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Silva-Cardoso J, Santos J, Araújo I, Andrade A, Morais Sarmento P, Santos P, Moura B, Marques I, Peres M, Ferreira JP, Agostinho J, Pimenta J. conTemporary reflectiOns regarding heart failure manaGEmenT - How to ovERcome the PorTuguese barriers (TOGETHER-PT). Rev Port Cardiol 2024; 43:225-235. [PMID: 37689388 DOI: 10.1016/j.repc.2023.05.012] [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: 01/10/2023] [Revised: 04/11/2023] [Accepted: 05/02/2023] [Indexed: 09/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a complex clinical syndrome that is a significant burden in hospitalisations, morbidity, and mortality. Although a significant effort has been made to better understand its consequences and current barriers in its management, there are still several gaps to address. The present work aimed to identify the views of a multidisciplinary group of health care professionals on HF awareness and literacy, diagnosis, treatment and organization of care, identifying current challenges and providing insights into the future. METHODS A steering committee was established, including members of the Heart Failure Study Group of the Portuguese Society of Cardiology (GEIC-SPC), the Heart Failure Study Group of the Portuguese Society of Internal Medicine (NEIC-SPMI) and the Cardiovascular Study Group (GEsDCard) of the Portuguese Association of General and Family Medicine (APMGF). This steering committee produced a 16-statement questionnaire regarding different HF domains that was answered to by a diversified group of 152 cardiologists, internists, general practitioners, and nurses with an interest or dedicated to HF using a five-level Likert scale. Full agreement was defined as ≥80% of level 5 (fully agree) responses. RESULTS Globally, consensus was achieved in all but one of the 16 statements. Full agreement was registered in seven statements, namely 3 of 4 statements for patient education and HF awareness and 2 in 4 statements of both HF diagnosis and healthcare organization, with proportions of fully agree responses ranging from 82.9% to 96.7%. None of the HF treatment statements registered full agreement but 3 of 4 achieved ≥80% of level 4 (agree) responses. CONCLUSION This document aims to be a call-to-action to improve HF patients' quality of life and prognosis, by promoting a change in HF care in Portugal.
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Affiliation(s)
- José Silva-Cardoso
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; RISE - Health Research Network, Portugal.
| | - Jonathan Santos
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; ARS Norte, ACES Vale Sousa Norte, USF Torrão, Portugal
| | - Inês Araújo
- Clínica de Insuficiência Cardíaca, Serviço de Medicina III, Hospital S. Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Aurora Andrade
- Serviço de Cardiologia, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Pedro Morais Sarmento
- Departamento de Medicina Interna e Hospital de Dia de Insuficiência Cardíaca do Hospital da Luz de Lisboa, Lisboa, Portugal
| | - Paulo Santos
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal; RISE - Health Research Network, Portugal; MEDCIDS, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Brenda Moura
- Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Irene Marques
- Serviço de Medicina Interna, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica - Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Marisa Peres
- Serviço de Cardiologia, Hospital de Santarém, Santarém, Portugal
| | - João Pedro Ferreira
- Unic@RISE, Serviço de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Université de Lorraine, Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Joao Agostinho
- Serviço de Cardiologia, Departamento de Coração e Vasos, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Pimenta
- Serviço de Medicina Interna, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; UnIC@RISE, Departamento de Medicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Valdiviesso R, Amaral TF, Moreira E, Sousa-Santos AR, Fernandes M, Aguiar MJV, Martins S, Azevedo LF, Fernandes L, Silva-Cardoso J, Borges N. Associations of medicine use and ejection fraction with the coexistence of frailty and sarcopenia in a sample of heart failure outpatients: a cross-sectional study. BMC Cardiovasc Disord 2023; 23:594. [PMID: 38053018 PMCID: PMC10696669 DOI: 10.1186/s12872-023-03632-x] [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: 07/26/2023] [Accepted: 11/25/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Frailty and sarcopenia have been extensively studied in heart failure (HF) patients, but their coexistence is unknown. The aim of this work is to describe the coexistence of these conditions in a sample of HF outpatients and its association with the use of medication and left-ventricular ejection fraction. METHODS Participants in this cross-sectional study were recruited from a HF outpatients' clinic in northern Portugal. Frailty phenotype was assessed according to Fried et al. Sarcopenia was evaluated according to the revised consensus of the European Working Group on Sarcopenia in Older People. RESULTS A total of 136 HF outpatients (33.8% women, median age 59 years) integrated this study. Frailty and sarcopenia accounted for 15.4% and 18.4% of the sample, respectively. Coexistence of frailty and sarcopenia was found in 8.1% of the participants, while 17.6% had only one of the conditions. In multivariable analysis (n = 132), increasing age (OR = 1.13;95%CI = 1.06,1.20), being a woman (OR = 65.65;95%CI = 13.50, 319.15), having heart failure with preserved ejection fraction (HFpEF) (OR = 5.61; 95%CI = 1.22, 25.76), and using antidepressants (OR = 11.05; 95%CI = 2.50, 48.82), anticoagulants (OR = 6.11; 95%CI = 1.69, 22.07), furosemide (OR = 3.95; 95%CI = 1.07, 14.55), and acetylsalicylic acid (OR = 5.01; 95%CI = 1.10, 22.90) were associated with increased likelihood of having coexistence of frailty and sarcopenia, while using statins showed the inverse effect (OR = 0.06; 95%CI = 0.01, 0.30). CONCLUSIONS The relatively low frequency of coexistence of frailty and sarcopenia signifies that each of these two conditions still deserve individual attention from health professionals in their clinical practice and should be screened separately. Being a woman, older age, having HFpEF, using anticoagulants, antidepressants, loop diuretics and acetylsalicylic acid, and not using statins, were associated with having concomitant frailty and sarcopenia. These patients can potentially benefit from interventions that impact their quality of life such as nutritional and mental health interventions and exercise training.
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Affiliation(s)
- Rui Valdiviesso
- FCNAUP, Faculty of Nutrition and Food Sciences of the University of Porto, Rua Do Campo Alegre, 823, 4150-180, Porto, Portugal.
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Teresa F Amaral
- FCNAUP, Faculty of Nutrition and Food Sciences of the University of Porto, Rua Do Campo Alegre, 823, 4150-180, Porto, Portugal
- LAETA-INEGI / FEUP, Associated Laboratory of Energy, Transports and Aerospace, Institute of Science and Innovation in Mechanical and Industrial Engineering, Faculty of Engineering of the University of Porto, Porto, Portugal
| | - Emília Moreira
- CINTESIS@RISE, Knowledge Management Unit, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ana Rita Sousa-Santos
- FCNAUP, Faculty of Nutrition and Food Sciences of the University of Porto, Rua Do Campo Alegre, 823, 4150-180, Porto, Portugal
- TOXRUN, Toxicology Research Unit, University Institute of Health Sciences, CESPU, CRL, Gandra, Portugal
- CESPU, University Cooperative, CRL, Gandra, Portugal
| | - Mário Fernandes
- FCNAUP, Faculty of Nutrition and Food Sciences of the University of Porto, Rua Do Campo Alegre, 823, 4150-180, Porto, Portugal
| | - Maria J V Aguiar
- FCNAUP, Faculty of Nutrition and Food Sciences of the University of Porto, Rua Do Campo Alegre, 823, 4150-180, Porto, Portugal
| | - Sónia Martins
- CINTESIS@RISE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Luís F Azevedo
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Lia Fernandes
- CINTESIS@RISE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of the University of Porto, Porto, Portugal
- Psychiatry Service, University Hospital Center of São João, Porto, Portugal
| | - José Silva-Cardoso
- CINTESIS@RISE, Department of Medicine, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiology, University Hospital Center of São João, Porto, Portugal
| | - Nuno Borges
- FCNAUP, Faculty of Nutrition and Food Sciences of the University of Porto, Rua Do Campo Alegre, 823, 4150-180, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
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Chilton RJ, Silva-Cardoso J. Mineralocorticoid receptor antagonists in cardiovascular translational biology. Cardiovasc Endocrinol Metab 2023; 12:e0289. [PMID: 37614245 PMCID: PMC10443768 DOI: 10.1097/xce.0000000000000289] [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: 03/06/2023] [Accepted: 06/19/2023] [Indexed: 08/25/2023]
Abstract
This review examines the role of mineralocorticoid receptor antagonists (MRAs) in cardiovascular biology and the molecular mechanisms involved in mineralocorticoid receptor antagonism. The data discussed suggest that MRAs can play an important role in decreasing the impact of inflammation and fibrosis on cardiorenal outcomes. Evidence derived from major randomized clinical trials demonstrates that steroidal MRAs reduce mortality in patients with heart failure and reduced ejection fraction. Initial positive findings observed in patients with chronic kidney disease and type 2 diabetes (T2D) indicate the possible mechanisms of action of nonsteroidal MRAs, and the clinical benefits for patients with cardiorenal disease and T2D. This article supports the application of basic science concepts to expand our understanding of the molecular mechanisms of action involved in pathophysiology. This approach encourages the development of treatment options before diseases clinically manifest. Video Abstract: http://links.lww.com/CAEN/A42.
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Affiliation(s)
- Robert J. Chilton
- Department of Medicine, Janey & Dolph Briscoe Division of Cardiology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - José Silva-Cardoso
- Heart Failure and Transplant Clinic, Cardiology Service, São João University Hospital Centre, Porto, Portugal
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Azzam AP, Fidelis T, Nunes A, Valdiviesso R, Limpo T, Moreira E, Silva-Cardoso J, Castro SL. Portuguese adaptation of the Chronic Heart Failure Knowledge Questionnaire (KQCHF). BMC Cardiovasc Disord 2023; 23:307. [PMID: 37337171 PMCID: PMC10280838 DOI: 10.1186/s12872-023-03325-5] [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: 12/20/2022] [Accepted: 05/29/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND A patient's knowledge of heart failure (HF) is associated with better outcomes. The more information patients have about their illness, the less likely they are to be readmitted to the hospital. Such knowledge includes the cause, symptoms, probable duration, and expected evolution of the clinical picture. In Portugal, a tool for testing patient knowledge is an unmet need. Therefore, this study aimed to adapt and test the Chronic Heart Failure Knowledge Questionnaire (KQCHF) for the Portuguese context. METHODS This work includes three cross-sectional studies. In Study 1, subjects were divided between before and after receiving information about HF. In Study 2, participants answered the questionnaire before and after reading the brochure. In Study 3, KQCHF was applied to patients with HF. Studies 1 and 2 were carried out in the general population. Study 3 was carried out with HF outpatients. Convenience sampling was applied to participants in the three studies. RESULTS In Study 1 (n = 45), those who received information had better scores (9.2 ± 1.9) than those who did not (6.0 ± 2.3). In Study 2 (n = 21), the scores were higher after reading the brochure (10.4 ± 1.7 vs. 6.5 ± 2.9). In Study 3 (n = 169), women had better scores than men (9.1 ± 2.1 vs. 8.3 ± 2.2, overall: 8.5 ± 2.2), and knowledge was correlated with education (r = .340, p < .001) and age (r = -.170, p = .030). CONCLUSION The Portuguese adaptation of KQCHF captured relevant knowledge about HF and has shown promising results for clinical and research purposes. The questionnaire can be useful in assessing HF patients' knowledge of their disease and as a basis for the implementation of general and personalised educational strategies to improve HF knowledge and, therefore, promote health literacy and self-care.
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Affiliation(s)
- Ana Paula Azzam
- Faculty of Psychology and Educational Sciences of the University of Porto, Rua Alfredo Allen, S/N, 4200-135, Porto, Portugal.
| | - Tatiane Fidelis
- Faculty of Psychology and Educational Sciences of the University of Porto, Rua Alfredo Allen, S/N, 4200-135, Porto, Portugal
| | - Andreia Nunes
- Faculty of Psychology and Educational Sciences of the University of Porto, Rua Alfredo Allen, S/N, 4200-135, Porto, Portugal
| | - Rui Valdiviesso
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Teresa Limpo
- Faculty of Psychology and Educational Sciences of the University of Porto, Rua Alfredo Allen, S/N, 4200-135, Porto, Portugal
| | - Emília Moreira
- CINTESIS@RISE, Knowledge Management Unit, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - José Silva-Cardoso
- CINTESIS@RISE, Department of Medicine, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiology, University Hospital Center of São João, Porto, Portugal
| | - São Luís Castro
- Faculty of Psychology and Educational Sciences of the University of Porto, Rua Alfredo Allen, S/N, 4200-135, Porto, Portugal
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Joseph P, Roy A, Lonn E, Störk S, Floras J, Mielniczuk L, Rouleau JL, Zhu J, Dzudie A, Balasubramanian K, Karaye K, AlHabib KF, Gómez-Mesa JE, Branch KR, Makubi A, Budaj A, Avezum A, Wittlinger T, Ertl G, Mondo C, Pogosova N, Maggioni AP, Orlandini A, Parkhomenko A, ElSayed A, López-Jaramillo P, Grinvalds A, Temizhan A, Hage C, Lund LH, Kazmi K, Lanas F, Sharma SK, Fox K, McMurray JJV, Leong D, Dokainish H, Khetan A, Yonga G, Kragholm K, Wagdy Shaker K, Mwita JC, Al-Mulla AA, Alla F, Damasceno A, Silva-Cardoso J, Dans AL, Sliwa K, O'Donnell M, Bazargani N, Bayés-Genís A, McCready T, Probstfield J, Yusuf S. Global Variations in Heart Failure Etiology, Management, and Outcomes. JAMA 2023; 329:1650-1661. [PMID: 37191704 PMCID: PMC10189564 DOI: 10.1001/jama.2023.5942] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023]
Abstract
Importance Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants Multinational HF registry of 23 341 participants in 40 high-income, upper-middle-income, lower-middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures HF cause, HF medication use, hospitalization, and death. Results Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper-middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower-middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper-middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower-middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper-middle-income countries (ratio = 2.4), similar in lower-middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper-middle-income countries (9.7%), then lower-middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower-middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.
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Affiliation(s)
- Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Eva Lonn
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Stefan Störk
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Department Internal Medicine, University Hospital, Würzburg, Germany
| | - John Floras
- Mount Sinai Hospital, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Mielniczuk
- University of Ottawa, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Jun Zhu
- FuWai Hospital, Beijing, China
| | - Anastase Dzudie
- Department of Global Health and Population, Lown Scholars Program, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kumar Balasubramanian
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Kamilu Karaye
- Bayero University and Aminu Kano Teaching Hospital, Department of Medicine, Kano, Nigeria
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Abel Makubi
- Community Development, Gender, Elderly, and Children, Ministry of Health, Dodoma, Tanzania
| | - Andrzej Budaj
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Thomas Wittlinger
- Department of Cardiology, Asklepios Hospital Goslar, Goslar, Germany
| | - Georg Ertl
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Department Internal Medicine, University Hospital, Würzburg, Germany
| | | | - Nana Pogosova
- Medical Research Center of Cardiology named after E.I. Chazov, Moscow, Russia
| | | | - Andres Orlandini
- Estudios Clínicos Latino America Collaborative Group, Rosario, Argentina
| | - Alexander Parkhomenko
- Emergency Cardiology Department, National Scientific Centre, Strazhesko Institute of Cardiology, Kiev, Ukraine
| | | | | | - Alex Grinvalds
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ahmet Temizhan
- Clinic of Cardiology, University of Health Science, Ankara City Hospital, Ankara, Türkiye
| | - Camilla Hage
- Karolinska Institutet, Department of Medicine, Cardiology Unit, Stockholm, Sweden
- Karolinska University Hospital, Heart and Vascular Theme, Heart Failure Section, Stockholm, Sweden
| | - Lars H Lund
- Karolinska Institutet, Department of Medicine, Cardiology Unit, Stockholm, Sweden
- Karolinska University Hospital, Heart and Vascular Theme, Heart Failure Section, Stockholm, Sweden
| | - Khawar Kazmi
- Department of Cardiology, Aga Khan University, Karachi, Pakistan
| | | | | | - Keith Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Darryl Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Hisham Dokainish
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Aditya Khetan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Gerald Yonga
- University of Nairobi, Department of Clinical Medicine and Therapeutics, Nairobi, Nairobi City County, Kenya
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kerolos Wagdy Shaker
- Aswan Heart Center, Magdi Yacoub Foundation, Department of Cardiology, Aswan, Egypt
| | | | | | - François Alla
- Bordeaux Population Health Research Center, Université de Bordeaux, Bordeaux, France
| | | | - José Silva-Cardoso
- Faculty of Medicine, University of Porto, Porto, Portugal
- São João University Hospital Centre, Porto, Portugal
| | - Antonio L Dans
- University of the Philippines, Medicine, Quezon City, National Capital Region, Philippines
| | - Karen Sliwa
- Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | - Martin O'Donnell
- College of Medicine, Nursing, and Health Sciences, University of Galway, Galway, Ireland
| | | | - Antoni Bayés-Genís
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, CIBERCV, Spain
| | - Tara McCready
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
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Valdiviesso R, Moreira E, Martins S, Azevedo LF, Ataíde R, Fernandes L, Silva-Cardoso J, Borges N. Frailty phenotype in heart failure: A condition that transcends age. Rev Port Cardiol 2023; 42:225-234. [PMID: 36623639 DOI: 10.1016/j.repc.2022.02.009] [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] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Studies on younger frail and pre-frail subjects suffering from heart failure (HF) are scarce, except for those focusing on the critically ill. This work aims to describe differences between younger (<65 years) and older (≥65 years) pre-frail and frail HF outpatients regarding their nutritional, functional and clinical statuses. METHODS In this cross-sectional study, a sample of 99 HF frail and pre-frail patients (aged 24-81 years, 38.4% women, 21.2% frail, 59.6% <65 years) was recruited from an HF outpatients' clinic in northern Portugal. Muscle mass was estimated from mid-upper arm muscle circumference. Weight status was assessed using body mass index. Hand grip strength and gait speed were measured. Medical records were reviewed. Associations between participants' characteristics and age were calculated using binary logistic regression. RESULTS Age was associated with hand grip strength (OR=0.90), gait speed (OR=0.01) and diabetes (OR=4.95). Obesity, muscle mass or heart failure functional classes were not associated with age categories. CONCLUSION There is an overall lack of differentiation between younger and older HF patients with the frailty phenotype. Therefore, frailty phenotype should be assessed in all patients, regardless of age. Hand grip strength seems to be a good predictor for older age and more studies are needed to define age-specific hand grip strength cut-offs for HF populations.
