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Teramoto K, Tay WT, Tromp J, Ouwerkerk W, Teng THK, Chandramouli C, Liew OW, Chong J, Poppe KK, Lund M, Devlin G, Troughton RW, Doughty RN, Richards AM, Lam CSP. Longitudinal NT-proBNP: Associations With Echocardiographic Changes and Outcomes in Heart Failure. J Am Heart Assoc 2024:e032254. [PMID: 38639333 DOI: 10.1161/jaha.123.032254] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/01/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The relationship of serial NT-proBNP (N-terminal pro-B-type natriuretic peptide) measurements with changes in cardiac features and outcomes in heart failure (HF) remains incompletely understood. We determined whether common clinical covariates impact these relationships. METHODS AND RESULTS In 2 nationwide observational populations with HF, the relationship of serial NT-proBNP measurements with serial echocardiographic parameters and outcomes was analyzed, further stratified by HF with reduced versus preserved left ventricular ejection fraction, inpatient versus outpatient enrollment, age, obesity, chronic kidney disease, atrial fibrillation, and attainment of ≥50% guideline-recommended doses of renin-angiotensin system inhibitors and β-blockers. Among 1911 patients (mean±SD age, 65.1±13.4 years; 26.6% women; 62% inpatient and 38% outpatient), NT-proBNP declined overall, with more rapid declines among inpatients, those with obesity, those with atrial fibrillation, and those attaining ≥50% guideline-recommended doses. Each doubling of NT-proBNP was associated with increases in left ventricular volume (by 6.1 mL), E/e' (transmitral to mitral annular early diastolic velocity ratio) (by 1.4 points), left atrial volume (by 3.6 mL), and reduced left ventricular ejection fraction (by -2.1%). The effect sizes of these associations were lower among patients with HF with preserved ejection fraction, atrial fibrillation, or advanced age (Pinteraction<0.001). A landmark analysis identified that an SD increase in NT-proBNP over 6 months was associated with a 27% increase in the risk of the composite event of HF hospitalization or all-cause death between 6 months and 2 years (adjusted hazard ratio, 1.27 [95% CI, 1.15-1.40]; P<0.001). CONCLUSIONS The relationships between NT-proBNP and structural/functional remodeling differed by age, presence of atrial fibrillation, and HF phenotypes. The association of increased NT-proBNP with increased risk of adverse outcomes was consistent in all subgroups.
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Affiliation(s)
- Kanako Teramoto
- Department of Biostatistics National Cerebral and Cardiovascular Center Osaka Japan
| | - Wan Ting Tay
- National Heart Research Institute Singapore, National Heart Centre Singapore Singapore
| | - Jasper Tromp
- Duke-NUS Medical School Singapore
- Saw Swee Hock School of Public Health National University of Singapore, The National University Health System Singapore
| | - Wouter Ouwerkerk
- National Heart Research Institute Singapore, National Heart Centre Singapore Singapore
- Department of Dermatology Amsterdam Medical Center Amsterdam the Netherlands
| | - Tiew-Hwa Katherine Teng
- National Heart Research Institute Singapore, National Heart Centre Singapore Singapore
- Duke-NUS Medical School Singapore
- School of Allied Health University of Western Australia Perth Australia
| | - Chanchal Chandramouli
- National Heart Research Institute Singapore, National Heart Centre Singapore Singapore
- Duke-NUS Medical School Singapore
| | - Oi Wah Liew
- Department of Medicine Cardiovascular Research Institute, National University of Singapore Singapore
| | - Jenny Chong
- Department of Medicine Cardiovascular Research Institute, National University of Singapore Singapore
| | - Katrina K Poppe
- Department of Medicine, Heart Health Research Group University of Auckland Auckland New Zealand
| | - Mayanna Lund
- Department of Cardiology Middlemore Hospital Auckland New Zealand
| | - Gerry Devlin
- Heart Foundation of New Zealand Auckland New Zealand
| | | | - Robert N Doughty
- Department of Medicine, Heart Health Research Group University of Auckland Auckland New Zealand
- Green Lane Cardiovascular Service Auckland City Hospital Auckland New Zealand
| | - Arthur Mark Richards
- Department of Medicine Cardiovascular Research Institute, National University of Singapore Singapore
- Christchurch Heart Institute, University of Otago Christchurch New Zealand
| | - Carolyn S P Lam
- National Heart Research Institute Singapore, National Heart Centre Singapore Singapore
- Duke-NUS Medical School Singapore
- Department of Cardiology University Medical Center Groningen Groningen the Netherlands
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Huang W, Ong WC, Wong MKF, Ng EYK, Koh T, Chandramouli C, Ng CT, Hummel Y, Huang F, Lam CSP, Tromp J. Applying the UTAUT2 framework to patients' attitudes toward healthcare task shifting with artificial intelligence. BMC Health Serv Res 2024; 24:455. [PMID: 38605373 PMCID: PMC11007870 DOI: 10.1186/s12913-024-10861-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Increasing patient loads, healthcare inflation and ageing population have put pressure on the healthcare system. Artificial intelligence and machine learning innovations can aid in task shifting to help healthcare systems remain efficient and cost effective. To gain an understanding of patients' acceptance toward such task shifting with the aid of AI, this study adapted the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), looking at performance and effort expectancy, facilitating conditions, social influence, hedonic motivation and behavioural intention. METHODS This was a cross-sectional study which took place between September 2021 to June 2022 at the National Heart Centre, Singapore. One hundred patients, aged ≥ 21 years with at least one heart failure symptom (pedal oedema, New York Heart Association II-III effort limitation, orthopnoea, breathlessness), who presented to the cardiac imaging laboratory for physician-ordered clinical echocardiogram, underwent both echocardiogram by skilled sonographers and the experience of echocardiogram by a novice guided by AI technologies. They were then given a survey which looked at the above-mentioned constructs using the UTAUT2 framework. RESULTS Significant, direct, and positive effects of all constructs on the behavioral intention of accepting the AI-novice combination were found. Facilitating conditions, hedonic motivation and performance expectancy were the top 3 constructs. The analysis of the moderating variables, age, gender and education levels, found no impact on behavioral intention. CONCLUSIONS These results are important for stakeholders and changemakers such as policymakers, governments, physicians, and insurance companies, as they design adoption strategies to ensure successful patient engagement by focusing on factors affecting the facilitating conditions, hedonic motivation and performance expectancy for AI technologies used in healthcare task shifting.
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Affiliation(s)
- Weiting Huang
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
| | - Wen Chong Ong
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Mark Kei Fong Wong
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Eddie Yin Kwee Ng
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Tracy Koh
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Chanchal Chandramouli
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Choon Ta Ng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | | | - Carolyn Su Ping Lam
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- , Us2.ai, Singapore, Singapore
| | - Jasper Tromp
- Duke-NUS Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System Singapore, Singapore, Singapore
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3
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Tromp J, Kosiborod MN, Angermann CE, Collins SP, Teerlink JR, Ponikowski P, Biegus J, Ferreira JP, Nassif ME, Psotka MA, Brueckmann M, Blatchford JP, Steubl D, Voors AA. Treatment effects of empagliflozin in hospitalized heart failure patients across the range of left ventricular ejection fraction - Results from the EMPULSE trial. Eur J Heart Fail 2024. [PMID: 38572654 DOI: 10.1002/ejhf.3218] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/23/2024] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
AIM The EMPULSE (EMPagliflozin in patients hospitalised with acUte heart faiLure who have been StabilizEd) trial showed that, compared to placebo, the sodium-glucose cotransporter 2 inhibitor empagliflozin (10 mg/day) improved clinical outcomes of patients hospitalized for acute heart failure (HF). We investigated whether efficacy and safety of empagliflozin were consistent across the spectrum of left ventricular ejection fraction (LVEF). METHODS AND RESULTS A total of 530 patients hospitalized for acute de novo or decompensated HF were included irrespective of LVEF. For the present analysis, patients were classified as HF with reduced (HFrEF, LVEF ≤40%), mildly reduced (HFmrEF, LVEF 41-49%) or preserved (HFpEF, LVEF ≥50%) ejection fraction at baseline. The primary endpoint was a hierarchical outcome of death, worsening HF events (HFE) and quality of life over 90 days, assessed by the win ratio. Secondary endpoints included individual components of the primary endpoint and safety. Out of 523 patients with baseline data, 354 (67.7%) had HFrEF, 54 (10.3%) had HFmrEF and 115 (22.0%) had HFpEF. The clinical benefit (hierarchical composite of all-cause death, HFE and Kansas City Cardiomyopathy Questionnaire total symptom score) of empagliflozin at 90 days compared to placebo was consistent across LVEF categories (≤40%: win ratio 1.35 [95% confidence interval 1.04, 1.75]; 41-49%: win ratio 1.25 [0.66, 2.37)] and ≥50%: win ratio 1.40 [0.87, 2.23], pinteraction = 0.96) with a favourable safety profile. Results were consistent across individual components of the hierarchical primary endpoint. CONCLUSION The clinical benefit of empagliflozin proved consistent across LVEF categories in the EMPULSE trial. These results support early in-hospital initiation of empagliflozin regardless of LVEF.
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Affiliation(s)
- Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore & the National University Health System, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
- George Institute for Global Health, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Christiane E Angermann
- Comprehensive Heart Failure Centre and Department of Medicine I (Cardiology), University and University Hospital of Würzburg, Würzburg, Germany
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center and Geriatric Research and Education Clinical Care, Tennessee Valley Healthcare Facility VA Medical Center, Nashville, TN, USA
| | - 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
| | - Piotr Ponikowski
- Institute of Heart Diseases, Medical University, Wroclaw, Poland
| | - Jan Biegus
- Institute of Heart Diseases, Medical University, Wroclaw, Poland
| | - João Pedro Ferreira
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Michael E Nassif
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | - Martina Brueckmann
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jonathan P Blatchford
- Elderbrook Solutions GmbH on behalf of Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Dominik Steubl
- Boehringer Ingelheim International, Ingelheim, Germany
- Department of Nephrology, Klinikum rechts der Isar, Faculty of Medicine, Technical University, Munich, Germany
| | - Adriaan A Voors
- University of Groningen Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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Agarwal A, Tromp J, Almahmeed W, Angermann C, Chandramouli C, Cho H, Choi DJ, Damasceno A, Filippatos G, Fonarow GC, Harikrishnan S, Lund L, Masoudi F, Mensah GA, Pathan A, Perel P, Pinto F, Ribeiro AL, Rich S, Sakata Y, Sliwa K, Sundstrom J, Wong R, Yancy C, Yiu K, Zhang J, Zhang Y, Lam CSP, Roth GA. Toward a Universal Definition of Etiologies in Heart Failure: Categorizing Causes and Advancing Registry Science. Circ Heart Fail 2024; 17:e011095. [PMID: 38626067 PMCID: PMC11027941 DOI: 10.1161/circheartfailure.123.011095] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/26/2024] [Indexed: 04/18/2024]
Abstract
Heart failure (HF) is a well-described final common pathway for a broad range of diseases however substantial confusion exists regarding how to describe, study, and track these underlying etiologic conditions. We describe (1) the overlap in HF etiologies, comorbidities, and case definitions as currently used in HF registries led or managed by members of the global HF roundtable; (2) strategies to improve the quality of evidence on etiologies and modifiable risk factors of HF in registries; and (3) opportunities to use clinical HF registries as a platform for public health surveillance, implementation research, and randomized registry trials to reduce the global burden of noncommunicable diseases. Investment and collaboration among countries to improve the quality of evidence in global HF registries could contribute to achieving global health targets to reduce noncommunicable diseases and overall improvements in population health.
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Affiliation(s)
- Anubha Agarwal
- Washington University in St. Louis School of Medicine, MO (A.A.)
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (J.T.)
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates (W.A.)
| | - Christiane Angermann
- Comprehensive Heart Failure Center, University Hospital Wuerzburg, Germany (C.A.)
| | | | - Hyunjai Cho
- Seoul National University Hospital, Korea (H.C., D.-J.C.)
| | - Don-Ju Choi
- Seoul National University Hospital, Korea (H.C., D.-J.C.)
| | | | - Gerasimos Filippatos
- University of Cyprus, School of Medicine and National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Greece (G.F.)
| | | | | | - Lars Lund
- Karolinska University Hospital, Stockholm, Sweden (L.L.)
| | - Fred Masoudi
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora (F.M.)
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.)
| | - Asad Pathan
- Tabba Heart Institute Karachi, Pakistan (A.P.)
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, United Kingdom (P.P.)
| | - Fausto Pinto
- Santa Maria University Hospital, University of Lisbon, Portugal (F.P.)
| | - Antonio Luiz Ribeiro
- Hospital das Clinicas and School of Medicine, Unversidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.)
| | - Stuart Rich
- Northwestern University Feinberg School of Medicine, Chicago, IL (S.R., C.Y.)
| | - Yasuhiko Sakata
- Tohoku University Graduate School of Medicine, Sendai, Japan (Y.S.)
- National Cerebral and Cardiovascular Center, Suita, Japan (Y.S.)
| | - Karen Sliwa
- University of Cape Town, South Africa (K.S.)
| | | | - Renee Wong
- Heart Failure and Arrhythmias Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.W.)
| | - Clyde Yancy
- Northwestern University Feinberg School of Medicine, Chicago, IL (S.R., C.Y.)
| | - Kelvin Yiu
- Institute of Cardiovascular Science and Medicine, Hong Kong University, Hong Kong and Department of Medicine, University of Hong Kong-Shenzhen Hospital, China (K.Y.)
| | - Jian Zhang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (J.Z., Y.Z.)
| | - Yuhui Zhang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (J.Z., Y.Z.)
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore (C.S.P.L.)
- Duke-NUS Medical School, Singapore and University Medical Centre Groningen, the Netherlands (C.S.P.L.)
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5
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Firima E, Gonzalez L, Manthabiseng M, Bane M, Lukau B, Leigh B, Kaufmann BA, Weisser M, Amstutz A, Tromp J, Labhardt ND, Burkard T. Implementing focused echocardiography and AI-supported analysis in a population-based survey in Lesotho: implications for community-based cardiovascular disease care models. Hypertens Res 2024; 47:708-713. [PMID: 38228749 PMCID: PMC10912015 DOI: 10.1038/s41440-023-01559-6] [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] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 01/18/2024]
Abstract
In settings where access to expert echocardiography is limited, focused echocardiography, combined with artificial intelligence (AI)-supported analysis, may improve diagnosis and monitoring of left ventricular hypertrophy (LVH). Sixteen nurses/nurse-assistants without prior experience in echocardiography underwent a 2-day hands-on intensive training to learn how to assess parasternal long axis views (PLAX) using an inexpensive hand-held ultrasound device in Lesotho, Southern Africa. Loops were stored on a cloud-drive, analyzed using deep learning algorithms at the University Hospital Basel, and afterwards confirmed by a board-certified cardiologist. The nurses/nurse-assistants obtained 756 echocardiograms. Of the 754 uploaded image files, 628 (83.3%) were evaluable by deep learning algorithms. Of those, results of 514/628 (81.9%) were confirmed by a cardiologist. Of the 126 not evaluable by the AI algorithm, 46 (36.5%) were manually evaluable. Overall, 660 (87.5%) uploaded files were evaluable and confirmed. Following short-term training of nursing cadres, a high proportion of obtained PLAX was evaluable using AI-supported analysis. This could be a basis for AI- and telemedical support in hard-to-reach areas with minimal resources.
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Affiliation(s)
- Emmanuel Firima
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Lucia Gonzalez
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | | | | | - Bailah Leigh
- University of Sierra Leone, Freetown, Sierra Leone
| | - Beat A Kaufmann
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Maja Weisser
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
| | - Alain Amstutz
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Niklaus Daniel Labhardt
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Thilo Burkard
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland
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6
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Tromp J, Sarra C, Nidhal B, Mejdi BM, Zouari F, Hummel Y, Mzoughi K, Kraiem S, Fehri W, Gamra H, Lam CSP, Mebazaa A, Addad F. Nurse-led home-based detection of cardiac dysfunction by ultrasound: results of the CUMIN pilot study. Eur Heart J Digit Health 2024; 5:163-169. [PMID: 38505488 PMCID: PMC10944680 DOI: 10.1093/ehjdh/ztad079] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/12/2023] [Accepted: 11/07/2023] [Indexed: 03/21/2024]
Abstract
Aims Access to echocardiography is a significant barrier to heart failure (HF) care in many low- and middle-income countries. In this study, we hypothesized that an artificial intelligence (AI)-enhanced point-of-care ultrasound (POCUS) device could enable the detection of cardiac dysfunction by nurses in Tunisia. Methods and results This CUMIN study was a prospective feasibility pilot assessing the diagnostic accuracy of home-based AI-POCUS for HF conducted by novice nurses compared with conventional clinic-based transthoracic echocardiography (TTE). Seven nurses underwent a one-day training program in AI-POCUS. A total of 94 patients without a previous HF diagnosis received home-based AI-POCUS, POC N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, and clinic-based TTE. The primary outcome was the sensitivity of AI-POCUS in detecting a left ventricular ejection fraction (LVEF) <50% or left atrial volume index (LAVI) >34 mL/m2, using clinic-based TTE as the reference. Out of seven nurses, five achieved a minimum standard to participate in the study. Out of the 94 patients (60% women, median age 67), 16 (17%) had an LVEF < 50% or LAVI > 34 mL/m2. AI-POCUS provided an interpretable LVEF in 75 (80%) patients and LAVI in 64 (68%). The only significant predictor of an interpretable LVEF or LAVI proportion was the nurse operator. The sensitivity for the primary outcome was 92% [95% confidence interval (CI): 62-99] for AI-POCUS compared with 87% (95% CI: 60-98) for NT-proBNP > 125 pg/mL, with AI-POCUS having a significantly higher area under the curve (P = 0.040). Conclusion The study demonstrated the feasibility of novice nurse-led home-based detection of cardiac dysfunction using AI-POCUS in HF patients, which could alleviate the burden on under-resourced healthcare systems.
