of studies with similar interventions and components. RESULTS A total of 137,621 adults (51% male) from 19 studies were included; 14 studies with unclear risk of bias and 5 with low risk of bias. Compared with standard of care, use of SGLT2i showed significant reductions for the outcome of cardiovascular (CV) mortality (14%), any-cause mortality (13%), major adverse CV events (MACE) (12%), heart failure (HF) hospitalization (31%), CV death or HF hospitalization (24%), nonfatal myocardial infarction (10%), and kidney composite outcome (36%). Treatment with GLP-1RA was associated with significant reductions for the outcome of CV mortality (13%), any-cause mortality (12%), MACE (14%), CV death or HF hospitalization (11%), nonfatal stroke (16%), and kidney composite outcome (22%). CONCLUSIONS The use of GLP-1RA and SGLT2i leads to a statistically significant benefit across most cardiorenal outcomes in the populations studied. This review shows a role for SGLT2i and GLP-1RA in cardiorenal protection in adults, independent of type 2 diabetes status.
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Affiliation(s)
- Muhammad Usman Ali
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - G B John Mancini
- Division of Cardiology, Centre for Cardiovascular Innovation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna Fitzpatrick-Lewis
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ruth Lewis
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Milos Jovkovic
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Shelley Zieroth
- Max Rady College of Medicine, Section of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eileen O'Meara
- Division of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Kim A Connelly
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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23
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Mancini GBJ, O'Meara E, Zieroth S, Bernier M, Cheng AYY, Cherney DZI, Connelly KA, Ezekowitz J, Goldenberg RM, Leiter LA, Nesrallah G, Paty BW, Piché ME, Senior P, Sharma A, Verma S, Woo V, Darras P, Grégoire J, Lonn E, Stone JA, Yale JF, Yeung C, Zimmerman D. 2022 Canadian Cardiovascular Society Guideline for Use of GLP-1 Receptor Agonists and SGLT2 Inhibitors for Cardiorenal Risk Reduction in Adults. Can J Cardiol 2022; 38:1153-1167. [PMID: 35961754 DOI: 10.1016/j.cjca.2022.04.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/20/2022] Open
Abstract
This guideline synthesizes clinical trial data supporting the role of glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter 2 inhibitors (SGLT2i) for treatment of heart failure (HF), chronic kidney disease, and for optimizing prevention of cardiorenal morbidity and mortality in patients with type 2 diabetes. It is on the basis of a companion systematic review and meta-analysis guided by a focused set of population, intervention, control, and outcomes (PICO) questions that address priority cardiorenal end points. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system and a modified Delphi process were used. We encourage comprehensive assessment of cardiovascular (CV) patients with routine measurement of estimated glomerular filtration rate, urinary albumin-creatinine ratio, glycosylated hemoglobin (A1c), and documentation of left ventricular ejection fraction (LVEF) when evaluating symptoms of HF. For patients with HF, we recommend integration of SGLT2i with other guideline-directed pharmacotherapy for the reduction of hospitalization for HF when LVEF is > 40% and for the reduction of all-cause and CV mortality, hospitalization for HF, and renal protection when LVEF is ≤ 40%. In patients with albuminuric chronic kidney disease, we recommend integration of SGLT2i with other guideline-directed pharmacotherapy to reduce all-cause and CV mortality, nonfatal myocardial infarction, and hospitalization for HF. We provide recommendations and algorithms for the selection of glucagon-like peptide-1 receptor agonists and SGLT2i for patients with type 2 diabetes and either established atherosclerotic CV disease or risk factors for atherosclerotic CV disease to reduce all-cause and CV mortality, nonfatal stroke, and for the prevention of hospitalization for HF and decline in renal function. We offer practical advice for safe use of these diabetes-associated agents with profound cardiorenal benefits.
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Affiliation(s)
- G B John Mancini
- Division of Cardiology, Centre for Cardiovascular Innovation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Eileen O'Meara
- Division of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Shelley Zieroth
- Max Rady College of Medicine, Section of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mathieu Bernier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Quebec, Canada
| | - Alice Y Y Cheng
- Division of Endocrinology, Unity Health Toronto and Trillium Health Partners, University of Toronto, Toronto, Ontario, Canada
| | - David Z I Cherney
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Keenan Research Center for Biomedical Science, St Michael's Hospital, Toronto, Ontario, Canada, and Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Justin Ezekowitz
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gihad Nesrallah
- Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, Humber River Hospital, North York, Ontario, Canada
| | - Breay W Paty
- Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie-Eve Piché
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Quebec, Canada
| | - Peter Senior
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | - Abhinav Sharma
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Woo
- Max Rady College of Medicine, Section of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pol Darras
- Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Grégoire
- Division of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Eva Lonn
- Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - James A Stone
- Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
| | - Jean-François Yale
- Division of Endocrinology and Metabolism, McGill University, Montreal, Quebec, Canada
| | - Colin Yeung
- Division of Cardiology (Regina), Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Deborah Zimmerman
- Division of Nephrology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Barkoudah E, Claggett BL, Lewis EF, O'Meara E, Clausell N, Diaz R, Fleg JL, Pitt B, Rouleau JL, Solomon SD, Pfeffer MA, Desai AS. Prognostic Impact of Cardiovascular versus Noncardiovascular Hospitalizations in Heart Failure with Preserved Ejection Fraction: Insights from TOPCAT. J Card Fail 2022; 28:1390-1397. [PMID: 35636727 DOI: 10.1016/j.cardfail.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients with heart failure (HF) with preserved ejection fraction (HFpEF) are commonly admitted to the hospital for both cardiovascular (CV) and noncardiovascular (non-CV) reasons. The prognostic implications of non-CV hospitalizations in this population are not well understood. In this study, we aimed to examine the prognostic implications of hospitalizations due to CV and non-CV reasons in a HFpEF population. METHODS AND RESULTS The Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial (TOPCAT) randomized 3,445 stable outpatients with chronic HF with left ventricular ejection fraction >=45% and either prior hospitalization for HF or elevated natriuretic peptides to treatment with spironolactone or placebo. Hospitalizations for any cause were reported by investigators during study follow-up and characterized according to prespecified category causes. This analysis focused on the subset of TOPCAT participants enrolled in the Americas (N=1,767), in which 2,973 hospitalizations were observed in 1,062 subjects (60%) over a mean follow-up of 3.3 years of study follow-up, of which 1,474 (49%) were ascribed to CV causes. Among 1,056 first hospitalizations, 478 (45%) were for CV reasons and 578 (55%) for non-CV reasons. Mortality rates were lowest for participants not hospitalized during the trial (3.2 per 100 patient-years (PY)), but similarly elevated following first hospitalization for CV and non-CV reasons (11.0 per 100 PY vs. 12.6 per 100 PY, respectively, p=0.24). Among those hospitalized for CV reasons, mortality rates were similar following hospitalization for HF and non-CV related reasons (15.2 per 100 PY vs. 12.6 per 100 PY, p=0.23). Recurrent hospitalization, whether due to CV or non-CV causes, was associated with heightened risk for subsequent mortality, with similar death rates following hospitalization twice for CV reasons (18.5 per 100 PY), twice for non-CV reasons (21.6 per 100 PY), or once each for CV and non-CV reasons (18.4 per 100 PY). CONCLUSION Among patients with HFpEF, hospitalization for any cause is associated with heightened risk for post-discharge mortality, with even higher risk associated with recurrent hospitalization. Given the high burden of non-CV hospitalizations in this population, targeted management of comorbid medical illness may be critical to reducing morbidity and mortality.
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Affiliation(s)
- Ebrahim Barkoudah
- Cardiovascular Division; Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | - Eldrin F Lewis
- Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA
| | - Eileen O'Meara
- Montreal Heart Institute Department of Medicine and Research Centre, and Université de Montréal, 5000 Belanger Street, Montréal, Québec, Canada
| | - Nadine Clausell
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Diaz
- Estudios Cardiológicos Latinoamérica, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | - Jerome L Fleg
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Bertram Pitt
- Division of Cardiology, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI
| | - Jean L Rouleau
- Montreal Heart Institute Department of Medicine and Research Centre, and Université de Montréal, 5000 Belanger Street, Montréal, Québec, Canada
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25
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Solomon SD, Vaduganathan M, Claggett BL, de Boer RA, DeMets D, Hernandez AF, Inzucchi SE, Kosiborod MN, Lam CSP, Martinez F, Shah SJ, Belohlavek J, Chiang CE, Willem Borleffs CJ, Comin-Colet J, Dobreanu D, Drozdz J, Fang JC, Alcocer Gamba MA, Al Habeeb W, Han Y, Cabrera Honorio JW, Janssens SP, Katova T, Kitakaze M, Merkely B, O'Meara E, Kerr Saraiva JF, Tereschenko SN, Thierer J, Vardeny O, Verma S, Vinh PN, Wilderäng U, Zaozerska N, Lindholm D, Petersson M, McMurray JJV. Baseline Characteristics of Patients With HF With Mildly Reduced and Preserved Ejection Fraction: DELIVER Trial. JACC Heart Fail 2022; 10:184-197. [PMID: 35241246 DOI: 10.1016/j.jchf.2021.11.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This report describes the baseline clinical profiles and management of DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure) trial participants and how these compare with those in other contemporary heart failure with preserved ejection fraction trials. BACKGROUND The DELIVER trial was designed to evaluate the effects of the sodium-glucose cotransporter-2 inhibitor dapagliflozin on cardiovascular death, heart failure (HF) hospitalization, or urgent HF visits in patients with HF with mildly reduced and preserved left ventricular ejection fraction (LVEF). METHODS Adults with symptomatic HF and LVEF >40%, with or without type 2 diabetes mellitus, elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and evidence of structural heart disease were randomized to dapagliflozin 10 mg once daily or matching placebo. RESULTS A total of 6,263 patients were randomized (mean age: 72 ± 10 years; 44% women; 45% type 2 diabetes mellitus; 45% with body mass index ≥30 kg/m2; and 57% with history of atrial fibrillation or flutter). Most participants had New York Heart Association functional class II symptoms (75%). Baseline mean LVEF was 54.2 ± 8.8% and median NT-proBNP of 1,399 pg/mL (IQR: 962 to 2,210 pg/mL) for patients in atrial fibrillation/flutter compared with 716 pg/mL (IQR: 469 to 1,281 pg/mL) in those who were not. Patients in both hospitalized and ambulatory settings were enrolled, including 10% enrolled in-hospital or within 30 days of a hospitalization for HF. Eighteen percent of participants had HF with improved LVEF. CONCLUSIONS DELIVER is the largest and broadest clinical trial of this population to date and enrolled high-risk, well-treated patients with HF with mildly reduced and preserved LVEF. (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure [NCT03619213]).