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Affiliation(s)
- Rui Valdiviesso
- FCNAUP - Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.
| | - Emília Moreira
- CINTESIS@RISE, Knowledge Management Unit, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sónia Martins
- ISSSP - Instituto Superior de Serviço Social do Porto, Porto, Portugal; CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rosário Ataíde
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Lia Fernandes
- CINTESIS@RISE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of the University of Porto, Porto, Portugal; Psychiatry Service, University Hospital Center of São João, Porto, Portugal
| | - José Silva-Cardoso
- CINTESIS@RISE, Department of Medicine, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Cardiology, University Hospital Center of São João, Porto, Portugal
| | - Nuno Borges
- FCNAUP - Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal; CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
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Silva-Cardoso J, Moreira E. Renin-angiotensin-aldosterone system inhibitors and the COVID-19 epidemic. Rev Port Cardiol 2022; 41:831-832. [PMID: 36043163 PMCID: PMC9411420 DOI: 10.1016/j.repc.2022.08.006] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- José Silva-Cardoso
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Centro Hospitalar Universitário de São João, Porto, Portugal; RISE - Rede de Investigação em Saúde, Laboratório Associado, Portugal.
| | - Emilia Moreira
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; RISE - Rede de Investigação em Saúde, Laboratório Associado, Portugal
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Valdiviesso R, Sousa-Santos AR, Azevedo LF, Moreira E, Amaral TF, Silva-Cardoso J, Borges N. Statins are associated with reduced likelihood of sarcopenia in a sample of heart failure outpatients: a cross-sectional study. BMC Cardiovasc Disord 2022; 22:356. [PMID: 35931947 PMCID: PMC9354359 DOI: 10.1186/s12872-022-02804-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/12/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sarcopenia is prevalent in heart failure (HF) patients, contributing to its poor prognosis. Statin use is postulated as a probable risk for developing sarcopenia, but little is known regarding this association in HF patients. This work aims at classifying and characterising sarcopenia and at describing the association of statin use with sarcopenia in a sample of Portuguese HF outpatients. METHODS In this cross-sectional study, a sample of 136 HF patients (median age: 59 years, 33.8% women) was recruited from an HF outpatients' clinic of a University Hospital in Portugal. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People 2. Clinical, nutritional, and dietary data were collected. RESULTS A total of 25 (18.4%) individuals were categorised as sarcopenic, ranging from 12.2% in younger (< 65 years) participants vs. 30.4% in older ones and from 3.3% in men vs. 47.8% in women. Severe sarcopenia accounted for 7.4% of the sample and sarcopenic obesity was identified in 5.1% of the individuals. A total of 65.4% of the participants were statin users. In multivariable analysis (n = 132, 25 sarcopenic), the use of statins was inversely associated with sarcopenia (OR = 0.03; 95% CI = 0.01, 0.30). Each additional age year was associated with a 9% increase in the likelihood of being sarcopenic (OR = 1.09; 95% CI = 1.01, 1.17), and each Kg.m-2 increment in body mass index was associated with a 21% decrease in the likelihood of sarcopenia (OR = 0.79; 95% CI = 0.65, 0.96). The daily use of five or more medicines was also directly associated with sarcopenia (OR = 26.87; 95% CI = 2.01, 359.26). On the other hand, being a man and being physically active were inversely associated with sarcopenia (OR = 0.01; 95% CI = 0.00, 0.07 and OR = 0.09; 95% CI = 0.01, 0.65, respectively). CONCLUSIONS Contrary to what was expected, patients medicated with statins were less likely to be sarcopenic. Although this finding deserves further research, we hypothesise that this might be related to the pleiotropic effects of statins on endothelial function, contributing to better neuromuscular fitness.
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Affiliation(s)
- Rui Valdiviesso
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Rua do Campo Alegre, 823, 4150-180, Porto, Portugal. .,CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, R. Dr. Plácido da Costa, s/n, ed. Nascente, piso 2, 4200-450, Porto, Portugal.
| | - Ana Rita Sousa-Santos
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Rua do Campo Alegre, 823, 4150-180, Porto, Portugal
| | - Luís F Azevedo
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, R. Dr. Plácido da Costa, s/n, ed. Nascente, piso 2, 4200-450, Porto, Portugal.,MEDCIS/FMUP - Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,RISE - Rede de Investigação em Saúde, Porto, Portugal
| | - Emília Moreira
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, R. Dr. Plácido da Costa, s/n, ed. Nascente, piso 2, 4200-450, Porto, Portugal.,MEDCIS/FMUP - Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,RISE - Rede de Investigação em Saúde, Porto, Portugal
| | - Teresa F Amaral
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Rua do Campo Alegre, 823, 4150-180, Porto, Portugal.,UISPA, LAETA-INEGI/FEUP - Unidade de Investigação de Integração de Sistemas e Unidade de Automação de Processos, Laboratório Associado em Energia, Transportes e Aeronáutica, Faculdade de Engenharia da Universidade do Porto, Instituto de Ciência e Inovação em Engenharia, Porto, Portugal
| | - José Silva-Cardoso
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, R. Dr. Plácido da Costa, s/n, ed. Nascente, piso 2, 4200-450, Porto, Portugal.,RISE - Rede de Investigação em Saúde, Porto, Portugal.,DM/FMUP - Departamento de Medicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,SC/CHUSJ - Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Nuno Borges
- FCNAUP - Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Rua do Campo Alegre, 823, 4150-180, Porto, Portugal.,CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, R. Dr. Plácido da Costa, s/n, ed. Nascente, piso 2, 4200-450, Porto, Portugal.,RISE - Rede de Investigação em Saúde, Porto, Portugal
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Rossignol P, Silva-Cardoso J, Kosiborod MN, Brandenburg, Cleland JG, Hadimeri H, Hullin R, Makela S, Mörtl D, Paoletti E, Pollock C, Vogt L, Jadoul M, Butler J. Pragmatic Diagnostic and Therapeutic Algorithms to Optimize New Potassium Binder use in Cardiorenal Disease. Pharmacol Res 2022; 182:106277. [PMID: 35662631 DOI: 10.1016/j.phrs.2022.106277] [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: 04/08/2022] [Revised: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pivotal randomized trials demonstrating efficacy, safety and good tolerance, of two new potassium binders (patiromer and sodium zirconium cyclosilicate) led to their recent approval. A major hurdle to the implementation of these potassium-binders is understanding how to integrate them safely and effectively into the long-term management of cardiovascular and kidney disease patients using renin angiotensin aldosterone system inhibitors (RAASi), the latter being prone to induce hyperkalaemia. METHODS a multidisciplinary academic panel including nephrologists and cardiologists was convened to develop consensus therapeutic algorithm(s) aimed at optimizing the use of the two novel potassium binders (patiromer and sodium zirconium cyclosilicate) in stable adults who require treatment with RAASi and experience(d) hyperkalaemia in a non-emergent setting. RESULTS Two dedicated pragmatic algorithms are proposed. The lowest intervention threshold (i.e. 5.1mmol/L or greater) was the one used in the patiromer and sodium zirconium cyclosilicate) pivotal trials, both drugs being indicated to treat hyperkalaemia in a non -emergent setting. Acknowledging the heterogeneity across specialty guidelines in hyperkalaemia definition and thresholds to intervene when facing hyperkalaemia, we have been mindful to use soft language i.e. "it is to consider", not necessarily "to do". CONCLUSIONS Providing the clinical community with pragmatic algorithms may help optimize the management of high-risk patients by avoiding the risks of both hyper and hypokalaemia and of suboptimal RAASi therapy.
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Affiliation(s)
- P Rossignol
- Université de Lorraine, INSERM CIC Plurithématique 1433, Nancy CHRU, Inserm U1116, FCRIN INI-CRCT, Nancy, France.
| | - J Silva-Cardoso
- Heart Failure and Transplant Clinic, Cardiology Service, São João University Hospital Centre, Faculty of Medicine, University of Porto, CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - M N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri; The George Institute for Global Health, and University of New South Wales, Sydney, New South Wales, Australia
| | - Brandenburg
- Department of Cardiology and Nephrology, Rhein-Maas Klinikum, Würselen, Germany
| | - J G Cleland
- Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow & National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - H Hadimeri
- Department of Nephrology, Skaraborgs sjukhus, Skövde, Sweden
| | - R Hullin
- Service de Cardiologie, Département Coeur-Vaisseaux, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Suisse
| | - S Makela
- Department of Internal Medicine, Kidney Unit, Tampere University Hospital, Tampere, Finland
| | - D Mörtl
- Department of Internal Medicine 3, University Hospital St. Pölten, St. Pölten, Austria
| | - E Paoletti
- Nephrology, Dialysis, and Transplantation, Policlinico San Martino, Genova, Italy
| | - C Pollock
- Renal Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - L Vogt
- Department of Internal Medicine, section Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - M Jadoul
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium;; Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - J Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
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Silva-Cardoso J, Fonseca C, Franco F, Morais J, Ferreira J, Brito D. Optimization of heart failure with reduced ejection fraction prognosis-modifying drugs: A 2021 heart failure expert consensus paper. Rev Port Cardiol 2021; 40:975-983. [PMID: 34922707 DOI: 10.1016/j.repce.2021.11.017] [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: 07/14/2021] [Accepted: 07/27/2021] [Indexed: 10/19/2022] Open
Abstract
Heart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients' functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members' clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks.
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Affiliation(s)
- José Silva-Cardoso
- Department of Medicine, Faculdade de Medicina, Universidade do Porto, Oporto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, Oporto, Portugal; CINTESIS, Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Oporto, Portugal.
| | - Cândida Fonseca
- Heart Failure Clinic, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Fátima Franco
- Serviço de Cardiologia, Unidade de Tratamento de Insuficiência Cardíaca Avançada (UTICA), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Morais
- Cardiology Division, Centro Hospitalar de Leiria, Leiria, Portugal; CiTechCare, Center for Innovative Care and Health, Instituto Politécnico de Leiria, Leiria, Portugal
| | - Jorge Ferreira
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Dulce Brito
- Heart and Vessels Department, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal; CCUL, Cardiovascular Center, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
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Cabral J, Vasconcelos H, Maia-Araújo P, Moreira E, Campelo M, Amorim S, Sousa A, Moura B, Pinto R, Dias C, Silva-Cardoso J. Sacubitril/valsartan in everyday clinical practice: an observational study based on the experience of a heart failure clinic. Cardiovasc Diagn Ther 2021; 11:1217-1227. [PMID: 35070791 PMCID: PMC8748480 DOI: 10.21037/cdt-21-312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/29/2021] [Indexed: 12/10/2023]
Abstract
BACKGROUND Heart failure (HF) is a growing public health problem. Sacubitril/valsartan is now recommended to be used in persistently symptomatic patients with left ventricular ejection fraction (LVEF) <40%, replacing angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs). In the present study, we aimed to characterise the challenges of sacubitril/valsartan use in everyday clinical practice. METHODS We assessed the medical records of patients with HF and reduced ejection fraction eligible for sacubitril/valsartan attending a HF clinic at a Portuguese University Hospital during 2018 (n=152). The number of eligible patients receiving the drug and the reasons for not prescribing sacubitril/valsartan were evaluated. Additionally, we assessed the tolerability of maximal doses of sacubitril/valsartan. New York Heart Association functional class (NYHA class) and LVEF before and after up-titration to maximal tolerated sacubitril/valsartan dose were compared. Median follow-up was 41 months. RESULTS Of the 152 included patients, 75 (49%) were prescribed the drug. The two main reasons for non-prescription were patient financial barriers (31%) and hypotension (27%). Only 33% of patients on sacubitril/valsartan did reach maximal dose. Hypotension was the main limiting factor for dose optimisation. Duration of sacubitril/valsartan treatment showed a positive association with LVEF improvement during follow-up (6.6% absolute LVEF increase/year). NYHA functional class improved significantly from baseline through the end of follow-up. CONCLUSIONS In every-day clinical practice, although sacubitril/valsartan was associated with a marked improvement in NYHA class and in LVEF, important financial and clinical barriers to the implementation of this therapy were identified.
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Affiliation(s)
- Joana Cabral
- Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
| | - Henrique Vasconcelos
- Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
| | - Paulo Maia-Araújo
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Emília Moreira
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Campelo
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Amorim
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alexandra Sousa
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiology, Hospital Santa Maria Maior, Barcelos, Portugal
| | - Brenda Moura
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiology, Hospital das Forças Armadas, Polo do Porto, Porto, Portugal
| | - Roberto Pinto
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Camila Dias
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Silva-Cardoso
- CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
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Silva-Cardoso J, Andrade A, Brito D, Ferreira J, Fonseca C, Peres M, Franco F, Moura B. SGLT-2 inhibitors: A step forward in the treatment of heart failure with reduced ejection fraction. Rev Port Cardiol (Engl Ed) 2021; 40:687-693. [PMID: 34503709 DOI: 10.1016/j.repce.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/01/2021] [Indexed: 12/16/2022] Open
Abstract
Heart failure (HF) is a major health problem with a significant impact on morbidity, mortality, quality of life and healthcare costs. Despite the positive impact of disease-modifying therapies developed over the last four decades, HF mortality and hospitalization remain high. We aim at reviewing the evidence supporting the use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors, as a novel strategy for HF with reduced ejection fraction (HFrEF) treatment. The consistent observation of a reduction in HF hospitalizations in type-2 diabetes cardiovascular safety trials EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58 and VERTIS raised the hypothesis that SGLT-2 inhibitors could have an impact in HF treatment. This hypothesis was first confirmed in 2019 with the DAPA-HF publication showing that dapagliflozin on top of optimized HFrEF therapy, reduced HF-hospitalizations and cardiovascular mortality. This was reinforced by the EMPEROR-Reduced publication in 2020 showing that empagliflozin on top of optimized HFrEF therapy, reduced HF-hospitalizations. Both studies established SGLT-2 inhibitors as a fourth pillar of HFrEF prognosis-modifying therapy, in addition to the gold standard triple neurohormonal modulation/blockade.
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Affiliation(s)
- José Silva-Cardoso
- Clínica de Insuficiência Cardíaca e Transplante, Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculdade de Medicina, Universidade do Porto, Porto, Portugal; CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal.
| | - Aurora Andrade
- Serviço de Cardiologia, Centro Hospitalar Tâmega e Sousa, Portugal
| | - Dulce Brito
- Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Jorge Ferreira
- Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Cândida Fonseca
- Unidade de Insuficiência Cardíaca, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Marisa Peres
- Serviço de Cardiologia, Hospital de Santarém, Santarém, Portugal
| | - Fátima Franco
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Brenda Moura
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal; Serviço de Cardiologia, Hospital das Forças Armadas - Pólo do Porto, Portugal
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Silva-Cardoso J, Fonseca C, Franco F, Morais J, Ferreira J, Brito D. Optimization of heart failure with reduced ejection fraction prognosis-modifying drugs: A 2021 heart failure expert consensus paper. Rev Port Cardiol 2021; 40:S0870-2551(21)00355-3. [PMID: 34462172 DOI: 10.1016/j.repc.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/14/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 12/22/2022] Open
Abstract
Heart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients' functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members' clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks.
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Affiliation(s)
- José Silva-Cardoso
- Department of Medicine, Faculdade de Medicina, Universidade do Porto, Oporto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, Oporto, Portugal; CINTESIS, Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Oporto, Portugal.
| | - Cândida Fonseca
- Heart Failure Clinic, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Fátima Franco
- Serviço de Cardiologia, Unidade de Tratamento de Insuficiência Cardíaca Avançada (UTICA), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Morais
- Cardiology Division, Centro Hospitalar de Leiria, Leiria, Portugal; CiTechCare, Center for Innovative Care and Health, Instituto Politécnico de Leiria, Leiria, Portugal
| | - Jorge Ferreira
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Dulce Brito
- Heart and Vessels Department, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal; CCUL, Cardiovascular Center, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
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Valdiviesso R, Azevedo LF, Moreira E, Ataíde R, Martins S, Fernandes L, Silva-Cardoso J, Borges N. Frailty phenotype and associated nutritional factors in a sample of Portuguese outpatients with heart failure. Nutr Metab Cardiovasc Dis 2021; 31:2391-2397. [PMID: 34112582 DOI: 10.1016/j.numecd.2021.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Frailty phenotype (FP) is very common in heart failure (HF) and both syndromes worsen one another. The aim of this study is to first describe FP in a sample of Portuguese patients with HF, and to analyse its association with nutritional and clinical statuses, namely, muscle mass, obesity and functional class. METHODS AND RESULTS In this cross-sectional study, a sample of 136 outpatients with HF (24-81 years, 33.8% women) were randomly selected from the appointments' listings of a HF and Transplant clinic in a Portuguese University Hospital. FP was assessed according to Fried et al. muscle mass was estimated from the mid-upper arm muscle circumference; weight status was assessed using the body mass index; HF functional classes were registered. The association between participants' characteristics and FP categories was analysed using logistic ordinal regression. The frequency of pre-frailty and frailty is 57.4% and 15.4%, respectively. Within frail individuals, 52.4% were under the age of 65. In multivariable analysis, frailty was positively associated with age 70 or older (OR = 3.44) and obesity (OR = 2.66), and negatively associated with muscle mass (OR = 0.77) and HF functional classes I (OR = 0.14) or II (OR = 0.29). CONCLUSION Muscle mass seems to be an important predictor of frailty in patients with HF and should be taken into account when designing intervention plans that allow for reverting or modifying frailty and pre-frailty. Younger patients should be monitored for the presence and evolution of FP.
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Affiliation(s)
- Rui Valdiviesso
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - Luís F Azevedo
- Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Emília Moreira
- Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Rosário Ataíde
- Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sónia Martins
- Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Departamento de Neurociências Clínicas e Saúde Mental, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Lia Fernandes
- Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Departamento de Neurociências Clínicas e Saúde Mental, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Serviço de Psiquiatria do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Silva-Cardoso
- Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Departamento de Medicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Nuno Borges
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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15
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Silva-Cardoso J, Andrade A, Brito D, Ferreira J, Fonseca C, Peres M, Franco F, Moura B. SGLT-2 inhibitors: A step forward in the treatment of heart failure with reduced ejection fraction. Rev Port Cardiol 2021. [PMID: 34083098 DOI: 10.1016/j.repc.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Heart failure (HF) is a major health problem with a significant impact on morbidity, mortality, quality of life and healthcare costs. Despite the positive impact of disease-modifying therapies developed over the last four decades, HF mortality and hospitalization remain high. We aim at reviewing the evidence supporting the use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors, as a novel strategy for HF with reduced ejection fraction (HFrEF) treatment. The consistent observation of a reduction in HF hospitalizations in type-2 diabetes cardiovascular safety trials EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58 and VERTIS raised the hypothesis that SGLT-2 inhibitors could have an impact in HF treatment. This hypothesis was first confirmed in 2019 with the DAPA-HF publication showing that dapagliflozin on top of optimized HFrEF therapy, reduced HF-hospitalizations and cardiovascular mortality. This was reinforced by the EMPEROR-Reduced publication in 2020 showing that empagliflozin on top of optimized HFrEF therapy, reduced HF-hospitalizations. Both studies established SGLT-2 inhibitors as a fourth pillar of HFrEF prognosis-modifying therapy, in addition to the gold standard triple neurohormonal modulation/blockade.
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Affiliation(s)
- José Silva-Cardoso
- Clínica de Insuficiência Cardíaca e Transplante, Serviço de Cardiologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculdade de Medicina, Universidade do Porto, Porto, Portugal; CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal.
| | - Aurora Andrade
- Serviço de Cardiologia, Centro Hospitalar Tâmega e Sousa, Portugal
| | - Dulce Brito
- Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Jorge Ferreira
- Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Cândida Fonseca
- Unidade de Insuficiência Cardíaca, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Marisa Peres
- Serviço de Cardiologia, Hospital de Santarém, Santarém, Portugal
| | - Fátima Franco
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Brenda Moura
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal; Serviço de Cardiologia, Hospital das Forças Armadas - Pólo do Porto, Portugal
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16
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Abraham WT, Lindenfeld J, Ponikowski P, Agostoni P, Butler J, Desai AS, Filippatos G, Gniot J, Fu M, Gullestad L, Howlett JG, Nicholls SJ, Redon J, Schenkenberger I, Silva-Cardoso J, Störk S, Krzysztof Wranicz J, Savarese G, Brueckmann M, Jamal W, Nordaby M, Peil B, Ritter I, Ustyugova A, Zeller C, Salsali A, Anker SD. Effect of empagliflozin on exercise ability and symptoms in heart failure patients with reduced and preserved ejection fraction, with and without type 2 diabetes. Eur Heart J 2021; 42:700-710. [PMID: 33351892 DOI: 10.1093/eurheartj/ehaa943] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [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: 06/09/2020] [Revised: 07/31/2020] [Accepted: 11/05/2020] [Indexed: 12/26/2022] Open
Abstract
AIMS The EMPERIAL (Effect of EMPagliflozin on ExeRcise ability and HF symptoms In patients with chronic heArt faiLure) trials evaluated the effects of empagliflozin on exercise ability and patient-reported outcomes in heart failure (HF) with reduced and preserved ejection fraction (EF), with and without type 2 diabetes (T2D), reporting, for the first time, the effects of sodium-glucose co-transporter-2 inhibition in HF with preserved EF (HFpEF). METHODS AND RESULTS HF patients with reduced EF (HFrEF) (≤40%, N = 312, EMPERIAL-Reduced) or preserved EF (>40%, N = 315, EMPERIAL-Preserved), with and without T2D, were randomized to empagliflozin 10 mg or placebo for 12 weeks. The primary endpoint was 6-minute walk test distance (6MWTD) change to Week 12. Key secondary endpoints included Kansas City Cardiomyopathy Questionnaire Total Symptom Score (KCCQ-TSS) and Chronic Heart Failure Questionnaire Self-Administered Standardized format (CHQ-SAS) dyspnoea score. 6MWTD median (95% confidence interval) differences, empagliflozin vs. placebo, at Week 12 were -4.0 m (-16.0, 6.0; P = 0.42) and 4.0 m (-5.0, 13.0; P = 0.37) in EMPERIAL-Reduced and EMPERIAL-Preserved, respectively. As the primary endpoint was non-significant, all secondary endpoints were considered exploratory. Changes in KCCQ-TSS and CHQ-SAS dyspnoea score were non-significant. Improvements with empagliflozin in exploratory pre-specified analyses of KCCQ-TSS responder rates, congestion score, and diuretic use in EMPERIAL-Reduced are hypothesis generating. Empagliflozin adverse events were consistent with those previously reported. CONCLUSION The primary outcome for both trials was neutral. Empagliflozin was well tolerated in HF patients, with and without T2D, with a safety profile consistent with that previously reported in T2D. Hypothesis-generating improvements in exploratory analyses of secondary endpoints with empagliflozin in HFrEF were observed.