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Affiliation(s)
- Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore & The National University Health System, 12 Science Drive 2, #10-01, Singapore 117549, Singapore
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Chenik Sarra
- Military Hospital Tunis, Q5PH+896, Tunis, Tunisia
| | - Bouchahda Nidhal
- Fattouma Bourguiba University Hospital—Research Laboratory LR12SP16 and University of Monastir, QRCM+4GJ, Monastir, Tunisia
| | - Ben Messaoud Mejdi
- Fattouma Bourguiba University Hospital—Research Laboratory LR12SP16 and University of Monastir, QRCM+4GJ, Monastir, Tunisia
| | - Fourat Zouari
- Hannibal Clinic, Rue de la feuille d'Erable - les berges du lac 2, Tunis, Tunisia
| | - Yoran Hummel
- Us2.ai, 2 College Rd, #02-00, Singapore 169850, Singapore
| | - Khadija Mzoughi
- Faculty of Medicine of Tunis, Habib Thameur Hospital Tunis & University of Tunis El Manar, Q5PG+CJ7, Rue Ali Ben Ayed, Tunis, Tunisia
| | - Sondes Kraiem
- Faculty of Medicine of Tunis, Habib Thameur Hospital Tunis & University of Tunis El Manar, Q5PG+CJ7, Rue Ali Ben Ayed, Tunis, Tunisia
| | - Wafa Fehri
- Military Hospital Tunis, Q5PH+896, Tunis, Tunisia
| | - Habib Gamra
- Fattouma Bourguiba University Hospital—Research Laboratory LR12SP16 and University of Monastir, QRCM+4GJ, Monastir, Tunisia
| | - Carolyn S P Lam
- Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
- National Heart Centre Singapore, 5 Hospital Dr, Singapore 169609, Singapore
| | - Alexandre Mebazaa
- Université Paris Cité, MASCOT Inserm Unit, 45 Rue des Saints-Pères, 75006 Paris, France
- Department of Anesthesia, Burn and Critical Care Medicine, AP-HP, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Faouzi Addad
- Hannibal Clinic, Rue de la feuille d'Erable - les berges du lac 2, Tunis, Tunisia
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7
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van Essen BJ, Tharshana GN, Ouwerkerk W, Yeo PSD, Sim D, Jaufeerally F, Ong HY, Ling LH, Soon DKN, Lee SGS, Leong G, Loh SY, San Tan R, Ramachandra CJ, Hausenloy DJ, Liew OW, Chong J, Voors AA, Lam CSP, Richards AM, Tromp J. Distinguishing heart failure with reduced ejection fraction from heart failure with preserved ejection fraction: A phenomics approach. Eur J Heart Fail 2024. [PMID: 38311963 DOI: 10.1002/ejhf.3156] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 02/06/2024] Open
Abstract
AIM Pathophysiological differences between patients with heart failure with preserved (HFpEF) and reduced (HFrEF) ejection fraction (EF) remain unclear. Therefore we used a phenomics approach, integrating selected proteomics data with patient characteristics and cardiac structural and functional parameters, to get insight into differential pathophysiological mechanisms and identify potential treatment targets. METHODS AND RESULTS We report data from a representative subcohort of the prospective Singapore Heart Failure Outcomes and Phenotypes (SHOP), including patients with HFrEF (EF <40%, n = 217), HFpEF (EF ≥50%, n = 213), and age- and sex-matched controls without HF (n = 216). We measured 92 biomarkers using a proximity extension assay and assessed cardiac structure and function in all participants using echocardiography. We used multi-block projection to latent structure analysis to integrate clinical, echocardiographic, and biomarker variables. Candidate biomarker targets were cross-referenced with small-molecule and drug databases. The total cohort had a median age of 65 years (interquartile range 60-71), and 50% were women. Protein profiles strongly discriminated patients with HFrEF (area under the curve [AUC] = 0.89) and HFpEF (AUC = 0.94) from controls. Phenomics analyses identified unique druggable inflammatory markers in HFpEF from the tumour necrosis factor receptor superfamily (TNFRSF), which were positively associated with hypertension, diabetes, and increased posterior and relative wall thickness. In HFrEF, interleukin (IL)-8 and IL-6 were possible targets related to lower EF and worsening renal function. CONCLUSION We identified pathophysiological mechanisms related to increased cardiac wall thickness parameters and potentially druggable inflammatory markers from the TNFRSF in HFpEF.
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Affiliation(s)
- Bart J van Essen
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ganash N Tharshana
- Saw Swee Hock School of Public Health and The National University Health System, Singapore, Singapore
| | - Wouter Ouwerkerk
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam, The Netherlands
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | | | - David Sim
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Fazlur Jaufeerally
- Duke-NUS Medical School, Singapore, Singapore
- Department of Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Lieng Hsi Ling
- National University Heart Centre Singapore, Cardiovascular Research Institute Singapore, National University of Singapore, Singapore, Singapore
| | | | - Shao Guang Sheldon Lee
- National University Heart Centre Singapore, Cardiovascular Research Institute Singapore, National University of Singapore, Singapore, Singapore
| | | | | | - Ru San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Chrishan J Ramachandra
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Changi General Hospital, Singapore, Singapore
| | - Derek J Hausenloy
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Changi General Hospital, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Oi Wai Liew
- National University Heart Centre Singapore, Cardiovascular Research Institute Singapore, National University of Singapore, Singapore, Singapore
| | - Jenny Chong
- National University Heart Centre Singapore, Cardiovascular Research Institute Singapore, National University of Singapore, Singapore, Singapore
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Carolyn S P Lam
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - A Mark Richards
- Khoo Teck Puat Hospital, Singapore, Singapore
- Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Jasper Tromp
- Saw Swee Hock School of Public Health and The National University Health System, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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8
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Baumhove L, Bomer N, Tromp J, van Essen BJ, Dickstein K, Cleland JG, Lang CC, Ng LL, Samani NJ, Anker SD, Metra M, van Veldhuisen DJ, van der Meer P, Voors AA. Clinical characteristics and prognosis of patients with heart failure and high concentrations of interleukin-17D. Int J Cardiol 2024; 396:131384. [PMID: 37739044 DOI: 10.1016/j.ijcard.2023.131384] [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: 07/12/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
AIMS Heart failure (HF) is associated with cytokine activation and inflammation. Experimental evidence suggests that plasma interleukin-17 (IL-17) is associated with myocardial fibrosis and cardiac dysfunction in HF. IL-17D, a subtype of IL-17 originates from particular tissues such as the heart. However, there is very limited data on the IL-17 cytokine family in patients with HF. Therefore, we investigated the association between circulating IL-17D levels, clinical characteristics and outcome in a large cohort of patients with heart failure. METHODS AND RESULTS Plasma IL-17D was measured in 2032 patients with HF from 11 European countries using a proximity extension assay. The primary outcome was a composite of HF hospitalization or all-cause mortality. Patients with higher plasma IL-17D concentrations were more likely to have atrial fibrillation (AF), renal dysfunction and heart failure with preserved ejection fraction (HFpEF) and had higher plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations (all p < 0.001). IL-17D was not associated with interleukin-6 (IL-6) or C-reactive protein (CRP) concentrations. After adjustment for confounders in a multivariable Cox regression analysis, patients in the highest quartile of plasma IL-17D had a significantly increased risk of the composite outcome of HF hospitalization or all-cause mortality compared to patients in the lowest quartile [Hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.05-1.57]. CONCLUSION In patients with HF, elevated plasma IL-17D concentrations are associated with higher plasma NT-proBNP concentrations and a higher prevalence of AF and renal dysfunction. High IL-17D concentrations are independently associated with worse outcome.
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Affiliation(s)
- Lukas Baumhove
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Nils Bomer
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Jasper Tromp
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands; Duke-NUS Medical School, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Bart J van Essen
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - John G Cleland
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow. UK
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
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9
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Ho AFW, Zheng H, Ng ZHC, Pek PP, Ng BJH, Chin YH, Lam TJR, Østbye T, Tromp J, Ong MEH, Yeo JW. Incidence and Long-Term Outcomes of Acute Myocardial Infarction Among Survivors of Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2024; 13:e031716. [PMID: 38156500 PMCID: PMC10863809 DOI: 10.1161/jaha.123.031716] [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: 07/11/2023] [Accepted: 10/31/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Despite the increasing long-term survival after out-of-hospital cardiac arrest (OHCA), the risk of subsequent acute myocardial infarction (AMI) remains poorly understood. We aimed to determine the incidence, predictors, and long-term outcomes of AMI among survivors of OHCA. METHODS AND RESULTS We assembled a retrospective cohort of 882 patients with OHCA who survived to 30 days or discharge from the hospital between 2010 and 2019. Survivors of OHCA had an increased risk of subsequent AMI, defined as AMI occurring 30 days after index OHCA or following discharge from the hospital after OHCA, compared with the general population when matched for age and sex (standardized incidence ratio, 4.64 [95% CI, 3.52-6.01]). Age-specific risks of subsequent AMI for men (standardized incidence ratio, 3.29 [95% CI, 2.39-4.42]) and women (standardized incidence ratio, 6.15 [95% CI, 3.27-10.52]) were significantly increased. A total of 7.2%, 8.3%, and 14.3% of survivors of OHCA had a subsequent AMI at 3 years, 5 years, and end of follow-up, respectively. Age at OHCA (hazard ratio [HR], 1.04 [95% CI, 1.02-1.06]) and past medical history of prior AMI, defined as any AMI preceding or during the index OHCA event (HR, 1.84 [95% CI, 1.05-3.22]), were associated with subsequent AMI, while an initial shockable rhythm was not (HR, 1.00 [95% CI, 0.52-1.94]). Survivors of OHCA with subsequent AMI had a higher risk of death (HR, 1.58 [95% CI, 1.12-2.22]) than those without. CONCLUSIONS Survivors of OHCA are at an increased risk of subsequent AMI compared with the general population. Prior AMI, but not an initial shockable rhythm, increases this risk, while subsequent AMI predicts death. Preventive measures for AMI including cardiovascular risk factor control and revascularization may thus improve outcomes in selected patients with cardiac pathogenesis.
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Affiliation(s)
- Andrew Fu Wah Ho
- Pre‐Hospital and Emergency Research Centre, Health Services & Systems Research, Duke‐NUS Medical SchoolSingapore
- Department of Emergency MedicineSingapore General HospitalSingapore
| | - Huili Zheng
- National Registry of Diseases Office, Health Promotion BoardSingapore
| | - Zi Hui Celeste Ng
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Pin Pin Pek
- Pre‐Hospital and Emergency Research Centre, Health Services & Systems Research, Duke‐NUS Medical SchoolSingapore
| | - Benny Jun Heng Ng
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Yip Han Chin
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | | | - Truls Østbye
- Programme in Health Services & Systems Research, Duke NUS Medical SchoolSingapore
| | - Jasper Tromp
- Saw Swee Hock School of Public HealthNational University of Singapore & the National University Health SystemSingapore
- Duke‐NUS Medical SchoolSingapore
| | - Marcus Eng Hock Ong
- Pre‐Hospital and Emergency Research Centre, Health Services & Systems Research, Duke‐NUS Medical SchoolSingapore
- Department of Emergency MedicineSingapore General HospitalSingapore
| | - Jun Wei Yeo
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
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10
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Myhre PL, Hung CL, Frost MJ, Jiang Z, Ouwerkerk W, Teramoto K, Svedlund S, Saraste A, Hage C, Tan RS, Beussink-Nelson L, Fermer ML, Gan LM, Hummel YM, Lund LH, Shah SJ, Lam CSP, Tromp J. External validation of a deep learning algorithm for automated echocardiographic strain measurements. Eur Heart J Digit Health 2024; 5:60-68. [PMID: 38264705 PMCID: PMC10802824 DOI: 10.1093/ehjdh/ztad072] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/08/2023] [Accepted: 10/12/2023] [Indexed: 01/25/2024]
Abstract
Aims Echocardiographic strain imaging reflects myocardial deformation and is a sensitive measure of cardiac function and wall-motion abnormalities. Deep learning (DL) algorithms could automate the interpretation of echocardiographic strain imaging. Methods and results We developed and trained an automated DL-based algorithm for left ventricular (LV) strain measurements in an internal dataset. Global longitudinal strain (GLS) was validated externally in (i) a real-world Taiwanese cohort of participants with and without heart failure (HF), (ii) a core-lab measured dataset from the multinational prevalence of microvascular dysfunction-HF and preserved ejection fraction (PROMIS-HFpEF) study, and regional strain in (iii) the HMC-QU-MI study of patients with suspected myocardial infarction. Outcomes included measures of agreement [bias, mean absolute difference (MAD), root-mean-squared-error (RMSE), and Pearson's correlation (R)] and area under the curve (AUC) to identify HF and regional wall-motion abnormalities. The DL workflow successfully analysed 3741 (89%) studies in the Taiwanese cohort, 176 (96%) in PROMIS-HFpEF, and 158 (98%) in HMC-QU-MI. Automated GLS showed good agreement with manual measurements (mean ± SD): -18.9 ± 4.5% vs. -18.2 ± 4.4%, respectively, bias 0.68 ± 2.52%, MAD 2.0 ± 1.67, RMSE = 2.61, R = 0.84 in the Taiwanese cohort; and -15.4 ± 4.1% vs. -15.9 ± 3.6%, respectively, bias -0.65 ± 2.71%, MAD 2.19 ± 1.71, RMSE = 2.78, R = 0.76 in PROMIS-HFpEF. In the Taiwanese cohort, automated GLS accurately identified patients with HF (AUC = 0.89 for total HF and AUC = 0.98 for HF with reduced ejection fraction). In HMC-QU-MI, automated regional strain identified regional wall-motion abnormalities with an average AUC = 0.80. Conclusion DL algorithms can interpret echocardiographic strain images with similar accuracy as conventional measurements. These results highlight the potential of DL algorithms to democratize the use of cardiac strain measurements and reduce time-spent and costs for echo labs globally.
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Affiliation(s)
- Peder L Myhre
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- K.G. Jebsen Center of Cardiac Biomarkers, University of Oslo, Oslo, Norway
| | - Chung-Lieh Hung
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei, Taiwan
| | | | | | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore, Singapore
- Department of Dermatology, Amsterdam Institute for Infection and Immunity, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kanako Teramoto
- Department of Biostatistics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Sara Svedlund
- Department of Clinical Physiology, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Ribocure Pharmaceuticals AB/Ribo Life Science Co Ltd, Gothenburg, Sweden
| | - Antti Saraste
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Camilla Hage
- Department of Cardiology, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore, Singapore
| | - Lauren Beussink-Nelson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maria L Fermer
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Li-Ming Gan
- Ribocure Pharmaceuticals AB/Ribo Life Science Co Ltd, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | | | - Lars H Lund
- Department of Cardiology, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Jasper Tromp
- National Heart Centre Singapore, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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11
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Erhardsson M, Ljung Faxén U, Venkateshvaran A, Svedlund S, Saraste A, Lagerström Fermer M, Gan L, Shah SJ, Tromp J, SP Lam C, Lund LH, Hage C. Regional differences and coronary microvascular dysfunction in heart failure with preserved ejection fraction. ESC Heart Fail 2023; 10:3729-3734. [PMID: 37920127 PMCID: PMC10682847 DOI: 10.1002/ehf2.14569] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 09/05/2023] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
AIMS In heart failure with preserved ejection fraction (HFpEF), regional heterogeneity of clinical phenotypes is increasingly recognized, with coronary microvascular dysfunction (CMD) potentially being a common shared feature. We sought to determine the regional differences in clinical characteristics and prevalence of CMD in HFpEF. METHODS AND RESULTS We analysed clinical characteristics and CMD in 202 patients with stable HFpEF (left ventricular ejection fraction ≥40%) in Finland, Singapore, Sweden, and United States in the multicentre PROMIS-HFpEF study. Patients with unrevascularized macrovascular coronary artery disease were excluded. CMD was assessed using Doppler echocardiography and defined as coronary flow reserve (adenosine-induced vs. resting flow) < 2.5. Patients from Singapore had the lowest body mass index yet highest prevalence of hypertension, dyslipidaemia, and diabetes; patients from Finland and Sweden were oldest, with the most atrial fibrillation, chronic kidney disease, and high smoking rates; and those from United States were youngest and most obese. The prevalence of CMD was 88% in Finland, 80% in Singapore, 77% in Sweden, and 59% in the United States; however, non-significant after adjustment for age, sex, N-terminal pro-brain natriuretic peptide, smoking, left atrial reservoir strain, and atrial fibrillation. Associations between CMD and clinical characteristics did not differ based on region (interaction analysis). CONCLUSIONS Despite regional differences in clinical characteristics, CMD was present in the majority of patients with HFpEF across different regions of the world with the lowest prevalence in the United States. This difference was explained by differences in patient characteristics. CMD could be a common therapeutic target across regions.
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Affiliation(s)
- Mikael Erhardsson
- Department of Medicine, Cardiology UnitKarolinska InstitutetStockholmSweden
| | - Ulrika Ljung Faxén
- Department of Medicine, Cardiology UnitKarolinska InstitutetStockholmSweden
- Karolinska University Hospital, Perioperative Medicine and Intensive CareStockholmSweden
| | | | - Sara Svedlund
- Department of Clinical Physiology, Institute of Medicine, Sahlgrenska University HospitalUniversity of GothenburgGothenburgSweden
| | - Antti Saraste
- Heart CenterTurku University Hospital, University of TurkuTurkuFinland
| | | | - Li‐Ming Gan
- Ribocure Pharmaceuticals AB, Sweden, Suzhou Ribo Life Science Co. Ltd.China
- Department of Cardiology, Department of Molecular and Clinical Medicine, Institute of MedicineSahlgrenska Academy at the University of GothenburgGothenburgSweden
| | - Sanjiv J. Shah
- Division of Cardiology, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Jasper Tromp
- Saw Swee Hock School of Public HealthNational University of Singapore & the National University Health SystemSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- National Heart Centre Singapore, Duke‐National University of SingaporeSingaporeSingapore
| | - Carolyn SP Lam
- National Heart Centre Singapore, Duke‐National University of SingaporeSingaporeSingapore
- University Medical Centre GroningenGroningenthe Netherlands
| | - Lars H. Lund
- Department of Medicine, Cardiology UnitKarolinska InstitutetStockholmSweden
- Karolinska University Hospital, Heart and Vascular ThemeStockholmSweden
| | - Camilla Hage
- Department of Medicine, Cardiology UnitKarolinska InstitutetStockholmSweden
- Karolinska University Hospital, Heart and Vascular ThemeStockholmSweden
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12
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Gerhardt T, Gerhardt LMS, Ouwerkerk W, Roth GA, Dickstein K, Collins SP, Cleland JGF, Dahlstrom U, Tay WT, Ertl G, Hassanein M, Perrone SV, Ghadanfar M, Schweizer A, Obergfell A, Filippatos G, Lam CSP, Tromp J, Angermann CE. Multimorbidity in patients with acute heart failure across world regions and country income levels (REPORT-HF): a prospective, multicentre, global cohort study. Lancet Glob Health 2023; 11:e1874-e1884. [PMID: 37973338 DOI: 10.1016/s2214-109x(23)00408-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Multimorbidity (two or more comorbidities) is common among patients with acute heart failure, but comprehensive global information on its prevalence and clinical consequences across different world regions and income levels is scarce. This study aimed to investigate the prevalence of multimorbidity and its effect on pharmacotherapy and prognosis in participants of the REPORT-HF study. METHODS REPORT-HF was a prospective, multicentre, global cohort study that enrolled adults (aged ≥18 years) admitted to hospital with a primary diagnosis of acute heart failure from 358 hospitals in 44 countries on six continents. Patients who currently or recently participated in a clinical treatment trial were excluded. Follow-up data were collected at 1-year post-discharge. The primary outcome was 1-year post-discharge mortality. All patients in the REPORT-HF cohort with full data on comorbidities were eligible for the present study. We stratified patients according to the number of comorbidities, and countries by world region and country income level. We used one-way ANOVA, χ2 test, or Mann-Whitney U test for comparisons between groups, as applicable, and Cox regression to analyse the association between multimorbidity and 1-year mortality. FINDINGS Between July 23, 2014, and March 24, 2017, 18 553 patients were included in the REPORT-HF study. Of these, 18 528 patients had full data on comorbidities, of whom 11 360 (61%) were men and 7168 (39%) were women. Prevalence rates of multimorbidity were lowest in southeast Asia (72%) and highest in North America (92%). Fewer patients from lower-middle-income countries had multimorbidity than patients from high-income countries (73% vs 85%, p<0·0001). With increasing comorbidity burden, patients received fewer guideline-directed heart failure medications, yet more drugs potentially causing or worsening heart failure. Having more comorbidities was associated with worse outcomes: 1-year mortality increased from 13% (no comorbidities) to 26% (five or more comorbidities). This finding was independent of common baseline risk factors, including age and sex. The population-attributable fraction of multimorbidity for mortality was higher in high-income countries than in upper-middle-income or lower-middle-income countries (for patients with five or more comorbidities: 61% vs 27% and 31%, respectively). INTERPRETATION Multimorbidity is highly prevalent among patients with acute heart failure across world regions, especially in high-income countries, and is associated with higher mortality, less prescription of guideline-directed heart failure pharmacotherapy, and increased use of potentially harmful medications. FUNDING Novartis Pharma. TRANSLATIONS For the Arabic, French, German, Hindi, Mandarin, Russian and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Teresa Gerhardt
- Cardiovascular Research Institute and the Department of Medicine, Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany; Berlin Institute of Health, Berlin, Germany; DZHK German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Louisa M S Gerhardt
- Fifth Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore; Department of Dermatology, University of Amsterdam Medical Centre, Amsterdam, Netherlands
| | - Gregory A Roth
- Division of Cardiology, Department of Medicine and Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kenneth Dickstein
- University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | - Sean P Collins
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, TN, USA; Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center, Nashville, TN, USA
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health & Well-Being, University of Glasgow, Glasgow, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Ulf Dahlstrom
- Department of Cardiology, Linkoping University, Linkoping, Sweden; Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | | | - Georg Ertl
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Würzburg, Germany; Department of Medicine 1, University Hospital Würzburg, Würzburg, Germany
| | - Mahmoud Hassanein
- Alexandria University, Faculty of Medicine, Cardiology Department, Alexandria, Egypt
| | - Sergio V Perrone
- FLENI Institute, Argentine Institute of Diagnosis and Treatment, Hospital El Cruce de Florencio Barela, Universidad Catolica Argentina, Buenos Aires, Argentina
| | | | | | | | - Gerasimos Filippatos
- School of Medicine, University of Cyprus, Nicosia, Cyprus; School of Medicine, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore; University Medical Centre Groningen, University of Groningen Department of Cardiology, Groningen, Netherlands
| | - Jasper Tromp
- Duke-National University of Singapore Medical School, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and the National University Health System, Singapore
| | - Christiane E Angermann
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Würzburg, Germany; Department of Medicine 1, University Hospital Würzburg, Würzburg, Germany.