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Affiliation(s)
- Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - David DeMets
- University of Wisconsin, Madison, Wisconsin, USA
| | | | | | | | - Carolyn S P Lam
- University of Groningen, Groningen, the Netherlands; National Heart Centre Singapore & Duke-National University of Singapore, Singapore
| | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jan Belohlavek
- General University Hospital, Charles University, Prague, Czech Republic
| | - Chern-En Chiang
- General Clinical Research Center and Division of Cardiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Josep Comin-Colet
- Cardiology Department, Bellvitge University Hospital, Bio-Heart (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Dan Dobreanu
- University of Medicine, Pharmacy, Science and Technology "G.E.Palade," Târgu Mureș, Romania
| | - Jaroslaw Drozdz
- Department Cardiology, Medical University Lodz, Lodz, Poland
| | - James C Fang
- University of Utah Medical Center, Salt Lake City, Utah, USA
| | | | - Waleed Al Habeeb
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia
| | - Yaling Han
- Cardiovascular Research Institute, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | | | - Stefan P Janssens
- Cardiac Intensive Care, Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Tsvetana Katova
- Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria
| | - Masafumi Kitakaze
- Kinshukai Hanwa Daini Senboku Hospital, Osaka, JapanHeart and Vascular Center
| | | | - Eileen O'Meara
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | - Sergey N Tereschenko
- Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow, Russia
| | - Jorge Thierer
- Jefe de Unidad de Insuficiencia Cardíaca, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Argentina
| | - Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Pham Nguyen Vinh
- Cardiovascular Center, Tam Anh hospital, Tan Tao University, Vietnam
| | - Ulrica Wilderäng
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Natalia Zaozerska
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Daniel Lindholm
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
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McDowell K, Welsh P, Docherty KF, Morrow DA, Jhund PS, De Boer RA, O'Meara E, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, Ponikowski P, Hammarstedt A, Langkilde AM, Sjöstrand M, Lindholm D, Solomon SD, Sattar N, Sabatine MS, McMurray JJ. Dapagliflozin reduces uric acid concentration, an independent predictor of adverse outcomes in
DAPA‐HF. Eur J Heart Fail 2022; 24:1066-1076. [PMID: 35064721 PMCID: PMC9540869 DOI: 10.1002/ejhf.2433] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 11/08/2022] Open
Abstract
Aims Blood uric acid (UA) levels are frequently elevated in patients with heart failure and reduced ejection fraction (HFrEF), may lead to gout and are associated with worse outcomes. Reduction in UA is desirable in HFrEF and sodium–glucose cotransporter 2 inhibitors may have this effect. We aimed to examine the association between UA and outcomes, the effect of dapagliflozin according to baseline UA level, and the effect of dapagliflozin on UA in patients with HFrEF in the DAPA‐HF trial. Methods and results The association between UA and the primary composite outcome of cardiovascular death or worsening heart failure, its components, and all‐cause mortality was examined using Cox regression analyses among 3119 patients using tertiles of UA, after adjustment for other prognostic variables. Change in UA from baseline over 12 months was also evaluated. Patients in tertile 3 (UA ≥6.8 mg/dl) versus tertile 1 (<5.4 mg/dl) were younger (66.3 ± 10.8 vs. 68 ± 10.2 years), more often male (83.1% vs. 71.5%), had lower estimated glomerular filtration rate (58.2 ± 17.4 vs. 70.6 ± 18.7 ml/min/1.73 m2), and more often treated with diuretics. Higher UA was associated with a greater risk of the primary outcome (adjusted hazard ratio tertile 3 vs. tertile 1: 1.32, 95% confidence interval [CI] 1.06–1.66; p = 0.01). The risk of heart failure hospitalization and cardiovascular death increased by 7% and 6%, respectively per 1 mg/dl unit increase of UA (p = 0.04 and p = 0.07). Spline analysis revealed a linear increase in risk above a cut‐off UA value of 7.09 mg/dl. Compared with placebo, dapagliflozin reduced UA by 0.84 mg/dl (95% CI −0.93 to −0.74) over 12 months (p < 0.001). Dapagliflozin improved outcomes, irrespective of baseline UA concentration. Conclusion Uric acid remains an independent predictor of worse outcomes in a well‐treated contemporary HFrEF population. Compared with placebo, dapagliflozin reduced UA and improved outcomes irrespective of UA concentration.
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Affiliation(s)
- Kirsty McDowell
- BHF Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Paul Welsh
- BHF Cardiovascular Research Centre University of Glasgow Glasgow UK
| | | | - David A Morrow
- Cardiovascular Division, Department of Medicine Brigham and Women's Hospital Boston MA USA
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Rudolf A De Boer
- Department of Cardiology University Medical Center and University of Groningen Groningen Netherlands
| | - Eileen O'Meara
- Montreal Heart Institute Université de Montréal Montreal Quebec Canada
| | | | - Lars Køber
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Mikhail N. Kosiborod
- Saint Luke's Mid America Heart Institute University of Missouri Kansas City MO USA
- The George Institute for Global Health University of New South Wales Sydney Australisa
| | | | - Piotr Ponikowski
- Centre for Heart Diseases, University Hospital Wroclaw Medical University Wroclaw Poland
| | - Ann Hammarstedt
- Late Stage Development, Cardiovascular, Renal and Metabolism Biopharmaceuticals R&D Astrazeneca Gothenburg Sweden
| | - Anna Maria Langkilde
- Late Stage Development, Cardiovascular, Renal and Metabolism Biopharmaceuticals R&D Astrazeneca Gothenburg Sweden
| | - Mikaela Sjöstrand
- Late Stage Development, Cardiovascular, Renal and Metabolism Biopharmaceuticals R&D Astrazeneca Gothenburg Sweden
| | - Daniel Lindholm
- Late Stage Development, Cardiovascular, Renal and Metabolism Biopharmaceuticals R&D Astrazeneca Gothenburg Sweden
| | - Scott D Solomon
- Cardiovascular Division, Department of Medicine Brigham and Women's Hospital Boston MA USA
| | - Naveed Sattar
- BHF Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Marc S. Sabatine
- TIMI Study Group, Cardiovascular Division Brigham and Women's Hospital, Harvard Medical School Boston MA USA
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27
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Docherty KF, Ogunniyi MO, Anand IS, Desai AS, Diez M, Howlett JG, Nicolau JC, O'Meara E, Verma S, Inzucchi SE, Køber L, Kosiborod MN, Lindholm D, Martinez FA, Bengtsson O, Ponikowski P, Sabatine MS, Sjöstrand M, Solomon SD, Langkilde AM, Jhund PS, McMurray JJV. Efficacy of Dapagliflozin in Black Versus White Patients With Heart Failure and Reduced Ejection Fraction. JACC Heart Fail 2022; 10:52-64. [PMID: 34969498 DOI: 10.1016/j.jchf.2021.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study sought to investigate the efficacy and safety of dapagliflozin in Black and White patients with heart failure (HF) with reduced ejection fraction (HFrEF) enrolled in DAPA-HF (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure). BACKGROUND Black patients may respond differently to certain treatments for HFrEF than White patients. METHODS Patients with New York Heart Association functional class II to IV with an ejection fraction of ≤40% and elevated N-terminal pro-B-type natriuretic peptide were eligible for DAPA-HF. Because >99% of Black patients were randomized in the Americas, this post hoc analysis considered Black and White patients enrolled only in North and South America. The primary outcome was the composite of a worsening HF event (HF hospitalization or urgent HF visit requiring intravenous therapy) or cardiovascular death. RESULTS Of the 4,744 patients randomized in DAPA-HF, 1,494 (31.5%) were enrolled in the Americas. Of these, 1,181 (79.0%) were White, and 225 (15.1%) were Black. Black patients had a higher rate of worsening HF events, but not mortality, compared with White patients. Compared with placebo, dapagliflozin reduced the risk of the primary endpoint similarly in Black patients (HR: 0.62; 95% CI: 0.37-1.03) and White patients (HR: 0.68; 95% CI: 0.52-0.90; P-interaction = 0.70). Consistent benefits were observed for other prespecified outcomes, including the composite of total (first and repeat) HF hospitalizations and cardiovascular death (P-interaction = 0.43) and Kansas City Cardiomyopathy Questionnaire total symptom score. Study drug discontinuation and serious adverse events were not more frequent in the dapagliflozin group than in the placebo group in either Black or White patients. CONCLUSIONS Dapagliflozin reduced the risk of worsening HF and cardiovascular death, and it improved symptoms, similarly in Black and White patients without an increase in adverse events. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure [DAPA-HF]; NCT03036124).
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Affiliation(s)
- Kieran F Docherty
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Modele O Ogunniyi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Inder S Anand
- Department of Medicine, University of Minnesota Medical School and VA Medical Center, Minneapolis, Minnesota, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mirta Diez
- Division of Cardiology, Institute Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Jonathan G Howlett
- University of Calgary, Cardiac Sciences and Medicine, Calgary, Alberta, Canada
| | - Jose C Nicolau
- Instituto do Coracao, Hospital das Clínicas Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Eileen O'Meara
- Deparment of Cardiology, Institute of Cardiology Montreal, Montreal, Montreal, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lars Køber
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | | | | | | | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
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28
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Legris V, Thibault B, Dupuis J, White M, Asgar AW, Fortier A, Pitre C, Bouabdallaoui N, Henri C, O'Meara E, Ducharme A. Right ventricular function and its coupling to pulmonary circulation predicts exercise tolerance in systolic heart failure. ESC Heart Fail 2021; 9:450-464. [PMID: 34953062 PMCID: PMC8788036 DOI: 10.1002/ehf2.13726] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/31/2021] [Accepted: 11/11/2021] [Indexed: 12/05/2022] Open
Abstract
Aims Right ventricular (RV) dysfunction, pulmonary hypertension, and exercise intolerance have prognostic values, but their interrelation is not fully understood. We investigated how RV function alone and its coupling with pulmonary circulation (RV‐PA) predict cardio‐respiratory fitness in patients with heart failure and reduced ejection fraction (HFrEF). Methods and results The Evaluation of Resynchronization Therapy for Heart Failure (EARTH) study included 205 HFrEF patients with narrow (n = 85) and prolonged (n = 120) QRS duration undergoing implantable cardioverter defibrillator implantation. All patients underwent a comprehensive evaluation with exercise tolerance tests and echocardiography. We investigated the correlations at baseline between RV parameters {size, function [tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RV‐FAC), and RV myocardial performance index (RV‐MPI)], pulmonary artery systolic pressure (PASP), and tricuspid regurgitation}; left ventricular ejection fraction (LVEF), left ventricular end‐diastolic volume index (LVEDVi), and left atrial volume index (LAVi); and cardiopulmonary exercise test (CPET) [peak VO2, minute ventilation/carbon dioxide production (VE/VCO2), 6 min walk distance (6MWD), and submaximal exercise duration (SED)]. We also studied the relationship between RV‐PA coupling (TAPSE/PASP ratio) and echocardiographic parameters in patients with both data available. Univariate and multivariate linear regression models were used. Patients enrolled in EARTH (overall population) were mostly male (73.2%), mean age 61.0 ± 9.8 years, New York Heart Association class II–III (87.8%), mean LVEF of 26.6 ± 7.7%, and reduced peak VO2 (15.1 ± 4.6 mL/kg/min). Of these, 100 had both TAPSE and PASP available (TAPSE/PASP population): they exhibited higher BNP, wider QRS duration, larger LVEDVi, with more having tricuspid regurgitation compared with the 105 patients for whom these values were not available (all P < 0.05). RV‐FAC (β = 7.5), LAVi (β = −0.1), and sex (female, β = −1.9) predicted peak VO2 in the overall population (all P = 0.01). When available, TAPSE/PASP ratio was the only echocardiographic parameter associated with peak VO2 (β = 6.8; P < 0.01), a threshold ≤0.45 predicting a peak VO2 ≤ 14 mL/kg/min (0.39 for VO2 ≤ 12). RV‐MPI was the only echocardiographic parameter associated with ventilatory inefficiency (VE/VCO2) and 6MWD (β = 21.9 and β = −69.3, respectively, both P ≤ 0.01) in the overall population. In presence of TAPSE/PASP, it became an important predictor for those two CPET (β = −18.0 and β = 72.4, respectively, both P < 0.01), together with RV‐MPI (β = 18.5, P < 0.01) for VE/VCO2. Tricuspid regurgitation predicted SED (β = −3.2, P = 0.03). Conclusions Right ventricular function assessed by echocardiography (RV‐MPI and RV‐FAC) is closely associated with exercise tolerance in patients with HFrEF. When the TAPSE/PASP ratio is available, this marker of RV‐PA coupling becomes the stronger echocardiographic predictor of exercise capacity in this population, highlighting its potential role as a screening tool to identify patients with reduced exercise capacity and potentially triage them to formal peak VO2 and/or evaluation for advanced HF therapies.