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Affiliation(s)
- William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, 473 West 12th Ave., Columbus, OH 43210, USA
| | - JoAnn Lindenfeld
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Piotr Ponikowski
- Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367, Wroclaw, Poland
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino-IRCCS, Via Carlo Parea, 4 - 20138, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19 20122, Milan, Italy
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS-39216, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Athens 157 72, Greece.,University of Cyprus, School of Medicine, Shacolas Educational Centre for Clinical Medicine, Palaios dromos Lefkosias Lemesou No.215/6, 2029 Aglantzia, Nicosia, Cyprus
| | - Jacek Gniot
- Department of Cardiology, Independent Public Healthcare, General Hospital in Puławy; ul. Bema 1; 24 - 100 Pulawy, Poland
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg University, Blå stråket 5, 413 45 Gothenburg, Sweden
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Søsterhjemmet, Kirkeveien 166, 2.etasje, 0450 Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Sogn Arena, Klaus Torgårds vei 3, 2. Etg, 0372 Oslo, Norway.,Center for Heart Failure Research, Department of Cardiology Medicine (Building 3), 1st floor, Oslo University Hospital, Kirkeveien 166, 0407 Oslo, Norway
| | - Jonathan G Howlett
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, 27 Rainforest Walk, Clayton VIC 3800, Melbourne, Australia
| | - Josep Redon
- INCLIVA Research Institute, University of Valencia, vinguda de Menéndez y Pelayo, 4, 46010 Valencia, and CIBERObn, Madrid, Spain
| | | | - José Silva-Cardoso
- CardioCare, CINTESIS-Center for Health Technology and Services Research, and Director of the Cardiology Service, Porto University Medical School, São João University Medical Centre, Rua Dr. Plácido da Costa, s/n 4200-450, Porto, Portugal
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, Würzburg University and University Hospital Würzburg, Straubmühlweg 2, 97078 Würzburg, Germany
| | - Jerzy Krzysztof Wranicz
- Department of Electrocardiology, Medical University of Lodz, al. Tadeusza Kościuszki 4, 90-41, Lodz, Poland
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, Solna Karolinska University Hospital D1:04, SE-171 76 Stockholm, Sweden
| | - Martina Brueckmann
- Boehringer Ingelheim International GmbH, Binger Str. 173, 55216 Ingelheim am Rhein, Germany.,Faculty of Medicine Mannheim, University of Heidelberg, Ludolf-Krehl-Str. 13-17, 68167 Mannheim, Germany
| | - Waheed Jamal
- Boehringer Ingelheim International GmbH, Binger Str. 173, 55216 Ingelheim am Rhein, Germany
| | - Matias Nordaby
- Boehringer Ingelheim International GmbH, Binger Str. 173, 55216 Ingelheim am Rhein, Germany
| | - Barbara Peil
- Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Str. 173, 55216 Ingelheim am Rhein, Germany
| | - Ivana Ritter
- Boehringer Ingelheim International GmbH, Binger Str. 173, 55216 Ingelheim am Rhein, Germany
| | - Anastasia Ustyugova
- Boehringer Ingelheim International GmbH, Binger Str. 173, 55216 Ingelheim am Rhein, Germany
| | - Cordula Zeller
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Str. 65, 88397 Biberach an der Riß, Germany
| | - Afshin Salsali
- Heart Failure and DM Global Development, Boehringer Ingelheim Pharmaceuticals, Inc, 900 Ridgebury Rd, Ridgefield, CT 06877, USA
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health, Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Föhrer Str. 15, 13353 Berlin, Germany
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17
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Johansson I, Joseph P, Balasubramanian K, McMurray JJV, Lund LH, Ezekowitz JA, Kamath D, Alhabib K, Bayes-Genis A, Budaj A, Dans ALL, Dzudie A, Probstfield JL, Fox KAA, Karaye KM, Makubi A, Fukakusa B, Teo K, Temizhan A, Wittlinger T, Maggioni AP, Lanas F, Lopez-Jaramillo P, Silva-Cardoso J, Sliwa K, Dokainish H, Grinvalds A, McCready T, Yusuf S. Health-Related Quality of Life and Mortality in Heart Failure: The Global Congestive Heart Failure Study of 23 000 Patients From 40 Countries. Circulation 2021; 143:2129-2142. [PMID: 33906372 DOI: 10.1161/circulationaha.120.050850] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Poor health-related quality of life (HRQL) is common in heart failure (HF), but there are few data on HRQL in HF and the association between HRQL and mortality outside Western countries. METHODS We used the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) to record HRQL in 23 291 patients with HF from 40 countries in 8 different world regions in the G-CHF study (Global Congestive Heart Failure). We compared standardized KCCQ-12 summary scores (adjusted for age, sex, and markers of HF severity) among regions (scores range from 0 to 100, with higher score indicating better HRQL). We used multivariable Cox regression with adjustment for 15 variables to assess the association between KCCQ-12 summary scores and the composite of all-cause death, HF hospitalization, and each component over a median follow-up of 1.6 years. RESULTS The mean age of participants was 65 years; 61% were men; 40% had New York Heart Association class III or IV symptoms; and 46% had left ventricular ejection fraction ≥40%. Average HRQL differed between regions (lowest in Africa [mean± SE, 39.5±0.3], highest in Western Europe [62.5±0.4]). There were 4460 (19%) deaths, 3885 (17%) HF hospitalizations, and 6949 (30%) instances of either event. Lower KCCQ-12 summary score was associated with higher risk of all outcomes; the adjusted hazard ratio (HR) for each 10-unit KCCQ-12 summary score decrement was 1.18 (95% CI, 1.17-1.20) for death. Although this association was observed in all regions, it was less marked in South Asia, South America, and Africa (weakest association in South Asia: HR, 1.08 [95% CI, 1.03-1.14]; strongest association in Eastern Europe: HR, 1.31 [95% CI, 1.21-1.42]; interaction P<0.0001). Lower HRQL predicted death in patients with New York Heart Association class I or II and III or IV symptoms (HR, 1.17 [95% CI, 1.14-1.19] and HR, 1.14 [95% CI, 1.12-1.17]; interaction P=0.13) and was a stronger predictor for the composite outcome in New York Heart Association class I or II versus class III or IV (HR 1.15 [95% CI, 1.13-1.17] versus 1.09 [95% CI, [1.07-1.11]; interaction P<0.0001). HR for death was greater in ejection fraction ≥40 versus <40% (HR, 1.23 [95% CI, 1.20-1.26] and HR, 1.15 [95% CI, 1.13-1.17]; interaction P<0.0001). CONCLUSION HRQL is a strong and independent predictor of all-cause death and HF hospitalization across all geographic regions, in mildly and severe symptomatic HF, and among patients with preserved and reduced ejection fraction. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03078166.
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Affiliation(s)
- Isabelle Johansson
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.).,Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Canada (S.Y., I.J.)
| | - Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Kumar Balasubramanian
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Scotland (J.J.V.M.)
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (L.H.L.).,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)
| | - Justin A Ezekowitz
- Faculty of Medicine and Dentistry, University of Alberta Canadian VIGOUR Center, University of Alberta, Edmonton, Canada (J.A.E.)
| | - Deepak Kamath
- Division of Clinical Research and Training, St John's Research Institute, India (D.K.)
| | - Khalid Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia (K.A.)
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.B.-G.).,Department of Medicine, Universitat Autonoma Barcelona, CIBERCV, Spain (A.B.-G.)
| | - Andrzej Budaj
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland (A.B.)
| | - Antonio L L Dans
- Department of Cardiac Sciences, University of Philippines, Manila, Philippines (A.L.L.D.)
| | - Anastase Dzudie
- Douala General Hospital, Cameroon (A.D.).,Clinical Research Education, Networking and Consultancy, Douala, Cameroon (A.D.).,Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon (A.D.)
| | | | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (K.A.A.F.)
| | - Kamilu M Karaye
- Department of Medicine, Aminu Kano Teaching Hospital and Bayero University Kano, Nigeria (K.M.K.)
| | - Abel Makubi
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania (A.M.)
| | - Bianca Fukakusa
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Koon Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Ahmet Temizhan
- Ankara City Hospital, Department of Cardiology, University of Health Sciences, Turkey (A.T.)
| | | | - Aldo P Maggioni
- ANMCO Research Center, Associazione Nazionale Medici Cardiologi Ospedalieri, Florence, Italy (A.P.M.)
| | | | - Patricio Lopez-Jaramillo
- Masira Research Institute, UDES, Bucaramanga, Colombia (P.L.-J.).,Facultad de Ciencias de la Salud, UTE, Quito, Ecuador (P.L.-J.)
| | - José Silva-Cardoso
- Faculty of Medicine, University of Porto, Sao Joao University Hospital Centre, Porto, Portugal (J.S.-C.)
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (K.S.)
| | - Hisham Dokainish
- Echocardiography Laboratory, Circulate Cardiac and Vascular Centre, Burlington, Canada (H.D.)
| | - Alex Grinvalds
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Tara McCready
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.)
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada (I.J., P.J., K.B., B.F., K.T., A.G., T.M., S.Y.).,Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Canada (S.Y., I.J.)
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18
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Silva-Cardoso J, Juanatey JRG, Comin-Colet J, Sousa JM, Cavalheiro A, Moreira E. The Future of Telemedicine in the Management of Heart Failure Patients. Card Fail Rev 2021; 7:e11. [PMID: 34136277 PMCID: PMC8201465 DOI: 10.15420/cfr.2020.32] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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] [Received: 12/17/2020] [Accepted: 02/22/2021] [Indexed: 12/20/2022] Open
Abstract
Telemedicine (TM) is potentially a way of escalating heart failure (HF) multidisciplinary integrated care. Despite the initial efforts to implement TM in HF management, we are still at an early stage of its implementation. The coronavirus disease 2019 pandemic led to an increased utilisation of TM. This tendency will probably remain after the resolution of this threat. Face-to-face medical interventions are gradually transitioning to the virtual setting by using TM. TM can improve healthcare accessibility and overcome geographic inequalities. It promotes healthcare system efficiency gains, and improves patient self-management and empowerment. In cooperation with human intervention, artificial intelligence can enhance TM by helping to deal with the complexities of multicomorbidity management in HF, and will play a relevant role towards a personalised HF patient approach. Artificial intelligence-powered/telemedical/heart team/multidisciplinary integrated care may be the next step of HF management. In this review, the authors analyse TM trends in the management of HF patients and foresee its future challenges within the scope of HF multidisciplinary integrated care.
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Affiliation(s)
- José Silva-Cardoso
- Faculty of Medicine, University of PortoPorto, Portugal
- São João University Hospital CentrePorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
| | | | - Josep Comin-Colet
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de LlobregatBarcelona, Spain
- Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L’Hospitalet de LlobregatBarcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
| | - José Maria Sousa
- São João University Hospital CentrePorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
| | - Ana Cavalheiro
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
- Department of Physical Rehabilitation, Centro Hospitalar do PortoPorto, Portugal
| | - Emília Moreira
- Faculty of Medicine, University of PortoPorto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Faculty of Medicine, University of PortoPorto, Portugal
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19
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Fonseca C, Brito D, Branco P, Frazão JM, Silva-Cardoso J, Bettencourt P. Hyperkalemia and management of renin-angiotensin-aldosterone system inhibitors in chronic heart failure with reduced ejection fraction: A systematic review. Rev Port Cardiol 2020; 39:517-541. [PMID: 32868174 DOI: 10.1016/j.repc.2020.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/24/2019] [Revised: 01/17/2020] [Accepted: 03/23/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Renin-angiotensin-aldosterone system inhibitors (RAASi) are the cornerstone of treatment of heart failure with reduced ejection fraction (HFrEF). RAASi optimization in real-life care is challenged by hyperkalemia, a potentially fatal adverse event, which can necessitate downtitration or discontinuation of RAASi and negatively impact survival in HFrEF. The literature on this problem is sparse. We performed a systematic review of studies on HFrEF to investigate the prevalence, incidence, and risk factors of hyperkalemia, RAASi prescription rates, frequency of RAASi downtitration or discontinuation due to hyperkalemia, and the potential negative effect of the latter on prognosis. METHODS We conducted a MEDLINE (PubMed) search including observational and interventional studies published between January 1987 and May 2018. RESULTS A total of 30 observational and 18 interventional studies were included in the review. The incidence of hyperkalemia reported was between 0% and 63% in observational studies and was between 0% and 30% in clinical trials. Risk factors for hyperkalemia included RAASi prescription, older age, diabetes, and chronic kidney disease. In real-life studies, RAASi were downtitrated or discontinued in 3-22% of HFrEF patients; hyperkalemia was the reported cause in 5% of cases. No reports were found on the impact on prognosis of RAASi downtitration or discontinuation due to hyperkalemia. CONCLUSIONS Hyperkalemia and RAASi downtitration or discontinuation are frequent, particularly in real-life HFrEF studies. Further research is needed to clarify the role of RAASi downtitration or discontinuation due to hyperkalemia and to assess its long-term prognostic impact in HFrEF patients.
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Affiliation(s)
- Cândida Fonseca
- Heart Failure Clinic, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisboa, Portugal; NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - Dulce Brito
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte (CHLN), Lisboa, Portugal; CCUL, Faculty of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Patrícia Branco
- Nephrology Department, Santa Cruz Hospital, Centro Hospitalar de Lisboa Ocidental (CHLO), Carnaxide, Portugal
| | - João Miguel Frazão
- Institute for Research and Innovation in Health Sciences (i3S) and Institute for Biomedical Engineering (INEB), Universidade do Porto, Porto, Portugal; Nephrology Department, Centro Hospitalar Universitário de São João (CHUSJ) and Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - José Silva-Cardoso
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Cardiology Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
| | - Paulo Bettencourt
- Internal Medicine Department, CUF Porto Hospital, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
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20
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Silva-Cardoso J, Sheikh O, Nashawi M, Pham S, Gallegos KM, Dinkha LR, Chilton RJ. Cardiorenal protection with SGLT2: Lessons from the cardiovascular outcome trials. J Diabetes 2020; 12:279-293. [PMID: 31688975 DOI: 10.1111/1753-0407.13007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/27/2019] [Accepted: 10/27/2019] [Indexed: 01/03/2023] Open
Abstract
Sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of drugs that were primarily developed for the treatment of type 2 diabetes mellitus. However, these agents have shown to provide additional beneficial effects. We will discuss three main topics regarding the use of SGLT2 inhibitors: noncardiovascular effects, cardiovascular benefits, and novel clinical indications. Multiple clinical trials and preliminary studies across varying disciplines have shown that these agents exhibit cardiorenal-protective benefits, retinoprotective benefits, and may aid in weight loss without causing marked hypoglycemia. Therefore, these agents represent an avenue in clinical practice to manage comorbid conditions in the hyperglycemic patient. Because of their multifaceted effects and robust action, SGLT2 inhibitors represent therapy options for providers that not only provide beneficial clinical results but also reduce total patient drug burden.
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Affiliation(s)
| | - Omar Sheikh
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
| | - Mouhamed Nashawi
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
| | - Son Pham
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
| | - Kelly M Gallegos
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
| | - Laith R Dinkha
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
| | - Robert J Chilton
- Department of Medicine, Division of Cardiology, UT Health San Antonio, San Antonio, Texas
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21
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Affiliation(s)
- Roberto Ferrari
- Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy Chair of Cardiology Azienda Ospedaliero-Universitaria di Ferrara Ospedale di Cona Via Aldo Moro 8, 44124 (Cona) Ferrara, Italy
| | - José Silva-Cardoso
- Department of Cardiology, Faculty of Medicine, CINTESIS-Center for Health Technology and Services Research, University of Porto, São João Medical Center, Porto, Portugal
| | - Maria Candida Fonseca
- Heart Failure Unit, Internal Medicine Department, São Francisco Xavier Hospital – Western Lisbon Hospital Centre (CHLO), Lisbon, Portugal and NOVA Medical School, Faculty of Medical Sciences, New University of Lisbon, Portugal
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Silva-Cardoso J, Brás D, Canário-Almeida F, Andrade A, Oliveira L, Pádua F, Fonseca C, Bragança N, Carvalho S, Soares R, Santos JF. Neurohormonal modulation: The new paradigm of pharmacological treatment of heart failure. Rev Port Cardiol 2019; 38:175-185. [PMID: 31029493 DOI: 10.1016/j.repc.2018.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/30/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022] Open
Abstract
The current paradigm of medical therapy for heart failure with reduced ejection fraction (HFrEF) is triple neurohormonal blockade with an angiotensin-converting enzyme inhibitor (ACEI), a beta-blocker (BB) and a mineralocorticoid receptor antagonist (MRA). However, three-year mortality remains over 30%. Stimulation of counter-regulatory systems in addition to neurohormonal blockade constitutes a new paradigm, termed neurohormonal modulation. Sacubitril/valsartan is the first element of this new strategy. PARADIGM-HF was the largest randomized clinical trial conducted in HFrEF. It included 8442 patients and compared the efficacy and safety of sacubitril/valsartan versus enalapril. The primary endpoint was the composite of cardiovascular mortality and hospitalization due to HF, which occurred in 914 (21.8%) patients receiving sacubitril/valsartan and in 1117 (26.5%) patients receiving enalapril (HR 0.8, 95% CI 0.73-0.87, p=0.0000002; NNT 21). Sacubitril/valsartan reduced both primary endpoint components, as well as sudden cardiac death, death due to worsening HF, and death from all causes. Patients on sacubitril/valsartan reported less frequent deterioration of HF and of quality of life, and discontinued study medication less frequently because of an adverse event. PARADIGM-HF demonstrated the superiority of sacubitril/valsartan over enalapril, with a 20% greater impact on cardiovascular mortality compared to ACEIs. Accordingly, in 2016, the European (ESC) and American (ACC/AHA/HFSA) cardiology societies simultaneously issued a class I recommendation for the replacement of ACEIs by sacubitril/valsartan in patients resembling PARADIGM-HF trial participants.