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13
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Kodogo V, Viljoen C, Hoevelmann J, Chakafana G, Tromp J, Farhan HA, Goland S, van der Meer P, Karaye K, Kryczka K, Hilfiker-Kleiner D, Jackson A, Mebazaa A, Böhm M, Pieske B, Bauersachs J, Bell L, Sliwa K. Proteomic Profiling in Patients With Peripartum Cardiomyopathy: A Biomarker Study of the ESC EORP PPCM Registry. JACC Heart Fail 2023; 11:1708-1725. [PMID: 37804308 DOI: 10.1016/j.jchf.2023.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/14/2023] [Accepted: 07/25/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) remains an important cause of maternal morbidity and mortality globally. The pathophysiology remains incompletely understood, and the diagnosis is often missed or delayed. OBJECTIVES This study explored the serum proteome profile of patients with newly diagnosed PPCM, as compared with matched healthy postpartum mothers, to unravel novel protein biomarkers that would further an understanding of the pathogenesis of PPCM and improve diagnostic precision. METHODS Study investigators performed untargeted serum proteome profiling using data-independent acquisition-based label-free quantitative liquid chromatography-tandem mass spectrometry on 84 patients with PPCM, as compared with 29 postpartum healthy controls (HCs). Significant changes in protein intensities were determined with nonpaired Student's t-tests and were further classified by using the Boruta algorithm. The proteins' diagnostic performance was evaluated by area under the curve (AUC) and validated using the 10-fold cross-validation. RESULTS Patients with PPCM presented with a mean left ventricular ejection fraction of 33.5% ± 9.3% vs 57.0% ± 8.8% in HCs (P < 0.001). Study investigators identified 15 differentially up-regulated and 14 down-regulated proteins in patients with PPCM compared with HCs. Seven of these proteins were recognized as significant by the Boruta algorithm. The combination of adiponectin, quiescin sulfhydryl oxidase 1, inter-α-trypsin inhibitor heavy chain, and N-terminal pro-B-type natriuretic peptide had the best diagnostic precision (AUC: 0.90; 95% CI: 0.84-0.96) to distinguish patients with PPCM from HCs. CONCLUSIONS Salient biologic themes related to immune response proteins, inflammation, fibrosis, angiogenesis, apoptosis, and coagulation were predominant in patients with PPCM compared with HCs. These newly identified proteins warrant further evaluation to establish their role in the pathogenesis of PPCM and potential use as diagnostic markers.
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Affiliation(s)
- Vitaris Kodogo
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Charle Viljoen
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Julian Hoevelmann
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Internal Medicine III-Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Graham Chakafana
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Chemistry and Biochemistry, Hampton University, Hampton, Virginia, USA
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore and the National University Health System, Singapore; Duke-National University of Singapore Medical School, Singapore
| | | | - Sorel Goland
- Heart Institute, Kaplan Medical Center, Rehovot, affiliated with the Hebrew University, Jerusalem, Israel
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Kamilu Karaye
- Department of Medicine, Bayero University, Kano, Nigeria
| | | | | | - Alice Jackson
- Institute of Cardiovascular and Medical Sciences, Glasgow University, Glasgow, United Kingdom
| | - Alexandre Mebazaa
- Paris Cité University, French National Institute of Health and Medical Research (INSERM) Cardiovascular MArkers in Stress Conditions (MASCOT), Paris, France; Department of Anesthesiology and Critical Care, Saint Louis Lariboisière Hospitals, Public Assistance Hospital of Paris, Paris, France
| | - Michael Böhm
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa; Internal Medicine Clinic III -Cardiology, Angiology, and Internist Intensive Medicine, Saarland University Hospital, Saarland University, Homburg, Germany
| | - Burkert Pieske
- Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Liam Bell
- Centre for Proteomic and Genomic Research, Cape Town, South Africa, Cape Town, South Africa
| | - Karen Sliwa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa.
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Ouwerkerk W, Belo Pereira JP, Maasland T, Emmens JE, Figarska SM, Tromp J, Koekemoer AL, Nelson CP, Nath M, Romaine SPR, Cleland JGF, Zannad F, van Veldhuisen DJ, Lang CC, Ponikowski P, Filippatos G, Anker S, Metra M, Dickstein K, Ng LL, de Boer RA, van Riel N, Nieuwdorp M, Groen AK, Stroes E, Zwinderman AH, Samani NJ, Lam CSP, Levin E, Voors AA. Multiomics Analysis Provides Novel Pathways Related to Progression of Heart Failure. J Am Coll Cardiol 2023; 82:1921-1931. [PMID: 37940229 DOI: 10.1016/j.jacc.2023.08.053] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Despite major advances in pharmacological treatment for patients with heart failure, residual mortality remains high. This suggests that important pathways are not yet targeted by current heart failure therapies. OBJECTIVES We sought integration of genetic, transcriptomic, and proteomic data in a large cohort of patients with heart failure to detect major pathways related to progression of heart failure leading to death. METHODS We used machine learning methodology based on stacked generalization framework and gradient boosting algorithms, using 54 clinical phenotypes, 403 circulating plasma proteins, 36,046 transcript expression levels in whole blood, and 6 million genomic markers to model all-cause mortality in 2,516 patients with heart failure from the BIOSTAT-CHF (Systems BIOlogy Study to TAilored Treatment in Chronic Heart Failure) study. Results were validated in an independent cohort of 1,738 patients. RESULTS The mean age of the patients was 70 years (Q1-Q3: 61-78 years), 27% were female, median N-terminal pro-B-type natriuretic peptide was 4,275 ng/L (Q1-Q3: 2,360-8,486 ng/L), and 7% had heart failure with preserved ejection fraction. During a median follow-up of 21 months, 657 (26%) of patients died. The 4 major pathways with a significant association to all-cause mortality were: 1) the PI3K/Akt pathway; 2) the MAPK pathway; 3) the Ras signaling pathway; and 4) epidermal growth factor receptor tyrosine kinase inhibitor resistance. Results were validated in an independent cohort of 1,738 patients. CONCLUSIONS A systems biology approach integrating genomic, transcriptomic, and proteomic data identified 4 major pathways related to mortality. These pathways are related to decreased activation of the cardioprotective ERBB2 receptor, which can be modified by neuregulin.
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Affiliation(s)
- Wouter Ouwerkerk
- Department of Dermatology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; National Heart Centre Singapore, Singapore.
| | - Joao P Belo Pereira
- Department of Experimental Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; HORAIZON BV, Delft, the Netherlands
| | - Troy Maasland
- Department of Experimental Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; HORAIZON BV, Delft, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Johanna E Emmens
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sylwia M Figarska
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jasper Tromp
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; National Heart Centre Singapore and Duke-National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Andrea L Koekemoer
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Mintu Nath
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Simon P R Romaine
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, United Kingdom; National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Faiez Zannad
- Clinical Investigation Center 1433, Université de Lorraine, Nancy, France; Clinical investigation Center 1433, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, Nancy, France; French Clinical Research Infrastructure Network-Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, French Institute of Health and Medical Research, Vandoeuvre-lès-Nancy, France
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Chim C Lang
- Cardiology, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Piotr Ponikowski
- Institute for Heart Diseases, Medical University, Wroclaw, Poland
| | - Gerasimos Filippatos
- Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefan Anker
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Brescia, Italy
| | - Kenneth Dickstein
- Stavanger University Hospital, University of Bergen, Stavanger, Norway
| | - Leong L Ng
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Natal van Riel
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Vascular Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Albert K Groen
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Erik Stroes
- Department of Vascular Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | | | - Evgeni Levin
- Department of Experimental Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; HORAIZON BV, Delft, the Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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15
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Lo JJ, Tromp J, Ouwerkwerk W, Ong MEH, Tan K, Sim D, Graves N. Examining predictors for 6-month mortality and healthcare utilization for patients admitted for heart failure in the acute care setting. Int J Cardiol 2023; 390:131237. [PMID: 37536421 DOI: 10.1016/j.ijcard.2023.131237] [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: 02/23/2023] [Revised: 06/21/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Acute heart failure (AHF) is a leading cause of mortality and hospitalization. Past studies reported increased healthcare spending in the last year of life in high-income countries, and this has been characterized as inappropriate healthcare resource utilization. The study aimed to examine potentially (in)appropriate healthcare utilization by comparing healthcare utilization patterns across predicted and observed 6-month mortality among patients admitted for HF. METHODS We conducted a retrospective cohort study among patients presenting at the emergency department (ED) of a tertiary hospital with HF as primary diagnosis and admitted after their ED discharge. We used LASSO Cox proportional hazards models to predict 6-month mortality, and estimated healthcare utilization patterns of predicted and observed mortality across inpatient healthcare services. RESULTS 3946 patients were admitted into the emergency department with a primary diagnosis of HF. From 57 candidate variables, 17 were retained in the final 6- month mortality model (C-statistic 0.66). Patients who died within 6-months of ED admission had longer length of stay (LOS) and less inpatient surgeries than those who survived. Patients with a greater predicted mortality risk were admitted to the ICU more often and had a longer LOS than those with a lower predicted mortality risk. CONCLUSIONS There were significant differences in healthcare resource utilization in patients admitted for AHF across predicted versus actual mortality. Lack of information on patients' preferences prevents the estimation of (in)appropriateness. Future studies should account for these considerations to estimate inappropriate healthcare utilization among these patients.
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Affiliation(s)
- Jamie J Lo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Wouter Ouwerkwerk
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Institute for Infection and Immunity, the Netherlands; National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Marcus E H Ong
- Health Services and System Research, Duke-NUS Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Kenneth Tan
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - David Sim
- National Heart Centre Singapore, Singapore
| | - Nicholas Graves
- Health Services and System Research, Duke-NUS Medical School, Singapore
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16
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Burger PM, Savarese G, Tromp J, Adamson C, Jhund PS, Benson L, Hage C, Tay WT, Solomon SD, Packer M, Rossello X, McEvoy JW, De Bacquer D, Timmis A, Vardas P, Graham IM, Di Angelantonio E, Visseren FLJ, McMurray JJV, Lam CSP, Lund LH, Koudstaal S, Dorresteijn JAN, Mosterd A. Personalized lifetime prediction of survival and treatment benefit in patients with heart failure with reduced ejection fraction: The LIFE-HF model. Eur J Heart Fail 2023; 25:1962-1975. [PMID: 37691140 DOI: 10.1002/ejhf.3028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/28/2023] [Revised: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023] Open
Abstract
AIMS Although trials have proven the group-level effectiveness of various therapies for heart failure with reduced ejection fraction (HFrEF), important differences in absolute effectiveness exist between individuals. We developed and validated the LIFEtime-perspective for Heart Failure (LIFE-HF) model for the prediction of individual (lifetime) risk and treatment benefit in patients with HFrEF. METHODS AND RESULTS Cox proportional hazards functions with age as the time scale were developed in the PARADIGM-HF and ATMOSPHERE trials (n = 15 415). Outcomes were cardiovascular death, heart failure (HF) hospitalization or cardiovascular death, and non-cardiovascular mortality. Predictors were age, sex, New York Heart Association class, prior HF hospitalization, diabetes mellitus, extracardiac vascular disease, systolic blood pressure, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and glomerular filtration rate. The functions were combined in life-tables to predict individual overall and HF hospitalization-free survival. External validation was performed in the SwedeHF registry, ASIAN-HF registry, and DAPA-HF trial (n = 51 286). Calibration of 2- to 10-year risk was adequate, and c-statistics were 0.65-0.74. An interactive tool was developed combining the model with hazard ratios from trials to allow estimation of an individual's (lifetime) risk and treatment benefit in clinical practice. Applying the tool to the development cohort, combined treatment with a mineralocorticoid receptor antagonist, sodium-glucose cotransporter 2 inhibitor, and angiotensin receptor-neprilysin inhibitor was estimated to afford a median of 2.5 (interquartile range [IQR] 1.7-3.7) and 3.7 (IQR 2.4-5.5) additional years of overall and HF hospitalization-free survival, respectively. CONCLUSION The LIFE-HF model enables estimation of lifelong overall and HF hospitalization-free survival, and (lifetime) treatment benefit for individual patients with HFrEF. It could serve as a tool to improve the management of HFrEF by facilitating personalized medicine and shared decision-making.
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Affiliation(s)
- Pascal M Burger
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- National University Health System Singapore, Singapore, Singapore
| | - Carly Adamson
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Lina Benson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Hage
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Wan Ting Tay
- National Heart Centre Singapore, Singapore, Singapore
| | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Centre, Dallas, TX, USA
| | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Adam Timmis
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Ian M Graham
- School of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin, Ireland
| | | | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
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17
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Ferreira JP, Blatchford JP, Teerlink JR, Kosiborod MN, Angermann CE, Biegus J, Collins SP, Tromp J, Nassif ME, Psotka MA, Comin-Colet J, Mentz RJ, Brueckmann M, Nordaby M, Ponikowski P, Voors AA. Mineralocorticoid receptor antagonist use and the effects of empagliflozin on clinical outcomes in patients admitted for acute heart failure: Findings from EMPULSE. Eur J Heart Fail 2023; 25:1797-1805. [PMID: 37540060 DOI: 10.1002/ejhf.2982] [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: 03/31/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
AIMS In patients hospitalized for acute heart failure (AHF) empagliflozin produced greater clinical benefit than placebo. Many patients with AHF are treated with mineralocorticoid receptor antagonists (MRAs). The interplay between empagliflozin and MRAs in AHF is yet to be explored. This study aimed to evaluate the efficacy and safety of empagliflozin versus placebo according to MRA use at baseline in the EMPULSE trial (NCT04157751). METHODS AND RESULTS In this analysis all comparisons were performed between empagliflozin and placebo, stratified by baseline MRA use. The primary outcome included all-cause death, heart failure events, and a ≥5 point difference in Kansas City Cardiomyopathy Questionnaire (KCCQ) total symptom score at 90 days, assessed using the win ratio (WR). First heart failure hospitalization or cardiovascular death was a secondary outcome. From the 530 patients randomized, 276 (52%) were receiving MRAs at baseline. MRA users were younger, had lower ejection fraction, better renal function, and higher KCCQ scores. The primary outcome showed benefit of empagliflozin irrespective of baseline MRA use (WR 1.46, 95% confidence interval [CI] 1.08-1.97 and WR 1.27, 95% CI 0.93-1.73 in MRA users and non-users, respectively; interaction p = 0.52). The effect of empagliflozin on first heart failure hospitalization or cardiovascular death was not modified by MRA use (hazard ratio [HR] 0.58, 95% CI 0.30-1.11 and HR 0.85, 95% CI 0.47-1.52 in MRA users and non-users, respectively; interaction p = 0.39). Investigator-reported and severe hyperkalaemia events were infrequent (<6%) irrespective of MRA use. CONCLUSIONS In patients admitted for AHF, initiation of empagliflozin produced clinical benefit and was well tolerated irrespective of background MRA use. These findings support the early use of empagliflozin on top of MRA therapy in patients admitted for AHF.
