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van Ommen AM, Diez Benavente E, Onland-Moret NC, Valstar GB, Cramer MJ, Rutten FH, Teske AJ, Menken R, Hofstra L, Tulevski II, Sweitzer N, Somsen GA, den Ruijter HM. Plasma Proteomic Patterns Show Sex Differences in Early Concentric Left Ventricular Remodeling. Circ Heart Fail 2023:e010255. [PMID: 37381923 DOI: 10.1161/circheartfailure.122.010255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND Concentric remodeling (cRM) can precede heart failure with preserved ejection fraction (HFpEF), a condition prevalent in women. METHODS Patients (n=60 593, 54.2% women) visiting outpatient clinics of Cardiology Centers of the Netherlands were analyzed for cRM, HFpEF development, and mortality risk. We studied risk factors for relative wall thickness both sex-stratified and in women and men combined. Biomarker profiling was performed (4534 plasma proteins) in a substudy involving 557 patients (65.4% women) to identify pathways involved in cRM. RESULTS cRM was present in 23.5% of women and 27.6% of men and associated with developing HFpEF (HR, 2.15 [95% CI, 1.51-2.99]) and mortality risk (HR, 1.09 [95% CI, 1.00-1.19]) in both sexes. Age, heart rate, and hypertension were statistically significantly stronger risk factors for relative wall thickness in women than men. Higher circulating levels of IFNA5 (interferon alpha-5) were associated with higher relative wall thickness in women only. Pathway analysis revealed differential pathway activation by sex and increased expression of inflammatory pathways in women. CONCLUSIONS cRM is prevalent in approximately 1 in 4 women and men visiting outpatient cardiology clinics and associated with HFpEF development and mortality risk in both sexes. Known risk factors for cRM were more strongly associated in women than men. Proteomic analysis revealed inflammatory pathway activation in women, with a central role for IFNA5. Differential biologic pathway activation by sex in cRM may contribute to the female predominance of HFpEF and holds promise for identification of new therapeutic avenues for prevention and treatment of HFpEF. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT001747.
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Affiliation(s)
- Anne-Mar van Ommen
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands. (A.-M.v.O., E.D.B., G.B.V., H.M.d.R.)
| | - Ernest Diez Benavente
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands. (A.-M.v.O., E.D.B., G.B.V., H.M.d.R.)
| | - N Charlotte Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands. (N.C.O.-M., F.H.R.)
| | - Gideon B Valstar
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands. (A.-M.v.O., E.D.B., G.B.V., H.M.d.R.)
| | - Maarten J Cramer
- Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, the Netherlands. (M.J.C., A.J.T.)
| | - Frans H Rutten
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands. (N.C.O.-M., F.H.R.)
| | - Arco J Teske
- Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, the Netherlands. (M.J.C., A.J.T.)
| | - Roxana Menken
- Cardiology Centers of the Netherlands (R.M., L.H., I.I.T., G.A.S.)
| | - Leonard Hofstra
- Cardiology Centers of the Netherlands (R.M., L.H., I.I.T., G.A.S.)
| | - Igor I Tulevski
- Cardiology Centers of the Netherlands (R.M., L.H., I.I.T., G.A.S.)
| | - Nancy Sweitzer
- Department of Medicine, Washington University School of Medicine, St. Louis, MO (N.S.)
| | - G Aernout Somsen
- Cardiology Centers of the Netherlands (R.M., L.H., I.I.T., G.A.S.)
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands. (A.-M.v.O., E.D.B., G.B.V., H.M.d.R.)