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Affiliation(s)
- Valéry Legris
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Bernard Thibault
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Jocelyn Dupuis
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Michel White
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Anita W Asgar
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Annik Fortier
- Montreal Health Institute Coordinating Center (MHICC), Montreal, Quebec, Canada
| | - Céline Pitre
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Nadia Bouabdallaoui
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Christine Henri
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Eileen O'Meara
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Anique Ducharme
- Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
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29
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Butt JH, Adamson C, Docherty KF, de Boer RA, Petrie MC, Inzucchi SE, Kosiborod MN, Maria Langkilde A, Lindholm D, Martinez FA, Bengtsson O, Schou M, O'Meara E, Ponikowski P, Sabatine MS, Sjöstrand M, Solomon SD, Jhund PS, McMurray JJV, Køber L. Efficacy and Safety of Dapagliflozin in Heart Failure With Reduced Ejection Fraction According to N-Terminal Pro-B-Type Natriuretic Peptide: Insights From the DAPA-HF Trial. Circ Heart Fail 2021; 14:e008837. [PMID: 34802253 DOI: 10.1161/circheartfailure.121.008837] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Effective therapies for HFrEF usually reduce NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, and it is important to establish whether new treatments are effective across the range of NT-proBNP. METHODS We evaluated both these questions in the DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) trial. Patients in New York Heart Association functional class II to IV with a left ventricular ejection fraction ≤40% and a NT-proBNP level ≥600 pg/mL (≥600 ng/L; ≥400 pg/mL if hospitalized for HF within the previous 12 months or ≥900 pg/mL if atrial fibrillation/flutter) were eligible. The primary outcome was the composite of an episode of worsening HF or cardiovascular death. RESULTS Of the 4744 randomized patients, 4742 had an available baseline NT-proBNP measurement (median, 1437 pg/mL [interquartile range, 857-2650 pg/mL]). Compared with placebo, treatment with dapagliflozin significantly reduced NT-proBNP from baseline to 8 months (absolute least-squares mean reduction, -303 pg/mL [95% CI, -457 to -150 pg/mL]; geometric mean ratio, 0.92 [95% CI, 0.88-0.96]). Dapagliflozin reduced the risk of worsening HF or cardiovascular death, irrespective of baseline NT-proBNP quartile; the hazard ratio for dapagliflozin versus placebo, from lowest to highest quartile was 0.43 (95% CI, 0.27-0.67), 0.77 (0.56-1.04), 0.78 (0.60-1.01), and 0.78 (0.64-0.95); P for interaction=0.09. Consistent benefits were observed for all-cause mortality. Compared with placebo, dapagliflozin increased the proportion of patients with a meaningful improvement (≥5 points) in Kansas City Cardiomyopathy Questionnaire total symptom score (P for interaction=0.99) and decreased the proportion with a deterioration ≥5 points (P for interaction=0.87) across baseline NT-proBNP quartiles. CONCLUSIONS In patients with HFrEF, dapagliflozin reduced NT-proBNP by 300 pg/mL after 8 months of treatment compared with placebo. In addition, dapagliflozin reduced the risk of worsening HF and death, and improved symptoms, across the spectrum of baseline NT-proBNP levels included in DAPA-HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03036124.
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Affiliation(s)
- Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (J.H.B., L.K.)
| | - Carly Adamson
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - Kieran F Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center and University of Groningen, the Netherlands (R.A.d.B.)
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale School of Medicine, New Haven, CT (S.E.I.)
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City (M.N.K.).,The George Institute for Global Health, University of New South Wales, Sydney, Australia (M.N.K.)
| | - Anna Maria Langkilde
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (A.M.L., D.L., O.B., M. Sjöstrand)
| | - Daniel Lindholm
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (A.M.L., D.L., O.B., M. Sjöstrand)
| | | | - Olof Bengtsson
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (A.M.L., D.L., O.B., M. Sjöstrand)
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospital, Herlev, Denmark (M. Schou)
| | - Eileen O'Meara
- Montreal Heart Institute, Université de Montréal, Quebec, Canada (E.O.)
| | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Poland (P.P.)
| | - Marc S Sabatine
- TIMI Study Group (M.S.S.), Brigham and Women's Hospital, Boston, MA.,Division of Cardiovascular Medicine (M.S.S., S.D.S.), Brigham and Women's Hospital, Boston, MA
| | - Mikaela Sjöstrand
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (A.M.L., D.L., O.B., M. Sjöstrand)
| | - Scott D Solomon
- Division of Cardiovascular Medicine (M.S.S., S.D.S.), Brigham and Women's Hospital, Boston, MA
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (J.H.B., L.K.)
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30
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Berg DD, Docherty KF, Sattar N, Jarolim P, Welsh P, Jhund PS, Anand IS, Chopra V, de Boer RA, Kosiborod MN, Nicolau JC, O'Meara E, Schou M, Hammarstedt A, Langkilde AM, Lindholm D, Sjöstrand M, McMurray JJV, Sabatine MS, Morrow DA. Serial Assessment of High-Sensitivity Cardiac Troponin and the Effect of Dapagliflozin in Patients with Heart Failure with Reduced Ejection Fraction: An Analysis of the DAPA-HF Trial. Circulation 2021; 145:158-169. [PMID: 34743554 DOI: 10.1161/circulationaha.121.057852] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Circulating high-sensitivity cardiac troponin T (hsTnT) predominantly reflects myocardial injury, and higher levels are associated with a higher risk of worsening heart failure (HF) and death in patients with HF with reduced ejection fraction (HFrEF). Less is known about the prognostic significance of changes in hsTnT over time, the effects of dapagliflozin on clinical outcomes in relation to baseline hsTnT levels, and the effect of dapagliflozin on hsTnT levels. Methods: DAPA-HF was a randomized, double-blind, placebo-controlled trial of dapagliflozin (10 mg daily) in patients with NYHA class II-IV symptoms and left ventricular ejection fraction ≤40% (median follow-up = 18.2 months). hsTnT (Roche Diagnostics) was measured at baseline in 3,112 patients and at 1 year in 2,506 patients. The primary endpoint was adjudicated worsening HF or cardiovascular death. Clinical endpoints were analyzed according to baseline hsTnT and change in hsTnT from baseline to 1 year. Comparative treatment effects on clinical endpoints with dapagliflozin vs. placebo were assessed by baseline hsTnT. The effect of dapagliflozin on hsTnT was explored. Results: Median baseline hsTnT concentration was 20.0 (25th-75th percentile, 13.7 to 30.2) ng/L. Over 1 year, 67.9% of patients had a ≥10% relative increase or decrease in hsTnT concentrations, and 43.5% had a ≥20% relative change. A stepwise gradient of higher risk for the primary endpoint was observed across increasing quartiles of baseline hsTnT concentration (adjusted hazard ratio [aHR] Q4 vs. Q1, 5.10; 95% CI, 3.67-7.08). Relative and absolute increases in hsTnT over 1 year were associated with higher subsequent risk of the primary endpoint. The relative reduction in the primary endpoint with dapagliflozin was consistent across quartiles of baseline hsTnT (p-interaction = 0.55), but patients in the top quartile tended to have the greatest absolute risk reduction (absolute risk difference, 7.5%; 95% CI, 1.0% - 14.0%). Dapagliflozin tended to attenuate the increase in hsTnT over time compared to placebo (relative least squares mean reduction, -3% [-6% to 0%]; p=0.076). Conclusions: Higher baseline hsTnT and greater increase in hsTnT over 1 year are associated with worse clinical outcomes. Dapagliflozin consistently reduced the risk of the primary endpoint, irrespective of baseline hsTnT levels. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique Identifier: NCT03036124.
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Affiliation(s)
- David D Berg
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kieran F Docherty
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Pardeep S Jhund
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | | | - Vijay Chopra
- Max Superspeciality Hospital, Saket, New Delhi, India
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, MO
| | - Jose C Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eileen O'Meara
- Department of Cardiology, Montreal Heart Institute and Université de Montréal, Montreal, Canada
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | | | | | | | | | - John J V McMurray
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David A Morrow
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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31
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Minamisawa M, Claggett B, Suzuki K, Hegde SM, Shah AM, Desai AS, Lewis EF, Shah SJ, Sweitzer NK, Fang JC, Anand IS, O'Meara E, Rouleau JL, Pitt B, Pfeffer MA, Solomon SD, Vardeny O. Association of Hyper-Polypharmacy With Clinical Outcomes in Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2021; 14:e008293. [PMID: 34674539 DOI: 10.1161/circheartfailure.120.008293] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Polypharmacy is associated with a poor prognosis in the elderly, however, information on the association of polypharmacy with cardiovascular outcomes in heart failure with preserved ejection fraction is sparse. This study sought to investigate the relationship between polypharmacy and adverse cardiovascular events in patients with heart failure with preserved ejection fraction. METHODS Baseline total number of medications was determined in 1758 patients with heart failure with preserved ejection fraction enrolled in the Americas regions of the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist), by 3 categories: nonpolypharmacy (<5 medications), polypharmacy (5-9), and hyper-polypharmacy (≥10). We examined the relationship of polypharmacy status with the primary outcome (cardiovascular death, HF hospitalization, or aborted cardiac arrest), hospitalizations for any reason, and serious adverse events. RESULTS The proportion of patients taking 5 or more medications was 92.5% (inclusive of polypharmacy [38.7%] and hyper-polypharmacy [53.8%]). Over a 2.9-year median follow-up, compared with patients with polypharmacy, hyper-polypharmacy was associated with an increased risk for the primary outcome, hospitalization for any reason and any serious adverse events in the univariable analysis, but not significantly associated with mortality. After multivariable adjustment for demographic and comorbidities, hyper-polypharmacy remained significantly associated with an increased risk for hospitalization for any reason (hazard ratio, 1.22 [95% CI, 1.05-1.41]; P=0.009) and any serious adverse events (hazard ratio, 1.23 [95% CI, 1.07-1.42]; P=0.005), whereas the primary outcome was no longer statistically significant. CONCLUSIONS Hyper-polypharmacy was common and associated with an elevated risk of hospitalization for any reason and any serious adverse events in patients with heart failure with preserved ejection fraction. There were no significant associations between polypharmacy status and mortality.
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Affiliation(s)
- Masatoshi Minamisawa
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.M., B.C., K.S., S.M.H., A.M.S., A.S.D., M.A.P., S.D.S.).,Department of Cardiovascular Medicine, Shinshu University Hospital, Matsumoto, Nagano, Japan (M.M.)
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.M., B.C., K.S., S.M.H., A.M.S., A.S.D., M.A.P., S.D.S.)
| | - Kota Suzuki
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.M., B.C., K.S., S.M.H., A.M.S., A.S.D., M.A.P., S.D.S.)
| | - Sheila M Hegde
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.M., B.C., K.S., S.M.H., A.M.S., A.S.D., M.A.P., S.D.S.)
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.M., B.C., K.S., S.M.H., A.M.S., A.S.D., M.A.P., S.D.S.)
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.M., B.C., K.S., S.M.H., A.M.S., A.S.D., M.A.P., S.D.S.)
| | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | | | - James C Fang
- University of Utah School of Medicine, Salt Lake City (J.C.F.)
| | | | | | | | | | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.M., B.C., K.S., S.M.H., A.M.S., A.S.D., M.A.P., S.D.S.)
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (M.M., B.C., K.S., S.M.H., A.M.S., A.S.D., M.A.P., S.D.S.)
| | - Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research and University of Minnesota Medical School (O.V.)