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Affiliation(s)
- João Pedro Ferreira
- Centre d'Investigations Cliniques Plurithématique 1433, INSERM, Université de Lorraine, Nancy, France
- F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
- UnIC@RISE, Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Jonathan P Blatchford
- Elderbrook Solutions GmbH, Bietigheim-Bissingen, Germany on behalf of Boehringer Ingelheim, Pharma GmbH & Co. KG, Biberach, Germany
| | - 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
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas, MO, USA
| | - Christiane E Angermann
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, and Department of Medicine 1, University Hospital Würzburg, Würzburg, Germany
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research and Education Clinical Care, Tennessee Valley Healthcare Facility VA Medical Center, Nashville, TN, USA
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore, the National University Health System, Singapore, Singapore, Singapore
| | - Michael E Nassif
- Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas, MO, USA
| | | | - Josep Comin-Colet
- Hospital Universitari de Bellvitge, University of Barcelona, IDIBELL and CIBERCV, Barcelona, Spain
| | - Robert J Mentz
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Martina Brueckmann
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Matias Nordaby
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Tromp J, Ezekowitz JA, Ouwerkerk W, Chandramouli C, Yiu KH, Angermann CE, Dahlstrom U, Ertl G, Hassanein M, Perrone SV, Ghadanfar M, Schweizer A, Obergfell A, Dickstein K, Collins SP, Filippatos G, Cleland JGF, Lam CSP. Global Variations According to Sex in Patients Hospitalized for Heart Failure in the REPORT-HF Registry. JACC Heart Fail 2023; 11:1262-1271. [PMID: 37678961 DOI: 10.1016/j.jchf.2023.06.028] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Previous reports suggest that risk factors, management, and outcomes of acute heart failure (AHF) may differ by sex, but they rarely extended analysis to low- and middle-income countries. OBJECTIVES In this study, the authors sought to analyze sex differences in treatment and outcomes in patients hospitalized for AHF in 44 countries. METHODS The authors investigated differences between men and women in treatment and outcomes in 18,553 patients hospitalized for AHF in 44 countries in the REPORT-HF (Registry to Assess Medical Practice With Longitudinal Observation for the Treatment of Heart Failure) registry stratified by country income level, income disparity, and world region. The primary outcome was 1-year all-cause mortality. RESULTS Women (n = 7,181) were older than men (n = 11,372), were more likely to have heart failure with preserved left ventricular ejection fraction, had more comorbid conditions except for coronary artery disease, and had more severe signs and symptoms at admission. Coronary angiography, cardiac stress tests, and coronary revascularization were less frequently performed in women than in men. Women with AHF and reduced left ventricular ejection fraction were less likely to receive an implanted device, regardless of region or country income level. Women were more likely to receive treatments that could worsen HF than men (18% vs 13%; P < 0.0001). In countries with low-income disparity, women had better 1-year survival than men. This advantage was lost in countries with greater income disparity (Pinteraction < 0.001). CONCLUSIONS Women were less likely to have diagnostic testing or receive guideline-directed care than men. A survival advantage for women was observed only in countries with low income disparity, suggesting that equity of HF care between sexes remains an unmet goal worldwide.
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Affiliation(s)
- Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Duke-NUS Medical School, Singapore.
| | - Justin A Ezekowitz
- The Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Wouter Ouwerkerk
- National Heart Centre, Singapore; Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | | | - Kai Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong, China; Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Christiane E Angermann
- Comprehensive Heart Failure Center, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Ulf Dahlstrom
- Departments of Cardiology and Health, Medicine, and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Georg Ertl
- Comprehensive Heart Failure Center, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Mahmoud Hassanein
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sergio V Perrone
- Sanctuary of the Trinidad Miter, Lezica Cardiovascular Institute, El Cruce Hospital by Florencio Varela, Buenos Aires, Argentina
| | | | | | | | | | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gerasimos Filippatos
- School of Medicine, University of Cyprus, Nicosia, Cyprus; Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Well-Being, University of Glasgow, Scotland, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Carolyn S P Lam
- Duke-NUS Medical School, Singapore; National Heart Centre, Singapore.
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19
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Tromp J, Jackson AM, Abdelhamid M, Fouad D, Youssef G, Petrie MC, Bauersachs J, Sliwa K, van der Meer P. Thromboembolic events in peripartum cardiomyopathy: Results from the ESC EORP PPCM registry. Eur J Heart Fail 2023; 25:1464-1466. [PMID: 37092321 DOI: 10.1002/ejhf.2871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/18/2023] [Accepted: 04/15/2023] [Indexed: 04/25/2023] Open
Affiliation(s)
- Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Duke-NUS Medical School Singapore, Singapore, Singapore
| | - Alice M Jackson
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | - Doaa Fouad
- Assiut University Heart Hospital, Assiut, Egypt
| | - Ghada Youssef
- Cardiology Department, Kasr Al Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Mark C Petrie
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, Department of Medicine and Cardiology, University of Cape Town, Cape Town, South Africa
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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20
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Vermeer MC, Arevalo Gomez KF, Hoes MF, Tromp J, Verdonschot JA, Henkens MT, Silljé HH, Bolling MC, van der Meer P. Clinical Outcome in KLHL24 Cardiomyopathy. Circ Genom Precis Med 2023; 16:401-403. [PMID: 37191012 PMCID: PMC10428098 DOI: 10.1161/circgen.122.003998] [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] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Mathilde C.S.C. Vermeer
- Department of Cardiology (M.C.S.C.V., K.F.A.G., J.T., H.H.W.S., P.v.d.M.), Center for Blistering Diseases, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Karla F. Arevalo Gomez
- Department of Cardiology (M.C.S.C.V., K.F.A.G., J.T., H.H.W.S., P.v.d.M.), Center for Blistering Diseases, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Martijn F. Hoes
- Department of Clinical Genetics (M.F.H., J.A.J.V.), Maastricht University Medical Center, The Netherlands
- Department of Cardiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands (M.F.H.)
- CARIM School for Cardiovascular Diseases, Maastricht, the Netherlands (M.F.H., M.T.H.M.H.)
| | - Jasper Tromp
- Department of Cardiology (M.C.S.C.V., K.F.A.G., J.T., H.H.W.S., P.v.d.M.), Center for Blistering Diseases, University of Groningen, University Medical Center Groningen, The Netherlands
- Saw Swee Hock School of Public Health, National University of Singapore & National University Health System (J.T.)
- Duke-NUS medical school Singapore (J.T.)
| | - Job A.J. Verdonschot
- Department of Clinical Genetics (M.F.H., J.A.J.V.), Maastricht University Medical Center, The Netherlands
| | - Michiel T.H.M. Henkens
- Department of Cardiology (M.T.H.M.H.), Maastricht University Medical Center, The Netherlands
- Department of Pathology (M.T.H.M.H.), Maastricht University Medical Center, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht, the Netherlands (M.F.H., M.T.H.M.H.)
| | - Herman H.W. Silljé
- Department of Cardiology (M.C.S.C.V., K.F.A.G., J.T., H.H.W.S., P.v.d.M.), Center for Blistering Diseases, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Maria C. Bolling
- Department of Dermatology (M.C.B.), Center for Blistering Diseases, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology (M.C.S.C.V., K.F.A.G., J.T., H.H.W.S., P.v.d.M.), Center for Blistering Diseases, University of Groningen, University Medical Center Groningen, The Netherlands
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21
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Lawson CA, Tay WT, Bernhardt L, Richards AM, Zaccardi F, Tromp J, Katherine Teng TH, Hung CL, Chandramouli C, Wander GS, Ouwerkerk W, Seidu S, Khunti K, Lam CS. Association Between Diabetes, Chronic Kidney Disease, and Outcomes in People With Heart Failure From Asia. JACC Asia 2023; 3:611-621. [PMID: 37614542 PMCID: PMC10442874 DOI: 10.1016/j.jacasi.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 08/25/2023]
Abstract
Background Diabetes mellitus (DM), chronic kidney disease (CKD), and heart failure (HF) are pathophysiologically linked and increasing in prevalence in Asian populations, but little is known about the interplay of DM and CKD on outcomes in HF. Objectives This study sought to investigate outcomes in patients with heart failure with preserved ejection fraction (HFpEF) vs heart failure with reduced ejection fraction (HFrEF) in relation to the presence of DM and CKD. Methods Using the multinational ASIAN-HF registry, we investigated associations between DM only, CKD only, and DM+CKD with: 1) composite of 1-year mortality or HF hospitalization; and 2) Kansas City Cardiomyopathy Questionnaire scores, according to HF subtype. Results In 5,239 patients with HF (74.6% HFrEF, 25.4% HFpEF; mean age 63 years; 29.1% female), 1,107 (21.1%) had DM only, 1,087 (20.7%) had CKD only, and 1,400 (26.7%) had DM+CKD. Compared with patients without DM nor CKD, DM+CKD was associated with 1-year all-cause mortality or HF hospitalization in HFrEF (adjusted HR: 2.07; 95% CI: 1.68-2.55) and HFpEF (HR: 2.37; 95% CI: 1.40-4.02). In HFrEF, DM only and CKD only were associated with 1-year all-cause mortality or HF hospitalization (both HRs: 1.43; 95% CI: 1.14-1.80), while in HFpEF, CKD only (HR: 2.54; 95% CI: 1.46-4.41) but not DM only (HR: 1.01; 95% CI: 0.52-1.95) was associated with increased risk (interaction P < 0.01). Adjusted Kansas City Cardiomyopathy Questionnaire scores were lower in patients with DM+CKD (HFrEF: mean 60.50, SEM 0.77, HFpEF: mean 70.10, SEM 1.06; P < 0.001) than with no DM or CKD (HFrEF: mean 66.00, SEM 0.65; and HFpEF: mean 75.80, SEM 0.99). Conclusions Combined DM and CKD adversely effected outcomes independently of HF subtype, with CKD a consistent predictor of worse outcomes. Strategies to prevent and treat DM and CKD in HF are urgently required.
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Affiliation(s)
- Claire A. Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Leicester Real World Evidence Unit, Leicester, United Kingdom
| | - Wan Ting Tay
- National Heart Centre Singapore, Singapore, Singapore
| | - Lizelle Bernhardt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - A. Mark Richards
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
- National University Heart Centre, Singapore
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester, United Kingdom
- Diabetes Research Centre, Leicester, United Kingdom
- National Institute for Health Research Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Chung-Lieh Hung
- Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chanchal Chandramouli
- National Heart Centre Singapore, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Gurpreet Singh Wander
- Department of Cardiology, Hero Heart Institute, Dayanand Medical College and Hospital, Ludhiana, India
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore, Singapore
- Department of Dermatology, University of Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Sam Seidu
- Leicester Real World Evidence Unit, Leicester, United Kingdom
- Diabetes Research Centre, Leicester, United Kingdom
- National Institute for Health Research Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester, United Kingdom
- Diabetes Research Centre, Leicester, United Kingdom
- National Institute for Health Research Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
| | - Carolyn S.P. Lam
- National Heart Centre Singapore, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
| | - ASIAN-HF Investigators
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Leicester Real World Evidence Unit, Leicester, United Kingdom
- National Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
- National University Heart Centre, Singapore
- Diabetes Research Centre, Leicester, United Kingdom
- National Institute for Health Research Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
- Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Cardiology, Hero Heart Institute, Dayanand Medical College and Hospital, Ludhiana, India
- Department of Dermatology, University of Amsterdam Medical Center, Amsterdam, the Netherlands
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
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22
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Sakaniwa R, Tromp J, Streng KW, Suthahar N, Kieneker LM, Postmus D, Iso H, Gansevoort RT, Bakker SJL, Hillege HL, de Boer RA, Demissei BG. Trajectories of renal biomarkers and new-onset heart failure in the general population: Findings from the PREVEND study. Eur J Heart Fail 2023; 25:1072-1079. [PMID: 37282824 DOI: 10.1002/ejhf.2925] [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: 02/08/2022] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023] Open
Abstract
AIMS Renal dysfunction is one of the most critical risk factors for developing heart failure (HF). However, the association between repeated measures of renal function and incident HF remains unclear. Therefore, this study investigated the longitudinal trajectories of urinary albumin excretion (UAE) and serum creatinine and their association with new-onset HF and all-cause mortality. METHODS AND RESULTS Using group-based trajectory analysis, we estimated trajectories of UAE and serum creatinine in 6881 participants from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study and their association with new-onset HF and all-cause death during the 11-years of follow-up. Most participants had stable low UAE or serum creatinine. Participants with persistently higher UAE or serum creatinine were older, more often men, and more often had comorbidities, such as diabetes, a previous myocardial infarction or dyslipidaemia. Participants with persistently high UAE had a higher risk of new-onset HF or all-cause mortality, whereas stable serum creatinine trajectories showed a linear association for new-onset HF and no association with all-cause mortality. CONCLUSION Our population-based study identified different but often stable longitudinal patterns of UAE and serum creatinine. Patients with persistently worse renal function, such as higher UAE or serum creatinine, were at a higher risk of HF or mortality.
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Affiliation(s)
- Ryoto Sakaniwa
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Jasper Tromp
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Saw Swee Hock School of Public Health, National University of Singapore & National University Health System, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Koen W Streng
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Navin Suthahar
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Lyanne M Kieneker
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Douwe Postmus
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- The Institute for Global Health Policy, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ron T Gansevoort
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hans L Hillege
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Biniyam G Demissei
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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23
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Tromp J, van der Meer P, Tay WT, Ling LH, Loh SY, Soon D, Chin C, Jaufeerally F, Bamadhaj S, Ng TP, Lee SSG, Sim D, Yeo PSD, Leong GKT, Ong HY, Tantoso E, Eisenhaber F, Richards AM, Lam CSP. Diagnostic Accuracy of the Electrocardiogram for Heart Failure With Reduced or Preserved Ejection Fraction. J Card Fail 2023; 29:1104-1106. [PMID: 37004866 DOI: 10.1016/j.cardfail.2023.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National Heart Centre Singapore, Singapore; University Medical Center Groningen, Groningen, the Netherlands; Duke-NUS Medical School, Singapore, Singapore
| | | | | | - Lieng Hsi Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | | | | | - Tze Pin Ng
- University Medical Center Groningen, Groningen, the Netherlands
| | | | - David Sim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; University Medical Center Groningen, Groningen, the Netherlands
| | | | | | | | - Erwin Tantoso
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Frank Eisenhaber
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Singapore
| | | | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; University Medical Center Groningen, Groningen, the Netherlands
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24
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Vijay A, Tay WT, Teng THK, Teramoto K, Tromp J, Ouwerkerk W, Lo SY, Shimizu W, Huffman MD, Lam CSP, Chandramouli C, Agarwal A. Polypill Eligibility for Patients with Heart Failure with Reduced Ejection Fraction in the ASIAN-HF Registry: A Cross-Sectional Analysis. Glob Heart 2023; 18:33. [PMID: 37334398 PMCID: PMC10275129 DOI: 10.5334/gh.1215] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/26/2023] [Indexed: 06/20/2023] Open
Abstract
Background The rates of guideline-directed medical therapy (GDMT) prescription for heart failure with reduced ejection fraction (HFrEF) in Asia remain sub-optimal. The primary objective of this study was to examine HFrEF polypill eligibility in the context of measured baseline prescription rates of individual components of GDMT among participants with HFrEF in Asia. Methods A retrospective analysis of 4,868 patients with HFrEF from the multi-national ASIAN-HF registry was performed, and 3,716 patients were included in the final, complete case analysis. Eligibility for a HFrEF polypill, upon which patients were grouped and characterized, was based on the following: left ventricular systolic dysfunction (LVEF < 40% on baseline echocardiography), systolic blood pressure ≥ 100 mm Hg, heart rate ≥ 50 beats/minute, eGFR ≥ 30 mL/min/1.73 m, and serum potassium ≤ 5.0 mEq/L. Regression analyses were performed to evaluate associations of the baseline sociodemographic factors with HFrEF polypill eligibility. Results Among 3,716 patients with HFrEF in the ASIAN-HF registry, 70.3% were eligible for a HFrEF polypill. HFrEF polypill eligibility was significantly higher than baseline rates of triple therapy prescription of GDMT across sex, all studied geographical regions, and income levels. Patients were more likely to be eligible for a HFrEF polypill if they were younger and male, with higher BMI and systolic blood pressure, and less likely to be eligible if they were from Japan and Thailand. Conclusion The majority of patients with HFrEF in ASIAN-HF were eligible for a HFrEF polypill and were not receiving conventional triple therapy. HFrEF polypills may be a feasible and scalable implementation strategy to help close the treatment gap among patients with HFrEF in Asia.
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Affiliation(s)
- Aishwarya Vijay
- Department of Cardiology, Washington University in St. Louis, MO, USA
| | | | - Tiew-Hwa K. Teng
- National Heart Centre Singapore, Singapore
- School of Allied Health, University of Western Australia, WA, Australia
| | - Kanako Teramoto
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Jasper Tromp
- National Heart Centre Singapore, Singapore
- Department of Cardiology, University Medical Centre Groningen, Groningen, Netherlands
| | - Wouter Ouwerkerk
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Seet Yoong Lo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Mark D. Huffman
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, MO, USA
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Anubha Agarwal
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, MO, USA
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25
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Lawson CA, Tay WT, Richards M, Zaccardi F, Tromp J, Teng THK, Hung CL, Chandramouli C, Wander GS, Ouwerkerk W, Teramoto K, Ali M, Kadam U, Hand S, Harrison M, Anand I, Naik A, Squire I, Khunti K, Stromberg A, Lam CS. Patient-Reported Status and Heart Failure Outcomes in Asia by Sex, Ethnicity, and Socioeconomic Status. JACC Asia 2023; 3:349-362. [PMID: 37323861 PMCID: PMC10261894 DOI: 10.1016/j.jacasi.2023.03.015] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 06/17/2023]
Abstract
Background In heart failure (HF), symptoms and health-related quality of life (HRQoL) are known to vary among different HF subgroups, but evidence on the association between changing HRQoL and outcomes has not been evaluated. Objectives The authors sought to investigate the relationship between changing symptoms, signs, and HRQoL and outcomes by sex, ethnicity, and socioeconomic status (SES). Methods Using the ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) Registry, we investigated associations between the 6-month change in a "global" symptoms and signs score (GSSS), Kansas City Cardiomyopathy Questionnaire overall score (KCCQ-OS), and visual analogue scale (VAS) and 1-year mortality or HF hospitalization. Results In 6,549 patients (mean age: 62 ± 13 years], 29% female, 27% HF with preserved ejection fraction), women and those in low SES groups had higher symptom burden but lower signs and similar KCCQ-OS to their respective counterparts. Malay patients had the highest GSSS (3.9) and lowest KCCQ-OS (58.5), and Thai/Filipino/others (2.6) and Chinese patients (2.7) had the lowest GSSS scores and the highest KCCQ-OS (73.1 and 74.6, respectively). Compared to no change, worsening of GSSS (>1-point increase), KCCQ-OS (≥10-point decrease) and VAS (>1-point decrease) were associated with higher risk of HF admission/death (adjusted HR: 2.95 [95% CI: 2.14-4.06], 1.93 [95% CI: 1.26-2.94], and 2.30 [95% CI: 1.51-3.52], respectively). Conversely, the same degrees of improvement in GSSS, KCCQ-OS, and VAS were associated with reduced rates (HR: 0.35 [95% CI: 0.25-0.49], 0.25 [95% CI: 0.16-0.40], and 0.64 [95% CI: 0.40-1.00], respectively). Results were consistent across all sex, ethnicity, and SES groups (interaction P > 0.05). Conclusions Serial measures of patient-reported symptoms and HRQoL are significant and consistent predictors of outcomes among different groups with HF and provide the potential for a patient-centered and pragmatic approach to risk stratification.