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Hofmeyer M, Haas G, Kransdorf E, Ewald G, Morris A, Owens A, Lowes B, Stoller D, Tang W, Garg S, Trachtenberg B, Shah P, Pamboukian S, Sweitzer N, Wheeler M, Wilcox J, Katz S, Pan S, Jimenez J, Smart F, Wang J, Gottlieb S, Judge D, Moore C, Huggins G, Jordan E, Kinnamon D, Ni H, Hershberger R. Genetic Signature of Dilated Cardiomyopathy Severity: The DCM Precision Medicine Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1674] [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: 04/05/2023] Open
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Meyer J, Sweitzer N, Aravot D, Milano C, Barac Y. Heart Transplant Survival and the Use of Donors with Intracranial Bleeding: Unos Registry Propensity Matched Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.186] [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: 04/05/2023] Open
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Hoyer‐Kimura C, Konhilas J, Sweitzer N, Ryan L, Hay M. Circulating neurodegeneration biomarkers neurofilament light protein and p‐tau181 are increased in individuals with heart failure at risk for vascular cognitive impairment. Alzheimers Dement 2022. [DOI: 10.1002/alz.059920] [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: 12/24/2022]
Affiliation(s)
| | - John Konhilas
- University of Arizona Tucson AZ USA
- Sarver Heart Center Tucson AZ USA
| | - Nancy Sweitzer
- University of Arizona Tucson AZ USA
- Sarver Heart Center Tucson AZ USA
| | - Lee Ryan
- University of Arizona Tucson AZ USA
- Evelyn F. McNight Brain Institute Tucson AZ USA
| | - Meredith Hay
- University of Arizona Tucson AZ USA
- ProNeurogen, Inc Tucson AZ USA
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Hoyer‐Kimura C, Konhilas J, Sweitzer N, Ryan L, Hay M. Angiotensin‐(1‐7)/Mas receptor agonist: a disease modifying therapeutic for VCID protects cognitive function and inhibits serum neurofilament light protein. Alzheimers Dement 2022. [DOI: 10.1002/alz.059909] [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: 12/24/2022]
Affiliation(s)
| | - John Konhilas
- University of Arizona Tucson AZ USA
- Sarver Heart Center Tucson AZ USA
| | - Nancy Sweitzer
- University of Arizona Tucson AZ USA
- Sarver Heart Center Tucson AZ USA
| | - Lee Ryan
- University of Arizona Tucson AZ USA
- Evelyn F. McNight Brain Institute Tucson AZ USA
| | - Meredith Hay
- University of Arizona Tucson AZ USA
- ProNeurogen, Inc Tucson AZ USA
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7
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Melton F, Palmer K, Solola S, Luy L, Herrera-Theut K, Zabala L, Knapp SM, Yee R, Yee E, Calhoun E, Hebdon MCT, Pool N, Sweitzer N, Breathett K. Race and Gender-Based Perceptions of Older Septuagenarian Adults. Womens Health Rep (New Rochelle) 2022; 3:944-956. [PMID: 36479377 PMCID: PMC9712052 DOI: 10.1089/whr.2022.0063] [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] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 06/17/2023]
Abstract
Objectives Older adults face racism, sexism, and ageism. As the U.S. population ages, it is important to understand how the current population views older adults. Methods Participants recruited through Amazon's Mechanical Turk provided perceptions of older Black and White models' photographs. Using mixed-effect models, we assessed interactions between race and gender of participants and models. Results Among Participants of Color and White participants (n = 712, 70% non-Hispanic White, 70% women, mean 37.81 years), Black models were perceived as more attractive, less threatening, and sadder than White models, but differences were greater for White participants (race-by-race interaction: attractive p = 0.003, threatening p = 0.009, sad p = 0.016). Each gender perceived their respective gender as more attractive (gender-by-gender interaction p < 0.0001). Male and female participants perceived male models as happier than female models, but differences were greater for male participants (p = 0.026). Irrespective of participant age group, women were perceived as more threatening (p = 0.012). Other perceptions were not significant. Discussion Participants had few biases toward older Black and White models, while gender biases favored men.