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Affiliation(s)
- J Silva-Cardoso
- Unidade de Doenças Cardiovasculares, Faculdade de Medicina da Universidade do Porto, Portugal; Centro de Pesquisa em Tecnologias e Serviços de Saúde, Universidade do Porto, Portugal; Clínica de Insuficiência Cardíaca e Transplante do Serviço de Cardiologia do Centro Hospitalar de S. João, Porto, Portugal.
| | - D Brás
- Medical Advisor, Departamento Médico, Novartis Farma-Produtos Farmacêuticos S.A., Lisboa, Portugal
| | - F Canário-Almeida
- Serviço de Cardiologia do Hospital Senhora da Oliveira, Guimarães, Portugal
| | - A Andrade
- Clínica de Insuficiência Cardíaca, Serviço de Cardiologia do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - L Oliveira
- Serviço de Cardiologia do Centro Hospitalar Cova da Beira, Covilhã, Portugal
| | - F Pádua
- Hospital Dr. José Maria Grande (Unidade Local de Saúde do Norte Alentejano), Portalegre, Portugal
| | - C Fonseca
- Unidade de Insuficiência Cardíaca, Serviço de Medicina III e Hospital Dia, Hospital São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - N Bragança
- Serviço de Medicina III, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - S Carvalho
- Serviço de Cardiologia do Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - R Soares
- Serviço de Cardiologia do Hospital de Santa Marta, Lisboa, Portugal
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Silva-Cardoso J, Brás D, Canário-Almeida F, Andrade A, Oliveira L, Pádua F, Fonseca C, Bragança N, Carvalho S, Soares R, Santos JF. Neurohormonal modulation: The new paradigm of pharmacological treatment of heart failure. Revista Portuguesa de Cardiologia (English Edition) 2019. [DOI: 10.1016/j.repce.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
PURPOSE OF REVIEW To evaluate the treatment of type 2 diabetes from a cardiologist's view. RECENT FINDINGS A new era in the treatment of type 2 diabetes began for the cardiologist in 2015 with the publication of the EMPA-REG outcome trial finding a significant reduction in CV death with empagliflozin (oral sodium-glucose co-transporter-2 [SGLT2] inhibitor) in patients with type 2 diabetes at increased cardiovascular risk. Shortly thereafter, the injectable glucagon-like peptide agonists (GLP-1) liraglutide and semaglutide found a significant reduction in composite major cardiovascular events (CV death, non-fatal MI, or stroke). Both classes have demonstrated significant renal protection when added to usual care. Moreover, there may be some exciting new benefits of SGLT2 inhibitors for patients with heart failure. These research studies are underway. These two new classes of cardiovascular drugs for type 2 diabetes usher in a new era for the cardiologist who sees greater than 50% of patients with diabetes. The off-target effect of these agents is different as with all new cardiovascular compounds. While safety profiles in these populations are consistent with the known effects of these classes, new off-target effects have been seen with some agents in this class. Ongoing collaboration between cardiologists and other care providers remains important in the implementation of the evidence and care of patients with type 2 diabetes.
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Affiliation(s)
- Robert J Chilton
- Division of Cardiology, UT Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7872, San Antonio, TX, 78229, USA.
| | - Kelly M Gallegos
- Division of Cardiology, UT Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7872, San Antonio, TX, 78229, USA
| | | | - Rene Oliveros
- Division of Cardiology, UT Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7872, San Antonio, TX, 78229, USA
| | - Son Pham
- Division of Cardiology, UT Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7872, San Antonio, TX, 78229, USA
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Zafrir B, Lund LH, Laroche C, Ruschitzka F, Crespo-Leiro MG, Coats AJS, Anker SD, Filippatos G, Seferovic PM, Maggioni AP, De Mora Martin M, Polonski L, Silva-Cardoso J, Amir O. Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14 964 patients in the European Society of Cardiology Heart Failure Long-Term Registry. Eur Heart J 2018; 39:4277-4284. [DOI: 10.1093/eurheartj/ehy626] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/18/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Barak Zafrir
- Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Lars H Lund
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cecile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France
| | - Frank Ruschitzka
- Heart Failure and Transplantation Clinic, University Hospital Zurich, Zurich, Switzerland
| | - Maria G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna (CHUAC), INIBIC, UDC, CIBERCV, La Coruna, Spain
| | | | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin Berlin, Germany
- Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, Athens, Greece
| | - Petar M Seferovic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France
- ANMCO Research Center, Florence, Italy
| | - Manuel De Mora Martin
- Department of Cardiology, Hospital Regional Universitario Carlos Haya, Malaga, Spain
| | | | - José Silva-Cardoso
- Department of Cardiology, Faculty of Medicine of Porto University, Hospital de Sao Joao, Porto, Portugal
| | - Offer Amir
- Department of Cardiovascular Medicine, Poriya Medical Center, Tiberius, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
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Javanainen T, Tolppanen H, Lassus J, Nieminen MS, Sionis A, Spinar J, Silva-Cardoso J, Greve Lindholm M, Banaszewski M, Harjola VP, Jurkko R. Predictive value of the baseline electrocardiogram ST-segment pattern in cardiogenic shock: Results from the CardShock Study. Ann Noninvasive Electrocardiol 2018; 23:e12561. [PMID: 29846022 DOI: 10.1111/anec.12561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The most common aetiology of cardiogenic shock (CS) is acute coronary syndrome (ACS), but even up to 20%-50% of CS is caused by other disorders. ST-segment deviations in the electrocardiogram (ECG) have been investigated in patients with ACS-related CS, but not in those with other CS aetiologies. We set out to explore the prevalence of different ST-segment patterns and their associations with the CS aetiology, clinical findings and 90-day mortality. METHODS We analysed the baseline ECG of 196 patients who were included in a multinational prospective study of CS. The patients were divided into 3 groups: (a) ST-segment elevation (STE). (b) ST-segment depression (STDEP). (c) No ST-segment deviation or ST-segment impossible to analyse (NSTD). A subgroup analysis of the ACS patients was conducted. RESULTS ST-segment deviations were present in 80% of the patients: 52% had STE and 29% had STDEP. STE was associated with the ACS aetiology, but one-fourth of the STDEP patients had aetiology other than ACS. The overall 90-day mortality was 41%: in STE 47%, STDEP 36% and NSTD 33%. In the multivariate mortality analysis, only STE predicted mortality (HR 1.74, CI95 1.07-2.84). In the ACS subgroup, the patients were equally effectively revascularized, and no differences in the survival were noted between the study groups. CONCLUSION ST-segment elevation is associated with the ACS aetiology and high mortality in the unselected CS population. If STE is not present, other aetiologies must be considered. When effectively revascularized, the prognosis is similar regardless of the ST-segment pattern in ACS-related CS.
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Affiliation(s)
- Tuija Javanainen
- Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Heli Tolppanen
- Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Johan Lassus
- Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Markku S Nieminen
- Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Alessandro Sionis
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | - Jindrich Spinar
- University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - José Silva-Cardoso
- Department of Cardiology, CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, São João Medical Center, University of Porto, Porto, Portugal
| | - Matias Greve Lindholm
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marek Banaszewski
- Institute of Cardiology, Intensive Cardiac Therapy Clinic, Warsaw, Poland
| | - Veli-Pekka Harjola
- Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Raija Jurkko
- Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Amorim S, Campelo M, Moura B, Martins E, Rodrigues J, Barroso I, Faria M, Guimarães T, Macedo F, Silva-Cardoso J, Maciel MJ. The role of biomarkers in dilated cardiomyopathy: Assessment of clinical severity and reverse remodeling. Rev Port Cardiol 2017; 36:709-716. [PMID: 28989069 DOI: 10.1016/j.repc.2017.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 09/14/2016] [Revised: 02/01/2017] [Accepted: 02/21/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Biomarkers in dilated cardiomyopathy (DCM) reflect various pathobiological processes, including neurohormonal activation, oxidative stress, matrix remodeling, myocyte injury and myocyte stretch. We assessed the role of biomarkers in clinical and echocardiographic parameters and in left ventricular (LV) reverse remodeling (LVRR). METHODS In this prospective study of 50 DCM patients (28 men, aged 59±10 years) with LV ejection fraction (LVEF) <40%, LVRR was defined as an increase of >10 U in LVEF after optimal medical therapy. RESULTS Baseline LVEF was 25.4±9.8% and LV end-diastolic diameter (LVEDD)/body surface area (BSA) was 34.2±4.5 mm/m2. LVRR occurred in 34% of patients within 17.6±15.6 months. No correlation was found between B-type natriuretic peptide (BNP), 25-hydroxyvitamin D (25(OH)D), CA-125, high-sensitivity C-reactive protein (hs-CRP), lipoprotein(a) [Lp(a)], noradrenaline, adrenaline, renin or aldosterone and LVRR. Patients in NYHA class III or IV, with pulmonary congestion or ankle edema, had higher CA-125, cystatin C, BNP and hs-CRP levels (p<0.05). CA-125 was correlated with BNP (r=0.61), hs-CRP (r=0.56) and uric acid (r=0.52) (all p=0.01). BNP correlated directly with LVEDD (r=0.49), LV volumes (r=0.51), pulmonary artery systolic pressure (PASP) (r=0.43) and E/e' (r=0.31), and was inversely correlated with LVEF (r=-0.50) and e' velocity (r=-0.32) (p<0.05). CA-125 was positively correlated with left atrial volume/BSA (r=0.46), E/A ratio (r=0.60) and PASP (r=0.49) (p<0.05). CONCLUSIONS No correlation was found between biomarkers and LVRR, but CA-125, BNP and hs-CRP were predictors of clinical severity and congestion. BNP correlated with parameters of systolic and diastolic dysfunction, while CA-125 correlated with measures of diastolic dysfunction.
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Affiliation(s)
- Sandra Amorim
- Cardiology Department, Centro Hospitalar São João, Porto, Portugal; Porto Medical School, Porto, Portugal.
| | - Manuel Campelo
- Cardiology Department, Centro Hospitalar São João, Porto, Portugal; Porto Medical School, Porto, Portugal
| | - Brenda Moura
- Cardiology Department, Centro Hospitalar São João, Porto, Portugal
| | - Elisabete Martins
- Cardiology Department, Centro Hospitalar São João, Porto, Portugal; Porto Medical School, Porto, Portugal
| | - João Rodrigues
- Cardiology Department, Centro Hospitalar São João, Porto, Portugal
| | - Isaac Barroso
- Clinical Pathology Department, Centro Hospitalar São João, Porto, Portugal
| | - Margarida Faria
- Clinical Pathology Department, Centro Hospitalar São João, Porto, Portugal
| | - Tiago Guimarães
- Clinical Pathology Department, Centro Hospitalar São João, Porto, Portugal; Porto Medical School, Porto, Portugal
| | - Filipe Macedo
- Cardiology Department, Centro Hospitalar São João, Porto, Portugal; Porto Medical School, Porto, Portugal
| | - José Silva-Cardoso
- Cardiology Department, Centro Hospitalar São João, Porto, Portugal; Porto Medical School, Porto, Portugal
| | - Maria Júlia Maciel
- Cardiology Department, Centro Hospitalar São João, Porto, Portugal; Porto Medical School, Porto, Portugal
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Tarvasmäki T, Haapio M, Mebazaa A, Sionis A, Silva-Cardoso J, Tolppanen H, Lindholm MG, Pulkki K, Parissis J, Harjola VP, Lassus J. Acute kidney injury in cardiogenic shock: definitions, incidence, haemodynamic alterations, and mortality. Eur J Heart Fail 2017; 20:572-581. [PMID: 28960633 DOI: 10.1002/ejhf.958] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/05/2017] [Accepted: 06/27/2017] [Indexed: 12/20/2022] Open
Affiliation(s)
- Tuukka Tarvasmäki
- Emergency Medicine, University of Helsinki, and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Haapio
- Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alexandre Mebazaa
- INSERM U942, Hôpital Lariboisière, APHP and University Paris Diderot, Paris, France
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB Sant Pau, Universitat de Barcelona, Barcelona, Spain
| | - José Silva-Cardoso
- CINTESIS - Center for Health Technology and Services Research, Department of Cardiology, Faculty of Medicine, University of Porto, São João Medical Center, Porto, Portugal
| | - Heli Tolppanen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Heart Center, Päijät-Häme Central Hospital, Lahti, Finland
| | - Matias Greve Lindholm
- Intensive Cardiac Care Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kari Pulkki
- Department of Clinical Chemistry, University of Eastern Finland and Eastern Finland Laboratory Centre, Kuopio, Finland
| | - John Parissis
- Heart Failure Unit, Attikon University Hospital, Athens, Greece
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Johan Lassus
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Amorim S, Campelo M, Martins E, Moura B, Sousa A, Pinho T, Silva-Cardoso J, Maciel MJ. Erratum to "Prevalence, predictors and prognosis of ventricular reverse remodeling in idiopathic dilated cardiomyopathy" (Rev. Port. Cardiol. 2016;35(5):253-260). Rev Port Cardiol 2017; 36:231. [PMID: 28288703 DOI: 10.1016/j.repc.2017.02.002] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Sandra Amorim
- Cardiology Department, Hospital de São João, Porto, Portugal.
| | - Manuel Campelo
- Cardiology Department, Hospital de São João, Porto, Portugal
| | | | - Brenda Moura
- Cardiology Department, Hospital de São João, Porto, Portugal
| | - Alexandra Sousa
- Cardiology Department, Hospital de São João, Porto, Portugal
| | - Teresa Pinho
- Cardiology Department, Hospital de São João, Porto, Portugal
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30
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Amorim S, Campelo M, Martins E, Moura B, Sousa A, Pinho T, Silva-Cardoso J, Maciel MJ. Erratum to “Prevalence, predictors and prognosis of ventricular reverse remodeling in idiopathic dilated cardiomyopathy” (Rev. Port. Cardiol. 2016;35(5):253-260). Revista Portuguesa de Cardiologia (English Edition) 2017. [DOI: 10.1016/j.repce.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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31
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Amorim S, Garcia R, Pinho T, Rodrigues J, Macedo F, Silva-Cardoso J, Maciel MJ. Left Ventricular Mechanical Reverse Remodelling Not Followed by Electrical Reverse Remodelling: A Case Report. Cardiology 2017; 138:80-86. [DOI: 10.1159/000475523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 11/19/2022]
Abstract
Patients with severely depressed left ventricular ejection fractions (LVEFs) receive implantable cardioverter-defibrillators (ICDs) for the primary prevention of sudden death. However, in some patients, LVEFs may improve or even normalize over time, and these patients would no longer be qualified for ICD implantation based on the original criteria for which they have initially received an ICD. We report a patient with idiopathic dilated cardiomyopathy whose LVEF recovered to normal values after pharmacological therapy. Meanwhile, the patient had life-threatening ventricular fibrillation, aborted by the ICD. We reflect on the pathological features of left ventricular reverse remodelling and ventricular arrhythmogenesis, where the myocardial substrate appears to play an important role. Also, after LVEF improvement in a patient with a cardiac device, there is still a debate on whether we should perform a battery replacement.
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Chiang CE, Naditch-Brûlé L, Brette S, Silva-Cardoso J, Gamra H, Murin J, Zharinov OJ, Steg PG. Atrial Fibrillation Management Strategies in Routine Clinical Practice: Insights from the International RealiseAF Survey. PLoS One 2016; 11:e0147536. [PMID: 26800084 PMCID: PMC4723091 DOI: 10.1371/journal.pone.0147536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/29/2015] [Indexed: 11/19/2022] Open
Abstract
Background Atrial fibrillation (AF) can be managed with rhythm- or rate-control strategies. There are few data from routine clinical practice on the frequency with which each strategy is used and their correlates in terms of patients’ clinical characteristics, AF control, and symptom burden. Methods RealiseAF was an international, cross-sectional, observational survey of 11,198 patients with AF. The aim of this analysis was to describe patient profiles and symptoms according to the AF management strategy used. A multivariate logistic regression identified factors associated with AF management strategy at the end of the visit. Results Among 10,497 eligible patients, 53.7% used a rate-control strategy, compared with 34.5% who used a rhythm-control strategy. In 11.8% of patients, no clear strategy was stated. The proportion of patients with AF-related symptoms (EHRA Class > = II) was 78.1% (n = 4396/5630) for those using a rate-control strategy vs. 67.8% for those using a rhythm-control strategy (p<0.001). Multivariate logistic regression analysis revealed that age <75 years or the paroxysmal or persistent form of AF favored the choice of a rhythm-control strategy. A change in strategy was infrequent, even in patients with European Heart Rhythm Association (EHRA) Class > = II. Conclusions In the RealiseAF routine clinical practice survey, rate control was more commonly used than rhythm control, and a change in strategy was uncommon, even in symptomatic patients. In almost 12% of patients, no clear strategy was stated. Physician awareness regarding optimal management strategies for AF may be improved.
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Affiliation(s)
- Chern-En Chiang
- General Clinical Research Center and Division of Cardiology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| | | | | | - José Silva-Cardoso
- Department of Cardiology, Porto Medical School, Hospital São João, Porto, Portugal
| | - Habib Gamra
- University of Monastir and Cardiology A Department, FattoumaBourguiba University Hospital, Monastir, Tunisia–LR12SP16 Cardiothrombosis
| | - Jan Murin
- Department of Internal Medicine and Cardiology, Comenius University, Bratislava, Slovakia
| | - Oleg J. Zharinov
- Functional Diagnostics Department, National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Philippe Gabriel Steg
- INSERM U-1148, Paris, France; Université Paris-Diderot, Paris, France; Assistance Publique–Hôpitaux de Paris, Hôpital Bichat, DHU FIRE, Paris, France; and NHLI, ICMS, Imperial College, Royal Brompton Hospital, London, United Kingdom
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33
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McMurray J, Packer M, Desai A, Gong J, Greenlaw N, Lefkowitz M, Rizkala A, Shi V, Rouleau J, Solomon S, Swedberg K, Zile MR, Andersen K, Arango JL, Arnold M, Be˘lohlávek J, Böhm M, Boytsov S, Burgess L, Cabrera W, Chen CH, Erglis A, Fu M, Gomez E, Gonzalez A, Hagege AA, Katova T, Kiatchoosakun S, Kim KS, Bayram E, Martinez F, Merkely B, Mendoza I, Mosterd A, Negrusz-Kawecka M, Peuhkurinen K, Ramires F, Refsgaard J, Senni M, Sibulo AS, Silva-Cardoso J, Squire I, Starling RC, Vinereanu D, Teerlink JR, Wong R. A putative placebo analysis of the effects of LCZ696 on clinical outcomes in heart failure. Eur Heart J 2015; 36:434-9. [PMID: 25416329 PMCID: PMC4328198 DOI: 10.1093/eurheartj/ehu455] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aims Although active-controlled trials with renin–angiotensin inhibitors are ethically mandated in heart failure with reduced ejection fraction, clinicians and regulators often want to know how the experimental therapy would perform compared with placebo. The angiotensin receptor-neprilysin inhibitor LCZ696 was compared with enalapril in PARADIGM-HF. We made indirect comparisons of the effects of LCZ696 with putative placebos. Methods and results We used the treatment-arm of the Studies Of Left Ventricular Dysfunction (SOLVD-T) as the reference trial for comparison of an ACE inhibitor to placebo and the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity-Alternative trial (CHARM-Alternative) as the reference trial for comparison of an ARB to placebo. The hazard ratio of LCZ696 vs. a putative placebo was estimated through the product of the hazard ratio of LCZ696 vs. enalapril (active-control) and that of the historical active-control (enalapril or candesartan) vs. placebo. For the primary composite outcome of cardiovascular death or heart failure hospitalization in PARADIGM-HF, the relative risk reduction with LCZ696 vs. a putative placebo from SOLVD-T was 43% (95%CI 34–50%; P < 0.0001) with similarly large effects on cardiovascular death (34%, 21–44%; P < 0.0001) and heart failure hospitalization (49%, 39–58%; P < 0.0001). For all-cause mortality, the reduction compared with a putative placebo was 28% (95%CI 15–39%; P < 0.0001). Putative placebo analyses based on CHARM-Alternative gave relative risk reductions of 39% (95%CI 27–48%; P < 0.0001) for the composite outcome of cardiovascular death or heart failure hospitalization, 32% (95%CI 16–45%; P < 0.0001) for cardiovascular death, 46% (33–56%; P < 0.0001) for heart failure hospitalization, and 26% (95%CI 11–39%; P < 0.0001) for all-cause mortality. Conclusion These indirect comparisons of LCZ696 with a putative placebo show that the strategy of combined angiotensin receptor blockade and neprilysin inhibition led to striking reductions in cardiovascular and all-cause mortality, as well as heart failure hospitalization. These benefits were obtained even though LCZ696 was added to comprehensive background beta-blocker and mineralocorticoid receptor antagonist therapy.