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Affiliation(s)
- Claire A. Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
- Leicester Real World Evidence Unit, Leicester, United Kingdom
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
| | | | - Mark Richards
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
- National University Heart Centre, Singapore
| | - Francesco Zaccardi
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
- Diabetes Research Centre, Leicester, United Kingdom
| | - Jasper Tromp
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- School of Allied Health, University of Western Australia, Australia
| | - Chung-Lieh Hung
- Department of Cardiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chanchal Chandramouli
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Gurpreet S. Wander
- Department of Cardiology, Hero Dayanand Medical College Heart Institute, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore
- Department of Dermatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | | | - Mohammad Ali
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Umesh Kadam
- Diabetes Research Centre, Leicester, United Kingdom
- Department of Health Sciences, University of Leicester, Leicestershire, United Kingdom
| | - Simon Hand
- Department of Health Sciences, University of Leicester, Leicestershire, United Kingdom
| | - Mary Harrison
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Inder Anand
- Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ajay Naik
- Care Institute of Medical Sciences, Ahmedabad, India
| | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester, United Kingdom
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester, United Kingdom
- Diabetes Research Centre, Leicester, United Kingdom
| | - Anna Stromberg
- Department of Health, Medicine and Caring Sciences, and Department of Cardiology, Linkoping University, Sweden
| | - Carolyn S.P. Lam
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- George Institute for Global Health, Sydney, Australia
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
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26
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Pocock SJ, Ferreira JP, Collier TJ, Angermann CE, Biegus J, Collins SP, Kosiborod M, Nassif ME, Ponikowski P, Psotka MA, Teerlink JR, Tromp J, Gregson J, Blatchford JP, Zeller C, Voors AA. The win ratio method in heart failure trials: lessons learnt from EMPULSE. Eur J Heart Fail 2023; 25:632-641. [PMID: 37038330 PMCID: PMC10330107 DOI: 10.1002/ejhf.2853] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/28/2023] [Accepted: 04/08/2023] [Indexed: 04/12/2023] Open
Abstract
AIMS The EMPULSE trial evaluated the clinical benefit of empagliflozin versus placebo using the stratified win ratio approach in 530 patients with acute heart failure (HF) after initial stabilization. We aim to elucidate how this method works and what it means, thereby giving guidance for use of the win ratio in future trials. METHODS AND RESULTS The primary trial outcome is a hierarchical composite of death, number of HF events, time to first HF event, or a ≥5-point difference in Kansas City Cardiomyopathy Questionnaire (KCCQ) total symptom score change at 90 days. In an overall (unstratified) analysis we show how comparison of all 265 x 265 patients pairs contribute to 'wins' for empagliflozin and placebo at all four levels of the hierarchy, leading to an unstratified win ratio of 1.38 (95% confidence interval [CI] 1.11-1.71; p = 0.0036). How such a win ratio should (and should not) be interpreted is then described. The more complex primary analysis using a stratified win ratio is then presented in detail leading to a very similar overall result. Win ratios for de novo acute HF and decompensated chronic HF patients were 1.29 and 1.39, respectively, their weighted combination yielding an overall stratified win ratio of 1.36 (95% CI 1.09-1.68) (p = 0.0054). Alternative ways of including HF events and KCCQ scores in the clinical hierarchy are presented, leading to recommendations for their use in future trials. Specifically, inclusion of both number of HF events and time-to-first HF event appears an unnecessary complication. Also, the use of a 5-point margin for KCCQ score paired comparisons is not statistically necessary. CONCLUSIONS The EMPULSE trial findings illustrate how deaths, clinical events and patient-reported outcomes can be integrated into a win ratio analysis strategy that yields clinically meaningful findings of patient benefit. This has implications for future trial designs that recognize the clinical priorities of patient evaluation and the need for efficient progress towards approval of new treatments.
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Affiliation(s)
- Stuart J Pocock
- Medical Statistics Department, London School of Hygiene & Tropical Medicine, London, UK
| | - João Pedro Ferreira
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, Université de Lorraine, and Inserm U1116, CHRU, Nancy, France
| | - Timothy J Collier
- Medical Statistics Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Christiane E Angermann
- Comprehensive Heart Failure Centre, University and University Hospital of Würzburg, and Department of Medicine I, University Hospital of Würzburg, Würzburg, Germany
| | - Jan Biegus
- Institute of Heart Diseases, Medical University, Wroclaw, Poland
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center and Geriatric Research and Education Clinical Care, Tennessee Valley Healthcare Facility VA Medical Center, Nashville, TN, USA
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
- George Institute for Global Health, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Michael E Nassif
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Piotr Ponikowski
- Institute of Heart Diseases, Medical University, Wroclaw, Poland
| | | | - 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
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore, and the National University Health System, Singapore, Singapore
| | - John Gregson
- Medical Statistics Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Jonathan P Blatchford
- Elderbrook Solutions GmbH on behalf of Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Cordula Zeller
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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27
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Farmakis D, Tromp J, Marinaki S, Ouwerkerk W, Angermann CE, Bistola V, Dahlstrom U, Dickstein K, Ertl G, Ghadanfar M, Hassanein M, Obergfell A, Perrone SV, Polyzogopoulou E, Schweizer A, Boletis I, Cleland JG, Collins SP, Lam CS, FIlippatos G. Impact of left ventricular ejection fraction phenotypes on healthcare-resource utilization in hospitalized heart failure: A secondary analysis of REPORT-HF. Eur J Heart Fail 2023. [PMID: 36974770 DOI: 10.1002/ejhf.2833] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Evidence on healthcare resource utilization (HCRU) for hospitalized patients with heart failure (HF) and reduced (HFrEF), mildly-reduced (HFmrEF) and preserved (HFpEF) left ventricular ejection fraction (LVEF) is limited. METHODS We analysed HCRU in relation to LVEF phenotypes, clinical features and in-hospital and 12-month outcomes in 16,943 patients hospitalized for HF in a worldwide registry. RESULTS HFrEF was more prevalent (53%) than HFmrEF (17%) or HFpEF (30%). Patients with HFmrEF and HFpEF were older, more often women, with milder symptoms and more comorbidities, but differences were not pronounced. HCRU was high in all three groups; 2 or more in- and out-hospital services were required by 51%, 49% and 52% of patients with HFrEF, HFmrEF and HFpEF, respectively, and ICU by 41%, 41% and 37%, respectively.Hospitalization length was similar (median, 8 days). Discharge prescription of neurohormonal inhibitors was <80% for each agent in HFrEF and only slightly lower in HFmrEF and HFpEF (74% and 67%, respectively for beta-blockers). Compared to HFrEF, 12-month all-cause and cardiovascular mortality were lower for HFmrEF [adjusted hazard ratios, 0.76 (0.68-0.84) and 0.77 (0.68-0.88)] and HFpEF [0.62 (0.56-0.68) and 0.60 (0.53-0.68)]; 12-month HF hospitalization was also lower for HFpEF and HFmrEF (21% and 20% versus 25% for HFrEF). In-hospital mortality, 12-month non-cardiovascular mortality and 12-month all-cause hospitalization were similar among groups. CONCLUSIONS In patients hospitalized for HF, overall HCRU was similarly high across LVEF spectrum, reflecting the subtle clinical differences among LVEF phenotypes during hospitalization. Discharge prescription of neurohormonal inhibitors were suboptimal in HFrEF and lower but significant in patients with HFpEF and HFmrEF, who had better long-term cardiovascular outcomes than HFrEF, but similar risk for non-cardiovascular events. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Jasper Tromp
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore, Singapore
- University Medical Centre Groningen, Groningen, Netherlands
- Saw Swee Hock school of Public Health, National University of Singapore, Singapore
| | - Smaragdi Marinaki
- National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore
- Amsterdam University Medical Centre
| | | | - Vasiliki Bistola
- Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ulf Dahlstrom
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | | | - Georg Ertl
- National Heart Centre Singapore, Singapore
- Amsterdam University Medical Centre
| | | | - Mahmoud Hassanein
- Alexandria University, Faculty of Medicine, Cardiology Department, Alexandria, Egypt
| | | | - Sergio V Perrone
- El Cruce Hospital by Florencio Varela, Lezica Cardiovascular Institute, Sanctuary of the Trinidad Miter, Buenos Aires, Argentina
| | - Eftihia Polyzogopoulou
- Department of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Ioannis Boletis
- National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - John Gf Cleland
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Well-Being, University of Glasgow, Glasgow, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Sean P Collins
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, TN, USA
| | - Carolyn Sp Lam
- National Heart Centre Singapore, Singapore
- Duke-National University of Singapore, Singapore
- University Medical Centre Groningen, Groningen, Netherlands
- Saw Swee Hock school of Public Health, National University of Singapore, Singapore
| | - Gerasimos FIlippatos
- Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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28
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Wu MZ, Teng THK, Tay WT, Ren QW, Tromp J, Ouwerkerk W, Chandramouli C, Huang JY, Chan YH, Teramoto K, Yu SY, Lawson C, Li HL, Tse YK, Li XL, Hung D, Tse HF, Lam CSP, Yiu KH. Chronic kidney disease begets heart failure and vice versa: temporal associations between heart failure events in relation to incident chronic kidney disease in type 2 diabetes. Diabetes Obes Metab 2023; 25:707-715. [PMID: 36346045 DOI: 10.1111/dom.14916] [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: 09/12/2022] [Revised: 10/29/2022] [Accepted: 11/05/2022] [Indexed: 11/10/2022]
Abstract
AIM To investigate the interplay of incident chronic kidney disease (CKD) and/or heart failure (HF) and their associations with prognosis in a large, population-based cohort with type 2 diabetes (T2DM). METHODS Patients aged ≥18 years with new-onset T2DM, without renal disease or HF at baseline, were identified from the territory-wide Clinical Data Analysis Reporting System between 2000 and 2015. Patients were followed up until December 31, 2020 for incident CKD and/or HF and all-cause mortality. RESULTS Among 102 488 patients (median age 66 years, 45.7% women, median follow-up 7.5 years), new-onset CKD occurred in 14 798 patients (14.4%), in whom 21.7% had HF. In contrast, among 9258 patients (9.0%) with new-onset HF, 34.6% had CKD. The median time from baseline to incident CKD or HF (4.4 vs. 4.1 years) did not differ. However, the median (interquartile range) time until incident HF after CKD diagnosis was 1.7 (0.5-3.6) years and was 1.2 (0.2-3.4) years for incident CKD after HF diagnosis (P < 0.001). The crude incidence of CKD was higher than that of HF: 17.6 (95% confidence interval [CI] 17.3-17.9) vs. 10.6 (95% CI 10.4-10.9)/1000 person-years, respectively, but incident HF was associated with a higher adjusted-mortality than incident CKD. The presence of either condition (vs. CKD/HF-free status) was associated with a three-fold hazard of death, whereas concomitant HF and CKD conferred a six to seven-fold adjusted hazard of mortality. CONCLUSION Cardiorenal complications are common and are associated with high mortality risk among patients with new-onset T2DM. Close surveillance of these dual complications is crucial to reduce the burden of disease.
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Affiliation(s)
- Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shen Zhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Cardiovascular Sciences Academic Clinical Programme, Singapore, Singapore
- School of Allied Health, University of Western Australia, Perth, Australia
| | - Wan-Ting Tay
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Jasper Tromp
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
- University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
- Department of Dermatology, University of Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Chanchal Chandramouli
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Cardiovascular Sciences Academic Clinical Programme, Singapore, Singapore
| | - Jia-Yi Huang
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yap-Hang Chan
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Kanako Teramoto
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
| | - Si-Yeung Yu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Claire Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Leicester Real World Evidence Unit, Leicester, UK
| | - Hang-Long Li
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yi-Kei Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Xin-Li Li
- Department of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Denise Hung
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shen Zhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Carolyn S P Lam
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Cardiovascular Sciences Academic Clinical Programme, Singapore, Singapore
- University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shen Zhen, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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29
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Valsaraj A, Kalmady SV, Sharma V, Frost M, Sun W, Sepehrvand N, Ong M, Equibec C, Dyck JRB, Anderson T, Becher H, Weeks S, Tromp J, Hung CL, Ezekowitz JA, Kaul P. Development and validation of echocardiography-based machine-learning models to predict mortality. EBioMedicine 2023; 90:104479. [PMID: 36857967 PMCID: PMC10006431 DOI: 10.1016/j.ebiom.2023.104479] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/03/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Echocardiography (echo) based machine learning (ML) models may be useful in identifying patients at high-risk of all-cause mortality. METHODS We developed ML models (ResNet deep learning using echo videos and CatBoost gradient boosting using echo measurements) to predict 1-year, 3-year, and 5-year mortality. Models were trained on the Mackay dataset, Taiwan (6083 echos, 3626 patients) and validated in the Alberta HEART dataset, Canada (997 echos, 595 patients). We examined the performance of the models overall, and in subgroups (healthy controls, at risk of heart failure (HF), HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)). We compared the models' performance to the MAGGIC risk score, and examined the correlation between the models' predicted probability of death and baseline quality of life as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ). FINDINGS Mortality rates at 1-, 3- and 5-years were 14.9%, 28.6%, and 42.5% in the Mackay cohort, and 3.0%, 10.3%, and 18.7%, in the Alberta HEART cohort. The ResNet and CatBoost models achieved area under the receiver-operating curve (AUROC) between 85% and 92% in internal validation. In external validation, the AUROCs for the ResNet (82%, 82%, and 78%) were significantly better than CatBoost (78%, 73%, and 75%), for 1-, 3- and 5-year mortality prediction respectively, with better or comparable performance to the MAGGIC score. ResNet models predicted higher probability of death in the HFpEF and HFrEF (30%-50%) subgroups than in controls and at risk patients (5%-20%). The predicted probabilities of death correlated with KCCQ scores (all p < 0.05). INTERPRETATION Echo-based ML models to predict mortality had good internal and external validity, were generalizable, correlated with patients' quality of life, and are comparable to an established HF risk score. These models can be leveraged for automated risk stratification at point-of-care. FUNDING Funding for Alberta HEART was provided by an Alberta Innovates - Health Solutions Interdisciplinary Team Grant no. AHFMRITG 200801018. P.K. holds a Canadian Institutes of Health Research (CIHR) Sex and Gender Science Chair and a Heart & Stroke Foundation Chair in Cardiovascular Research. A.V. and V.S. received funding from the Mitacs Globalink Research Internship.
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Affiliation(s)
| | - Sunil Vasu Kalmady
- Canadian VIGOUR Centre, University of Alberta, Alberta, Canada; Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | | | | | - Weijie Sun
- Canadian VIGOUR Centre, University of Alberta, Alberta, Canada; Department of Computing Science, University of Alberta, Edmonton, Alberta, Canada
| | - Nariman Sepehrvand
- Canadian VIGOUR Centre, University of Alberta, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | | | | | - Jason R B Dyck
- Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Todd Anderson
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Harald Becher
- Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Sarah Weeks
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore & National University Health System, Singapore; Duke-NUS Medical School, Singapore
| | | | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada.
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30
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Peters AE, Tromp J, Shah SJ, Lam CSP, Lewis GD, Borlaug BA, Sharma K, Pandey A, Sweitzer NK, Kitzman DW, Mentz RJ. Phenomapping in heart failure with preserved ejection fraction: insights, limitations, and future directions. Cardiovasc Res 2023; 118:3403-3415. [PMID: 36448685 PMCID: PMC10144733 DOI: 10.1093/cvr/cvac179] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 04/30/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 12/05/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous entity with complex pathophysiology and manifestations. Phenomapping is the process of applying statistical learning techniques to patient data to identify distinct subgroups based on patterns in the data. Phenomapping has emerged as a technique with potential to improve the understanding of different HFpEF phenotypes. Phenomapping efforts have been increasing in HFpEF over the past several years using a variety of data sources, clinical variables, and statistical techniques. This review summarizes methodologies and key takeaways from these studies, including consistent discriminating factors and conserved HFpEF phenotypes. We argue that phenomapping results to date have had limited implications for clinical care and clinical trials, given that the phenotypes, as currently described, are not reliably identified in each study population and may have significant overlap. We review the inherent limitations of aggregating and utilizing phenomapping results. Lastly, we discuss potential future directions, including using phenomapping to optimize the likelihood of clinical trial success or to drive discovery in mechanisms of the disease process of HFpEF.
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Affiliation(s)
- Anthony E Peters
- Division of Cardiology, Duke University School of Medicine,
Durham, North Carolina 27708, USA
- Duke Clinical Research Institute, Durham, North
Carolina 27701, USA
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore
& the National University Health System, Singapore
- Department of Cardiology, University Medical Center
Groningen, Groningen, The
Netherlands
- Duke-National University of Singapore Medical School,
Singapore
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of
Medicine, Chicago, IL, USA
| | - Carolyn S P Lam
- Department of Cardiology, University Medical Center
Groningen, Groningen, The
Netherlands
- Duke-National University of Singapore Medical School,
Singapore
- National Heart Centre Singapore, Singapore
| | - Gregory D Lewis
- Division of Cardiology, Massachusetts General Hospital,
Boston, Massachusetts, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, Minnesota, USA
| | - Kavita Sharma
- Division of Cardiology, Johns Hopkins University School of
Medicine, Baltimore, Maryland, USA
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical
Center, Dallas, Texas, USA
| | - Nancy K Sweitzer
- Cardiovascular Medicine, Sarver Heart Center, University of
Arizona, Tucson, Arizona, USA
| | - Dalane W Kitzman
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake
Forest School of Medicine, Winston-Salem, North
Carolina, USA
- Sections on Geriatrics, Department of Internal Medicine, Wake Forest School
of Medicine, Winston-Salem, North Carolina,
USA
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine,
Durham, North Carolina 27708, USA
- Duke Clinical Research Institute, Durham, North
Carolina 27701, USA
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31
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Affiliation(s)
- Iris E Beldhuis
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Jasper Tromp
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.,Saw Swee Hock School of Public Health, National University of Singapore, and the National University Health System, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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32
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Teng THK, Tay WT, Ouwerkerk W, Tromp J, Richards AM, Gamble G, Greene SJ, Yiu KH, Poppe K, Ling LH, Lund M, Sim D, Devlin G, Loh SY, Troughton R, Ren QW, Jaufeerally F, Lee SGS, Tan RS, Soon DKN, Leong G, Ong HY, Yeo DPS, Lam CSP, Doughty RN. Titration of medications and outcomes in multi-ethnic heart failure cohorts (with reduced ejection fraction) from Singapore and New Zealand. ESC Heart Fail 2023; 10:1280-1293. [PMID: 36722315 PMCID: PMC10053276 DOI: 10.1002/ehf2.14275] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/14/2022] [Accepted: 12/07/2022] [Indexed: 02/02/2023] Open
Abstract
AIMS We investigated titration patterns of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs) and beta-blockers, quality of life (QoL) over 6 months, and associated 1 year outcome [all-cause mortality/heart failure (HF) hospitalization] in a real-world population with HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS Participants with HFrEF (left ventricular ejection fraction <40%) from a prospective multi-centre study were examined for use and dose [relative to guideline-recommended maintenance dose (GRD)] of ACEis/ARBs and beta-blockers at baseline and 6 months. 'Stay low' was defined as <50% GRD at both time points, 'stay high' as ≥50% GRD, and 'up-titrate' and 'down-titrate' as dose trajectories. Among 1110 patients (mean age 63 ± 13 years, 16% women, 26% New York Heart Association Class III/IV), 714 (64%) were multi-ethnic Asians from Singapore and 396 were from New Zealand (mainly European ethnicity). Baseline use of either ACEis/ARBs or beta-blockers was high (87%). Loop diuretic was prescribed in >80% of patients, mineralocorticoid receptor antagonist in about half of patients, and statins in >90% of patients. At baseline, only 11% and 9% received 100% GRD for each drug class, respectively, with about half (47%) achieving ≥50% GRD for ACEis/ARBs or beta-blockers. At 6 months, a large majority remained in the 'stay low' category, one third remained in 'stay high', whereas 10-16% up-titrated and 4-6% down-titrated. Patients with lower (vs. higher) N-terminal pro-beta-type natriuretic peptide levels were more likely to be up-titrated or be in 'stay high' for ACEis/ARBs and beta-blockers (P = 0.002). Ischaemic aetiology, prior HF hospitalization, and enrolment in Singapore (vs. New Zealand) were independently associated with higher odds of 'staying low' (all P < 0.005) for prescribed doses of ACEis/ARBs and beta-blockers. Adjusted for inverse probability weighting, ≥100% GRD for ACEis/ARBs [hazard ratio (HR) = 0.42; 95% confidence interval (CI) 0.24-0.73] and ≥50% GRD for beta-blockers (HR = 0.58; 95% CI 0.37-0.90) (vs. Nil) were associated with lower hazards for 1 year composite outcome. Country of enrolment did not modify the associations of dose categories with 1 year composite outcome. Higher medication doses were associated with greater improvements in QoL. CONCLUSIONS Although HF medication use at baseline was high, most patients did not have these medications up-titrated over 6 months. Multiple clinical factors were associated with changes in medication dosages. Further research is urgently needed to investigate the causes of lack of up-titration of HF therapy (and its frequency), which could inform strategies for timely up-titration of HF therapy based on clinical and biochemical parameters.