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32
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Rosano GMC, Allen LA, Abdin A, Lindenfeld J, O'Meara E, Lam CSP, Lancellotti P, Savarese G, Gottlieb SS, Teerlink J, Wintrich J, Böhm M. Drug Layering in Heart Failure: Phenotype-Guided Initiation. JACC Heart Fail 2021; 9:775-783. [PMID: 34627725 DOI: 10.1016/j.jchf.2021.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 12/11/2022]
Abstract
Medications with proven benefit in patients with heart failure with reduced ejection fraction are recommended, according to prospective large clinical trials, in the stable patient after careful up-titration in a strict sequential order. Although the relevance of careful clinical up-titration is unproven, there is evidence that after recompensation and shortly after hospital discharge, the rate of cardiovascular death and hospitalization is high. Clinical studies provided evidence that the onset of treatment effects is rapid, occurring within 28 days with most of these drugs used, and in some trials, early treatment after discharge or already started in the hospital has provided benefits. Therefore, early treatment without deferring it to the stable outpatient may be useful to reduce cardiac-related events further. This expert opinion proposes treatment layering according to individual patient phenotypes involving heart rate, blood pressure, impaired renal function, and electrolyte disturbances, as well as dedicated subgroups of patients with specific requirements for treatment initiation. This complements other approaches that suggest starting sequential treatment according to the size of treatment effects of drugs, specific cardiac diseases, and patient wishes. Patient phenotyping may guide personalized drug layering in heart failure with reduced ejection fraction that provides the best outcomes, whereas pragmatic clinical trials are warranted to scrutinize the effectiveness of these approaches.
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Affiliation(s)
- Giuseppe M C Rosano
- Centre for Clinical and Basic Research, IRCCS San Raffaele Roma, Rome, Italy
| | - Larry A Allen
- Division of Cardiology, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Amr Abdin
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Joann Lindenfeld
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eileen O'Meara
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Carolyn S P Lam
- Duke-National University of Singapore and National Heart Centre Singapore, Singapore
| | | | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Stephen S Gottlieb
- University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - John Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Jan Wintrich
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany.
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33
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Wiefels C, Kandolin R, Garrard L, Wells G, deKemp R, Liu P, Chow B, O'Meara E, Sirois M, Chen L, Beanlands R, Mielniczuk L. NTPROBNP, HS-TNT AND SST2 LEVELS ARE RELATED TO THE EXTENT OF HIBERNATION IN ISCHEMIC HEART FAILURE PATIENTS. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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34
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Li F, Santillan-Urquiza E, Cronin U, O'Meara E, McCarthy W, Hogan SA, Wilkinson MG, Tobin JT. Assessment of the response of indigenous microflora and inoculated Bacillus licheniformis endospores in reconstituted skim milk to microwave and conventional heating systems by flow cytometry. J Dairy Sci 2021; 104:9627-9644. [PMID: 34127263 DOI: 10.3168/jds.2020-19875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/23/2021] [Indexed: 11/19/2022]
Abstract
Heat treatment is one of the most widely used processing technologies in the dairy industry. Its primary purpose is to destroy microorganisms, both pathogenic and spoilage, to ensure the product is safe and has a reasonable shelf life. In this study microwave volumetric heating (MVH) was compared with a conventional tubular heat exchanger (THE), in terms of the effects of each at a range of temperatures (75°C, 85°C, 95°C, 105°C, 115°C, and 125°C) on indigenous microflora viability and the germination of inoculated Bacillus licheniformis endospores in reconstituted skim milk. To assess the heat treatment-related effects on microbial viability, classical agar-based tests were applied to obtain the counts of 4 various microbiological groups including total bacterial, thermophilic bacterial, mesophilic aerobic bacterial endospore, and thermophilic aerobic bacterial endospore counts, and additional novel insights into cell permeability and spore germination profiles post-heat treatment were obtained using real-time flow cytometry (FC) methods. No significant differences in the plate counts of the indigenous microorganisms tested, the plate counts of the inoculated B. licheniformis, or the relative percentage of germinating endospores were observed between MVH- and THE-treated samples, at equal temperatures in the range specified above, indicating that both methods inactivated inoculated endospores to a similar degree (up to 70% as measured by FC and 5 log reduction as measured by plate counting for some treatments of inoculated endospores). Furthermore, increased cell permeability of indigenous microflora was observed by FC after MVH compared with THE treatment of uninoculated skim milk, which was reflected in lower total bacterial count at a treatment temperature of 105°C. This work demonstrates the utility of FC as a rapid method for assessing cell viability and spore inactivation for postthermal processing in dairy products and overall provides evidence that MVH is at least as effective at eliminating native microflora and inoculated B. licheniformis endospores as THE.
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Affiliation(s)
- F Li
- Food Chemistry and Technology Department, Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, P61 C996, Ireland
| | - E Santillan-Urquiza
- Food Chemistry and Technology Department, Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, P61 C996, Ireland
| | - U Cronin
- Department of Biological Sciences, School of Natural Sciences, Faculty of Science and Engineering, University of Limerick, Limerick, V94 T9PX, Ireland
| | - E O'Meara
- Department of Biological Sciences, School of Natural Sciences, Faculty of Science and Engineering, University of Limerick, Limerick, V94 T9PX, Ireland
| | - W McCarthy
- Food Chemistry and Technology Department, Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, P61 C996, Ireland
| | - S A Hogan
- Food Chemistry and Technology Department, Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, P61 C996, Ireland
| | - M G Wilkinson
- Department of Biological Sciences, School of Natural Sciences, Faculty of Science and Engineering, University of Limerick, Limerick, V94 T9PX, Ireland
| | - J T Tobin
- Food Chemistry and Technology Department, Teagasc Food Research Centre, Moorepark, Fermoy, County Cork, P61 C996, Ireland.
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35
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Butt JH, Docherty KF, Petrie MC, Schou M, Kosiborod MN, O'Meara E, Katova T, Ljungman CEA, Diez M, Ogunniyi MO, Langkilde AM, Sjöstrand M, Lindholm D, Bengtsson O, Martinez FA, Ponikowski P, Sabatine MS, Solomon SD, Jhund PS, McMurray JJV, Køber L. Efficacy and Safety of Dapagliflozin in Men and Women With Heart Failure With Reduced Ejection Fraction: A Prespecified Analysis of the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure Trial. JAMA Cardiol 2021; 6:678-689. [PMID: 33787831 DOI: 10.1001/jamacardio.2021.0379] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Women may respond differently to certain treatments for heart failure (HF) with reduced ejection fraction (HFrEF) than men. Objective To investigate the efficacy and safety of dapagliflozin compared with placebo in men and women with HFrEF enrolled in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial (DAPA-HF). Design, Setting, and Participants Prespecified subgroup analysis of a phase 3 randomized clinical trial conducted at 410 sites in 20 countries. Patients with New York Heart Association functional class II through IV with an ejection fraction of 40% or less and elevated N-terminal pro-B-type natriuretic peptide were eligible. Data were analyzed between June 2020 and January 2021. Interventions Addition of once-daily 10 mg of dapagliflozin or placebo to guideline-recommended therapy. Main Outcomes and Measures The primary outcome was the composite of an episode of worsening HF (HF hospitalization or urgent HF visit requiring intravenous therapy) or cardiovascular death. Results A total of 4744 patients were randomized in DAPA-HF, of whom 1109 were women (23.4%). Compared with placebo, dapagliflozin reduced the risk of worsening HF events or cardiovascular death to a similar extent in both men and women (hazard ratios, 0.73 [95% CI, 0.63-0.85] and 0.79 [95% CI, 0.59-1.06], respectively; P for interaction = .67). Consistent benefits were observed for the components of the primary outcome and all-cause mortality. Compared with placebo, dapagliflozin increased the proportion of patients with a meaningful improvement in symptoms (Kansas City Cardiomyopathy Questionnaire total symptom score of ≥5 points; men, 59% vs 50%; women, 57% vs 54%; P for interaction = .14) and decreased the proportion with worsening symptoms (Kansas City Cardiomyopathy Questionnaire total symptom score decrease of ≥5 points; men, 25% vs 34%; women, 27% vs 31%; P for interaction = .15), irrespective of sex. Results were consistent for the Kansas City Cardiomyopathy Questionnaire clinical summary score and overall summary score. Study drug discontinuation and serious adverse events were not more frequent in the dapagliflozin group than in the placebo group in either men or women. Conclusions and Relevance Dapagliflozin reduced the risk of worsening HF, cardiovascular death, and all-cause death and improved symptoms, physical function, and health-related quality of life similarly in men and women with heart failure and reduced ejection fraction. In addition, dapagliflozin was safe and well-tolerated irrespective of sex. Trial Registration ClinicalTrials.gov Identifier: NCT03036124.
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Affiliation(s)
- Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kieran F Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospital, Herlev, Denmark
| | - Mikhail N Kosiborod
- St Luke's Mid America Heart Institute, University of Missouri-Kansas City.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Eileen O'Meara
- Department of Cardiology, Montreal Heart Institute, Montreal, Ontario, Canada
| | - Tzvetana Katova
- Clinic of Cardiology, National Cardiology Hospital, Sofia, Bulgaria
| | - Charlotta E A Ljungman
- Department of Molecular and Clinical Medicine and Cardiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Mirta Diez
- Division of Cardiology, Institute Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Modele O Ogunniyi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anna Maria Langkilde
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Mikaela Sjöstrand
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Daniel Lindholm
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Olof Bengtsson
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wrocław, Poland
| | - Marc S Sabatine
- TIMI Study Group, Brigham and Women's Hospital, Boston, Massachusetts
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Mentz RJ, Ambrosy AP, Ezekowitz JA, Lewis GD, Butler J, Wong YW, De Pasquale CG, Troughton RW, O'Meara E, Rockhold FW, Garg J, Samsky MD, Leloudis D, Dugan M, Mundy LM, Hernandez AF. Randomized Placebo-Controlled Trial of Ferric Carboxymaltose in Heart Failure With Iron Deficiency: Rationale and Design. Circ Heart Fail 2021; 14:e008100. [PMID: 34003690 PMCID: PMC8136455 DOI: 10.1161/circheartfailure.120.008100] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Iron deficiency (ID) has a prevalence of ≈40% to 50% among patients in heart failure (HF) with reduced ejection fraction and is associated with worse prognosis. Several trials demonstrated that intravenous ferric carboxymaltose leads to early and sustained improvement in patient-reported outcomes and functional capacity in patients with HF with reduced ejection fraction with ID, yet morbidity and mortality data are limited. METHODS The objective of the HEART-FID trial (Ferric Carboxymaltose in Heart Failure With Iron Deficiency) is to assess efficacy and safety of ferric carboxymaltose compared with placebo as treatment for symptomatic HF with reduced ejection fraction with ID. HEART-FID is a multicenter, randomized, double-blind, placebo-controlled trial enrolling ≈3014 patients at ≈300 international centers. Eligible patients are aged ≥18 years in stable chronic HF with New York Heart Association functional class II to IV symptoms, ejection fraction ≤40%, ID (ferritin <100 ng/mL or ferritin 100-300 ng/mL with a transferrin saturation <20%), and documented HF hospitalization or elevated N-terminal pro-brain natriuretic peptide. Consented patients are assigned to ferric carboxymaltose or placebo at baseline, with repeated visits/assessments every 6 months for additional study drug based on hemoglobin and iron indices for the trial duration. The primary end point is a hierarchical composite of death and HF hospitalization at 12 months and change from baseline to 6 months in the 6-minute walk test distance. CONCLUSIONS The HEART-FID trial will inform clinical practice by clarifying the role of long-term treatment with intravenous ferric carboxymaltose, added to usual care, in ambulatory patients with symptomatic HF with reduced ejection fraction with ID. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03037931.
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Affiliation(s)
- Robert J Mentz
- Duke Clinical Research Institute, Durham, NC (R.J.M., F.R., J.G., M.D.S., D.L., A.F.H.)
| | - Andrew P Ambrosy
- Division of Cardiology, The Permanente Medical Group, San Francisco, CA (A.P.A.).,Division of Research, Kaiser Permanente Northern California, Oakland (A.P.A.)
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (J.A.E.)
| | - Gregory D Lewis
- Division of Cardiology, Massachusetts General Hospital, Boston (G.D.L.)