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Affiliation(s)
- John McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
- *Corresponding authors. (J.M.); (M.P.)
| | - Milton Packer
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- *Corresponding authors. (J.M.); (M.P.)
| | - Akshay Desai
- Brigham and Women's Hospital, Cardiovascular Medicine, Boston, MA, USA
| | - Jianjian Gong
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - Adel Rizkala
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Victor Shi
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Jean Rouleau
- Université de Montréal, Institut de Cardiologie, Montréal, Canada
| | - Scott Solomon
- Brigham and Women's Hospital, Cardiovascular Medicine, Boston, MA, USA
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; Imperial College, London, UK
| | - Michael R. Zile
- Charles Ezra Daniel Professor of Medicine, Medical University of South Carolina, RHJ Department of VA Medical Center, Charleston, SC, USA
| | - Karl Andersen
- Cardiovascular Research Center, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Malcolm Arnold
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, Ontario, Canada
| | - Jan Be˘lohlávek
- 2nd Department of Medicine, Cardiovascular Medicine, General Teaching Hospital and 1st Medical School, Charles University in Prague, Czech Republic
| | - Michael Böhm
- Department of Cardiology, University of the Saarland, Homburg/Saar, Germany
| | - Sergey Boytsov
- National Research Center for Preventive Medicine, Moscow, Russia
| | - Lesley Burgess
- Cardiology Trial Unit, University of Stellenbosch, Stellenbosch, South Africa
| | | | - Chen-Huan Chen
- Professor of Medicine, Faculty of Medicine, National Yang-Ming University, Chief, Division of Faculty Development, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | | | - Michael Fu
- Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden
| | | | - Angel Gonzalez
- Instituto Dominicano de Cardiología, Santo Domingo, República Dominicana
| | | | - Tzvetana Katova
- Department of Noninvasive Cardiovascular Imaging and Functional Diagnostic, National Cardiology Hospital, Bulgaria
| | | | - Kee-Sik Kim
- Department of Cardiology, Daegu Catholic University Medicine Centre, Republic of Korea
| | | | | | - Bela Merkely
- Heart and Vascular Center Semmelweis University, Budapest, Hungary
| | - Iván Mendoza
- Central University of Venezuela, Caracas, Venezuela
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Centre, The Netherlands
| | | | - Keijo Peuhkurinen
- Finnish Foundation for Cardiovascular Research, Kuopio University, Kuopio, Finland
| | - Felix Ramires
- Heart Institute (InCor)-University of São Paulo, School of Medicine, São Paulo, SP, Brazil
| | - Jens Refsgaard
- Department of Cardiology, Viborg Hospital, Viborg, Denmark
| | - Michele Senni
- Cardiology 1, Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy, Italy
| | | | | | - Iain Squire
- University of Leicester and NIHR Cardiovascular Research Unit, Leicester, UK
| | - Randall C. Starling
- Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, Emergency and University Hospital, Bucharest, Romania
| | - John R. Teerlink
- San Francisco Veterans Affairs Medical Center and University of California San Francisco, San Francisco, CA, USA
| | - Raymond Wong
- Department of Cardiology, National University Hearty Centre, Singapore
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Ramos V, Bettencourt N, Silva J, Ferreira N, Chiribiri A, Schuster A, Leite-Moreira A, Silva-Cardoso J, Nagel E, Gama V. Noninvasive anatomical and functional assessment of coronary artery disease. Revista Portuguesa de Cardiologia (English Edition) 2015. [DOI: 10.1016/j.repce.2014.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ramos V, Bettencourt N, Silva J, Ferreira N, Chiribiri A, Schuster A, Leite-Moreira A, Silva-Cardoso J, Nagel E, Gama V. Noninvasive anatomical and functional assessment of coronary artery disease. Rev Port Cardiol 2015; 34:223-32. [DOI: 10.1016/j.repc.2014.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 08/25/2014] [Accepted: 10/10/2014] [Indexed: 11/25/2022] Open
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Domingos J, Augustine D, Leeson P, Noble J, Doan HL, Boubrit L, Cheikh-Khalifa R, Laveau F, Djebbar M, Pousset F, Isnard R, Hammoudi N, Lisi M, Cameli M, Di Tommaso C, Curci V, Reccia R, Maccherini M, Henein MY, Mondillo S, Leitman M, Vered Z, Rashid H, Yalcin MU, Gurses KM, Kocyigit D, Evranos B, Yorgun H, Sahiner L, Kaya B, Aytemir K, Ozer N, Bertella E, Petulla' M, Baggiano A, Mushtaq S, Russo E, Gripari P, Innocenti E, Andreini D, Tondo C, Pontone G, Necas J, Kovalova S, Hristova K, Shiue I, Bogdanva V, Teixido Tura G, Sanchez V, Rodriguez-Palomares J, Gutierrez L, Gonzalez-Alujas T, Garcia-Dorado D, Forteza A, Evangelista A, Timoteo AT, Aguiar Rosa S, Cruz Ferreira R, Campbell R, Carrick D, Mccombe C, Tzemos N, Berry C, Sonecki P, Noda M, Setoguchi M, Ikenouchi T, Nakamura T, Yamamoto Y, Murakami T, Katou Y, Usui M, Ichikawa K, Isobe M, Kwon B, Roh J, Kim H, Ihm S, Barron AJ, Francis D, Mayet J, Wensel R, Kosiuk J, Dinov B, Bollmann A, Hindricks G, Breithardt O, Rio P, Moura Branco L, Galrinho A, Cacela D, Pinto Teixeira P, Afonso Nogueira M, Pereira-Da-Silva T, Abreu J, Teresa Timoteo A, Cruz Ferreira R, Pavlyukova E, Tereshenkova E, Karpov R, Piatkowski R, Kochanowski J, Opolski G, Barbier P, Mirea O, Guglielmo M, Savioli G, Cefalu C, Pudil R, Horakova L, Rozloznik M, Balestra C, Rimbas R, Enescu O, Calin S, Vinereanu D, Karsenty C, Hascoet S, Hadeed K, Semet F, Dulac Y, Alacoque X, Leobon B, Acar P, Dharma S, Sukmawan R, Soesanto A, Vebiona K, Firdaus I, Danny S, Driessen MMP, Sieswerda G, Post M, Snijder R, Van Dijk A, Leiner T, Meijboom F, Chrysohoou C, Tsitsinakis G, Tsiachris D, Aggelis A, Herouvim E, Vogiatzis I, Pitsavos C, Koulouris G, Stefanadis C, Erdei T, Edwards J, Braim D, Yousef Z, Fraser A, Avenatti E, Magnino C, Omede' P, Presutti D, Moretti C, Iannaccone A, Ravera A, Gaita F, Milan A, Veglio F, Barbier P, Scali M, Simioniuc A, Guglielmo M, Savioli G, Cefalu C, Mirea O, Fusini L, Dini F, Okura H, Murata E, Kataoka T, Zaroui A, Ben Halima M, Mourali M, Mechmeche R, Rodriguez Palomares JF, Gutierrez L, Maldonado G, Garcia G, Otaegui I, Garcia Del Blanco B, Teixido G, Gonzalez Alujas M, Evangelista A, Garcia Dorado D, Godinho AR, Correia A, Rangel I, Rocha A, Rodrigues J, Araujo V, Almeida P, Macedo F, Maciel M, Rekik B, Mghaieth F, Aloui H, Boudiche S, Jomaa M, Ayari J, Tabebi N, Farhati A, Mourali S, Dekleva M, Markovic-Nikolic N, Zivkovic M, Stankovic A, Boljevic D, Korac N, Beleslin B, Arandjelovic A, Ostojic M, Galli E, Guirette Y, Auffret V, Daudin M, Fournet M, Mabo P, Donal E, Chin CWL, Luo E, Hwan J, White A, Newby D, Dweck M, Carstensen HG, Larsen LH, Hassager C, Kofoed KF, Jensen JS, Mogelvang R, Kowalczyk M, Debska M, Kolesnik A, Dangel J, Kawalec W, Migliore R, Adaniya M, Barranco M, Miramont G, Gonzalez S, Tamagusuku H, Davidsen ES, Kuiper KKJ, Matre K, Gerdts E, Igual Munoz B, Maceira Gonzalez A, Erdociain Perales M, Estornell Erill J, Valera Martinez F, Miro Palau V, Piquer Gil M, Sepulveda Sanchez P, Cervera Zamora A, Montero Argudo A, Placido R, Silva Marques J, Magalhaes A, Guimaraes T, Nobre E Menezes M, Goncalves S, Ramalho A, Robalo Martins S, Almeida A, Nunes Diogo A, Abid L, Ben Kahla S, Charfeddine S, Abid D, Kammoun S, Tounsi A, Abid L, Abid D, Charfeddine S, Hammami R, Triki F, Akrout M, Mallek S, Hentati M, Kammoun S, Sirbu CF, Berrebi A, Huber A, Folliguet T, Yang LT, Shih J, Liu Y, Li Y, Tsai L, Luo C, Tsai W, Babukov R, Bartosh F, Bazilev V, Muraru D, Cavalli G, Addetia K, Miglioranza M, Veronesi F, Mihaila S, Tadic M, Cucchini U, Badano L, Lang R, Miyazaki S, Slavich M, Miyazaki T, Figini F, Lativ A, Chieffo A, Montrfano M, Alfieri O, Colombo A, Agricola E, Liu D, Hu K, Herrmann S, Stoerk S, Kramer B, Ertl G, Bijnens B, Weidemann F, Brand M, Butz T, Tzikas S, Van Bracht M, Roeing J, Wennemann R, Christ M, Grett M, Trappe HJ, Scherzer S, Geroldinger A, Krenn L, Roth C, Gangl C, Maurer G, Rosenhek R, Neunteufl T, Binder T, Bergler-Klein J, Martins E, Pinho T, Leite S, Azevedo O, Belo A, Campelo M, Amorim S, Rocha-Goncalves F, Goncalves L, Silva-Cardoso J, Ahn H, Kim K, Jeon H, Youn H, Haland T, Saberniak J, Leren I, Edvardsen T, Haugaa K, Ziolkowska L, Boruc A, Kowalczyk M, Turska-Kmiec A, Zubrzycka M, Kawalec W, Monivas Palomero V, Mingo Santos S, Goirigolzarri Artaza J, Rodriguez Gonzalez E, Rivero Arribas B, Castro Urda V, Dominguez Rodriguez F, Mitroi C, Gracia Lunar I, Fernadez Lozano I, Palecek T, Masek M, Kuchynka P, Fikrle M, Spicka I, Rysava R, Linhart A, Saberniak J, Hasselberg N, Leren I, Haland T, Borgquist R, Platonov P, Edvardsen T, Haugaa K, Ancona R, Comenale Pinto S, Caso P, Coopola M, Arenga F, Rapisarda O, D'onofrio A, Sellitto V, Calabro R, Rosca M, Popescu B, Calin A, Mateescu A, Beladan C, Jalba M, Rusu E, Zilisteanu D, Ginghina C, Pressman G, Cepeda-Valery B, Romero-Corral A, Moldovan R, Saenz A, Orban M, Samuel S, Fijalkowski M, Fijalkowska M, Gilis-Siek N, Blaut K, Galaska R, Sworczak K, Gruchala M, Fijalkowski M, Nowak R, Gilis-Siek N, Fijalkowska M, Galaska R, Gruchala M, Ikonomidis I, Triantafyllidi H, Trivilou P, Tzortzis S, Papadopoulos C, Pavlidis G, Paraskevaidis I, Lekakis J, Kaymaz C, Aktemur T, Poci N, Ozturk S, Akbal O, Yilmaz F, Tokgoz Demircan H, Kirca N, Tanboga I, Ozdemir N, Greiner S, Jud A, Aurich M, Hess A, Hilbel T, Hardt S, Katus H, D'ascenzi F, Cameli M, Alvino F, Lisi M, Focardi M, Solari M, Bonifazi M, Mondillo S, Konopka M, Krol W, Klusiewicz A, Burkhard K, Chwalbinska J, Pokrywka A, Dluzniewski M, Braksator W, King GJ, Coen K, Gannon S, Fahy N, Kindler H, Clarke J, Iliuta L, Rac-Albu M, Placido R, Robalo Martins S, Guimaraes T, Nobre E Menezes M, Cortez-Dias N, Francisco A, Silva G, Goncalves S, Almeida A, Nunes Diogo A, Kyu K, Kong W, Songco G, Galupo M, Castro M, Shin Hnin W, Ronald Lee C, Poh K, Milazzo V, Di Stefano C, Tosello F, Leone D, Ravera A, Sabia L, Sobrero G, Maule S, Veglio F, Milan A, Jamiel AM, Ahmed AM, Farah I, Al-Mallah MH, Petroni R, Magnano R, Bencivenga S, Di Mauro M, Petroni S, Altorio S, Romano S, Penco M, Kumor M, Lipczynska M, Klisiewicz A, Wojcik A, Konka M, Kozuch K, Szymanski P, Hoffman P, Rimbas R, Rimbas M, Enescu O, Mihaila S, Calin S, Vinereanu D, Donal E, Reynaud A, Lund L, Persson H, Hage C, Oger E, Linde C, Daubert J, Maria Oliveira Lima M, Costa H, Gomes Da Silva M, Noman Alencar M, Carmo Pereira Nunes M, Costa Rocha M, Abid L, Charfeddine S, Ben Kahla S, Abid D, Siala A, Hentati M, Kammoun S, Kovalova S, Necas J, Ozawa K, Funabashi N, Takaoka H, Kobayashi Y, Matsumura Y, Wada M, Hirakawa D, Yasuoka Y, Morimoto N, Takeuchi H, Kitaoka H, Sugiura T, Lakkas L, Naka K, Ntounousi E, Gkirdis I, Koutlas V, Bechlioulis A, Pappas K, Katsouras C, Siamopoulos K, Michalis L, Naka K, Evangelou D, Kalaitzidis R, Bechlioulis A, Lakkas L, Gkirdis I, Tzeltzes G, Nakas G, Katsouras C, Michalis L, Generati G, Bandera F, Pellegrino M, Labate V, Alfonzetti E, Guazzi M, Zagatina A, Zhuravskaya N, Al-Mallah M, Alsaileek A, Qureshi W, Karsenty C, Hascoet S, Peyre M, Hadeed K, Alacoque X, Amadieu R, Leobon B, Dulac Y, Acar P, Yamanaka Y, Sotomi Y, Iwakura K, Inoue K, Toyoshima Y, Tanaka K, Oka T, Tanaka N, Orihara Y, Fujii K, Soulat-Dufour L, Lang S, Boyer-Chatenet L, Van Der Vynckt C, Ederhy S, Adavane S, Haddour N, Boccara F, Cohen A, Huitema M, Boerman S, Vorselaars V, Grutters J, Post M, Gopal AS, Saha S, Toole R, Kiotsekoglou A, Cao J, Reichek N, Meyer CG, Altiok E, Al Ateah G, Lehrke M, Becker M, Lotfi S, Autschbach R, Marx N, Hoffmann R, Frick M, Nemes A, Sepp R, Kalapos A, Domsik P, Forster T, Caro Codon J, Blazquez Bermejo Z, Lopez Fernandez T, Valbuena Lopez SC, Iniesta Manjavacas AM, De Torres Alba F, Dominguez Melcon F, Pena Conde L, Moreno Yanguela M, Lopez-Sendon JL, Nemes A, Lengyel C, Domsik P, Kalapos A, Orosz A, Varkonyi T, Forster T, Rendon J, Saldarriaga CI, Duarte N, Nemes A, Domsik P, Kalapos A, Forster T, Nemes A, Domsik P, Kalapos A, Sepp R, Foldeak D, Borbenyi Z, Forster T, Hamdy A, Fereig H, Nabih M, Abdel-Aziz A, Ali A, Broyd C, Wielandts JY, De Buck S, Michielsen K, Louw R, Garweg C, Nuyts J, Ector J, Maes F, Heidbuchel H, Gillis K, Bala G, Tierens S, Cosyns B, Maurovich-Horvat P, Horvath T, Jermendy A, Celeng C, Panajotu A, Bartykowszki A, Karolyi M, Tarnoki A, Jermendy G, Merkely B. Poster session 2: Thursday 4 December 2014, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Packer M, McMurray JJV, Desai AS, Gong J, Lefkowitz MP, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile M, Andersen K, Arango JL, Arnold JM, Bělohlávek J, Böhm M, Boytsov S, Burgess LJ, Cabrera W, Calvo C, Chen CH, Dukat A, Duarte YC, Erglis A, Fu M, Gomez E, Gonzàlez-Medina A, Hagège AA, Huang J, Katova T, Kiatchoosakun S, Kim KS, Kozan Ö, Llamas EB, Martinez F, Merkely B, Mendoza I, Mosterd A, Negrusz-Kawecka M, Peuhkurinen K, Ramires FJA, Refsgaard J, Rosenthal A, Senni M, Sibulo AS, Silva-Cardoso J, Squire IB, Starling RC, Teerlink JR, Vanhaecke J, Vinereanu D, Wong RCC. Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure. Circulation 2014; 131:54-61. [PMID: 25403646 DOI: 10.1161/circulationaha.114.013748] [Citation(s) in RCA: 480] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical trials in heart failure have focused on the improvement in symptoms or decreases in the risk of death and other cardiovascular events. Little is known about the effect of drugs on the risk of clinical deterioration in surviving patients. METHODS AND RESULTS We compared the angiotensin-neprilysin inhibitor LCZ696 (400 mg daily) with the angiotensin-converting enzyme inhibitor enalapril (20 mg daily) in 8399 patients with heart failure and reduced ejection fraction in a double-blind trial. The analyses focused on prespecified measures of nonfatal clinical deterioration. In comparison with the enalapril group, fewer LCZ696-treated patients required intensification of medical treatment for heart failure (520 versus 604; hazard ratio, 0.84; 95% confidence interval, 0.74-0.94; P=0.003) or an emergency department visit for worsening heart failure (hazard ratio, 0.66; 95% confidence interval, 0.52-0.85; P=0.001). The patients in the LCZ696 group had 23% fewer hospitalizations for worsening heart failure (851 versus 1079; P<0.001) and were less likely to require intensive care (768 versus 879; 18% rate reduction, P=0.005), to receive intravenous positive inotropic agents (31% risk reduction, P<0.001), and to have implantation of a heart failure device or cardiac transplantation (22% risk reduction, P=0.07). The reduction in heart failure hospitalization with LCZ696 was evident within the first 30 days after randomization. Worsening of symptom scores in surviving patients was consistently more common in the enalapril group. LCZ696 led to an early and sustained reduction in biomarkers of myocardial wall stress and injury (N-terminal pro-B-type natriuretic peptide and troponin) versus enalapril. CONCLUSIONS Angiotensin-neprilysin inhibition prevents the clinical progression of surviving patients with heart failure more effectively than angiotensin-converting enzyme inhibition. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01035255.