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Affiliation(s)
- Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,School of Allied Health, University of Western Australia, Perth, Australia
| | | | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore.,Department of Dermatology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Jasper Tromp
- Duke-NUS Medical School, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - A Mark Richards
- National University Heart Centre, Singapore.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Greg Gamble
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Katrina Poppe
- School of Medicine, University of Auckland, Auckland, New Zealand
| | | | | | - David Sim
- National Heart Centre Singapore, Singapore
| | - Gerard Devlin
- School of Medicine, University of Auckland, Auckland, New Zealand.,Tairāwhiti District Health Board, Gisborne, New Zealand
| | | | | | - Qing-Wen Ren
- Cardiology Division, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | | | | | - Ru San Tan
- National Heart Centre Singapore, Singapore
| | | | | | | | | | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Rob N Doughty
- School of Medicine, University of Auckland, Auckland, New Zealand
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33
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Ren QW, Katherine Teng TH, Tse YK, Tay WT, Li HL, Tromp J, Yu SY, Hung D, Wu MZ, Chen C, Yuk Yuen JK, Huang JY, Ouwerkerk W, Li XL, Teramoto K, Chandramouli C, Tse HF, Lam CSP, Yiu KH. Incidence, Clinical Correlates, and Prognostic Impact of Dementia in Heart Failure: A Population-Based Cohort Study. JACC Asia 2023; 3:108-119. [PMID: 36873768 PMCID: PMC9982209 DOI: 10.1016/j.jacasi.2022.09.016] [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] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 01/05/2023]
Abstract
Background Heart failure (HF) may increase the risk of dementia via shared risk factors. Objectives The authors investigated the incidence, types, clinical correlates, and prognostic impact of dementia in a population-based cohort of patients with index HF. Methods The previously territory-wide database was interrogated to identify eligible patients with HF (N = 202,121) from 1995 to 2018. Clinical correlates of incident dementia and their associations with all-cause mortality were assessed using multivariable Cox/competing risk regression models where appropriate. Results Among a total cohort aged ≥18 years with HF (mean age 75.3 ± 13.0 years, 51.3% women, median follow-up 4.1 [IQR: 1.2-10.2] years), new-onset dementia occurred in 22,145 (11.0%), with age-standardized incidence rate of 1,297 (95% CI: 1,276-1,318) per 10,000 in women and 744 (723-765) per 10,000 in men. Types of dementia were Alzheimer's disease (26.8%), vascular dementia (18.1%), and unspecified dementia (55.1%). Independent predictors of dementia included: older age (≥75 years, subdistribution hazard ratio [SHR]: 2.22), female sex (SHR: 1.31), Parkinson's disease (SHR: 1.28), peripheral vascular disease (SHR: 1.46), stroke (SHR: 1.24), anemia (SHR: 1.11), and hypertension (SHR: 1.21). The population attributable risk was highest for age ≥75 years (17.4%) and female sex (10.2%). New-onset dementia was independently associated with increased risk of all-cause mortality (adjusted SHR: 4.51; P < 0.001). Conclusions New-onset dementia affected more than 1 in 10 patients with index HF over the follow-up, and portended a worse prognosis in these patients. Older women were at highest risk and should be targeted for screening and preventive strategies.
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Affiliation(s)
- Qing-Wen Ren
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,School of Allied Health, University of Western Australia, Perth, Australia
| | - Yi-Kei Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | | | - Hang-Long Li
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Jasper Tromp
- National Heart Centre Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Si-Yeung Yu
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Denise Hung
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Mei-Zhen Wu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Christopher Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Jia-Yi Huang
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore.,Department of Dermatology, University of Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - Xin-Li Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | | | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore.,University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China.,Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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34
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Ang N, Chandramouli C, Yiu K, Lawson C, Tromp J. Heart Failure and Multimorbidity in Asia. Curr Heart Fail Rep 2023; 20:24-32. [PMID: 36811820 PMCID: PMC9977703 DOI: 10.1007/s11897-023-00585-2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 02/24/2023]
Abstract
PURPOSE OF THE REVIEW Multimorbidity, the presence of two or more comorbidities, is common in patients with heart failure (HF) and worsens clinical outcomes. In Asia, multimorbidity has become the norm rather than the exception. Therefore, we evaluated the burden and unique patterns of comorbidities in Asian patients with HF. RECENT FINDINGS Asian patients with HF are almost a decade younger than Western Europe and North American patients. However, over two in three patients have multimorbidity. Comorbidities usually cluster due to the close and complex links between chronic medical conditions. Elucidating these links may guide public health policies to address risk factors. In Asia, barriers in treating comorbidities at the patient, healthcare system and national level hamper preventative efforts. Asian patients with HF are younger yet have a higher burden of comorbidities than Western patients. A better understanding of the unique co-occurrence of medical conditions in Asia can improve the prevention and treatment of HF.
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Affiliation(s)
- Nathalie Ang
- Saw Swee Hock School of Public Health, The National University of Singapore (NUS), 12 Science Drive 2, Singapore, #10-01117549, Singapore
| | - Chanchal Chandramouli
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Center, Singapore, Singapore
| | - Kelvin Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | | | - Jasper Tromp
- Saw Swee Hock School of Public Health, The National University of Singapore (NUS), 12 Science Drive 2, Singapore, #10-01117549, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.
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35
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Maeda D, Dotare T, Matsue Y, Teramoto K, Sunayama T, Tromp J, Minamino T. Blood pressure in heart failure management and prevention. Hypertens Res 2023; 46:817-833. [PMID: 36604473 DOI: 10.1038/s41440-022-01158-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 09/28/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023]
Abstract
Hypertension is a leading cause of heart failure and other cardiovascular diseases. Its role in the pathogenesis of heart failure with reduced ejection fraction (HFrEF) differs from that in heart failure with preserved ejection fraction (HFpEF). Moreover, rigorous blood pressure control may reduce the incidence of heart failure. However, once heart failure develops, prognosis is affected by blood pressure, which may differ between patients with and without heart failure. Therefore, the association between guideline-directed medical therapy (GDMT) for heart failure and its uptitration must be considered for blood pressure management and should not be overlooked. Heart failure medications affect the blood pressure and efficacy per baseline blood pressure value. This review discusses the potential mechanisms by which hypertension leads to HFrEF or HFpEF, the impact of hypertension on incident heart failure, and the recommended approaches for blood pressure management in patients with heart failure. Comparison between patients with and without heart failure regarding blood pressure The association between CV events and SBP is linear in patients without heart failure; however, it becomes J-shaped or inverse linear in those with heart failure. The management of BP, including optimal BP or pharmacotherapy, differs between the two populations. ACEi angiotensin-converting enzyme inhibitors, ARB angiotensin II receptor blockers; ARNi angiotensin receptor-neprilysin inhibitors, BB beta-blockers, BP blood pressure, CV cardiovascular, DASH Dietary Approaches to Stop Hypertension, GDMT guideline-directed medical therapy, HF heart failure, HFrEF heart failure with reduced ejection fraction, MRA mineralocorticoid receptor antagonists, SBP systolic blood pressure, SGLT2i sodium-glucose cotransporter 2 inhibitors.
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Affiliation(s)
- Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Kanako Teramoto
- National Heart Centre, Singapore, Singapore.,Department of Biostatistics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore & the National University Health System, Singapore, Singapore.,Duke-National University of Singapore, Singapore, Singapore.,Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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36
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Biegus J, Voors AA, Collins SP, Kosiborod MN, Teerlink JR, Angermann CE, Tromp J, Ferreira JP, Nassif ME, Psotka MA, Brueckmann M, Salsali A, Blatchford JP, Ponikowski P. Impact of empagliflozin on decongestion in acute heart failure: the EMPULSE trial. Eur Heart J 2023; 44:41-50. [PMID: 36254693 PMCID: PMC9805406 DOI: 10.1093/eurheartj/ehac530] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/25/2022] [Accepted: 09/13/2022] [Indexed: 02/06/2023] Open
Abstract
AIMS Effective and safe decongestion remains a major goal for optimal management of patients with acute heart failure (AHF). The effects of the sodium-glucose cotransporter 2 inhibitor empagliflozin on decongestion-related endpoints in the EMPULSE trial (NCT0415775) were evaluated. METHODS AND RESULTS A total of 530 patients hospitalized for AHF were randomized 1:1 to either empagliflozin 10 mg once daily or placebo for 90 days. The outcomes investigated were: weight loss (WL), WL adjusted for mean daily loop diuretic dose (WL-adjusted), area under the curve of change from baseline in N-terminal pro-B-type natriuretic peptide levels, hemoconcentration, and clinical congestion score after 15, 30, and 90 days of treatment. Compared with placebo, patients treated with empagliflozin demonstrated significantly greater reductions in all studied markers of decongestion at all time-points, adjusted mean differences (95% confidence interval) at Days 15, 30, and 90 were: for WL -1.97 (-2.86, -1.08), -1.74 (-2.73, -0.74); -1.53 (-2.75, -0.31) kg; for WL-adjusted: -2.31 (-3.77, -0.85), -2.79 (-5.03, -0.54), -3.18 (-6.08, -0.28) kg/40 mg furosemide i.v. or equivalent; respectively (all P < 0.05). Greater WL at Day 15 (i.e. above the median WL in the entire population) was associated with significantly higher probability for clinical benefit at Day 90 (hierarchical composite of all-cause death, heart failure events, and a 5-point or greater difference in Kansas City Cardiomyopathy Questionnaire total symptom score change from baseline to 90 days) with the win ratio of 1.75 (95% confidence interval 1.37, 2.23; P < 0.0001). CONCLUSION Initiation of empagliflozin in patients hospitalized for AHF resulted in an early, effective and sustained decongestion which was associated with clinical benefit at Day 90.
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Affiliation(s)
- Jan Biegus
- Corresponding author. Tel: +48 71 733 11 12,
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O Box 30001, 9700 RB Groningen, HPC AB 31, The Netherlands
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research and Education Clinical Care, Tennessee Valley Healthcare Facility VA Medical Center, Nashville, TN, USA
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
- The George Institute for Global Health and the University of New South Wales, Sydney, New South Wales, Australia
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, 4150 Clement Street San Francisco, CA 94121, USA
| | - Christiane E Angermann
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, and Department of Medicine 1, University Hospital Würzburg, Am Schwarzenberg 15, Haus A15 97078 Würzburg, Germany
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore, the National University Health System, Singapore; 12 Science Drive 2, #10-01, Singapore 117549
| | - Joao Pedro Ferreira
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques Plurithématique 1433, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
- UnIC@RISE, Department of Surgery and Physiology, Cardiovascular Research and Development Center, University of Porto, Porto, Portugal
| | - Michael E Nassif
- Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City, MO, USA
| | - Mitchell A Psotka
- Inova Heart and Vascular Institute, Falls Church, VA, 3300 Gallows Road Falls Church, Virginia 22042, USA
| | - Martina Brueckmann
- Boehringer Ingelheim International GmbH, Binger Straße 173, 55216 Ingelheim am Rhein, Germany
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Afshin Salsali
- Novo Nordisk pharmaceutical company, Vandtårnsvej 110, 2860 Søborg, Copenhagen, Denmark
- Faculty of Medicine, Rutgers University, New Brunswick, NJ, 125 Paterson street, New Brunswick, NJ 08901, USA
| | - Jonathan P Blatchford
- Elderbrook Solutions GmbH, Sky Tower, Borsigstr. 4, D-74321 Bietigheim-Bissingen, Germany
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, Wroclaw 50-556, Poland
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Ouwerkerk W, Tromp J, Cleland JGF, Angermann CE, Dahlstrom U, Ertl G, Hassanein M, Perrone SV, Ghadanfar M, Schweizer A, Obergfell A, Dickstein K, Filippatos G, Collins SP, Lam CSP. Association of time-to-intravenous furosemide with mortality in acute heart failure: data from REPORT-HF. Eur J Heart Fail 2023; 25:43-51. [PMID: 36196060 PMCID: PMC10099670 DOI: 10.1002/ejhf.2708] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 02/03/2023] Open
Abstract
AIM Acute heart failure can be a life-threatening medical condition. Delaying administration of intravenous furosemide (time-to-diuretics) has been postulated to increase mortality, but prior reports have been inconclusive. We aimed to evaluate the association between time-to-diuretics and mortality in the international REPORT-HF registry. METHODS AND RESULTS We assessed the association of time-to-diuretics within the first 24 h with in-hospital and 30-day post-discharge mortality in 15 078 patients from seven world regions in the REPORT-HF registry. We further tested for effect modification by baseline mortality risk (ADHERE risk score), left ventricular ejection fraction (LVEF) and region. The median time-to-diuretics was 67 (25th-75th percentiles 17-190) min. Women, patients with more signs and symptoms of heart failure, and patients from Eastern Europe or Southeast Asia had shorter time-to-diuretics. There was no significant association between time-to-diuretics and in-hospital mortality (p > 0.1). The 30-day mortality risk increased linearly with longer time-to-diuretics (administered between hospital arrival and 8 h post-hospital arrival) (p = 0.016). This increase was more significant in patients with a higher ADHERE risk score (pinteraction = 0.008), and not modified by LVEF or geographic region (pinteraction > 0.1 for both). CONCLUSION In REPORT-HF, longer time-to-diuretics was not associated with higher in-hospital mortality. However, we did found an association with increased 30-day mortality, particularly in high-risk patients, and irrespective of LVEF or geographic region. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02595814.
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Affiliation(s)
- Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore.,Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection & Immunity Institute, Amsterdam, The Netherlands
| | - Jasper Tromp
- Duke-National University of Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health & Well-Being, University of Glasgow and National Heart & Lung Institute, Imperial College, London, UK
| | - Christiane E Angermann
- University and University Hospital Würzburg, Comprehensive Heart Failure Center, Würzburg, Germany
| | - Ulf Dahlstrom
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Georg Ertl
- University and University Hospital Würzburg, Comprehensive Heart Failure Center, Würzburg, Germany
| | - Mahmoud Hassanein
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sergio V Perrone
- El Cruce Hospital by Florencio Varela, Lezica Cardiovascular Institute, Sanctuary of the Trinidad Miter, Buenos Aires, Argentina
| | | | | | | | - Kenneth Dickstein
- University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | - Gerasimos Filippatos
- School of Medicine, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Duke-National University of Singapore, Singapore
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van Essen BJ, Tromp J, Ter Maaten JM, Greenberg BH, Gimpelewicz C, Felker GM, Davison BA, Severin T, Pang PS, Cotter G, Teerlink JR, Metra M, Voors AA. Characteristics and clinical outcomes of patients with acute heart failure with a supranormal left ventricular ejection fraction. Eur J Heart Fail 2023; 25:35-42. [PMID: 36114655 PMCID: PMC10092799 DOI: 10.1002/ejhf.2695] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 02/03/2023] Open
Abstract
AIM Recent data suggest that guideline-directed medical therapy of patients with heart failure (HF) with reduced ejection fraction (HFrEF) might improve clinical outcomes in patients with HF up to a left ventricular ejection fraction (LVEF) of 55-65%, whereas patients with higher LVEF do not seem to benefit. Recent data have shown that LVEF may have a U-shaped relation with outcome, with poorer outcome also in patients with supranormal values. This suggests that patients with supranormal LVEF may be a distinctive group of patients. METHODS AND RESULTS RELAX-AHF-2 was a multicentre, placebo-controlled trial on the effects of serelaxin on 180-day cardiovascular (CV) mortality and worsening HF at day 5 in patients with acute HF. Echocardiograms were performed at hospital admission in 6128 patients: 155 (2.5%) patients were classified as HF with supranormal ejection fraction (HFsnEF; LVEF >65%), 1440 (23.5%) as HF with preserved ejection fraction (HFpEF; LVEF 50-65%), 1353 (22.1%) as HF with mildly reduced ejection fraction (HFmrEF; LVEF 41-49%) and 3180 (51.9%) as HFrEF (LVEF <40%). Patients with HFsnEF compared to HFpEF were more often women, had higher prevalence of non-ischaemic HF, had lower levels of natriuretic peptides, were less likely to be treated with beta-blockers and had higher blood urea nitrogen plasma levels. All-cause mortality was not statistically different between groups, although patients with HFsnEF had the highest numerical rate. A declining trend was seen in the proportion of 180-day deaths due to CV causes from HFrEF (290/359, 80.8%) to HFsnEF (14/24, 58.3%). The reverse was observed with death from non-CV causes. No treatment effect of serelaxin was observed in any of the subgroups. CONCLUSIONS In this study, only 2.5% of patients were classified as HFsnEF. HFsnEF was primarily characterized by female sex, lower natriuretic peptides and a higher risk of non-CV death.