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson (J.B.)
| | - Yee Weng Wong
- Heart Lung Institute, The Prince Charles Hospital, and School of Clinical Medicine, The University of Queensland, Australia (Y.W.W.)
| | | | - Richard W Troughton
- Department of Medicine, Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (R.W.T.)
| | - Eileen O'Meara
- Montreal Heart Institute and Université de Montréal, Quebec, Canada (E.O.)
| | - Frank W Rockhold
- Duke Clinical Research Institute, Durham, NC (R.J.M., F.R., J.G., M.D.S., D.L., A.F.H.)
| | - Jyostna Garg
- Duke Clinical Research Institute, Durham, NC (R.J.M., F.R., J.G., M.D.S., D.L., A.F.H.)
| | - Marc D Samsky
- Duke Clinical Research Institute, Durham, NC (R.J.M., F.R., J.G., M.D.S., D.L., A.F.H.)
| | - Dianne Leloudis
- Duke Clinical Research Institute, Durham, NC (R.J.M., F.R., J.G., M.D.S., D.L., A.F.H.)
| | - Michael Dugan
- American Regent, Inc, Norristown, Pennsylvania (M.D., L.M.M.)
| | - Linda M Mundy
- American Regent, Inc, Norristown, Pennsylvania (M.D., L.M.M.)
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, NC (R.J.M., F.R., J.G., M.D.S., D.L., A.F.H.)
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Teerlink JR, Diaz R, Felker GM, McMurray JJV, Metra M, Solomon SD, Biering-Sørensen T, Böhm M, Bonderman D, Fang JC, Lanfear DE, Lund M, Momomura SI, O'Meara E, Ponikowski P, Spinar J, Flores-Arredondo JH, Claggett BL, Heitner SB, Kupfer S, Abbasi SA, Malik FI. Effect of Ejection Fraction on Clinical Outcomes in Patients Treated With Omecamtiv Mecarbil in GALACTIC-HF. J Am Coll Cardiol 2021; 78:97-108. [PMID: 34015475 DOI: 10.1016/j.jacc.2021.04.065] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND In GALACTIC-HF (Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure) (n = 8,256), the cardiac myosin activator, omecamtiv mecarbil, significantly reduced the primary composite endpoint (PCE) of time-to-first heart failure event or cardiovascular death in patients with heart failure and reduced ejection fraction (EF) (≤35%). OBJECTIVES The purpose of this study was to evaluate the influence of baseline EF on the therapeutic effect of omecamtiv mecarbil. METHODS Outcomes in patients treated with omecamtiv mecarbil were compared with placebo according to EF. RESULTS The risk of the PCE in the placebo group was nearly 1.8-fold greater in the lowest EF (≤22%) compared with the highest EF (≥33%) quartile. Amongst the pre-specified subgroups, EF was the strongest modifier of the treatment effect of omecamtiv mecarbil on the PCE (interaction as continuous variable, p = 0.004). Patients receiving omecamtiv mecarbil had a progressively greater relative and absolute treatment effect as baseline EF decreased, with a 17% relative risk reduction for the PCE in patients with baseline EF ≤22% (n = 2,246; hazard ratio: 0.83; 95% confidence interval: 0.73 to 0.95) compared with patients with EF ≥33% (n = 1,750; hazard ratio: 0.99; 95% confidence interval: 0.84 to 1.16; interaction as EF by quartiles, p = 0.013). The absolute reduction in the PCE increased with decreasing EF (EF ≤22%; absolute risk reduction, 7.4 events per 100 patient-years; number needed to treat for 3 years = 11.8), compared with no reduction in the highest EF quartile. CONCLUSIONS In heart failure patients with reduced EF, omecamtiv mecarbil produced greater therapeutic benefit as baseline EF decreased. These findings are consistent with the drug's mechanism of selectively improving systolic function and presents an important opportunity to improve the outcomes in a group of patients at greatest risk. (Registrational Study With Omecamtiv Mecarbil/AMG 423 to Treat Chronic Heart Failure With Reduced Ejection Fraction [GALACTIC-HF]; NCT02929329).
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Affiliation(s)
- John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California, USA.
| | - Rafael Diaz
- Estudios Clinicos Latino America (ECLA), Rosario, Argentina
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital & Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Böhm
- Saarland University, Klink für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | | | | | - David E Lanfear
- Henry Ford Heart and Vascular Institute, Detroit, Michigan, USA
| | - Mayanna Lund
- Cardiology Department, Middlemore Hospital, Otahuhu, Auckland, New Zealand
| | | | - Eileen O'Meara
- Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | | | - Jindrich Spinar
- University Hospital St. Ann and Medical Faculty, Brno, Czech Republic
| | | | - Brian L Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Stuart Kupfer
- Cytokinetics, Inc., South San Francisco, California, USA
| | | | - Fady I Malik
- Cytokinetics, Inc., South San Francisco, California, USA
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Docherty KF, Jhund PS, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, Ponikowski P, DeMets DL, Sabatine MS, Bengtsson O, Sjöstrand M, Langkilde AM, Desai AS, Diez M, Howlett JG, Katova T, Ljungman CEA, O'Meara E, Petrie MC, Schou M, Verma S, Vinh PN, Solomon SD, McMurray JJV. Effects of dapagliflozin in DAPA-HF according to background heart failure therapy. Eur Heart J 2021; 41:2379-2392. [PMID: 32221582 PMCID: PMC7327533 DOI: 10.1093/eurheartj/ehaa183] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/07/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022] Open
Abstract
Aims In the DAPA-HF trial, the SGLT2 inhibitor dapagliflozin reduced the risk of worsening heart failure (HF) and death in patients with HF and reduced ejection fraction. We examined whether this benefit was consistent in relation to background HF therapy. Methods and results In this post hoc analysis, we examined the effect of study treatment in the following yes/no subgroups: diuretic, digoxin, mineralocorticoid receptor antagonist (MRA), sacubitril/valsartan, ivabradine, implanted cardioverter-defibrillating (ICD) device, and cardiac resynchronization therapy. We also examined the effect of study drug according to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker dose, beta-blocker (BB) dose, and MRA (≥50% and <50% of target dose). We analysed the primary composite endpoint of cardiovascular death or a worsening HF event. Most randomized patients (n = 4744) were treated with a diuretic (84%), renin–angiotensin system (RAS) blocker (94%), and BB (96%); 52% of those taking a BB and 38% taking a RAS blocker were treated with ≥50% of the recommended dose. Overall, the dapagliflozin vs. placebo hazard ratio (HR) was 0.74 [95% confidence interval (CI) 0.65–0.85] for the primary composite endpoint (P < 0.0001). The effect of dapagliflozin was consistent across all subgroups examined: the HR ranged from 0.57 to 0.86 for primary endpoint, with no significant randomized treatment-by-subgroup interaction. For example, the HR in patients taking a RAS blocker, BB, and MRA at baseline was 0.72 (95% CI 0.61–0.86) compared with 0.77 (95% CI 0.63–0.94) in those not on all three of these treatments (P-interaction 0.64). Conclusion The benefit of dapagliflozin was consistent regardless of background therapy for HF.
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Affiliation(s)
- Kieran F Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510 USA
| | - Lars Køber
- Rigshospitalet Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA
| | - Felipe A Martinez
- National University of Cordoba, Av.Colon 2057, Cordoba X5003DSE, Argentina
| | - Piotr Ponikowski
- Wroclaw Medical University, Borowska 213, Wroclaw 50-556, Poland
| | - David L DeMets
- Department of Biostatistics & Medical Informatics, University of Wisconsin, 610 Walnut Street, 250 WARF, Madison, WI 53726, USA
| | - Marc S Sabatine
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115 USA
| | - Olof Bengtsson
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Pepparedsleden 1, Mölndal 431 83, Sweden
| | - Mikaela Sjöstrand
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Pepparedsleden 1, Mölndal 431 83, Sweden
| | - Anna Maria Langkilde
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Pepparedsleden 1, Mölndal 431 83, Sweden
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Mirta Diez
- Division of Cardiology, Institute Cardiovascular de Buenos Aires, Av. Libertador 6302, C1428ART - Buenos Aires, Argentina
| | - Jonathan G Howlett
- University of Calgary, Cardiac Sciences and Medicine, Room c838, 1403- 29th street NW, Calgary Alberta Canada, T2N2Y9
| | - Tzvetana Katova
- Clinic of Cardiology, National Cardiology Hospital, 65 Konyovitsa Str., Sofia 1309, Bulgaria
| | - Charlotta E A Ljungman
- Department of Molecular and Clinical Medicine and Cardiology, Sahlgrenska Academy, Gothenburg 413 45, Sweden
| | - Eileen O'Meara
- Montreal Heart Institute, University of Montreal, 5000 Belanger, Montreal, Quebec H1T1C8, Canada
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Morten Schou
- Department of Cardiology, Gentofte University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Canada M5B 1W8
| | - Pham Nguyen Vinh
- Department of Internal Medicine, Tan Tao University, Tan Duc Cardiology Hospital, No. 04 Nguyen Luong Bang, Tan Phu Ward, District 7, Ho Chi Minh City 70000, Vietnam
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
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McDonald M, Virani S, Chan M, Ducharme A, Ezekowitz JA, Giannetti N, Heckman GA, Howlett JG, Koshman SL, Lepage S, Mielniczuk L, Moe GW, O'Meara E, Swiggum E, Toma M, Zieroth S, Anderson K, Bray SA, Clarke B, Cohen-Solal A, D'Astous M, Davis M, De S, Grant ADM, Grzeslo A, Heshka J, Keen S, Kouz S, Lee D, Masoudi FA, McKelvie R, Parent MC, Poon S, Rajda M, Sharma A, Siatecki K, Storm K, Sussex B, Van Spall H, Yip AMC. CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction. Can J Cardiol 2021; 37:531-546. [PMID: 33827756 DOI: 10.1016/j.cjca.2021.01.017] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 12/14/2022] Open
Abstract
In this update of the Canadian Cardiovascular Society heart failure (HF) guidelines, we provide comprehensive recommendations and practical tips for the pharmacologic management of patients with HF with reduced ejection fraction (HFrEF). Since the 2017 comprehensive update of the Canadian Cardiovascular Society guidelines for the management of HF, substantial new evidence has emerged that has informed the care of these patients. In particular, we focus on the role of novel pharmacologic therapies for HFrEF including angiotensin receptor-neprilysin inhibitors, sinus node inhibitors, sodium glucose transport 2 inhibitors, and soluble guanylate cyclase stimulators in conjunction with other long established HFrEF therapies. Updated recommendations are also provided in the context of the clinical setting for which each of these agents might be prescribed; the potential value of each therapy is reviewed, where relevant, for chronic HF, new onset HF, and for HF hospitalization. We define a new standard of pharmacologic care for HFrEF that incorporates 4 key therapeutic drug classes as standard therapy for most patients: an angiotensin receptor-neprilysin inhibitor (as first-line therapy or after angiotensin converting enzyme inhibitor/angiotensin receptor blocker titration); a β-blocker; a mineralocorticoid receptor antagonist; and a sodium glucose transport 2 inhibitor. Additionally, many patients with HFrEF will have clinical characteristics for which we recommended other key therapies to improve HF outcomes, including sinus node inhibitors, soluble guanylate cyclase stimulators, hydralazine/nitrates in combination, and/or digoxin. Finally, an approach to management that integrates prioritized pharmacologic with nonpharmacologic and invasive therapies after a diagnosis of HFrEF is highlighted.