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Affiliation(s)
- Milton Packer
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - John J V McMurray
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Akshay S Desai
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Jianjian Gong
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Martin P Lefkowitz
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Adel R Rizkala
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Jean L Rouleau
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Victor C Shi
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Scott D Solomon
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Karl Swedberg
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Michael Zile
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Karl Andersen
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Juan Luis Arango
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - J Malcolm Arnold
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Jan Bělohlávek
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Michael Böhm
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Sergey Boytsov
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Lesley J Burgess
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Walter Cabrera
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Carlos Calvo
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Chen-Huan Chen
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Andrej Dukat
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Yan Carlos Duarte
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Andrejs Erglis
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Michael Fu
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Efrain Gomez
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Angel Gonzàlez-Medina
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Albert A Hagège
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Jun Huang
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Tzvetana Katova
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Songsak Kiatchoosakun
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Kee-Sik Kim
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Ömer Kozan
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Edmundo Bayram Llamas
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Felipe Martinez
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Bela Merkely
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Iván Mendoza
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Arend Mosterd
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Marta Negrusz-Kawecka
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Keijo Peuhkurinen
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Felix J A Ramires
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Jens Refsgaard
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Arvo Rosenthal
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Michele Senni
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Antonio S Sibulo
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - José Silva-Cardoso
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Iain B Squire
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Randall C Starling
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - John R Teerlink
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Johan Vanhaecke
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Dragos Vinereanu
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
| | - Raymond Ching-Chiew Wong
- From the Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (M.P.); BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK (J.J.V.M.); Brigham and Women's Hospital, Cardiovascular Medicine, MA (A.S.D., S.D.S.); Novartis Pharmaceutical Corporation, East Hanover, NJ (J.G., M.P.L., A.R.R., V.C.S.); Université de Montréal, Institut de Cardiologie, Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, Gothenburg, Sweden (K.S.); The Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC (M.Z.); School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland (K.A.); Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala (J.L.A); Western University, Department of Medicine and Physiology, Ontario, Canada (J.M.A.); 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic (J.B.); Department of Cardiology, University of the Saarland, Homburg/Saar, Germany (M.B.); National Research Center for Preventive Medicine, Moscow, Russia (S.B.); TREAD Research, Cardiology Unit, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Parow, South Africa (L.J.B.); Clinica Vesalio, Lima, Peru (W.C.); Unidad de Hipertensión Arterial y Riesgo Vascular, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain (C.C.); Department of Medicine, National Yang-Ming University, Taiwan, Republic of China (C.-H.C.); Second Department of Internal Medicine, Comenius University in Bratislava, Bratislava, Slovakia (A.D.); Luis Vernaza Hospital, Guayaquil, Ecuador (Y.C.D.); Faculty of Medicine, Institute of Cardiology, University of Latvia, Riga, Latvia (A.E.); Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden (M.F.); Clinica Shaio, Bo
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Caiani E, Pellegrini A, Carminati M, Lang R, Auricchio A, Vaida P, Obase K, Sakakura T, Komeda M, Okura H, Yoshida K, Zeppellini R, Noni M, Rigo T, Erente G, Carasi M, Costa A, Ramondo B, Thorell L, Akesson-Lindow T, Shahgaldi K, Germanakis I, Fotaki A, Peppes S, Sifakis S, Parthenakis F, Makrigiannakis A, Richter U, Sveric K, Forkmann M, Wunderlich C, Strasser R, Djikic D, Potpara T, Polovina M, Marcetic Z, Peric V, Ostenfeld E, Werther-Evaldsson A, Engblom H, Ingvarsson A, Roijer A, Meurling C, Holm J, Radegran G, Carlsson M, Tabuchi H, Yamanaka T, Katahira Y, Tanaka M, Kurokawa T, Nakajima H, Ohtsuki S, Saijo Y, Yambe T, D'alto M, Romeo E, Argiento P, D'andrea A, Vanderpool R, Correra A, Sarubbi B, Calabro' R, Russo M, Naeije R, Saha SK, Warsame TA, Caelian AG, Malicse M, Kiotsekoglou A, Omran AS, Sharif D, Sharif-Rasslan A, Shahla C, Khalil A, Rosenschein U, Erturk M, Oner E, Kalkan A, Pusuroglu H, Ozyilmaz S, Akgul O, Aksu H, Akturk F, Celik O, Uslu N, Bandera F, Pellegrino M, Generati G, Donghi V, Alfonzetti E, Guazzi M, Rangel I, Goncalves A, Sousa C, Correia A, Martins E, Silva-Cardoso J, Macedo F, Maciel M, Lee S, Kim W, Yun H, Jung L, Kim E, Ko J, Enescu O, Florescu M, Rimbas R, Cinteza M, Vinereanu D, Kosmala W, Rojek A, Cielecka-Prynda M, Laczmanski L, Mysiak A, Przewlocka-Kosmala M, Liu D, Hu K, Niemann M, Herrmann S, Cikes M, Gaudron P, Knop S, Ertl G, Bijnens B, Weidemann F, Saravi M, Tamadoni A, Jalalian R, Hojati M, Ramezani S, Yildiz A, Inci U, Bilik M, Yuksel M, Oyumlu M, Kayan F, Ozaydogdu N, Aydin M, Akil M, Tekbas E, Shang Q, Zhang Q, Fang F, Wang S, Li R, Lee AP, Yu C, Mornos C, Ionac A, Cozma D, Popescu I, Ionescu G, Dan R, Petrescu L, Sawant A, Srivatsa S, Adhikari P, Mills P, Srivatsa S, Boshchenko A, Vrublevsky A, Karpov R, Trifunovic D, Stankovic S, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Banovic M, Tesic M, Petrovic M, Dragovic M, Ostojic M, Zencirci E, Esen Zencirci A, Degirmencioglu A, Karakus G, Ekmekci A, Erdem A, Ozden K, Erer H, Akyol A, Eren M, Zamfir D, Tautu O, Onciul S, Marinescu C, Onut R, Comanescu I, Oprescu N, Iancovici S, Dorobantu M, Melao F, Pereira M, Ribeiro V, Oliveira S, Araujo C, Subirana I, Marrugat J, Dias P, Azevedo A, Grillo MT, Piamonti B, Abate E, Porto A, Dell'angela L, Gatti G, Poletti A, Pappalardo A, Sinagra G, Pinto-Teixeira P, Galrinho A, Branco L, Fiarresga A, Sousa L, Cacela D, Portugal G, Rio P, Abreu J, Ferreira R, Fadel B, Abdullah N, Al-Admawi M, Pergola V, Bech-Hanssen O, Di Salvo G, Tigen MK, Pala S, Karaahmet T, Dundar C, Bulut M, Izgi A, Esen AM, Kirma C, Boerlage-Van Dijk K, Yamawaki M, Wiegerinck E, Meregalli P, Bindraban N, Vis M, Koch K, Piek J, Bouma B, Baan J, Mizia M, Sikora-Puz A, Gieszczyk-Strozik K, Lasota B, Chmiel A, Chudek J, Jasinski M, Deja M, Mizia-Stec K, Silva Fazendas Adame PR, Caldeira D, Stuart B, Almeida S, Cruz I, Ferreira A, Lopes L, Joao I, Cotrim C, Pereira H, Unger P, Dedobbeleer C, Stoupel E, Preumont N, Argacha J, Berkenboom G, Van Camp G, Malev E, Reeva S, Vasina L, Pshepiy A, Korshunova A, Timofeev E, Zemtsovsky E, Jorgensen PG, Jensen J, Fritz-Hansen T, Biering-Sorensen T, Jons C, Olsen N, Henri C, Magne J, Dulgheru R, Laaraibi S, Voilliot D, Kou S, Pierard L, Lancellotti P, Tayyareci Y, Dworakowski R, Kogoj P, Reiken J, Kenny C, Maccarthy P, Wendler O, Monaghan M, Song J, Ha T, Jung Y, Seo M, Choi S, Kim Y, Sun B, Kim D, Kang D, Song J, Le Tourneau T, Topilsky Y, Inamo J, Mahoney D, Suri R, Schaff H, Enriquez-Sarano M, Bonaque Gonzalez J, Sanchez Espino A, Merchan Ortega G, Bolivar Herrera N, Ikuta I, Macancela Quinonez J, Munoz Troyano S, Ferrer Lopez R, Gomez Recio M, Dreyfus J, Cimadevilla C, Brochet E, Himbert D, Iung B, Vahanian A, Messika-Zeitoun D, Izumo M, Takeuchi M, Seo Y, Yamashita E, Suzuki K, Ishizu T, Sato K, Aonuma K, Otsuji Y, Akashi Y, Muraru D, Addetia K, Veronesi F, Corsi C, Mor-Avi V, Yamat M, Weinert L, Lang R, Badano L, Minamisawa M, Koyama J, Kozuka A, Motoki H, Izawa A, Tomita T, Miyashita Y, Ikeda U, Florescu C, Niemann M, Liu D, Hu K, Herrmann S, Gaudron P, Scholz F, Stoerk S, Ertl G, Weidemann F, Marchel M, Serafin A, Kochanowski J, Piatkowski R, Madej-Pilarczyk A, Filipiak K, Hausmanowa-Petrusewicz I, Opolski G, Meimoun P, M'barek D, Clerc J, Neikova A, Elmkies F, Tzvetkov B, Luycx-Bore A, Cardoso C, Zemir H, Mansencal N, Arslan M, El Mahmoud R, Pilliere R, Dubourg O, Ikonomidis I, Lambadiari V, Pavlidis G, Koukoulis C, Kousathana F, Varoudi M, Tritakis V, Triantafyllidi H, Dimitriadis G, Lekakis I, Kovacs A, Kosztin A, Solymossy K, Celeng C, Apor A, Faludi M, Berta K, Szeplaki G, Foldes G, Merkely B, Kimura K, Daimon M, Nakajima T, Motoyoshi Y, Komori T, Nakao T, Kawata T, Uno K, Takenaka K, Komuro I, Gabric ID, Vazdar L, Pintaric H, Planinc D, Vinter O, Trbusic M, Bulj N, Nobre Menezes M, Silva Marques J, Magalhaes R, Carvalho V, Costa P, Brito D, Almeida A, Nunes-Diogo A, Davidsen ES, Bergerot C, Ernande L, Barthelet M, Thivolet S, Decker-Bellaton A, Altman M, Thibault H, Moulin P, Derumeaux G, Huttin O, Voilliot D, Frikha Z, Aliot E, Venner C, Juilliere Y, Selton-Suty C, Yamada T, Ooshima M, Hayashi H, Okabe S, Johno H, Murata H, Charalampopoulos A, Tzoulaki I, Howard L, Davies R, Gin-Sing W, Grapsa J, Wilkins M, Gibbs J, Castillo J, Bandeira A, Albuquerque E, Silveira C, Pyankov V, Chuyasova Y, Lichodziejewska B, Goliszek S, Kurnicka K, Dzikowska Diduch O, Kostrubiec M, Krupa M, Grudzka K, Ciurzynski M, Palczewski P, Pruszczyk P, Arana X, Oria G, Onaindia J, Rodriguez I, Velasco S, Cacicedo A, Palomar S, Subinas A, Zumalde J, Laraudogoitia E, Saeed S, Kokorina M, Fromm A, Oeygarden H, Waje-Andreassen U, Gerdts E, Gomez E, Vallejo N, Pedro-Botet L, Mateu L, Nunyez R, Llobera L, Bayes A, Sabria M, Antonini-Canterin F, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Antonini-Canterin F, Pudil R, Praus R, Vasatova M, Vojacek J, Palicka V, Hulek P, Pradel S, Mohty D, Damy T, Echahidi N, Lavergne D, Virot P, Aboyans V, Jaccard A, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Antonini-Canterin F, Doulaptsis C, Symons R, Matos A, Florian A, Masci P, Dymarkowski S, Janssens S, Bogaert J, Lestuzzi C, Moreo A, Celik S, Lafaras C, Dequanter D, Tomkowski W, De Biasio M, Cervesato E, Massa L, Imazio M, Watanabe N, Kijima Y, Akagi T, Toh N, Oe H, Nakagawa K, Tanabe Y, Ikeda M, Okada K, Ito H, Milanesi O, Biffanti R, Varotto E, Cerutti A, Reffo E, Castaldi B, Maschietto N, Vida V, Padalino M, Stellin G, Bejiqi R, Retkoceri R, Bejiqi H, Retkoceri A, Surdulli S, Massoure P, Cautela J, Roche N, Chenilleau M, Gil J, Fourcade L, Akhundova A, Cincin A, Sunbul M, Sari I, Tigen M, Basaran Y, Suermeci G, Butz T, Schilling I, Sasko B, Liebeton J, Van Bracht M, Tzikas S, Prull M, Wennemann R, Trappe H, Attenhofer Jost CH, Pfyffer M, Scharf C, Seifert B, Faeh-Gunz A, Naegeli B, Candinas R, Medeiros-Domingo A, Wierzbowska-Drabik K, Roszczyk N, Sobczak M, Plewka M, Krecki R, Kasprzak J, Ikonomidis I, Varoudi M, Papadavid E, Theodoropoulos K, Papadakis I, Pavlidis G, Triantafyllidi H, Anastasiou - Nana M, Rigopoulos D, Lekakis J, Tereshina O, Surkova E, Vachev A, Merchan Ortega G, Bonaque Gonzalez J, Sanchez Espino A, Bolivar Herrera N, Bravo Bustos D, Ikuta I, Aguado Martin M, Navarro Garcia F, Ruiz Lopez F, Gomez Recio M, Merchan Ortega G, Bonaque Gonzalez J, Bravo Bustos D, Sanchez Espino A, Bolivar Herrera N, Bonaque Gonzalez J, Navarro Garcia F, Aguado Martin M, Ruiz Lopez M, Gomez Recio M, Eguchi H, Maruo T, Endo K, Nakamura K, Yokota K, Fuku Y, Yamamoto H, Komiya T, Kadota K, Mitsudo K, Nagy AI, Manouras A, Gunyeli E, Shahgaldi K, Winter R, Hoffmann R, Barletta G, Von Bardeleben S, Kasprzak J, Greis C, Vanoverschelde J, Becher H, Hu K, Liu D, Niemann M, Herrmann S, Cikes M, Gaudron P, Knop S, Ertl G, Bijnens B, Weidemann F, Di Salvo G, Al Bulbul Z, Issa Z, Khan A, Faiz A, Rahmatullah S, Fadel B, Siblini G, Al Fayyadh M, Menting ME, Van Den Bosch A, Mcghie J, Cuypers J, Witsenburg M, Van Dalen B, Geleijnse M, Roos-Hesselink J, Olsen F, Jorgensen P, Mogelvang R, Jensen J, Fritz-Hansen T, Bech J, Biering-Sorensen T, Agoston G, Pap R, Saghy L, Forster T, Varga A, Scandura S, Capodanno D, Dipasqua F, Mangiafico S, Caggegi AM, Grasso C, Pistritto AM, Imme' S, Ministeri M, Tamburino C, Cameli M, Lisi M, D'ascenzi F, Cameli P, Losito M, Sparla S, Lunghetti S, Favilli R, Fineschi M, Mondillo S, Ojaghihaghighi Z, Javani B, Haghjoo M, Moladoust H, Shahrzad S, Ghadrdoust B, Altman M, Aussoleil A, Bergerot C, Bonnefoy-Cudraz E, Derumeaux GA, Thibault H, Shkolnik E, Vasyuk Y, Nesvetov V, Shkolnik L, Varlan G, Gronkova N, Kinova E, Borizanova A, Goudev A, Saracoglu E, Ural D, Sahin T, Al N, Cakmak H, Akbulut T, Akay K, Ural E, Mushtaq S, Andreini D, Pontone G, Bertella E, Conte E, Baggiano A, Annoni A, Formenti A, Fiorentini C, Pepi M, Cosgrove C, Carr L, Chao C, Dahiya A, Prasad S, Younger J, Biering-Sorensen T, Christensen L, Krieger D, Mogelvang R, Jensen J, Hojberg S, Host N, Karlsen F, Christensen H, Medressova A, Abikeyeva L, Dzhetybayeva S, Andossova S, Kuatbayev Y, Bekbossynova M, Bekbossynov S, Pya Y, Farsalinos K, Tsiapras D, Kyrzopoulos S, Spyrou A, Stefopoulos C, Romagna G, Tsimopoulou K, Tsakalou M, Voudris V, Cacicedo A, Velasco Del Castillo S, Anton Ladislao A, Aguirre Larracoechea U, Onaindia Gandarias J, Romero Pereiro A, Arana Achaga X, Zugazabeitia Irazabal G, Laraudogoitia Zaldumbide E, Lekuona Goya I, Varela A, Kotsovilis S, Salagianni M, Andreakos V, Davos C, Merchan Ortega G, Bonaque Gonzalez J, Sanchez Espino A, Bolivar Herrera N, Macancela Quinones J, Ikuta I, Ferrer Lopez R, Munoz Troyano S, Bravo Bustos D, Gomez Recio M. Poster session Friday 13 December - PM: 13/12/2013, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cakmak H, Ural E, Sahin T, Al N, Emre E, Saracoglu E, Akbulut T, Ural D, Rangel I, Goncalves A, Sousa C, Rodrigues J, Macedo F, Silva-Cardoso J, Maciel M, Iliuta L, Nagata Y, Takeuchi M, Kuwaki H, Hasyashi A, Otani K, Yoshitani H, Osuji Y, Haberka M, Liszka J, Kozyra A, Tabor Z, Finik M, Gasior Z, Hasselberg N, Haugaa K, Brunet A, Kongsgaard E, Donal E, Edvardsen T, Sugano A, Seo Y, Sato K, Atsumi A, Yamamoto M, Machino T, Harimura Y, Kawamura R, Ishizu T, Aonuma K, Biering-Sorensen T, Hoffmann S, Mogelvang R, Iversen A, Fritz-Hansen T, Bech J, Jensen J, Flarup Dons M, Biering-Soerensen T, Skov Jensen J, Fritz Hansen T, Bech J, Chantal De Knegt M, Sivertsen J, Moegelvang R. Moderated Posters session * The prognostic value of myocardial deformation imaging in cardiomyopathy: 12/12/2013, 08:30-12:30 * Location: Moderated Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Silva-Cardoso J, Zharinov OJ, Ponikowski P, Naditch-Brûlé L, Lewalter T, Brette S, Steg PG. Heart failure in patients with atrial fibrillation is associated with a high symptom and hospitalization burden: the RealiseAF survey. Clin Cardiol 2013; 36:766-74. [PMID: 24105492 DOI: 10.1002/clc.22209] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 08/21/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) and heart failure (HF) often coexist; the consequences of such coexistence are unclear. HYPOTHESIS HF in patients with AF is associated with poor outcomes. METHODS This post hoc analysis of RealiseAF, a survey of AF patients, compared symptoms, hospitalizations, management, and AF control in patients with vs without HF. A total of 10,523 AF patients were analyzed according to presence/absence of HF. RESULTS History of HF was present in 45.8%, and in more patients with permanent vs persistent, paroxysmal, or first-episode AF (55.6%, 44.3%, 32.9%, and 29.8%, respectively; P < 0.0001). Patients with vs those without history of HF, and patients with HF and reduced ejection fraction (HF-REF) vs those with HF and a preserved ejection fraction (HF-PEF), had more frequent cardiovascular (CV) risk factors and more severe symptoms. Presence vs absence of HF, and HF-REF vs HF-PEF, were associated with lower rates of AF control (54.6% vs 62.8% and 49.3% vs 60.3%, respectively; both P < 0.0001). The rate-control strategy was used more frequently in HF patients, particularly those with HF-REF, than the rhythm-control strategy. CV hospitalizations occurred more frequently in patients with HF than those without (41.8% vs 17.5%; P < 0.001) and more frequently in patients with HF-REF than in those with HF-PEF (51.6% vs 35.6%; P < 0.0001). CONCLUSIONS AF patients with HF, particularly HF-REF, experience heavy symptom and hospitalization burdens, and have relatively low rates of AF control. Further studies are needed to identify ways to improve the management and treatment outcomes of this very high-risk patient population.