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Affiliation(s)
- Forest Melton
- Department of Clinical Translational Sciences, College of Medicine, University of Arizona, Phoenix, Arizona, USA
| | - Kelly Palmer
- Department of Promotion Science, College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Sade Solola
- Division of Cardiology, Brown University, Providence, Rhode Island, USA
| | - Luis Luy
- University of Rochester, Rochester, New York, USA
| | - Kathryn Herrera-Theut
- Department of Internal Medicine and Pediatrics, College of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Leanne Zabala
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Shannon M. Knapp
- Division of Cardiovascular Medicine Statistics, College of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Ryan Yee
- Clinical Research Office, Indiana University, Indianapolis, Indiana, USA
| | - Erika Yee
- College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Elizabeth Calhoun
- College of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Natalie Pool
- School of Nursing, University of Northern Colorado, Greeley, Colorado, USA
| | - Nancy Sweitzer
- Division of Cardiology, Washington University, St. Louis, Missouri, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, College of Medicine, Krannert Institute of Cardiology, Indiana University, Indianapolis, Indiana, USA
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Chirinos J, Lopez-Jaramillo P, Giamarellos-Bourboulis E, Dávila-Del-Carpio G, Bizri A, Andrade-Villanueva J, Salman O, Cure-Cure C, Rosado-Santander N, Giraldo MC, González-Hernández L, Moghnieh R, Angeliki R, Saldarriaga MC, Pariona M, Medina C, Dimitroulis I, Vlachopoulos C, Gutierrez C, Rodriguez-Mori J, Gomez-Laiton E, Pereyra R, Hernández JR, Arbañil H, Accini-Mendoza J, Pérez-Mayorga M, Milionis H, Poulakou G, Sánchez G, Valdivia-Vega R, Villavicencio-Carranza M, Ayala-Garcia R, Castro-Callirgos C, Carrasco RA, Danos WL, Sharkoski T, Greene K, Pourmussa B, Greczylo C, Chittams J, Katsaounou P, Alexiou Z, Sympardi S, Sweitzer N, Putt M, Cohen J. A Randomized Trial of Lipid Metabolism Modulation with Fenofibrate for Acute Coronavirus Disease 2019. Res Sq 2022:rs.3.rs-1933913. [PMID: 35982675 PMCID: PMC9387540 DOI: 10.21203/rs.3.rs-1933913/v1] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Abnormal cellular lipid metabolism appears to underlie SARS-CoV-2 cytotoxicity and may involve inhibition of peroxisome proliferator activated receptor alpha (PPARα). Fenofibrate, a PPAR-α activator, modulates cellular lipid metabolism. Fenofibric acid has also been shown to affect the dimerization of angiotensin-converting enzyme 2, the cellular receptor for SARS-CoV-2. Fenofibrate and fenofibric acid have been shown to inhibit SARS-CoV-2 replication in cell culture systems in vitro . Methods We randomly assigned 701 participants with COVID-19 within 14 days of symptom onset to 145 mg of fenofibrate (nanocrystal formulation with dose adjustment for renal function or dose-equivalent preparations of micronized fenofibrate or fenofibric acid) vs. placebo for 10 days, in a double-blinded fashion. The primary endpoint was a ranked severity score in which participants were ranked across hierarchical tiers incorporating time to death, duration of mechanical ventilation, oxygenation parameters, subsequent hospitalizations and symptom severity and duration. ClinicalTrials.gov registration: NCT04517396. Findings: Mean age of participants was 49 ± 16 years, 330 (47%) were female, mean BMI was 28 ± 6 kg/m 2 , and 102 (15%) had diabetes mellitus. A total of 41 deaths occurred. Compared with placebo, fenofibrate administration had no effect on the primary endpoint. The median (interquartile range [IQR]) rank in the placebo arm was 347 (172, 453) vs. 345 (175, 453) in the fenofibrate arm (P = 0.819). There was no difference in various secondary and exploratory endpoints, including all-cause death, across randomization arms. These results were highly consistent across pre-specified sensitivity and subgroup analyses. Conclusion Among patients with COVID-19, fenofibrate has no significant effect on various clinically relevant outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Oday Salman
- Hospital of the University of Pennsylvania and Perelman School of Medicine, American University of Beirut
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tiffany Sharkoski
- Hospital of the University of Pennsylvania and Perelman School of Medicine
| | - Katherine Greene
- Hospital of the University of Pennsylvania and Perelman School of Medicine
| | - Bianca Pourmussa
- Hospital of the University of Pennsylvania and Perelman School of Medicine
| | - Candy Greczylo
- Hospital of the University of Pennsylvania and Perelman School of Medicine
| | | | | | | | | | | | - Mary Putt
- Perelman School of Medicine. University of Pennsylvania
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9