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Affiliation(s)
- Michael McDonald
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
| | - Sean Virani
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Chan
- University of Alberta, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Anique Ducharme
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | - George A Heckman
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Jonathan G Howlett
- Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | | | - Serge Lepage
- Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Lisa Mielniczuk
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Eileen O'Meara
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Elizabeth Swiggum
- Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada
| | - Mustafa Toma
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kim Anderson
- Dalhousie University QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Sharon A Bray
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Brian Clarke
- Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | | | | | - Margot Davis
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabe De
- London Health Sciences, Western University, London, Ontario, Canada
| | - Andrew D M Grant
- Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Adam Grzeslo
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jodi Heshka
- Ottawa Cardiovascular Centre, Ottawa, Ontario, Canada
| | - Sabina Keen
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Simon Kouz
- Centre Intégré de Santé et de Services Sociaux de Lanaudière - Centre Hospitalier de Lanaudière, Joliette, Québec, Canada
| | - Douglas Lee
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Robert McKelvie
- St Joseph's Health Care, Western University, London, Ontario, Canada
| | - Marie-Claude Parent
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Stephanie Poon
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Miroslaw Rajda
- Dalhousie University QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | | | - Kate Storm
- Dalhousie University QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Bruce Sussex
- Memorial University, St John's, Newfoundland, Canada
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40
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Beldhuis IE, Myhre PL, Bristow M, Claggett B, Damman K, Fang JC, Fleg JL, McKinlay S, Lewis EF, O'Meara E, Pitt B, Shah SJ, Vardeny O, Voors AA, Pfeffer MA, Solomon SD, Desai AS. Spironolactone in Patients With Heart Failure, Preserved Ejection Fraction, and Worsening Renal Function. J Am Coll Cardiol 2021; 77:1211-1221. [PMID: 33663739 DOI: 10.1016/j.jacc.2020.12.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Treatment of heart failure with preserved ejection fraction (HFpEF) with spironolactone is associated with lower risk of heart failure hospitalization (HFH) but increased risk of worsening renal function (WRF). The prognostic implications of spironolactone-associated WRF in HFpEF patients are not well understood. OBJECTIVES The purpose of this study was to investigate the association between WRF, spironolactone treatment, and clinical outcomes in patients with HFpEF. METHODS In 1,767 patients randomized to spironolactone or placebo in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial)-Americas study, we examined the incidence of WRF (doubling of serum creatinine) by treatment assignment. Associations between incident WRF and subsequent risk for the primary study endpoint of cardiovascular (CV) death, HFH, or aborted cardiac arrest and key secondary outcomes, including CV death, HFH, and all-cause mortality according to treatment assignment, were examined in time-updated Cox proportional hazards models with an interaction term. RESULTS WRF developed in 260 (14.7%) patients with higher rates in those assigned to spironolactone compared to placebo (17.8% vs. 11.6%; odds ratio: 1.66; 95% confidence interval: 1.27 to 2.17; p < 0.001). Regardless of treatment, incident WRF was associated with increased risk for the primary endpoint (hazard ratio: 2.04; 95% confidence interval: 1.52 to 2.72; p < 0.001) after multivariable adjustment. Although there was no statistical interaction between treatment assignment and WRF regarding the primary endpoint (interaction p = 0.11), spironolactone-associated WRF was associated with lower risk of CV death (interaction p = 0.003) and all-cause mortality (interaction p = 0.001) compared with placebo-associated WRF. CONCLUSIONS Among HFpEF patients enrolled in TOPCAT-Americas, spironolactone increased risk of WRF compared with placebo. Rates of CV death were lower with spironolactone in both patients with and without WRF.
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Affiliation(s)
- Iris E Beldhuis
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands. https://twitter.com/iebeldhuis
| | - Peder L Myhre
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Medicine, Akershus University Hospital, Lorenskog, Norway. https://twitter.com/pmyhre
| | - Michael Bristow
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin Damman
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - James C Fang
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jerome L Fleg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sonja McKinlay
- New England Research Institutes, Watertown, Massachusetts, USA
| | - Eldrin F Lewis
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Adriaan A Voors
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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41
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Shen L, Kristensen SL, Bengtsson O, Böhm M, de Boer RA, Docherty KF, Inzucchi SE, Katova T, Køber L, Kosiborod MN, Langkilde AM, Lindholm D, Martinez MFA, O'Meara E, Nicolau JC, Petrie MC, Ponikowski P, Sabatine MS, Schou M, Sjöstrand M, Solomon SD, Jhund PS, McMurray JJV. Dapagliflozin in HFrEF Patients Treated With Mineralocorticoid Receptor Antagonists: An Analysis of DAPA-HF. JACC Heart Fail 2021; 9:254-264. [PMID: 33549554 DOI: 10.1016/j.jchf.2020.11.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/30/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the efficacy and safety of dapagliflozin in patients taking or not taking an mineralocorticoid receptor antagonist (MRA) at baseline in the DAPA-HF (Dapagliflozin And Prevention of Adverse outcomes in Heart Failure) trial. BACKGROUND MRAs and sodium glucose co-transporter 2 inhibitors each have diuretic activity, lower blood pressure, and reduce glomerular filtration rate (GFR). Therefore, it is important to investigate the safety, as well as efficacy, of their combination. METHODS A total of 4,744 patients with heart failure with reduced ejection fraction (HFrEF) were randomized to placebo or dapagliflozin 10 mg daily. The efficacy of dapagliflozin on the primary composite outcome (cardiovascular death or episode of worsening heart failure) and its components was examined according to MRA use, as were predefined safety outcomes. RESULTS A total of 3,370 patients (71%) were treated with an MRA and they were younger (65 vs. 69 years of age), less often from North America (9% vs. 26%), had worse New York Heart Association functional class (35% vs. 25% in class III/IV), lower left ventricular ejection fraction (30.7% vs. 31.9%) and systolic blood pressure (120.3 vs. 125.5 mm Hg), but higher estimated GFR (67.1 vs. 62.6 ml/min/1.73 m2), than patients not taking an MRA. The benefit of dapagliflozin compared with placebo was similar in patients taking or not taking an MRA: hazard ratio: 0.74 (95% confidence interval [CI]: 0.63 to 0.87) versus 0.74 (95% CI: 0.57 to 0.95), respectively, for the primary endpoint (p value for interaction = 0.97); similar findings were observed for secondary endpoints. In both MRA subgroups, safety outcomes were similar in patients randomized to dapagliflozin or placebo. CONCLUSIONS Dapagliflozin was similarly efficacious and safe in patients with HFrEF taking or not taking an MRA, supporting the use of both drugs together. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure [DAPA-HF]; NCT03036124).
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Affiliation(s)
- Li Shen
- Department of Medicine, Hangzhou Normal University, Hangzhou, China; BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Søren Lund Kristensen
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | | | - Michael Böhm
- Klinik für Innere Medizin III, Universität des Saarlandes, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center and University of Groningen, Groningen, the Netherlands
| | - Kieran F Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tzvetana Katova
- Clinic of Cardiology, National Cardiology Hospital, Sofia, Bulgaria
| | - Lars Køber
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | | | | | - Eileen O'Meara
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jose C Nicolau
- Instituto do Coracao (InCor), Hospital das Clínicas Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Morten Schou
- Department of Cardiology, Gentofte University Hospital Copenhagen, Copenhagen, Denmark
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
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Teerlink JR, Diaz R, Felker GM, McMurray JJV, Metra M, Solomon SD, Adams KF, Anand I, Arias-Mendoza A, Biering-Sørensen T, Böhm M, Bonderman D, Cleland JGF, Corbalan R, Crespo-Leiro MG, Dahlström U, Echeverria LE, Fang JC, Filippatos G, Fonseca C, Goncalvesova E, Goudev AR, Howlett JG, Lanfear DE, Li J, Lund M, Macdonald P, Mareev V, Momomura SI, O'Meara E, Parkhomenko A, Ponikowski P, Ramires FJA, Serpytis P, Sliwa K, Spinar J, Suter TM, Tomcsanyi J, Vandekerckhove H, Vinereanu D, Voors AA, Yilmaz MB, Zannad F, Sharpsten L, Legg JC, Varin C, Honarpour N, Abbasi SA, Malik FI, Kurtz CE. Cardiac Myosin Activation with Omecamtiv Mecarbil in Systolic Heart Failure. N Engl J Med 2021; 384:105-116. [PMID: 33185990 DOI: 10.1056/nejmoa2025797] [Citation(s) in RCA: 335] [Impact Index Per Article: 111.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016-002299-28.).
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Affiliation(s)
- John R Teerlink
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Rafael Diaz
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - G Michael Felker
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - John J V McMurray
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Marco Metra
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Scott D Solomon
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Kirkwood F Adams
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Inder Anand
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Alexandra Arias-Mendoza
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Tor Biering-Sørensen
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Michael Böhm
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Diana Bonderman
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - John G F Cleland
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Ramon Corbalan
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Maria G Crespo-Leiro
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Ulf Dahlström
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Luis E Echeverria
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - James C Fang
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Gerasimos Filippatos
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Cândida Fonseca
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Eva Goncalvesova
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Assen R Goudev
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Jonathan G Howlett
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - David E Lanfear
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Jing Li
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Mayanna Lund
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Peter Macdonald
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Viacheslav Mareev
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Shin-Ichi Momomura
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Eileen O'Meara
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Alexander Parkhomenko
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Piotr Ponikowski
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Felix J A Ramires
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Pranas Serpytis
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Karen Sliwa
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Jindrich Spinar
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Thomas M Suter
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Janos Tomcsanyi
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Hans Vandekerckhove
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Dragos Vinereanu
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Adriaan A Voors
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Mehmet B Yilmaz
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Faiez Zannad
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Lucie Sharpsten
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Jason C Legg
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Claire Varin
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Narimon Honarpour
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Siddique A Abbasi
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Fady I Malik
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
| | - Christopher E Kurtz
- From the Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco (J.R.T.), Amgen, Thousand Oaks (L.S., J.C.L., N.H., S.A.A., C.E.K.), and Cytokinetics, South San Francisco (F.I.M.) - all in California; Estudios Clínicos Latino América, Rosario, Argentina (R.D.); the Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham (G.M.F.), and the University of North Carolina, Chapel Hill (K.F.A.) - both in North Carolina; the British Heart Foundation Cardiovascular Research Centre (J.J.V.M.) and the Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing (J.G.F.C.), University of Glasgow, Glasgow, and the National Heart and Lung Institute, Imperial College, London (J.G.F.C.) - both in the United Kingdom; Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy (M.M.); the Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (S.D.S.); the University of Minnesota, Minneapolis (I.A.); Instituto Nacional de Cardiología, Mexico City (A.A.-M.); the Department of Cardiology, Herlev and Gentofte Hospital, and the Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen (T.B.-S.); Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany (M.B.); Medical University of Vienna, Vienna (D.B.); Pontificia Universidad Católica de Chile, Santiago (R.C.); Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña, A Coruña, Spain (M.G.C.-L.); the Departments of Cardiology and Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden (U.D.); Fundación Cardiovascular de Colombia, Floridablanca, Colombia (L.E.E.); University of Utah, Salt Lake City (J.C.F.); National and Kapodistrian University of Athens, Attikon University Hospital, Athens (G.F.); Hospital S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (C.F.); Commenius University, Bratislava, Slovakia (E.G.); the Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria (A.R.G.); Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, AB (J.G.H.), and Montreal Heart Institute and Université de Montréal, Montreal (E.O.) - both in Canada; the Heart and Vascular Institute, Henry Ford Hospital, Detroit (D.E.L.); the National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (J.L.); Middlemore Hospital, Otahuhu, Auckland, New Zealand (M.L.); St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia (P.M.); University Clinic of Lomonosov, Moscow State University, Moscow (V.M.); Saitama Citizens Medical Center, Saitama, Japan (S.M.); Institute of Cardiology, Kyiv, Ukraine (A.P.); Wroclaw Medical University, Wroclaw, Poland (P.P.); Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo (F.J.A.R.); Vilnius University, Vilnius, Lithuania (P.S.); the University of Cape Town, Cape Town, South Africa (K.S.); the Internal Cardiology Department, St. Ann Hospital and Masaryk University Brno, Brno, Czech Republic (J.S.); the Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (T.M.S.); St. John of God Hospital, Budapest, Hungary (J.T.); AZ Sint-Lucas, Ghent, Belgium (H.V.); the University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania (D.V.); the University of Groningen, Groningen, the Netherlands (A.A.V.); Dokuz Eylul University, Izmir, Turkey (M.B.Y.); and Université de Lorraine, INSERM Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Régional Universitaire de Nancy, Nancy (F.Z.), and Servier, Suresnes (C.V.) - both in France
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43
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O'Meara E, Verma S. When and How to Use Sodium-Glucose Cotransporter 2 Inhibitors in Patients With Heart Failure With Reduced Ejection Fraction or Chronic Kidney Disease. Can J Cardiol 2021; 37:669-673. [PMID: 33450364 DOI: 10.1016/j.cjca.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/18/2022] Open
Abstract
The role of sodium-glucose cotransporter 2 (SGLT2) inhibitors in preventing heart failure (HF) in people with type 2 diabetes (T2DM) is now part of current treatment recommendations. Two large clinical trials (DAPA-HF and EMPEROR-Reduced) have recently highlighted the important impact of SGLT2 inhibitors in patients with HF and a reduced ejection fraction (HFrEF), with significant outcome benefits on HF hospitalisations and cardiovascular mortality, and similar effects in patients with and without T2DM. These benefits were observed on top of excellent background HF therapy, and there were no treatment interactions between SGLT2 inhibitors and background HF therapy. There were no increases in adverse events of interest in the SGLT2 inhibitor arm, including volume depletion, adverse renal events, hypoglycemia, amputation, and ketoacidosis, demonstrating the favourable safety profile of this treatment in HFrEF. Approximately 40%-50% of patients with HFrEF have chronic kidney disease (CKD), and the recently reported results of the DAPA-CKD trial indicate that dapagliflozin can prevent renal and cardiovascular outcomes in patients with established CKD, whether diabetes is present or not. Although the mechanisms of action of SGLT2 inhibitors are not fully understood, the hypotheses that have been proposed for their HF outcome benefits include a reduction of preload via osmotic diuresis, lowering of afterload, reduction in myocardial mass, alteration of myocardial energy substrate toward a more efficient glucose metabolism, modulation of renal sympathetic afferent tone, and increased erythropoiesis. We here present a summary of the evidence as well as a practical perspective on prescribing SGLT2 inhibitors in patients with HFrEF, with or without diabetes.