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Affiliation(s)
- José Silva-Cardoso
- Department of Cardiology, Porto Medical School, São João Hospital, Porto, Portugal
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Rangel I, Goncalves A, Sousa C, Leite S, Campelo M, Martins E, Amorim S, Moura B, Silva-Cardoso J, Maciel MJ. Iron deficiency status irrespectively of anaemia: a predictor of unfavorable outcome in chronic heart failure patients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pinho T, Cruz C, Madureira AJ, Lebreiro A, Campelo M, Souteiro D, Ramos I, Silva-Cardoso J, Maciel MJ. Arrhythmic risk in adult patients after repaired tetralogy of Fallot: cardiovascular magnetic resonance predictors. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Amorim SMR, Campelo M, Martins E, Moura B, Silva-Cardoso J, Maciel MJ. Reverse ventricular remodeling after pharmacological therapy in idiopathic dilated cardiomyopathy- prevalence and prognosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bettencourt N, Ferreira N, Chiribiri A, Schuster A, Sampaio F, Santos L, Melica B, Rodrigues A, Braga P, Teixeira M, Leite-Moreira A, Silva-Cardoso J, Portugal P, Gama V, Nagel E. Additive value of magnetic resonance coronary angiography in a comprehensive cardiac magnetic resonance stress-rest protocol for detection of functionally significant coronary artery disease: a pilot study. Circ Cardiovasc Imaging 2013; 6:730-8. [PMID: 23833284 DOI: 10.1161/circimaging.113.000280] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 12/30/2022]
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) myocardial perfusion imaging (MPI) is a state-of-the-art noninvasive modality for detection of myocardial ischemia and coronary artery disease. Magnetic resonance coronary angiography (MRCA) allows visualization of the coronary tree, but its incremental value as part of a CMR protocol including MPI and late gadolinium enhancement (LGE) is not well established. We aimed to evaluate the additive diagnostic value of a 3-dimensional whole-heart MRCA integration into a 1.5T CMR-MPI/LGE protocol for the detection of functionally significant coronary artery disease. METHODS AND RESULTS Forty-three symptomatic patients (61 ± 8.3 years; 65% men) with suspected coronary artery disease and intermediate/high-pretest probability underwent CMR (including CMR-MPI, MRCA, and LGE) and x-ray invasive coronary angiography (XA) with fractional flow reserve evaluation. Diagnostic performances of MRCA, CMR-MPI/LGE, and MRCA+CMR-MPI/LGE integration were determined having XA+fractional flow reserve as standard for coronary artery disease (≥90% stenosis/occlusion or fractional flow reserve ≤ 0.80 in vessels>2 mm). MRCA inclusion into the CMR protocol was associated with a mean increase of 7.9 ± 4.69 (0-17.7) minutes in total examination duration (14%). On patient-based analysis, MRCA had 96% sensitivity, 68% specificity, positive predictive value of 79%, and negative predictive value of 93%. CMR-MPI/LGE had 79% sensitivity, 95% specificity, positive predictive value of 95%, and negative predictive value of 78%. Integration of MRCA with CMR-MPI/LGE further improved CMR performance to 96% sensitivity, 89% specificity, positive predictive value of 92%, and negative predictive value of 94%, with a global accuracy of 93%. CONCLUSIONS In this intermediate/high-pretest population, integration of noncontrast-enhanced whole-heart MRCA nonsignificantly improved per-patient diagnostic accuracy of a comprehensive 1.5-T stress-rest CMR-MPI/LGE protocol at a cost of longer scanning times.
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Bettencourt N, Chiribiri A, Schuster A, Ferreira N, Sampaio F, Pires-Morais G, Santos L, Melica B, Rodrigues A, Braga P, Azevedo L, Teixeira M, Leite-Moreira A, Silva-Cardoso J, Nagel E, Gama V. Direct comparison of cardiac magnetic resonance and multidetector computed tomography stress-rest perfusion imaging for detection of coronary artery disease. J Am Coll Cardiol 2013; 61:1099-107. [PMID: 23375929 DOI: 10.1016/j.jacc.2012.12.020] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 12/04/2012] [Accepted: 12/26/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study sought to compare the diagnostic performance of a multidetector computed tomography (MDCT) integrated protocol (IP) including coronary angiography (CTA) and stress-rest perfusion (CTP) with cardiac magnetic resonance myocardial perfusion imaging (CMR-Perf) for detection of functionally significant coronary artery disease (CAD). BACKGROUND MDCT stress-rest perfusion methods were recently described as adjunctive tools to improve CTA accuracy for detection of functionally significant CAD. However, only a few studies compared these MDCT-IP with other clinically validated perfusion techniques like CMR-Perf. Furthermore, CTP has never been validated against the invasive reference standard, fractional flow reserve (FFR), in patients with suspected CAD. METHODS 101 symptomatic patients with suspected CAD (62 ± 8.0 years, 67% males) and intermediate/high pre-test probability underwent MDCT, CMR and invasive coronary angiography. Functionally significant CAD was defined by the presence of occlusive/subocclusive stenoses or FFR measurements ≤ 0.80 in vessels >2mm. RESULTS On a patient-based model, the MDCT-IP had a sensitivity, specificity, positive and negative predictive values of 89%, 83%, 80% and 90%, respectively (global accuracy 85%). These results were closely related with those achieved by CMR-Perf: 89%, 88%, 85% and 91%, respectively (global accuracy 88%). When comparing test accuracies using noninferiority analysis, differences greater than 11% in favour of CMR-Perf can be confidently excluded. CONCLUSIONS MDCT protocols integrating CTA and stress-rest perfusion detect functionally significant CAD with similar accuracy as CMR-Perf. Both approaches yield a very good accuracy. Integration of CTP and CTA improves MDCT performance for the detection of relevant CAD in intermediate to high pre-test probability populations.
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Affiliation(s)
- Nuno Bettencourt
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
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Altman M, Bergerot C, Thibault H, Aussoleil A, Skuldadt Davidsen E, Barthelet M, Derumeaux GA, Grapsa J, Zimbarra Cabrita I, Afilalo J, Paschou S, Dawson D, Durighel G, O'regan D, Howard L, Gibbs J, Nihoyannopoulos P, Morenate Navio M, Mesa Rubio M, Ortega MD, Ruiz Ortiz M, Castillo Bernal F, Del Pino CL, Toledano F, Alvarez-Ossorio MP, Ojeda Pineda S, Lezo Cruz-Conde JSD, Jasaityte R, Claus P, Teske A, Herbots L, Verheyden B, Rademakers F, D'hooge J, Tocchetti CG, Coppola C, Rea D, Quintavalle C, Guarino L, Castaldo N, De Lorenzo C, Condorelli G, Arra C, Maurea N, Voilliot D, Huttin O, Camara Y, Djaballah W, Carillo S, Zinzius P, Sellal J, Angioi M, Juilliere Y, Selton-Suty C, Dobrowolski P, Klisiewicz A, Florczak E, Prejbisz A, Szwench E, Rybicka J, Januszewicz A, Hoffman P, Jurado Roman A, De Dios Perez S, De Nicolas JMM, Diaz Anton B, Rubio Alonso B, Martin Asenjo R, Mayordomo Gomez S, Villagraz Tecedor L, Blazquez L, De Meneses RT, Bernard A, Hernandez AI, Reynaud A, Lerclercq C, Daubert J, Donal E, Arjan Singh R, Sivarani S, Lim S, Azman W, Almeida M, Cardim N, Fonseca V, Carmelo V, Santos S, Santos T, Toste J, Kosmala W, Orda A, Karolko B, Mysiak A, Przewlocka-Kosmala M, Farsalinos K, Tsiapras D, Kyrzopoulos S, Avramidou E, Vassilopoulou D, Voudris V, Hayrapetyan H, Adamyan K, Jurado Roman A, De Dios Perez S, Rubio Alonso B, De Nicolas JMM, Diaz Anton B, Martin Asenjo R, Montero Cabezas J, Granda Nistal C, Garcia Aranda B, Sanchez Sanchez V, Sestito A, Lamendola P, Di Franco A, Lauria C, Lanza G, Kukucka M, Unbehaun A, Buz S, Mladenow A, Kuppe H, Pasic M, Habazettl H, Gemma D, Montoro Lopez N, De Celix MGR, Lopez Fernandez T, De Torres Alba F, Del Valle DI, Ramirez U, Mesa J, Moreno Yanguela M, Lopez Sendon J, Eveborn GW, Schirmer H, Lunde P, Heggelund G, Rasmussen K, Wang Z, Lasota B, Mizia-Stec K, Mizia M, Chmiel A, Adamczyk T, Chudek J, Gasior Z, Venkatesh A, Johnson J, Sahlen A, Brodin L, Winter R, Shahgaldi K, Manouras A, Valbuena S, Iniesta A, Lopez T, De Torres F, Salinas P, Garcia S, Ramirez U, Mesa J, Moreno M, Lopez-Sendon J, Lebid I, Kobets T, Kuzmenko T, Katsanos S, Yiu K, Clavel M, Nina Ajmone N, Van Der Kley F, Rodes Cabau J, Schalij M, Bax J, Pibarot P, Delgado V, Fusini L, Tamborini G, Muratori M, Gripari P, Marsan N, Cefalu' C, Ewe S, Maffessanti F, Delgado V, Pepi M, Hasselberg N, Haugaa K, Petri H, Berge K, Leren T, Bundgaard H, Edvardsen T, Ancona R, Comenale Pinto S, Caso P, Coppola M, Rapisarda O, Cavallaro C, Vecchione F, D'onofrio A, Calabro' R, Rimbas R, Mihaila S, Enescu O, Patrascu N, Dragoi R, Rimbas M, Pop C, Vinereanu D, Gustafsson S, Morner S, Gronlund C, Suhr O, Lindqvist P, Di Bella G, Zito C, Minutoli F, Madaffari A, Cusma Piccione M, Mazzeo A, Massimo R, Pasquale M, Vita G, Carerj S, Rangel I, Goncalves A, Sousa C, Correia A, Martins E, Silva-Cardoso J, Macedo F, Maciel M, Pfeiffer B, Rigopoulos A, Seggewiss H, Alvarez Fuente M, Sainz Costa T, Medrano C, Navarro M, Blazquez Gamero D, Ramos J, Mellado M, De Jose M, Munoz M, Maroto E, Gargani L, Gosciniak P, Pratali L, Agoston G, Bruni C, Guiducci S, Matucci Cerinic M, Varga A, Sicari R, Picano E, Yiu K, Zhao C, Mei M, Yeung C, Siu C, Tse H, Florescu M, Enescu O, Magda L, Mincu R, Vinereanu D, Daha I, Stanescu CM, Chirila L, Baicus C, Vlase A, Dan G, Montoro Lopez M, Florez Gomez R, Alonso Ladreda A, Itziar Soto C, Rios Blanco J, Gemma D, De Torres Alba F, Moreno Yanguela M, Lopez Sendon J, Guzman Martinez G, Lichodziejewska B, Kurnicka K, Goliszek S, Kostrubiec M, Dzikowska-Diduch O, Ciurzynski M, Labyk A, Krupa M, Palczewski P, Pruszczyk P, De Sousa CC, Rangel I, Correia A, Martins E, Vigario A, Pinho T, Silva Cardoso J, Goncalves A, Macedo F, Maciel M, Park SJ, Song JE, Lee YJ, Ha MR, Chang SA, Choi JO, Lee SC, Park S, Oh J, Van De Bruaene A, De Meester P, Buys R, Vanhees L, Delcroix M, Voigt J, Budts W, Blundo A, Buccheri S, Monte IP, Leggio S, Tamburino C, Sotaquira M, Fusini L, Maffessanti F, Pepi M, Lang R, Caiani E, Floria M, De Roy L, Xhaet O, Blommaert D, Jamart J, Gerard M, Deceuninck O, Marchandise B, Seldrum S, Schroeder E, Unsworth B, Sohaib S, Kulwant-Kaur K, Malcolme-Lawes L, Kanagaratnam P, Malik I, Ren B, Mulder H, Haak A, Van Stralen M, Szili-Torok T, Pluim J, Geleijnse M, Bosch J, Baglini R, Amaducci A, D'ancona G, Van Den Oord S, Akkus Z, Bosch J, Ten Kate G, Renaud G, Sijbrands E, De Jong N, Van Der Lugt A, Van Der Steen A, Schinkel A, Bjallmark A, Larsson M, Grishenkov D, Brodin LA, Brismar T, Paradossi G, Sveen KA, Nerdrum T, Hanssen K, Dahl-Jorgensen K, Steine K, Cimino S, Pedrizzetti G, Tonti G, Canali E, Petronilli V, Cicogna F, Arcari L, De Luca L, Iacoboni C, Agati L, Abdel Moneim SS, Eifert Rain S, Bernier M, Bhat G, Hagen M, Bott-Kitslaar D, Castello R, Wilansky S, Pellikka P, Mulvagh S, Delithanasis I, Celutkiene J, Kenny C, Monaghan M, Park W, Hong G, Son J, Lee S, Kim U, Park J, Shin D, Kim Y, Toutouzas K, Drakopoulou M, Aggeli C, Felekos I, Nikolaou C, Synetos A, Stathogiannis K, Tsiamis E, Siores E, Stefanadis C, Plicht B, Kahlert P, Grave T, Buck T, Konorza T, Gursoy M, Gokdeniz T, Astarcioglu M, Bayram Z, Cakal B, Karakoyun S, Kalcik M, Acar R, Kahveci G, Ozkan M, Maffessanti F, Tamborini G, Tsang W, Weinert L, Gripari P, Fusini L, Muratori M, Caiani E, Lang R, Pepi M, Yurdakul S, Avci B, Sahin S, Dilekci B, Aytekin S, Ancona R, Comenale Pinto S, Caso P, Arenga F, Coppola M, Rapisarda O, Calabro' R, Hascoet S, Martin R, Dulac Y, Peyre M, Benzouid C, Hadeed K, Acar P, Celutkiene J, Zakarkaite D, Skorniakov V, Zvironaite V, Grabauskiene V, Burca J, Ciparyte L, Laucevicius A, Di Salvo G, Rea A, D'aiello A, Del Gaizo F, Pergola V, D'andrea A, Caso P, Pacileo G, Calabro R, Russo M, Dedobbeleer C, Hadefi A, Naeije R, Unger P, Mornos C, Cozma D, Ionac A, Mornos A, Valcovici M, Pescariu S, Petrescu L, Hu K, Liu D, Niemann M, Herrmann S, Cikes M, Stoerk S, Knop S, Ertl G, Bijnens B, Weidemann F, De Knegt M, Biering-Sorensen T, Sogaard P, Sivertsen J, Jensen J, Mogelvang R, Dedobbeleer C, Hadefi A, Unger P, Naeije R, Lam W, Tang M, Chan K, Yang Y, Fang F, Sun J, Yu C, Lam Y, Panoulas V, Sulemane S, Bratsas A, Konstantinou K, Nihoyannopoulos P, Cimino S, Canali E, Petronilli V, Cicogna F, Arcari L, De Luca L, Francone M, Iacoboni C, Agati L, Schau T, Seifert M, Ridjab D, Schoep M, Gottwald M, Neuss M, Meyhoefer J, Zaenker M, Butter C, Tarr A, Stoebe S, Pfeiffer D, Hagendorff A, Maret E, Ahlander BM, Bjorklund PG, Engvall J, Staskiewicz G, Czekajska-Chehab E, Adamczyk P, Siek E, Przybylski P, Maciejewski R, Drop A, Jimenez Rubio C, Isasti Aizpurua G, Miralles Ibarra J, Al-Mallah M, Somg T, Alam S, Chattahi J, Zweig B, Dhanalakota K, Boedeker S, Ananthasubramaniam K, Park C, March K, Jones S, Mayet J, Tillin T, Chaturvedi N, Hughes A, Hamodraka E, Kallistratos E, Karamanou A, Tsoukas T, Mavropoulos D, Kouremenos N, Zaharopoulou I, Nikolaidis N, Kremastinos D, Manolis A, Loboz-Rudnicka M, Jaroch J, Bociaga Z, Kruszynska E, Ciecierzynska B, Dziuba M, Dudek K, Uchmanowicz I, Loboz-Grudzien K, Silva D, Magalhaes A, Jorge C, Cortez-Dias N, Carrilho-Ferreira P, Silva Marques J, Portela I, Pascoa C, Nunes Diogo A, Brito D, Roosens B, Bala G, Droogmans S, Hostens J, Somja J, Delvenne E, Schiettecatte J, Lahoutte T, Van Camp G, Cosyns B. Poster Session: Right ventricular systolic function. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ojaghi-Haghighi Z, Mostafavi A, Moladoust H, Noohi F, Maleki M, Esmaeilzadeh M, Samiei N, Hosseini S, Jasaityte R, Teske A, Claus P, Verheyden B, Rademakers F, D'hooge J, Patrianakos A, Zacharaki A, Kalogerakis A, Nyktari E, Maniatakis P, Parthenakis F, Vardas P, Hilde JM, Skjoerten I, Humerfelt S, Hansteen V, Melsom M, Hisdal J, Steine K, Ippolito R, Gripari P, Muraru D, Esposito R, Kocabay G, Tamborini G, Galderisi M, Maffessanti F, Badano L, Pepi M, Yurdakul S, Oner F, Sahin T, Avci B, Tayyareci Y, Direskeneli H, Aytekin S, Filali T, Jedaida B, Lahidheb D, Gommidh M, Mahfoudhi H, Hajlaoui N, Dahmani R, Fehri W, Haouala H, Andova V, Georgievska-Ismail L, Srbinovska-Kostovska E, Gardinger Y, Joanna Hlebowicz J, Ola Bjorgell O, Magnus Dencker M, Liao MT, Tsai CT, Lin JL, Piestrzeniewicz K, Luczak K, Maciejewski M, Komorowski J, Jankiewicz-Wika J, Drozdz J, Ismail MF, Alasfar A, Elassal M, El-Sayed S, Ibraheim M, Dobrowolski P, Klisiewicz A, Florczak E, Prejbisz A, Szwench E, Rybicka J, Januszewicz A, Hoffman P, Santos Furtado M, Nogueira K, Arruda A, Rodrigues AC, Carvalho F, Silva M, Cardoso A, Lira-Filho E, Pinheiro J, Andrade JL, Mohammed M, Zito C, Cusma-Piccione M, Di Bella G, Taha N, Zagari D, Oteri A, Quattrone A, Boretti I, Carerj S, Obremska O, Boratynska B, Poczatek P, Zon Z, Magott M, Klinger K, Szenczi O, Szelid Z, Soos P, Bagyura Z, Edes E, Jozan P, Merkely B, Ahn J, Kim D, Jeon D, Kim I, Baeza Garzon F, Delgado M, Mesa D, Ruiz M, De Lezo JS, Pan M, Leon C, Castillo F, Morenate M, Toledano F, Zhong L, Lim E, Shanmugam N, Law S, Ong B, Katwadi K, Tan R, Chua Y, Liew R, Ding Z, Von Bibra H, Leclerque C, Schuster T, Schumm-Draeger PM, Bonios M, Kaladaridou A, Papadopoulou O, Tasoulis A, Pamboucas C, Ntalianis A, Nanas J, Toumanidis S, Silva D, Cortez-Dias N, Carrilho-Ferreira P, Placido R, Jorge C, Calisto C, Robalo Martins S, Carvalho De Sousa J, Pinto F, Nunes Diogo A, Przewlocka-Kosmala M, Orda A, Karolko B, Mysiak A, Kosmala W, Moral Torres S, Rodriguez-Palomares J, Pineda V, Gruosso D, Evangelista A, Garcia-Dorado D, Figueras J, Cambronero E, Corbi MJ, Valle A, Cordoba J, Llanos C, Fernandez M, Lopez I, Hidalgo V, Barambio M, Jimenez J, D'andrea A, Riegler L, Cocchia R, Russo M, Bossone E, Calabro R, Iniesta Manjavacas A, Valbuena Lopez S, Lopez Fernandez T, Garcia-Blas S, De Torres Alba F, De Diego JG, Ramirez Valdiris U, Mesa Garcia J, Moreno Yanguela M, Lopez-Sendon J, Logstrup B, Andersen H, Thuesen L, Christiansen E, Terp K, Klaaborg K, Poulsen S, Cacicedo A, Velasco S, Aguirre U, Onaindia J, Rodriguez I, Oria G, Subinas A, Zugazabeitia G, Romero A, Laraudogoitia Zaldumbide E, Weisz S, Magne J, Dulgheru R, Rosca M, Pierard L, Lancellotti P, Auffret V, Donal E, Bedossa M, Boulmier D, Laurent M, Verhoye J, Le Breton H, Van Hall S, Herbrand T, Ketterer U, Keymel S, Boering Y, Rassaf T, Meyer C, Zeus T, Kelm M, Balzer J, Floria M, Seldrum S, Mariciuc M, Laurence G, Buche M, Eucher P, Louagie Y, Jamart J, Marchandise B, Schroeder E, Venkatesh A, Sahlen A, Johnson J, Brodin L, Winter R, Shahgaldi K, Manouras A, Maffessanti F, Tamborini G, Fusini L, Gripari P, Muratori M, Alamanni F, Bartorelli A, Ferrari C, Caiani E, Pepi M, Yaroslavskaya E, Kuznetsov V, Pushkarev G, Krinochkin D, Zyrianov I, Ciobotaru C, Kobayashi Y, Yamamoto K, Kobayashi Y, Hirose E, Hirohata A, Ohe T, Jhund P, Cunningham T, Murday V, Findlay I, Sonecki P, Rangel I, Sousa C, Goncalves A, Correia A, Vigario A, Martins E, Silva-Cardoso J, Macedo F, Maciel M, Lovric D, Samardzic J, Milicic D, Reskovic V, Baricevic Z, Ivanac I, Separovic Hanzevacki J, Kim K, Song J, Jeong H, Yoon H, Ahn Y, Jeong M, Cho J, Park J, Kang J, Iorio A, Pinamonti B, Bobbo M, Merlo M, Barbati G, Massa L, Faganello G, Di Lenarda A, Sinagra G, Heggemann F, Hamm K, Streitner F, Sueselbeck T, Papavassiliu T, Borggrefe M, Haghi D, Ferreira F, Galrinho A, Soares R, Branco L, Abreu J, Feliciano J, Papoila A, Alves M, Leal A, Ferreira R, Reynaud A, Donal E, Lund LH, Oger E, Drouet E, Hage C, Bauer F, Linde C, Daubert J, Schnell F, Donal E, Lentz P, Kervio G, Leurent G, Mabo P, Carre F, Rodrigues A, Roque M, Arruda A, Becker D, Barros S, Kay F, Emerick T, Pinheiro J, Sampaio-Barros P, Andrade J, Yamada S, Okada K, Iwano H, Nishino H, Nakabachi M, Yokoyama S, Kaga S, Mikami T, Tsutsui H, Mincu R, Magda S, Dumitrache Rujinski S, Constantinescu T, Mihaila S, Ciobanu A, Florescu M, Vinereanu D, Ashcheulova T, Kovalyova O, Ardeleanu E, Gurgus D, Gruici A, Suciu R, Ana I, Bergenzaun L, Ohlin H, Gudmundsson P, Willenheimer R, Chew M, Charalampopoulos A, Howard L, Davies R, Gin-Sing W, Tzoulaki I, Grapsa I, Gibbs S, Caiani E, Massabuau P, Weinert L, Lairez O, Berry M, Sotaquira M, Vaida P, Lang R, Khan I, Waterhouse D, Asegdom S, Alqaseer M, Foley D, Mcadam B, Colonna P, Michelotto E, Genco W, Rubino M, Pugliese S, Belfiore A, Sorino M, Trisorio Liuzzi M, Antonelli G, Palasciano G, Duszanska A, Skoczylas I, Streb W, Kukulski T, Polonski L, Kalarus Z, Fleig A, Seitz K, Secades S, Martin M, Corros C, Rodriguez M, De La Hera J, Garcia A, Velasco E, Fernandez E, Barriales V, Lambert J, Zwas DR, Hoss S, Leibowitz D, Beeri R, Lotan C, Gilon D, Wierzbowska-Drabik K, Roszczyk N, Sobczak M, Plewka M, Chrzanowski L, Lipiec P, Kasprzak J, Wita K, Mizia-Stec K, Wrobel W, Plonska-Gosciniak E, Goncalves A, Sousa C, Rangel I, Pinho T, Wang Y, Houle H, Madureira AJ, Macedo F, Zamorano J, Maciel MJ, Ancona R, Comenale Pinto S, Caso P, Coppola M, Rapisarda O, Calabro' R, Cadenas Chamorro R, Lopez T, Gomez J, Moreno M, Salinas P, Jimenez Rubio C, Valbuena S, Manjavacas A, De Torres F, Lopez-Sendon J, Vaugrenard T, Huttin O, Rouge A, Schwartz J, Zinzius P, Popovic B, Sellal J, Aliot E, Juilliere Y, Selton-Suty C, Looi J, Lee A, Hsiung M, Song W, Wong R, Underwood MJ, Fang F, Lin Q, Lam Y, Yu C, Vitarelli A, Nguyen B, Capotosto L, D-Alessandro G, D-Ascanio M, Rafique A, Gang E, Barilla F, Siegel R, Kydd A, Khan F, Watson W, Mccormick L, Virdee M, Dutka D, Ranjbar S, Karvandi M, Hassantash S, Grapsa J, Efthimiadis I, Pakrashi T, Dawson D, Punjabi P, Nihoyannopoulos P, Jasaityte R, D'hooge J, Rademakers F, Claus P, Henein M, Soderberg S, Tossavainen E, Henein M, Lindqvist P, Bellsham-Revell H, Bell A, Miller O, Simpson J, Altekin E, Kucuk M, Yanikoglu A, Karakas S, Er A, Ozel D, Ermis C, Demir I, Henein M, Soderberg S, Henein M, Lindqvist P, Bajraktari G, Di Salvo G, Baldini L, Del Gaizo F, Rea A, Pergola V, Caso P, Pacileo G, Fadel B, Calabro R, Russo M, Seo JS, Choi GN, Jin HY, Seol SH, Jang JS, Yang TH, Kim DK, Kim DS, Papadopoulou E, Kaladaridou A, Hatzidou S, Agrios J, Pamboukas C, Antoniou A, Toumanidis S, Gargiulo P, Dellegrottaglie S, Bruzzese D, Scala O, D'amore C, Ruggiero D, Marciano C, Vassallo E, Pirozzi E, Perrone Filardi P, Mor-Avi V, Kachenoura N, Lodato J, Port S, Chandra S, Freed B, Bhave N, Newby B, Lang R, Patel A, Dwivedi G, Alam M, Boczar K, Chow B, Staskiewicz G, Czekajska-Chehab E, Uhlig S, Tomaszewski A, Przegalinski J, Maciejewski R, Drop A, Di Giammarco G, Canosa C, Foschi M, Liberti G, Bedir M, Marinelli D, Masuyama S, Rabozzi R, Vijayan S, Miller H, Muthusamy R, Smith S, Gargani L, Pang P, Davis E, Schumacher A, Sicari R, Picano E, Mizia-Stec K, Chmiel A, Mizia M, Haberka M, Gieszczyk K, Sikora - Puz A, Lasota B, Trojnarska O, Grajek S, Gasior Z, Koumoulidis A, Vlasseros I, Tousoulis D, Katsi V, Avgeropoulou A, Divani M, Stefanadis C, Kallikazaros I. Poster session Thursday 6 December - AM: Other myocardial diseases. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jovanovic I, Giga V, Tesic M, Paunovic I, Kostic J, Dobric M, Dikic M, Stepanovic J, Belesiln B, Djordjevic-Dikic A, Lindqvist P, Henein M, Soderberg S, Gonzalez M, Tossavainen E, Djordjevic-Dikic A, Tesic M, Stepanovic J, Giga V, Kostic J, Trifunovic D, Jovanovic I, Paunovic I, Stanic S, Beleslin B, Koutsogiannis N, Moulias A, Xanthopoulou I, Mavronasiou E, Kakkavas A, Davlouros P, Alexopoulos D, Barbier P, Cefalu' C, Gripari P, Pontone G, Andreini D, Pepi M, Duncan AM, Snow T, Barker S, Davies S, Di Mario C, Moat N, Serra W, Chetta A, Marangio E, Reverberi C, Cattabiani MA, Ardissino D, Sahlen A, Hakansson F, Shahgaldi K, Manouras A, Norman M, Winter R, Johnson J, Fawzi S, Rafla SM, El Atroush H, Farouk K, Wilson C, Hilde J, Skjoerten I, Melsom M, Humerfelt S, Hansteen V, Hisdal J, Steine K, Rees P, Hutchings S, Magnino C, Omede' P, Avenatti E, Chiarlo M, Presutti D, Bucca C, Moretti C, Gaita F, Veglio F, Milan A, Kostic J, Tesic M, Stepanovic J, Giga V, Paunovic I, Marinkovic A, Jovanovic I, Beleslin B, Ostojic M, Djordjevic Dikic A, Najjar E, Winter R, Gunyeli E, Shahgaldi K, Manouras A, Rodriguez Munoz DA, Moya Mur J, Baguda JDJ, Lazaro Rivera C, Navas Tejedor P, Jimenez Nacher J, Castillo Orive M, Fernandez-Golfin C, Zamorano Gomez J, Satendra M, Sargento L, Sousa C, Lousada N, Palma Reis R, Said K, Shehata A, Ashour Z, El-Tobgi S, Li Kam Wa M, Pabari P, Perry S, Kyriacou A, Manisty C, Francis D, Kusmierczyk-Droszcz B, Kowalik E, Niewiadomska J, Lech A, Hoffman P, Patrianakos A, Kalogerakis A, Zacharaki A, Nyktari E, Psathakis E, Parthenakis F, Vardas P, Stefani L, Milicia M, Bartolini A, Gori N, Tempesti G, Toncelli L, Vono M, Di Tante V, Pedri S, Galanti G, Zhong L, Huang F, Le T, Chen Q, Gao F, Tan R, Anwar A, Nosir Y, Alasnig M, Llemit M, Alhagoly A, Chamsi-Pasha H, Trifunovic D, Ostojic M, Stankovic S, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Beleslin B, Djordjevic-Dikic A, Banovic M, Tesic M, Orii M, Hirata K, Tanimoto T, Ishibashi K, Yamano T, Ino Y, Yamaguchi T, Kubo T, Imanishi T, Akasaka T, Giesecke A, Ripsweden J, Shahgaldi K, Guyeli E, Winter R, Hristova K, Vasilev D, Pavlov P, Katova T, Simova I, Kostova V, Wada T, Hirata KH, Kubo T, Shiono Y, Ishibashi K, Tanimoto T, Ino Y, Yamaguchi T, Imanishi TI, Akasaka T, Martirosyan M, Adamyan K, Chilingaryan A, Negrea S, Alexandrescu C, Civaia F, Bourlon F, Dreyfus G, Malev E, Kim G, Omelchenko M, Mitrofanova L, Zemtsovsky E, Santoro A, Costantino F, Dores E, Tarsia G, Di Natale M, Innelli P, Schiano Lomoriello V, De Stefano F, Galderisi M, Lee SP, Ahn H, Hwang H, Kim H, Kim Y, Kim K, Kim K, Sohn D, Ahn H, Calin A, Popescu B, Rosca M, Beladan C, Enache R, Gurzun M, Calinescu C, Calin C, Ginghina C, Rafla S, Hamdy S, Lotfi M, Elneklawy M, Mordi I, Spratt J, Sonecki P, Stanton T, Mcculloch A, Goodfield N, Tzemos N, Ghulam Ali S, Fusini L, Tamborini G, Celeste F, Gripari P, Muratori M, Maffessanti F, Mirea O, Alamanni F, Pepi M, Demirkan B, Guray Y, Guray U, Ege M, Kisacik H, Sasmaz H, Korkmaz S, Petrovic-Nagorni S, Zdravkovic-Ciric S, Nagorni A, Stanojevic D, Jankovic-Tomasevic R, Atanaskovic V, Mitic V, Szymanski C, Magne J, Rusinaru D, Fournier A, Mezghani S, Peltier M, Touati G, Tribouilloy C, Huttin O, Khachab H, Voilliot D, Schwartz J, Zinzius P, Lemoine S, Carillo S, Popovic B, Juilliere Y, Selton-Suty C, Kimura K, Takenaka K, Ebihara A, Uno K, Morita H, Nakajima T, Motoyoshi Y, Komori T, Yatomi Y, Nagai R, Mihaila S, Mincu R, Rimbas R, Badiu C, Vinereanu D, Igual Munoz B, Maceira Gonzalez A, Domingo Valero D, Estornell Erill J, Giner Blasco J, Arnau Vives M, Molina Aguilar P, Navarro Manchon J, Zorio Grima E, Miglioranza M, Sant'anna R, Rover M, Mantovani A, Lessa J, Haertel J, Salgado Filho P, Kalil R, Leiria T, Risum N, Sogaard P, Fritz Hansen T, Bruun N, Kisslo J, Velazquez E, Jons C, Olsen N, Azevedo O, Lourenco M, Machado I, Pereira V, Medeiros R, Pereira A, Quelhas I, Lourenco A, Rangel I, Goncalves A, Sousa C, Correia A, Pinho T, Madureira A, Martins E, Silva-Cardoso J, Macedo F, Maciel M, Kinova E, Zlatareva N, Goudev A, Rogge B, Cramariuc D, Lonnebakken M, Rieck A, Gohlke-Baerwolf C, Chambers J, Boman K, Gerdts E, Florescu M, Mihalcea D, Enescu O, Suran B, Mincu R, Patrascu N, Magda L, Cinteza M, Vinereanu D, Bruno R, Cogo A, Bartesaghi M, Thapa K, Duo E, Basnyat B, Ghiadoni L, Picano E, Sicari R, Pratali L, Jensen-Urstad K, Nordin A, Bjornadal L, Svenungsson E, King GJ, Murphy R, Almuntaser I, Mc Loughlin B, Livingston A, Nevin S, Clarke J, De Sousa CC, Rangel I, Martins E, Correia A, Nadais G, Silveira F, Silva Cardoso J, Goncalves A, Macedo F, Maciel M, Lindqvist P, Henein M, Hornsten R, Rasmunsson J, Hedstrom M, Alm C, Filali T, Jedaida B, Lahidheb D, Gommidh M, Mahfoudhi H, Hajlaoui N, Dahmani R, Fehri W, Haouala H, Shin SH, Woo S, Kim D, Park K, Kwan J, Brambila CA, Gabrielli L, Bijnens B, Marin J, Sitges I, Grazioli G, Pare C, Mont L, Brugada J, Sitges M, Pica S, Ghio S, Raineri C, Camporotondo R, Rordorf R, Previtali M, Landolina M, Valentini A, Turco A, Visconti L, Stuart B, Santos A, Cruz I, Caldeira D, Cotrim C, Fazendas P, Joao I, Almeida A, Pereira H, Goncalves A, Pinho T, Sousa C, Rangel I, Correia A, Madureira A, Macedo F, Zamorano JL, Maciel M, Driessen M, Kort E, Leiner T, Cramer M, Sieswerda G, Chamuleau S, Kim D, Choi Y, Park H, Kim H, Shin J, Song J, Kang D, Song J, Parisi V, Galasso G, Festa G, Piccolo R, Rengo G, De Rosa R, Pagano G, Iacotucci P, Leosco D, Piscione F, Bellsham-Revell H, Nedjati-Gilani S, Yao C, Pushparajah K, Penney G, Simpson J, Lopez Melgar B, Sanchez Sanchez V, Rodriguez Garcia J, Coma Samartin R, Martin Asenjo R, Fernandez Casares S, Lopez-Guarch CJ, Diaz Anton B, Mayordomo Gomez S, Lombera Romero F, Yamada S, Okada K, Iwano H, Nishino H, Nakabachi M, Yokoyama S, Kaga S, Mikami T, Tsutsui H, Stoebe S, Tarr A, Pfeiffer D, Hagendorff A, Klitsie L, Roest A, Kuipers I, Van Der Hulst A, Hazekamp M, Blom N, Ten Harkel A, Hagendorff A, Stoebe S, Tarr A, Gelbrich G, Loeffler M, Pfeiffer D, Badran H, Elnoamany M, Soltan G, Ezat M, Elsedi M, Abdelfatah R, Yacoub M, Kydd A, Khan F, Mccormick L, Gopalan D, Virdee M, Dutka D, Ruiz Ortiz M, Mesa D, Delgado M, Romo E, Morenate M, Baeza F, Castillo F, Lopez Granados A, Del Prado JA, De Lezo JS, Kilickiran Avci B, Yurdakul S, Sahin S, Ermis E, Dilekci B, Aytekin S, Turhan S, Gerede D, Hural R, Ozcan O, Candemir B, Erol C, Saha SK, Kiotsekoglou A, Gopal A, Govind S, Lindqvist P, Soderberg S, Kawata T, Daimon M, Sekita G, Miyazaki S, Ichikawa R, Maruyama M, Suzuki H, Daida H, Persic V, Lovric D, Jurin H, Pehar Pejcinovic V, Baricevic Z, Pezo Nikolic B, Ivanac Vranesic I, Separovic Hanzevacki J, Ahn H, Cho G, Lee S, Kim H, Kim Y, Sohn D, Igual Munoz B, Estornell Erill J, Gonzalez AM, Bel Minguez A, Perez Guillen M, Donate Bertolin L, Monmeneu Menadas J, Lopez Lereu P, La Huerta AA, Argudo AM, Igual Munoz B, Gonzalez AM, Valero DD, La Huerta AA, Fernandez PA, Ferrer JM, Rueda Soriano J, Buendia Sanchez F, Estornell Erill J, Carrasco J, Carvalho MS, De Araujo Goncalves P, Sousa P, Dores H, Marques H, Pereira Machado F, Gaspar A, Aleixo A, Mota Carmo M, Roquette J, Vassiliadis IV, Despotopoulos E, Kaitozis O, Tekedis C, Al-Mallah M, Nour K, Tomaszewski A, Kutarski A, Brzozowski W, Tomaszewski M, Oleszczak K, Tong J, Bian Y, Yang F, Li P, Chen L, Shen X, Xu Y, Yan L, Kilickiran Avci B, Yurdakul S, Sahin S, Ermis E, Dilekci B, Aytekin S, Hristova K, Marinov R, Georgiev S, Kaneva A, Lasarov S, Mitev P, Katova T, Pilosoff V, Ikonomidis I, Tzortzis S, Triantafyllidi H, Paraskevaidis I, Trivilou P, Papadakis I, Papadopoulos C, Pavlidis G, Anastasiou-Nana M, Lekakis J. Poster session: Aortic stenosis. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Steg PG, Alam S, Chiang CE, Gamra H, Goethals M, Inoue H, Krapf L, Lewalter T, Merioua I, Murin J, Naditch-Brûlé L, Ponikowski P, Rosenqvist M, Silva-Cardoso J, Zharinov O, Brette S, Neill JO. Symptoms, functional status and quality of life in patients with controlled and uncontrolled atrial fibrillation: data from the RealiseAF cross-sectional international registry. Heart 2011; 98:195-201. [DOI: 10.1136/heartjnl-2011-300550] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Martins E, Oliveira A, Silva-Cardoso J, Faria T, Pinho T, Campelo M, Madureira A, Ribeiro O, Ramos I, Pereira JG, Rocha-Gonçalves F. Meta-Iodobenzylguanidine Iodine-123 and Cardiac Adrenergic Activity in Familial Dilated Cardiomyopathy. JACC Cardiovasc Imaging 2010; 3:959-63. [DOI: 10.1016/j.jcmg.2010.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 06/29/2010] [Accepted: 07/07/2010] [Indexed: 11/27/2022]
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