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Cikes M, Planinc I, Claggett B, Cunningham J, Milicic D, Sweitzer N, Senni M, Gori M, Linssen G, Shah SJ, Packer M, Pfeffer M, Zile MR, Anand I, Chiang LM, Lam CSP, Redfield M, Desai AS, McMurray JJV, Solomon SD. Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction: The PARAGON-HF Trial. JACC Heart Fail 2022; 10:336-346. [PMID: 35483796 DOI: 10.1016/j.jchf.2022.01.018] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES In this study, the authors sought to assess the relationship between AFF and outcomes, the treatment response to sacubitril/valsartan and first-detected AFF in patients with HFpEF enrolled in the PARAGON-HF trial. BACKGROUND Atrial fibrillation and flutter (AFF) are common in heart failure with preserved ejection fraction (HFpEF) and increase the risk of adverse outcomes. METHODS A total of 4,776 patients formed 3 groups: those with AFF according to electrocardiography (ECG) at enrollment (n = 1,552; 33%), those with history of AFF but without AFF on ECG at enrollment (n = 1,005; 21%), and those without history of AFF or AFF on ECG at enrollment (n = 2,219, 46%). We assessed outcomes, treatment response to sacubitril/valsartan in each group, and the risk associated with first-detected AFF in patients without any known AFF. The primary outcome was a composite of total heart failure hospitalizations and cardiovascular death. RESULTS History of AFF and AFF at enrollment were associated with higher risk of the primary outcome (risk ratio [RR]: 1.36 [95% CI: 1.12-1.65] and RR: 1.31 [1.11-1.54], respectively), than no AFF. Neither history of AFF nor AFF at enrollment modified the treatment effect of sacubitril/valsartan. Post randomization AFF occurred in 12% of patients without previous AFF and was associated with 2.8-fold higher risk of the primary outcome, but it was not influenced by sacubitril/valsartan. CONCLUSIONS History of AFF and AFF on ECG at enrollment were associated with a higher risk of the primary outcome. First-detected AFF was not influenced by sacubitril/valsartan, yet it was associated with increased risk of all subsequent outcomes and may represent a potential target for future HFpEF trials. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711).
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Affiliation(s)
- Maja Cikes
- Department for Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ivo Planinc
- Department for Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jonathan Cunningham
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Davor Milicic
- Department for Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | | | - Mauro Gori
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Milton Packer
- Baylor University Medical Center, Dallas, Texas, USA
| | - Marc Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael R Zile
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Duke-National University of Singapore
| | | | - Akshay S Desai
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Toosizadeh N, Eskandari M, Ehsani H, Parvaneh S, Asghari M, Sweitzer N. Frailty assessment using a novel approach based on combined motor and cardiac functions: a pilot study. BMC Geriatr 2022; 22:199. [PMID: 35287574 PMCID: PMC8919591 DOI: 10.1186/s12877-022-02849-3] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/14/2022] [Indexed: 01/06/2023] Open
Abstract
Background Previous research showed association between frailty and an impaired autonomic nervous system; however, the direct effect of frailty on heart rate (HR) behavior during physical activity is unclear. The purpose of the current study was to determine the association between HR increase and decrease with frailty during a localized upper-extremity function (UEF) task to establish a multimodal frailty test. Methods Older adults aged 65 or older were recruited and performed the UEF task of rapid elbow flexion for 20 s with the right arm. Wearable gyroscopes were used to measure forearm and upper-arm motion, and electrocardiography were recorded using leads on the left chest. Using this setup, HR dynamics were measured, including time to peak HR, recovery time, percentage increase in HR during UEF, and percentage decrease in HR during recovery after UEF. Results Fifty-six eligible participants were recruited, including 12 non-frail (age = 76.92 ± 7.32 years), and 40 pre-frail (age = 80.53 ± 8.12 years), and four frail individuals (age = 88.25 ± 4.43 years). Analysis of variance models showed that the percentage increase in HR during UEF and percentage decrease in HR during recovery were both 47% smaller in pre-frail/frail older adults compared to non-frails (p < 0.01, effect size = 0.70 and 0.62 for increase and decrease percentages). Using logistic models with both UEF kinematics and HR parameters as independent variables, frailty was predicted with a sensitivity of 0.82 and specificity of 0.83. Conclusion Current findings showed evidence of strong association between HR dynamics and frailty. It is suggested that combining kinematics and HR data in a multimodal model may provide a promising objective tool for frailty assessment.