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Affiliation(s)
- Eileen O'Meara
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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44
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De Marco C, Claggett BL, de Denus S, Zile MR, Huynh T, Desai AS, Sirois MG, Solomon SD, Pitt B, Rouleau JL, Pfeffer MA, O'Meara E. Impact of diabetes on serum biomarkers in heart failure with preserved ejection fraction: insights from the TOPCAT trial. ESC Heart Fail 2021; 8:1130-1138. [PMID: 33438360 PMCID: PMC8006665 DOI: 10.1002/ehf2.13153] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/20/2020] [Accepted: 11/23/2020] [Indexed: 01/09/2023] Open
Abstract
Aims Diabetes mellitus (DM) is common in heart failure with preserved ejection fraction (HFpEF). Patients with DM and heart failure with reduced ejection fraction have higher levels of cardiac, profibrotic, and proinflammatory biomarkers relative to non‐diabetics. Limited data are available regarding the biomarker profiles of HFpEF patients with diabetes (DM) vs. no diabetes (non‐DM) and the impact of spironolactone on these biomarkers. This study aims to address such gaps in the literature. Methods and results Biomarkers were measured at randomization and at 12 months in 248 patients enrolled in Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist's North American cohort. At baseline, DM patients had significantly lower estimated glomerular filtration rate and higher high‐sensitivity C‐reactive protein, pro‐collagen type III amino‐terminal peptide, tissue inhibitor of metalloproteinase 1 (TIMP‐1), and galectin‐3 levels than those without diabetes. There was a significantly larger 12 month increase in levels of high‐sensitivity troponin T (hs‐TnT), a marker of myocyte death, in DM patients. Elevated pro‐collagen type III amino‐terminal peptide and galectin‐3 levels were associated with an increased risk of the primary outcome (cardiovascular mortality, aborted cardiac arrest, or heart failure hospitalization) in DM patients, but not in those without diabetes. A statistically significant interaction between spironolactone and diabetes status was observed for hs‐TnT and for TIMP‐1, with greater biomarker reductions among those with diabetes treated with spironolactone. Conclusions The presence of diabetes is associated with higher levels of cardiac, profibrotic, and proinflammatory biomarkers in HFpEF. Spironolactone appears to alter the determinants of extracellular matrix remodelling in an anti‐fibrotic fashion in patients with diabetes, reflected by changes in hs‐TnT and TIMP‐1 levels over time.
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Affiliation(s)
- Corrado De Marco
- Division of CardiologyMontreal Heart Institute and Université de Montréal5000 rue BélangerMontrealQCH1T 1C8Canada
| | | | - Simon de Denus
- Division of CardiologyMontreal Heart Institute and Université de Montréal5000 rue BélangerMontrealQCH1T 1C8Canada
| | - Michael R. Zile
- Division of CardiologyMedical University of South CarolinaCharlestonSCUSA
| | - Thao Huynh
- McGill University Health Centre and McGill UniversityMontrealQCCanada
| | - Akshay S. Desai
- Cardiovascular DivisionBrigham and Women's HospitalBostonMAUSA
| | - Martin G. Sirois
- Division of CardiologyMontreal Heart Institute and Université de Montréal5000 rue BélangerMontrealQCH1T 1C8Canada
| | | | - Bertram Pitt
- University of Michigan School of MedicineAnn ArborMIUSA
| | - Jean L. Rouleau
- Division of CardiologyMontreal Heart Institute and Université de Montréal5000 rue BélangerMontrealQCH1T 1C8Canada
| | - Marc A. Pfeffer
- Cardiovascular DivisionBrigham and Women's HospitalBostonMAUSA
| | - Eileen O'Meara
- Division of CardiologyMontreal Heart Institute and Université de Montréal5000 rue BélangerMontrealQCH1T 1C8Canada
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45
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Teerlink JR, Diaz R, Felker GM, McMurray JJV, Metra M, Solomon SD, Adams KF, Anand I, Arias-Mendoza A, Biering-Sørensen T, Böhm M, Bonderman D, Cleland JGF, Corbalan R, Crespo-Leiro MG, Dahlström U, Echeverria Correa LE, Fang JC, Filippatos G, Fonseca C, Goncalvesova E, Goudev AR, Howlett JG, Lanfear DE, Lund M, Macdonald P, Mareev V, Momomura SI, O'Meara E, Parkhomenko A, Ponikowski P, Ramires FJA, Serpytis P, Sliwa K, Spinar J, Suter TM, Tomcsanyi J, Vandekerckhove H, Vinereanu D, Voors AA, Yilmaz MB, Zannad F, Sharpsten L, Legg JC, Abbasi SA, Varin C, Malik FI, Kurtz CE. Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction: GALACTIC-HF baseline characteristics and comparison with contemporary clinical trials. Eur J Heart Fail 2020; 22:2160-2171. [PMID: 32985088 PMCID: PMC7756903 DOI: 10.1002/ejhf.2015] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 01/10/2023] Open
Abstract
AIMS The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is being tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial. Here we describe the baseline characteristics of participants in GALACTIC-HF and how these compare with other contemporary trials. METHODS AND RESULTS Adults with established HFrEF, New York Heart Association (NYHA) functional class ≥II, ejection fraction ≤35%, elevated natriuretic peptides and either current hospitalization for heart failure or history of hospitalization/emergency department visit for heart failure within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic-guided dosing: 25, 37.5, or 50 mg bid). A total of 8256 patients [male (79%), non-white (22%), mean age 65 years] were enrolled with a mean ejection fraction 27%, ischaemic aetiology in 54%, NYHA class II 53% and III/IV 47%, and median N-terminal pro-B-type natriuretic peptide 1971 pg/mL. Heart failure therapies at baseline were among the most effectively employed in contemporary heart failure trials. GALACTIC-HF randomized patients representative of recent heart failure registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure <100 mmHg (n = 1127), estimated glomerular filtration rate <30 mL/min/1.73 m2 (n = 528), and treated with sacubitril/valsartan at baseline (n = 1594). CONCLUSIONS GALACTIC-HF enrolled a well-treated, high-risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation.
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Affiliation(s)
- John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rafael Diaz
- Estudios Clinicos Latino America (ECLA), Rosario, Argentina
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Marco Metra
- Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Inder Anand
- University of Minnesota, Minneapolis, MN, USA
| | | | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital & Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Böhm
- Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany
| | | | - John G F Cleland
- National Heart and Lung Institute, Imperial College, London, UK.,Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ramon Corbalan
- Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Maria G Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC). CIBERCV. INIBIC. Universidade da Coruña, A Coruña, Spain
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | | | | | | | - Cândida Fonseca
- Hospital S. Francisco Xavier, CHLO; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Assen R Goudev
- Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria
| | - Jonathan G Howlett
- Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | | | - Vyacheslav Mareev
- University Clinic of Lomonosov Moscow State University, Moscow, Russia
| | | | - Eileen O'Meara
- Montreal Heart Institute and Université de Montréal, Montreal, Canada
| | | | | | - Felix J A Ramires
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Karen Sliwa
- University of Cape Town, Johannesburg, South Africa
| | | | - Thomas M Suter
- Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania
| | | | | | - Faiez Zannad
- Université de Lorraine, Inserm INI CRCT, CHRU Nancy, Nancy, France
| | | | | | | | | | - Fady I Malik
- Cytokinetics, Inc., South San Francisco, CA, USA
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46
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Jhund PS, Solomon SD, Docherty KF, Heerspink HJL, Anand IS, Böhm M, Chopra V, de Boer RA, Desai AS, Ge J, Kitakaze M, Merkley B, O'Meara E, Shou M, Tereshchenko S, Verma S, Vinh PN, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, Ponikowski P, Sabatine MS, Bengtsson O, Langkilde AM, Sjöstrand M, McMurray JJV. Efficacy of Dapagliflozin on Renal Function and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction: Results of DAPA-HF. Circulation 2020; 143:298-309. [PMID: 33040613 PMCID: PMC7834909 DOI: 10.1161/circulationaha.120.050391] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Supplemental Digital Content is available in the text. Many patients with heart failure and reduced ejection fraction (HFrEF) have chronic kidney disease that complicates pharmacological management and is associated with worse outcomes. We assessed the safety and efficacy of dapagliflozin in patients with HFrEF, according to baseline kidney function, in the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-outcomes in Heart Failure). We also examined the effect of dapagliflozin on kidney function after randomization.
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Affiliation(s)
- Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (P.S.J., K.F.D., J.J.V.M.)
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (S.D.S., A.S.D.)
| | - Kieran F Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (P.S.J., K.F.D., J.J.V.M.)
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), University Medical Center Groningen, University of Groningen, The Netherlands
| | - Inder S Anand
- Department of Cardiology, University of Minnesota, Minneapolis (I.S.A.)
| | - Michael Böhm
- Department of Medicine, Saarland University Hospital, Homburg-Saar, Germany (M.B.)
| | - Vijay Chopra
- Department of Cardiology, Max Super Speciality Hospital, Saket, New Delhi, India (V.C.)
| | - Rudolf A de Boer
- Department of Cardiology (R.A.d.B.), University Medical Center Groningen, University of Groningen, The Netherlands
| | - Akshay S Desai
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (S.D.S., A.S.D.)
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease and Zhongshan Hospital Fudan University, China (J.G.)
| | - Masafumi Kitakaze
- Cardiovascular Division of Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (M.K.)
| | - Bela Merkley
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.)
| | - Eileen O'Meara
- Department of Cardiology, Montreal Heart Institute, Canada (E.O.)
| | - Morten Shou
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark (M. Shou)
| | - Sergey Tereshchenko
- Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow, Russia (S.T.)
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Canada (S.V.)
| | - Pham Nguyen Vinh
- Department of Internal Medicine, Tan Tao University, Tan Duc, Vietnam (P.N.V.)
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale School of Medicine, New Haven, CT (S.E.I.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.K.)