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Affiliation(s)
- Bart J van Essen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jasper Tromp
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Saw Swee Hock School of Public Health, National University of Singapore & the National University Health System, Singapore.,Duke-NUS Medical School, Singapore
| | - Jozine M Ter Maaten
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Beth A Davison
- Momentum Research Inc., Chapel Hill, NC, USA.,Inserm U 942 (MASCOT), Hopital Lariboisière, Paris, France
| | | | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gad Cotter
- Momentum Research Inc., Chapel Hill, NC, USA.,Inserm U 942 (MASCOT), Hopital Lariboisière, Paris, France
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, CA, USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Teramoto K, Tay WT, Tromp J, Katherine Teng TH, Chandramouli C, Ouwerkerk W, Lawson CA, Huang W, Hung CL, Chopra V, Anand I, Mark Richards A, Lam CSP. Patient-Reported Versus Physician-Assessed Health Status in Heart Failure With Reduced and Preserved Ejection Fraction From ASIAN-HF Registry. Circ Cardiovasc Qual Outcomes 2023; 16:e009134. [PMID: 36484254 DOI: 10.1161/circoutcomes.122.009134] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND We aimed to assess if discordance between patient-reported Kansas City Cardiomyopathy Questionnaire (KCCQ)-overall summary (os) score and physician-assessed New York Heart Association (NYHA) class is common among patients with heart failure (HF) with reduced or preserved ejection fraction, and determine its association with outcomes. METHODS A total of 4818 patients with HF were classified according to KCCQ-os score (range 0-100, dichotomized by median value 71.9 into high [good] versus low [bad]) and NYHA class (I/II [good] or III/IV [bad]) as concordant good (low NYHA class, high KCCQ-os score), concordant bad (high NYHA class, low KCCQ-os score), discordant worse NYHA class (high NYHA class, high KCCQ-os score), and discordant worse KCCQ-os score (low NYHA class, low-KCCQ-os score). The composite of HF hospitalization or death at 1 year was compared across groups. RESULTS There were 2070 (43.0%) concordant good, 1099 (22.8%) concordant bad, 331 (6.9%) discordant worse NYHA class, and 1318 (27.4%) discordant worse KCCQ-os score patients. Compared with concordant good, adverse outcomes were the highest in concordant bad (HR, 2.7 [95% CI, 2.2-3.5]) followed by discordant worse KCCQ-os score (HR, 1.8 [95% CI, 1.4-2.2]) and discordant worse NYHA class (HR, 1.5 [95% CI, 1.0-2.3]); with no modification by HF phenotype (preserved versus reduced ejection fraction, Pinteraction=0.52). At 6 months, 1403 (48%) experienced clinically significant improvement in KCCQ-os score (≥5 points increase over 6 months). Patients with improved KCCQ-os at 6 months (HR, 0.65 [95% CI, 0.47-0.92]) had better outcomes and the association was not modified by HF phenotype (Pinteraction=0.40). CONCLUSIONS One-third of patients with HF had discordance between patient-reported and clinician-assessed health status, largely attributable to worse patient-reported outcomes. Such discordance, particularly in those with discordantly worse KCCQ, should alert physicians to an increased risk of HF hospitalization and death, and prompt further assessment for potential drivers of worse patient-reported outcomes relative to physicians' assessment.
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Affiliation(s)
- Kanako Teramoto
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,National Cerebral and Cardiovascular Center, Osaka, Japan (K.T.)
| | - Wan Ting Tay
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.)
| | - Jasper Tromp
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,Saw Swee Hock School of Public Health National University of Singapore and the National University Health System (J.T.)
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,School of Allied Health, University of Western Australia, Perth, Australia (T.-H.K.T.)
| | - Chanchal Chandramouli
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,Duke-NUS Medical School, Singapore (J.T., T.-H.K.T., C.C., C.S.P.L.)
| | - Wouter Ouwerkerk
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,Amsterdam Medical Center, Department of Dermatology, The Netherlands (W.O.)
| | - Claire A Lawson
- Department of Cardiovascular Research, University of Leicester, United Kingdom (C.A.L.)
| | - Weiting Huang
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.)
| | | | - Vijay Chopra
- Max Super Specialty Hospital, New Delhi, India (V.C.)
| | - Inder Anand
- Cardiovascular division, University of Minnesota, Minneapolis (I.A.)
| | - Arthur Mark Richards
- Cardiovascular Research Institute, National University of Singapore (A.M.R.).,Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.)
| | - Carolyn S P Lam
- National Heart Centre Singapore (K.T., W.T.T., J.T., T.-H.K.T., C.C., W.O., W.H., C.S.P.L.).,Duke-NUS Medical School, Singapore (J.T., T.-H.K.T., C.C., C.S.P.L.).,Department of Cardiology, University Medical Center Groningen, The Netherlands (C.S.P.L.)
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Venkateshvaran A, Faxen UL, Hage C, Michaëlsson E, Svedlund S, Saraste A, Beussink-Nelson L, Fermer ML, Gan LM, Tromp J, Lam CSP, Shah SJ, Lund LH. Association of epicardial adipose tissue with proteomics, coronary flow reserve, cardiac structure and function, and quality of life in heart failure with preserved ejection fraction: insights from the PROMIS-HFpEF study. Eur J Heart Fail 2022; 24:2251-2260. [PMID: 36196462 PMCID: PMC10092436 DOI: 10.1002/ejhf.2709] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 07/02/2022] [Revised: 09/09/2022] [Accepted: 10/02/2022] [Indexed: 01/18/2023] Open
Abstract
AIM Epicardial adipose tissue (EAT) may play a role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). We investigated associations of EAT with proteomics, coronary flow reserve (CFR), cardiac structure and function, and quality of life (QoL) in the prospective multinational PROMIS-HFpEF cohort. METHODS AND RESULTS Epicardial adipose tissue was measured by echocardiography in 182 patients and defined as increased if ≥9 mm. Proteins were measured using high-throughput proximity extension assays. Microvascular dysfunction was evaluated with Doppler-based CFR, cardiac structural and functional indices with echocardiography and QoL by Kansas City Cardiomyopathy Questionnaire (KCCQ). Patients with increased EAT (n = 54; 30%) had higher body mass index (32 [28-40] vs. 27 [23-30] kg/m2 ; p < 0.001), lower N-terminal pro-B-type natriuretic peptide (466 [193-1133] vs. 1120 [494-1990] pg/ml; p < 0.001), smaller indexed left ventricular (LV) end-diastolic and left atrial (LA) volumes and tendency to lower KCCQ score. Non-indexed LV/LA volumes did not differ between groups. When adjusted for body mass index, EAT remained associated with LV septal wall thickness (coefficient 1.02, 95% confidence interval [CI] 1.00-1.04; p = 0.018) and mitral E wave deceleration time (coefficient 1.03, 95% CI 1.01-1.05; p = 0.005). Increased EAT was associated with proteomic markers of adipose biology and inflammation, insulin resistance, endothelial dysfunction, and dyslipidaemia but not significantly with CFR. CONCLUSION Increased EAT was associated with cardiac structural alterations and proteins expressing adiposity, inflammation, lower insulin sensitivity and endothelial dysfunction related to HFpEF pathology, probably driven by general obesity. Potential local mechanical or paracrine effects mediated by EAT remain to be elucidated.
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Affiliation(s)
| | - Ulrika Ljung Faxen
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Camilla Hage
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erik Michaëlsson
- Early Clinical Development, Research and Early Development Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Sara Svedlund
- Department of Clinical Physiology, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Antti Saraste
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Lauren Beussink-Nelson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maria Lagerstrom Fermer
- Early Clinical Development, Research and Early Development Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Li-Ming Gan
- Early Clinical Development, Research and Early Development Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore & National University Health System, Singapore.,Duke-NUS Medical School, Singapore
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,University Medical Centre, Groningen, The Netherlands
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lars H Lund
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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41
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Tromp J, Bauer D, Claggett BL, Frost M, Iversen MB, Prasad N, Petrie MC, Larson MG, Ezekowitz JA, Solomon SD. A formal validation of a deep learning-based automated workflow for the interpretation of the echocardiogram. Nat Commun 2022; 13:6776. [PMID: 36351912 PMCID: PMC9646849 DOI: 10.1038/s41467-022-34245-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
This study compares a deep learning interpretation of 23 echocardiographic parameters-including cardiac volumes, ejection fraction, and Doppler measurements-with three repeated measurements by core lab sonographers. The primary outcome metric, the individual equivalence coefficient (IEC), compares the disagreement between deep learning and human readers relative to the disagreement among human readers. The pre-determined non-inferiority criterion is 0.25 for the upper bound of the 95% confidence interval. Among 602 anonymised echocardiographic studies from 600 people (421 with heart failure, 179 controls, 69% women), the point estimates of IEC are all <0 and the upper bound of the 95% confidence intervals below 0.25, indicating that the disagreement between the deep learning and human measures is lower than the disagreement among three core lab readers. These results highlight the potential of deep learning algorithms to improve efficiency and reduce the costs of echocardiography.
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Affiliation(s)
- Jasper Tromp
- grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore & National University Health System, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, Singapore, Singapore
| | - David Bauer
- grid.38142.3c000000041936754XCardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Brian L. Claggett
- grid.38142.3c000000041936754XCardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | | | | | - Narayana Prasad
- grid.38142.3c000000041936754XCardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Mark C. Petrie
- grid.8756.c0000 0001 2193 314XBritish Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Martin G. Larson
- grid.189504.10000 0004 1936 7558Department of Biostatistics, School of Public Health, Boston University, Boston, MA USA
| | - Justin A. Ezekowitz
- grid.17089.370000 0001 2190 316XDivision of Cardiology and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB Canada ,grid.17089.370000 0001 2190 316XCanadian Vigour Centre, University of Alberta, Edmonton, AB Canada
| | - Scott D. Solomon
- grid.38142.3c000000041936754XCardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
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42
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Vermeer M, Arevalo Gomez KF, Hoes MF, Tromp J, Verdonschot JAJ, Henkens MTHM, Sillje HHW, Bolling MC, Van Der Meer P. Severe early-onset cardiomyopathy and poor prognosis observed in 73 patients with pathogenic KLHL24 variants. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.887] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Pathogenic variants in KLHL24 might cause skin fragility or cardiomyopathy. KLHL24 controls desmin turnover and patients with heterozygous gain-of-function variants (HET-GOF; i.e. overactivity), typically born with epidermolysis bullosa simplex (EBS), can develop dilated cardiomyopathy (DCM), whereas patients with homozygous loss-of-function variants (HOM-LOF) can develop hypertrophic cardiomyopathy (HCM).
Purpose
This study aims to characterize the cardiac phenotype and prognosis of patients with pathogenic KLHL24 variants.
Methods
Observational studies on KLHL24 found in PUBMED were included in this analysis. Patients were stratified according to their genotype and the study outcomes were cardiomyopathy diagnosis and cardiovascular (CV) events. CV events were defined as sudden cardiac death (SCD), death from heart failure (HF) or heart transplantation (HTx). Kaplan-Meier (KM) curves were constructed to visualize the age at diagnosis and CV event free-survival. For the HET-GOF group, this analysis was stratified by sex and log-rank testing was used to test for significant differences in the distribution. To achieve between group balance, the sex-stratified KM curves were weighted for age and cohort.
Results
In total, 73 patients from 14 studies were included in this analysis and Figure 1A shows their geographic distribution. In general, patients have a median age [IQR] of 18 [7–33]), 53% were men, 38% were diagnosed with cardiomyopathy, and 84% were patients with HET-GOF variants. Patients with HOM-LOF variants have a median age of 27 [26–31] and 55% is male (Figure 1B). HOM-LOF variants c.917G>A [p.(Arg306His)] and c.1048G>T [p.(Glu350*)] segregated in 2 Middle Eastern families, reporting 11 patients born from seemingly unaffected consanguineous heterozygous parents. All HOM-LOF patients were diagnosed with HCM before the age of 32 (27, [26–31]; Figure 1C), resulting in 4 CV events (SCD n=3; HTx n=1; Figure 1D). Patients with HET-GOF variants have a median age of 14 [6–33] and 53% were men (Figure 1B). HET-GOF variants c.1A>G, c.1A>T, c.2T>C, c.3G>T, c.3G>A and c.22A>T [p.(Val2_Met29)] segregated with disease in 34 families, reporting 62 patients in 14 countries. All patients with HET-GOF had EBS at birth and 27% was diagnosed with DCM. The probability of diagnosis during lifetime was significantly different (p<0.001, weighted p<0.001) between men (25 [16–34], n=9) and women (45 [31–47], n=8; Figure 1E). In total, 7 CV events (SCD n=1; HF n=4; HTx n=2) were reported for patients with HET-GOF variants. Figure 1F shows the general differences in CV events between sexes (p=0.026, weighted p=0.073). The median age of CV events for men was 20 (n=4) and 54 for women (n=3).
Conclusions
Patients with HOM-LOF variants were diagnosed at an early age with a severe form of HCM. Men with HET-GOF variants were diagnosed with DCM earlier than women. Men also have a higher probability for CV events at a younger age than women.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Research Counsel (ERC-2016-STG)
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Affiliation(s)
- M Vermeer
- University Medical Center Groningen, Department of Cardiology , Groningen , The Netherlands
| | - K F Arevalo Gomez
- University Medical Center Groningen, Department of Cardiology , Groningen , The Netherlands
| | - M F Hoes
- Maastricht University Medical Centre (MUMC), Cardiology , Maastricht , The Netherlands
| | - J Tromp
- Duke-NUS Graduate Medical School Singapore , Singapore , Singapore
| | - J A J Verdonschot
- Maastricht University Medical Centre (MUMC), Clinical Genetics , Maastricht , The Netherlands
| | - M T H M Henkens
- Maastricht University Medical Centre (MUMC), Cardiology , Maastricht , The Netherlands
| | - H H W Sillje
- University Medical Center Groningen, Department of Cardiology , Groningen , The Netherlands
| | - M C Bolling
- University Medical Center Groningen, Department of Dermatology , Groningen , The Netherlands
| | - P Van Der Meer
- University Medical Center Groningen, Department of Cardiology , Groningen , The Netherlands
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43
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Kodogo V, Viljoen C, Chakafana G, Hoevelmann J, Jackson A, Al-Farhan H, Goland S, Tromp J, Van Der Meer P, Karaye K, Kryczka K, Mebazaa A, Bauersachs J, Bell L, Sliwa K. Exploratory proteome profiling in patients with peripartum cardiomyopathy – a biomarker study on the EORP cohort. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2515] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The diagnosis of peripartum cardiomyopathy (PPCM) remains challenging as heart failure symptoms may also occur during normal pregnancy. This is further aggravated by the absence of biomarkers specific for diagnosis or prognosis of women with PPCM. Indeed, current evidence from the EURObservational Research Programme (EORP) Registry, an ongoing prospective, international, multicentre, observational registry for women with PPCM, report that the time to diagnosis after symptom onset varies from 19.4 to 38.3 days.
Aims
We performed exploratory serum proteome profiling on patients with PPCM, as compared with healthy postpartum mothers, to uncover novel protein biomarkers that would further our understanding of the pathogenesis of the disease and enhance diagnostic evaluation.
Methods
Demographic and clinical data, as well as serum samples were collected from 84 patients with PPCM from seven EORP participating countries and 29 healthy controls (HC) from South Africa. Serum proteomic profiling was conducted using DIA-based label-free quantitative (LFQ) LC-MS at the time of diagnosis from depleted serum samples. Mass spectrometry data were analyzed by Spectronaut v15 using a study-specific spectral library. Proteomic statistical analysis was performed using Perseus version 2.0.3.0 (FDR=0.05; S=0.1).
Results
Patients with PPCM had advanced heart failure (50% had New York Heart Association functional classes III/IV, mean left ventricular ejection fraction [LVEF] of 33.5%±9.3 [vs 57.0±8.8 in HC, p<0.001]). Amongst the 329 proteins that were identified in the serum samples, 17 proteins were significantly differentially upregulated and 18 downregulated in patients with PPCM as compared to the HC (all p<0.05; Figure 1). Adiponectin (log fold change 1.378, p=0.001), pregnancy-specific beta-1-glycoprotein 1 (1.207, p=0.022), disintegrin metalloproteinase domain-containing protein 12 (1.185, p=0.039), peptidyl-prolyl cis-trans isomerase (1.182, p=0.031) and sulfhydryl oxidase 1 (1.101, p=0.004) were among the upregulated proteins, whilst immunoglobulin kappa variable 2–29 (0.856, p=0.029), ficolin-3 (0.898, p=0.001), platelet basic protein (0.917, p=0.006) and thrombospondin-1 (0.930, p=0.043) were among the downregulated. Gene ontology indicated that thrombospondin receptor activity, fibronectin-binding, and vascular endothelial growth factor receptor 2 binding among the most significant regulated molecular functions. The area under the curve (AUC) of the top 10 up-regulated biomarkers ranged from 0.61–0.68 (p<0.05).
Conclusion
Salient biological themes related to immune response proteins, inflammation, fibrosis, angiogenesis, apoptosis, and blood coagulation were identified to be predominant in PPCM versus HC. This indicates the complex pathophysiological mechanisms of PPCM. The newly identified proteins warrant further studies to evaluate their potential use as diagnostic and prognostic markers for PPCM.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): 1. EurObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy2. Cape Heart Institute, University of Cape Town, South Africa
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Affiliation(s)
- V Kodogo
- University of Cape Town, Cape Heart Institute , Cape Town , South Africa
| | - C Viljoen
- University of Cape Town, Division of Cardiology, Department of Medicine , Cape Town , South Africa
| | - G Chakafana
- Stanford University Medical Center , Stanford , United States of America
| | - J Hoevelmann
- University of Cape Town, Cape Heart Institute , Cape Town , South Africa
| | - A Jackson
- Institute of Cardiovascular and Medical Sciences , Glasgow , United Kingdom
| | - H Al-Farhan
- University of Baghdad College of Medicine , Baghdad , Iraq
| | - S Goland
- Hadassah-Hebrew University, Heart Institute, Kaplan Medical Center, Rehovot , Jerusalem , Israel
| | - J Tromp
- University Medical Center Groningen, Department of Cardiology , Groningen , The Netherlands
| | - P Van Der Meer
- University Medical Center Groningen, Department of Cardiology , Groningen , The Netherlands
| | - K Karaye
- Aminu Kano Teaching Hospital, Department of Medicine , Kano , Nigeria
| | - K Kryczka
- Institute of Cardiology in Anin , Warsaw , Poland
| | - A Mebazaa
- Lariboisiere APHP Site of Saint Louis University Hospital, Department of Anesthesiology , Paris , France
| | - J Bauersachs
- Hannover Medical School, 11. Department of Cardiology and Angiology , Hannover , Germany
| | - L Bell
- University of Cape Town, 12. Centre for Proteomic and Genomic Research, Cape Town, South Africa , Cape Town , South Africa
| | - K Sliwa
- University of Cape Town, Cape Heart Institute , Cape Town , South Africa
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44
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Voors AA, Damman K, Teerlink JR, Angermann CE, Collins SP, Kosiborod M, Biegus J, Ferreira JP, Nassif ME, Psotka MA, Tromp J, Brueckmann M, Blatchford JP, Salsali A, Ponikowski P. Renal effects of empagliflozin in patients hospitalized for acute heart failure: from the EMPULSE trial. Eur J Heart Fail 2022; 24:1844-1852. [PMID: 36066557 PMCID: PMC9828037 DOI: 10.1002/ejhf.2681] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 06/14/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 01/12/2023] Open
Abstract
AIM The sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin improved clinical outcomes in patients hospitalized for acute heart failure. In patients with chronic heart failure, SGLT2 inhibitors cause an early decline in estimated glomerular filtration rate (eGFR) followed by a slower eGFR decline over time than placebo. However, the effects of SGLT2 inhibitors on renal function during a hospital admission for acute heart failure remain largely unknown. METHODS AND RESULTS Between 1 and 5 days after a hospitalization for acute heart failure, 530 patients with an eGFR >20 ml/min/1.73 m2 were randomized to 10 mg of empagliflozin or placebo and treated for 90 days. Renal function and electrolytes were measured at baseline, and after 15, 30 and 90 days. We evaluated the effect of empagliflozin on eGFR over time and the impact of baseline eGFR on the primary hierarchical outcome of death, worsening heart failure events and quality of life. Mean baseline eGFR was 52.4 ml/min/1.73 m2 in the empagliflozin group and 55.7 ml/min/1.73 m2 in the placebo group. Empagliflozin caused an initial decline in eGFR (-2 ml/min/1.73 m2 at day 15 compared to placebo). At day 90, eGFR was similar between empagliflozin and placebo. Investigator-reported acute renal failure occurred in 7.7% of empagliflozin versus 12.1% of placebo patients. The overall clinical benefit (hierarchical composite of all-cause death, heart failure events and quality of life) of empagliflozin was unaffected by baseline eGFR. CONCLUSION In patients hospitalized for acute heart failure, empagliflozin caused an early modest decline in renal function which was no longer evident after 90 days. Acute renal events were similar in both groups. The clinical benefit of empagliflozin was consistent regardless of baseline renal function.
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Affiliation(s)
- Adriaan A. Voors
- Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Kevin Damman
- Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - John R. Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Christiane E. Angermann
- Comprehensive Heart Failure CentreUniversity & University Hospital of WürzburgWürzburgGermany
| | - Sean P. Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center and Geriatric Research and Education Clinical CareTennessee Valley Healthcare Facility VA Medical CenterNashvilleTNUSA
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri‐Kansas CityKansas CityMSUSA,The George Institute for Global Health and The University of New South WalesSydneyNSWAustralia
| | - Jan Biegus
- Institute of Heart DiseasesMedical UniversityWroclawPoland
| | - João Pedro Ferreira
- Inserm INI‐CRCT, CHRUUniversité de LorraineNancyFrance,Cardiovascular Research and Development Center, Department of Surgery and PhysiologyFaculty of Medicine of the University of PortoPortoPortugal
| | - Michael E. Nassif
- Saint Luke's Mid America Heart Institute and the University of MissouriKansas CityMSUSA
| | | | - Jasper Tromp
- Saw Swee Hock School of Public HealthNational University of Singapore, and the National University Health SystemSingapore
| | - Martina Brueckmann
- Boehringer Ingelheim International GmbHIngelheimGermany,First Department of Medicine faculty of Medicine MannheimUniversity of HeidelbergMannheimGermany
| | - Jonathan P. Blatchford
- Elderbrook Solutions GmbH on behalf of Boehringer Ingelheim Pharma GmbH & Co. KGBiberachGermany
| | - Afshin Salsali
- Boehringer Ingelheim Pharmaceuticals Inc.RidgefieldCTUSA,Faculty of MedicineRutgers UniversityNew BrunswickNJUSA
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45
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Baumhove L, Tromp J, Figarska S, van Essen BJ, Anker SD, Dickstein K, Cleland JG, Lang CC, Filippatos G, Ng LL, Samani NJ, Metra M, van Veldhuisen DJ, Lam CSP, Voors AA, van der Meer P. Heart failure with normal LVEF in BIOSTAT-CHF. Int J Cardiol 2022; 364:85-90. [PMID: 35649488 DOI: 10.1016/j.ijcard.2022.05.054] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 11/05/2022]
Abstract
AIMS Several studies have shown that heart failure (HF) drug treatment seems to benefit patients with preserved ejection fraction (HFpEF) and a left ventricular ejection fraction (LVEF) up to 55-60% but not with higher LVEF. Certain HF drugs are now indicated in patients with HFpEF and a LVEF below normal. However, not much is known about patients with a normal LVEF. Therefore, we investigated the prevalence, clinical characteristics and outcome of patients with HF and a normal LVEF. METHODS AND RESULTS Normal LVEF was defined according to the Recommendations for Cardiac Chamber Quantification from the American Society of Echocardiography as a LVEF ≥62% for men and ≥ 64% for women. Preserved ejection fraction was defined as a LVEF ≥50% and reduced ejection fraction as a LVEF <50%. In the total cohort of 1568 studied patients with heart failure (mean age 73 years; 33.6% female) 57 patients (3.6%) had a normal LVEF. These patients least likely had a previous myocardial infarction (p < 0.001) or diabetes (p = 0.045), had the lowest Left Ventricular End Diastolic Diameter (p < 0.001), the highest rate of previous HF hospitalization in the last year (p = 0.015), the highest cardiac output (p < 0.001) and were most frequently women (p < 0.001). Patients with a normal LVEF had the lowest risk for the primary combined outcome of all-cause mortality and HF hospitalization. CONCLUSION Only 3.6% of patients with HF had a sex-adjusted normal LVEF. Despite the sex-adjusted cut-offs they were more frequently female with less ischemic heart disease, higher cardiac output and better clinical outcomes.
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Affiliation(s)
- Lukas Baumhove
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
| | - Jasper Tromp
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands; National Heart Centre Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Sylwia Figarska
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Bart J van Essen
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Stefan D Anker
- Department of Cardiology (CVK), and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - John G Cleland
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow and National Heart & Lung Institute, Imperial College, London, UK
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, Medical Research Institute, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Brescia, Italy
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Duke-National University of Singapore, Singapore
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
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46
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Teramoto K, Teng THK, Chandramouli C, Tromp J, Sakata Y, Lam CSP. Epidemiology and Clinical Features of Heart Failure with Preserved Ejection Fraction. Card Fail Rev 2022; 8:e27. [PMID: 35991117 PMCID: PMC9379774 DOI: 10.15420/cfr.2022.06] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 01/17/2022] [Accepted: 04/09/2022] [Indexed: 12/16/2022] Open
Abstract
Heart failure (HF) with preserved ejection (HFpEF) constitutes a large and growing proportion of patients with HF around the world, and is now responsible for more than half of all HF cases in ageing societies. While classically described as a condition of elderly, hypertensive women, recent studies suggest heterogeneity in clinical phenotypes involving differential characteristics and pathophysiological mechanisms. Despite a paucity of disease-modifying therapy for HFpEF, an understanding of phenotypic similarities and differences among patients with HFpEF around the world provides the foundation to recognise the clinical condition for early treatment, as well as to identify modifiable risk factors for preventive intervention. This review summarises the epidemiology of HFpEF, its common clinical features and risk factors, as well as differences by age, comorbidities, race/ethnicity and geography.
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Affiliation(s)
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore; School of Allied Health, University of Western Australia, Perth, Australia; Duke-National University of Singapore Medical School, Singapore
| | - Chanchal Chandramouli
- National Heart Centre Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Jasper Tromp
- National Heart Centre Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and the National University Health System, Singapore
| | | | - Carolyn SP Lam
- National Heart Centre Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore; Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
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47
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Henkens MTHM, Stroeks SLVM, Raafs AG, Sikking MA, Tromp J, Ouwerkerk W, Hazebroek MR, Krapels IPC, Knackstedt C, van den Wijngaard A, Brunner HG, Heymans SRB, Verdonschot JAJ. Dynamic Ejection Fraction Trajectory in Patients With Dilated Cardiomyopathy With a Truncating Titin Variant. Circ Heart Fail 2022; 15:e009352. [PMID: 35543125 DOI: 10.1161/circheartfailure.121.009352] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michiel T H M Henkens
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H.).,Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H., J.A.J.V.).,Netherlands Heart Institute, Utrecht (M.T.H.M.H.)
| | - Sophie L V M Stroeks
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H.).,Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H., J.A.J.V.)
| | - Anne G Raafs
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H.).,Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H., J.A.J.V.)
| | - Maurits A Sikking
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H.).,Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H., J.A.J.V.)
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore (NUS) (J.T.).,National Heart Centre Singapore, Singapore (J.T., W.O.).,Duke-NUS Medical School, Singapore (J.T., W.O.).,Yong Loo Lin School of Medicine, National University of Singapore (J.T.).,Duke-NUS School of Medicine, Singapore (J.T.)
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore (J.T., W.O.).,Duke-NUS Medical School, Singapore (J.T., W.O.).,Department of Dermatology, Amsterdam UMC, Amsterdam Infection & Immunity Institute, University of Amsterdam, the Netherlands (W.O.)
| | - Mark R Hazebroek
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H.).,Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H., J.A.J.V.)
| | - Ingrid P C Krapels
- Department of Clinical Genetics, Maastricht University Medical Center+, the Netherlands (I.P.C.K., A.v.d.W., H.G.B., J.A.J.V.)
| | - Christian Knackstedt
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H.).,Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H., J.A.J.V.)
| | - Arthur van den Wijngaard
- Department of Clinical Genetics, Maastricht University Medical Center+, the Netherlands (I.P.C.K., A.v.d.W., H.G.B., J.A.J.V.)
| | - Han G Brunner
- Department of Clinical Genetics, Maastricht University Medical Center+, the Netherlands (I.P.C.K., A.v.d.W., H.G.B., J.A.J.V.).,GROW Institute for Developmental Biology and Cancer, Maastricht University, the Netherlands (H.G.B.).,Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (H.G.B.)
| | - Stephane R B Heymans
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H.).,Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H., J.A.J.V.).,Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Belgium (S.R.B.H.)
| | - Job A J Verdonschot
- Department of Cardiology, Maastricht University Medical Center+, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H.).,Centre for Heart Failure Research, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands (M.T.H.M.H., S.L.V.M.S., A.G.R., M.A.S., M.R.H., C.K., S.R.B.H., J.A.J.V.).,Department of Clinical Genetics, Maastricht University Medical Center+, the Netherlands (I.P.C.K., A.v.d.W., H.G.B., J.A.J.V.)
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Kosiborod MN, Angermann CE, Collins SP, Teerlink JR, Ponikowski P, Biegus J, Comin-Colet J, Ferreira JP, Mentz RJ, Nassif ME, Psotka MA, Tromp J, Brueckmann M, Blatchford JP, Salsali A, Voors AA. Effects of Empagliflozin on Symptoms, Physical Limitations, and Quality of Life in Patients Hospitalized for Acute Heart Failure: Results From the EMPULSE Trial. Circulation 2022; 146:279-288. [PMID: 35377706 PMCID: PMC9311476 DOI: 10.1161/circulationaha.122.059725] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [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: 12/14/2022]
Abstract
BACKGROUND Patients hospitalized for acute heart failure experience poor health status, including a high burden of symptoms and physical limitations, and poor quality of life. SGLT2 (sodium-glucose cotransporter 2) inhibitors improve health status in chronic heart failure, but their effect on these outcomes in acute heart failure is not well characterized. We investigated the effects of the SGLT2 inhibitor empagliflozin on symptoms, physical limitations, and quality of life, using the Kansas City Cardiomyopathy Questionnaire (KCCQ) in the EMPULSE trial (Empagliflozin in Patients Hospitalized With Acute Heart Failure Who Have Been Stabilized). METHODS Patients hospitalized for acute heart failure were randomized to empagliflozin 10 mg daily or placebo for 90 days. The KCCQ was assessed at randomization and 15, 30, and 90 days. The effects of empagliflozin on the primary end point of clinical benefit (hierarchical composite of all-cause death, heart failure events, and a 5-point or greater difference in KCCQ Total Symptom Score [TSS] change from baseline to 90 days) were examined post hoc across the tertiles of baseline KCCQ-TSS. In prespecified analyses, changes (randomization to day 90) in KCCQ domains, including TSS, physical limitations, quality of life, clinical summary, and overall summary scores were evaluated using a repeated measures model. RESULTS In total, 530 patients were randomized (265 each arm). Baseline KCCQ-TSS was low overall (mean [SD], 40.8 [24.0] points). Empagliflozin-treated patients experienced greater clinical benefit across the range of KCCQ-TSS, with no treatment effect heterogeneity (win ratio [95% CIs] from lowest to highest tertile: 1.49 [1.01-2.20], 1.37 [0.94-1.99], and 1.48 [1.00-2.20], respectively; P for interaction=0.94). Beneficial effects of empagliflozin on health status were observed as early as 15 days and persisted through 90 days, at which point empagliflozin-treated patients experienced a greater improvement in KCCQ TSS, physical limitations, quality of life, clinical summary, and overall summary (placebo-adjusted mean differences [95% CI]: 4.45 [95% CI, 0.32-8.59], P=0.03; 4.80 [95% CI, 0.00-9.61], P=0.05; 4.66 [95% CI, 0.32-9.01], P=0.04; 4.85 [95% CI, 0.77-8.92], P=0.02; and 4.40 points [95% CI, 0.33-8.48], P=0.03, respectively). CONCLUSIONS Initiation of empagliflozin in patients hospitalized for acute heart failure produced clinical benefit regardless of the degree of symptomatic impairment at baseline, and improved symptoms, physical limitations, and quality of life, with benefits seen as early as 15 days and maintained through 90 days. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT0415775.
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Affiliation(s)
- Mikhail N. Kosiborod
- Saint Luke’s Mid America Heart Institute, Kansas City, MO (M.N.K., M.E.N.).,School of Medicine, University of Missouri-Kansas City (M.N.K., M.E.N.).,The George Institute for Global Health, University of New South Wales, Sydney, Australia (M.N.K.)
| | - Christiane E. Angermann
- Comprehensive Heart Failure Centre, University and University Hospital of Würzburg, Germany (C.E.A.)
| | - Sean P. Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN (S.P.C.).,Geriatric Research and Education Clinical Care, Tennessee Valley Healthcare Facility VA Medical Center, Nashville (S.P.C.)
| | - John R. Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco (J.R.T.)
| | - Piotr Ponikowski
- Institute of Heart Diseases, Medical University, Wroclaw, Poland (P.P., J.B.)
| | - Jan Biegus
- Institute of Heart Diseases, Medical University, Wroclaw, Poland (P.P., J.B.)
| | - Josep Comin-Colet
- Hospital Universitari de Bellvitge, The Institute of Biomedical Research of Bellvitge (IDIBELL), Barcelona, Spain (J.C.-C.)
| | - João Pedro Ferreira
- Université de Lorraine, Inserm INI-CRCT, CHRU, Nancy, France (J.P.F.).,Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Portugal (J.P.F.)
| | - Robert J. Mentz
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC (R.J.M.)
| | - Michael E. Nassif
- Saint Luke’s Mid America Heart Institute, Kansas City, MO (M.N.K., M.E.N.).,School of Medicine, University of Missouri-Kansas City (M.N.K., M.E.N.)
| | | | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore (J.T.)
| | - Martina Brueckmann
- Boehringer Ingelheim International GmbH, Germany (M.B.).,First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany (M.B.)
| | - Jonathan P. Blatchford
- Elderbrook Solutions GmbH on behalf of Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany (J.P.B.)
| | - Afshin Salsali
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT (A.S.).,Faculty of Medicine, Rutgers University, New Brunswick, NJ (A.S.)
| | - Adriaan A. Voors
- University of Groningen, Department of Cardiology, University Medical Center Groningen, The Netherlands (A.A.V.)
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Tromp J, Ouwerkerk W, Lam CSP, Voors AA. Reply: Assessing Pharmacologic Treatment Effect From a Meta-Analysis in Heart Failure. JACC Heart Fail 2022; 10:527-528. [PMID: 35772864 DOI: 10.1016/j.jchf.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
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50
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Van den Berg M, Beerendonk C, Kaal S, Mandigers C, Schuurman T, Tol J, Tromp J, Van der Vorst M, Braat D, Hermens R. P-452 Suboptimal quality of integrated female oncofertility care is associated with a lowered quality of life and more decisional conflict and regret in female cancer survivors. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.016] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is quality of female oncofertility care associated with quality of life, decisional conflict, regret, reproductive concerns, and fertility preservation knowledge in female cancer survivors?
Summary answer
Receiving high-quality integrated female oncofertility care is associated with an improved quality of life, and with less decisional conflict and regret in female cancer survivors.
What is known already
Female adolescent and young adult cancer patients should be informed about their infertility risks due to cancer treatment. However, adherence to oncofertility guidelines is far from optimal. At this moment, it is not known whether adherence to oncofertility guidelines measured with quality indicators is associated with a better quality of life, less decisional conflict, regret, and reproductive concerns in female cancer survivors
Study design, size, duration
A multicenter cross-sectional survey study was conducted to measure the association between quality of oncofertility care and patient-reported outcome measures (PROMs).
Participants/materials, setting, methods
Female AYA cancer survivors (18-40 years) who were diagnosed in 2016 or 2017, and received a (potential) gonadotoxic treatment were eligible to participate. They were recruited from six hospitals across the Netherlands and were asked to fill in a survey. Quality indicators were used to assess quality of care, and validated scales to assess PROMs. Quality indicator and PROM scores were calculated, and associations were analyzed by T-tests and multilevel multivariate analyses
Main results and the role of chance
In total, 121 out of 344 female cancer survivors participated. Female cancer survivors received a suboptimal quality of care with 8 out of 11 quality indicators scoring <90% adherence. Of all patients, 72,7% was informed about their infertility, 51,2% was offered a referral, with 18,8% all aspects were discussed in counselling, and 35,5% received written and/or digital information. When survivors were informed about infertility risks, and were offered fertility preservation counseling, and received digital/written information (i.e. adherence to three quality indicators), their quality of life was highest, and levels of decisional conflict and regret were lowest. Physical quality of life, decision regret, reproductive concerns, and fertility preservation knowledge scores were significantly influenced by female cancer survivor’s age, relationship status, strength of wish to conceive, and type of cancer.
Limitations, reasons for caution
Selection bias could have occurred as we have no insight into reasons for non-responding and we have a low response rate. Furthermore, recall bias could have played a role as patients were asked to fill in questions three to four years after their diagnosis, treatment, and consultation.
Wider implications of the findings
As quality of oncofertility care is suboptimal, strategies should be developed and tailored to the current gaps, and to guideline-specific barriers, to improve quality of care and, importantly, quality of life in female cancer survivors.
Trial registration number
N/A
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Affiliation(s)
- M Van den Berg
- Radboud university medical center, Obstetrics and Gynaecology , Nijmegen, The Netherlands
| | - C Beerendonk
- Radboud university medical center, Obstetrics and Gynaecology , Nijmegen, The Netherlands
| | - S Kaal
- Radboud university medical center, Medical Oncology , Nijmegen, The Netherlands
| | - C Mandigers
- Canisius-Wilhelmina Hospital, Medical Oncology , Nijmegen, The Netherlands
| | - T Schuurman
- The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Center for Gynecologic Oncology Amsterdam , Amsterdam, The Netherlands
| | - J Tol
- Jeroen Bosch Hospital, Medical Oncology , Den Bosch, The Netherlands
| | - J Tromp
- Amsterdam University Medical Center, Medical Oncology , Amsterdam, The Netherlands
| | - M Van der Vorst
- Rijnstate Hospital, Medical Oncology , Arnhem, The Netherlands
| | - D Braat
- Radboud university medical center, Obstetrics and Gynaecology , Nijmegen, The Netherlands
| | - R Hermens
- Radboud university medical center, IQ Healthcare , Nijmegen, The Netherlands
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