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City (M.N.K.).,The George Institute for Global Health, University of New South Wales, Sydney, Australia (M.N.K.)
| | | | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Poland (P.P.)
| | - Marc S Sabatine
- TIMI Study Group, Brigham and Women's Hospital, Boston, MA (M.S.S.)
| | - Olof Bengtsson
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., A.M.L., M. Sjöstrand)
| | - Anna Maria Langkilde
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., A.M.L., M. Sjöstrand)
| | - Mikaela Sjöstrand
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., A.M.L., M. Sjöstrand)
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (P.S.J., K.F.D., J.J.V.M.)
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47
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Docherty KF, Jhund PS, Anand I, Bengtsson O, Böhm M, de Boer RA, DeMets DL, Desai AS, Drozdz J, Howlett J, Inzucchi SE, Johanson P, Katova T, Køber L, Kosiborod MN, Langkilde AM, Lindholm D, Martinez FA, Merkely B, Nicolau JC, O'Meara E, Ponikowski P, Sabatine MS, Sjöstrand M, Solomon SD, Tereshchenko S, Verma S, McMurray JJV. Effect of Dapagliflozin on Outpatient Worsening of Patients With Heart Failure and Reduced Ejection Fraction: A Prespecified Analysis of DAPA-HF. Circulation 2020; 142:1623-1632. [PMID: 32883108 PMCID: PMC7580857 DOI: 10.1161/circulationaha.120.047480] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Supplemental Digital Content is available in the text. In the DAPA-HF trial (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure), dapagliflozin, added to guideline-recommended therapies, reduced the risk of mortality and heart failure (HF) hospitalization. We examined the frequency and significance of episodes of outpatient HF worsening, requiring the augmentation of oral therapy, and the effects of dapagliflozin on these additional events.
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Affiliation(s)
- Kieran F Docherty
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, UK (K.F.D., P.S.J., J.J.V.M.)
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, UK (K.F.D., P.S.J., J.J.V.M.)
| | - Inder Anand
- Department of Cardiology, University of Minnesota, Minneapolis (I.A.)
| | - Olof Bengtsson
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., P.J., A.M.L., D.L., M.S.)
| | - Michael Böhm
- Department of Medicine, Saarland University Hospital, Homburg/Saar, Germany (M.B.)
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (R.A.d.B.)
| | - David L DeMets
- Department of Biostatistics & Medical Informatics, University of Wisconsin, Madison (D.L.D.)
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.S.D., S.D.S.)
| | - Jaroslaw Drozdz
- Department of Cardiology, Medical University of Lodz, Poland (J.D.)
| | - Jonathan Howlett
- University of Calgary, Cumming School of Medicine and Libin Cardiovascular Institute, Alberta, Canada (J.H.)
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, CT (S.E.I.)
| | - Per Johanson
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., P.J., A.M.L., D.L., M.S.)
| | - Tzvetana Katova
- Clinic of Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.)
| | - Lars Køber
- Department of Cardiology Copenhagen University Hospital, Denmark (L.K.)
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (M.N.K.).,The George Institute for Global Health and University of New South Wales, Sydney, Australia (M.N.K.)
| | - Anna Maria Langkilde
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., P.J., A.M.L., D.L., M.S.)
| | - Daniel Lindholm
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., P.J., A.M.L., D.L., M.S.)
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.)
| | - Jose C Nicolau
- Instituto do Coracao (InCor), Hospital das Clínicas Faculdade de Medicina, Universidade de São Paulo, Brazil (J.C.N.)
| | - Eileen O'Meara
- Department of Cardiology, Montreal Heart Institute, Ontario, Canada (E.O'M.)
| | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Poland (P.P.)
| | - Marc S Sabatine
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.S.S.)
| | - Mikaela Sjöstrand
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., P.J., A.M.L., D.L., M.S.)
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.S.D., S.D.S.)
| | - Sergey Tereshchenko
- Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow, Russia (S.T.)
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada (S.V.)
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, UK (K.F.D., P.S.J., J.J.V.M.)
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48
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de Denus S, Mottet F, Korol S, Feroz Zada Y, Provost S, Mongrain I, Asselin G, Oussaïd E, Busseuil D, Lettre G, Rioux J, Racine N, O'Meara E, White M, Rouleau J, Tardif JC, Dubé MP. A genetic association study of heart failure: more evidence for the role of BAG3 in idiopathic dilated cardiomyopathy. ESC Heart Fail 2020; 7:4384-4389. [PMID: 32869539 PMCID: PMC7754954 DOI: 10.1002/ehf2.12934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 01/22/2023] Open
Abstract
Aims Few investigations have been conducted to identify genetic determinants of common, polygenetic forms of heart failure (HF), and only a limited number of these genetic associations have been validated by multiple groups. Methods and results We performed a case–control study to further investigate the potential impact of 14 previously reported candidate genes on the risk of HF and specific HF sub‐types. We also performed an exploratory genome‐wide study. We included 799 patients with HF and 1529 controls. After adjusting for age, sex, and genetic ancestry, we found that the C allele of rs2234962 in BAG3 was associated with a decreased risk of idiopathic dilated cardiomyopathy (odds ratio 0.42, 95% confidence interval 0.25–0.68, P = 0.0005), consistent with a previous report. No association for the other primary variants or exploratory genome‐wide study was found. Conclusions Our findings provide independent replication for the association between a common coding variant (rs2234962) in BAG3 and the risk of idiopathic dilated cardiomyopathy.
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Affiliation(s)
- Simon de Denus
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, QC, Canada
| | - Fannie Mottet
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Sandra Korol
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Yassamin Feroz Zada
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, QC, Canada
| | - Sylvie Provost
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, QC, Canada
| | - Ian Mongrain
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, QC, Canada
| | - Géraldine Asselin
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, QC, Canada
| | - Essaïd Oussaïd
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, QC, Canada
| | - David Busseuil
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada
| | - Guillaume Lettre
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - John Rioux
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Normand Racine
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Eileen O'Meara
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Michel White
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jean Rouleau
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jean Claude Tardif
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Marie-Pierre Dubé
- Montreal Heart Institute, 5000 Bélanger, Montreal, QC, H1T 1C8, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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49
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Jarjour M, Henri C, de Denus S, Fortier A, Bouabdallaoui N, Nigam A, O'Meara E, Ahnadi C, White M, Garceau P, Racine N, Parent MC, Liszkowski M, Giraldeau G, Rouleau JL, Ducharme A. Care Gaps in Adherence to Heart Failure Guidelines: Clinical Inertia or Physiological Limitations? JACC Heart Fail 2020; 8:725-738. [PMID: 32800509 DOI: 10.1016/j.jchf.2020.04.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/13/2020] [Accepted: 04/30/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study evaluated the impact of clinical and physiological factors limiting treatment optimization toward recommended medical therapy in heart failure (HF). BACKGROUND Although guidelines aim to assist physicians in prescribing evidence-based therapies and to improve outcomes of patients with HF and reduced ejection fraction (HFrEF), gaps in clinical care persist. METHODS Medical records of all patients with HFrEF followed for at least 6 months at the authors' HF clinic (n = 511) allowed for drug optimization and were reviewed regarding the prescription rates of recommended pharmacological agents and devices (implantable cardioverter-defibrillator [ICD] or cardiac resynchronization therapy [CRT]). Then, an algorithm integrating clinical (New York Heart Association [NYHA] functional class, heart rate, blood pressure and biologic parameters (creatinine, serum potassium) based on the inclusion/exclusion criteria of landmark trials guiding these recommendations) was applied for each agent and device to identify potential explanations for treatment gaps. RESULTS Gross prescription rates were high for beta-blockers (98.6%), mineralocorticoid receptor antagonist (MRA) (93.4%), vasodilators (90.3%), ICDs (75.1%), and CRT (82.1%) among those eligible, except for ivabradine (46.3%, n = 41). However, achievement of target physiological doses was lower (beta-blockers, 67.5%; MRA, 58.9%; and vasodilators, 63.4%), and one-fifth of patient dosages were still being up-titrated. Suboptimal doses were associated with older age (odds ratio [OR]: 1.221; p < 0.0001) and history of stroke or transient ischemic attack (TIA) (no vs. yes, OR: 0.264; p = 0.0336). CONCLUSIONS Gaps in adherence to guidelines exist in specialized HF setting and are mostly explained by limiting physiological factors rather than inertia. Older age and history of stroke/TIA, potential markers of frailty, are associated with suboptimal doses of guideline-directed medical therapy, suggesting that an individualized rather than a "one-size-fits-all" approach may be required.
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Affiliation(s)
- Marilyne Jarjour
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Christine Henri
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Simon de Denus
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Annik Fortier
- Biostatistics, Montreal Health Innovation Coordinating Center, Montreal, Quebec, Canada
| | | | - Anil Nigam
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Eileen O'Meara
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Charaf Ahnadi
- Collaborative Research for Effective Diagnostics, University Hospital Center of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michel White
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Patrick Garceau
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Normand Racine
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | | | - Mark Liszkowski
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | | | | | - Anique Ducharme
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada.
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50
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Cunningham JW, Claggett BL, O'Meara E, Prescott MF, Pfeffer MA, Shah SJ, Redfield MM, Zannad F, Chiang LM, Rizkala AR, Shi VC, Lefkowitz MP, Rouleau J, McMurray JJV, Solomon SD, Zile MR. Effect of Sacubitril/Valsartan on Biomarkers of Extracellular Matrix Regulation in Patients With HFpEF. J Am Coll Cardiol 2020; 76:503-514. [PMID: 32731928 DOI: 10.1016/j.jacc.2020.05.072] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Myocardial fibrosis may contribute to the pathophysiology of heart failure with preserved ejection fraction. Given the biochemical targets of sacubitril/valsartan, this study hypothesized that circulating biomarkers reflecting the mechanisms that determine extracellular matrix homeostasis are altered by sacubitril/valsartan compared with valsartan alone. OBJECTIVES This study investigated the effects of sacubitril/valsartan on biomarkers of extracellular matrix homeostasis and the association between biomarkers and the primary endpoint (total heart failure hospitalizations and cardiovascular death). METHODS N-terminal propeptide of collagen I and III, tissue inhibitor of matrix metalloproteinase 1, carboxyl-terminal telopeptide of collagen type I, and soluble ST2 were measured at baseline (n = 1,135) and 16 (n = 1,113) and 48 weeks (n = 1,016) after randomization. The effects of sacubitril/valsartan on these biomarkers were compared with those of valsartan alone. Baseline biomarker values and changes from baseline to 16 weeks were related to primary endpoint. RESULTS At baseline, all 5 biomarkers were higher than published referent control values. Sixteen weeks after randomization, sacubitril/valsartan decreased tissue inhibitor of matrix metalloproteinase 1 by 8% (95% confidence interval [CI]: 6% to 10%; p < 0.001), soluble ST2 by 4% (95% CI: 1% to 7%; p = 0.002), and N-terminal propeptide of collagen III by 3% (95% CI: 0% to 6%; p = 0.04) and increased carboxyl-terminal telopeptide of collagen type I by 4% (95% CI: 1% to 8%; p = 0.02) compared with valsartan alone, consistently in men and women and patients with left ventricular ejection fraction above or below the median of 57%. Higher levels of tissue inhibitor of matrix metalloproteinase 1 and soluble ST2 at baseline and increases in these markers at 16 weeks were associated with higher primary endpoint event rates. CONCLUSIONS Biomarkers reflecting extracellular matrix homeostasis are elevated in heart failure with preserved ejection fraction, favorably altered by sacubitril/valsartan, and have important prognostic value. (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711).
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Affiliation(s)
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eileen O'Meara
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | | | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Faiez Zannad
- Centre d'Investigations Cliniques-Plurithématique 1433, and Institut National de la Santé et de la Recherche Médicale U1116, Centre Hospitalier Regional Universitaire, French Clinical Research Infrastructure Network, Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Nancy, France
| | | | | | | | | | - Jean Rouleau
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Michael R Zile
- Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina; Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
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