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Affiliation(s)
- Nima Toosizadeh
- Department of Biomedical Engineering, University of Arizona, 1230 N Cherry Avenue, Tucson, AZ, 85719, USA. .,Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, USA. .,Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, USA.
| | - Maryam Eskandari
- Department of Computer Sciences, University of Arizona, Tucson, AZ, USA
| | - Hossein Ehsani
- Kinesiology Department, University of Maryland, College Park, MD, USA
| | | | - Mehran Asghari
- Department of Biomedical Engineering, University of Arizona, 1230 N Cherry Avenue, Tucson, AZ, 85719, USA
| | - Nancy Sweitzer
- Arizona Sarver Heart Center, Department of Medicine, University of Arizona, Tucson, USA
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11
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Butler J, Stebbins A, Melenovsky V, Sweitzer N, Cowie M, Stehlik J, Ezekowitz J, Hernandez A, Lam C, Nkulikiyinka R, O'Connor C, Pieske B, Ponikowski P, Voors A, Armstrong P. Vericiguat and health status outcomes in heart failure with reduced ejection fraction: insights from the VICTORIA trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In the VICTORIA trial, vericiguat compared with placebo reduced the risk of the primary endpoint of cardiovascular death (CVD) or hospitalization for heart failure (HFH) among 5050 patients with worsening HF with reduced ejection fraction (HFrEF).
Purpose
We evaluated whether the efficacy of vericiguat on clinical outcomes varied according to participants' baseline health status, as assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ)-23, and how vericiguat affected health status post-randomization.
Methods
KCCQ-23 was completed at randomization and at 4, 16, and 32 weeks. Patients were grouped based on tertiles of baseline KCCQ total symptom score (TSS; <55.2, 55.2–79.2, and >79.2), clinical summary score (CSS; <52.1, 52.1–76.0, and >76.2) and overall summary score (OSS; <48.5, 48.5–70.8, and >70.8) across tertiles 1–3, respectively. Cox proportional hazard models were performed for the tertiles to evaluate the effects of vericiguat on the primary outcomes.
Results
Overall 4741, 4664, and 4470 participants had KCCQ-TSS (median 68.8 [interquartile range 47.9, 85.4]), KCCQ-CSS (65.6 [45.8, 81.8]) and KCCQ-OSS (59.9 [42.0, 77.1]) available at baseline. Vericiguat reduced CVD or HFH risk across baseline KCCQ-TSS (P=0.21), KCCQ-CSS (P=0.13) and KCCQ-OSS (P=0.65) tertiles (Table). The effect of vericiguat on HFH alone was also not modified by baseline KCCQ-TSS, CSS and OSS (all P>0.05) scores. At 4 weeks after randomization, improvement in both vericiguat and placebo arms was seen in KCCQ-TSS (vericiguat 6.3 vs. placebo 6.3; P=0.85), KCCQ-CSS (vericiguat: 5.7 vs. placebo 5.7, P=0.54), and KCCQ-OSS (vericiguat 6.3 vs. placebo 5.7, P=0.36). Similar results were seen at weeks 16 and 32.
Conclusion
Vericiguat reduced the risk of the composite outcome of CVD or HFH as well as HFH alone across the range of baseline health status. Addition of vericiguat to best standard of care did not significantly improve health status compared with standard of care alone in HF patients with a recent worsening event. The early improvement in KCCQ seen in both randomized groups underscore the need to assess trajectory of health status changes in the spectrum of patients with HFrEF.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Merck & Co., Inc. and Bayer
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Affiliation(s)
- J Butler
- The University of Mississippi Medical Center, Jackson, United States of America
| | - A Stebbins
- Duke Clinical Research Institute, Durham, United States of America
| | - V Melenovsky
- Institute for Clinical and Experimental Medicine-IKEM, Prague, Czechia
| | - N Sweitzer
- University of Arizona, Sarver Heart Center, Tucson, United States of America
| | - M.R Cowie
- Imperial College London, London, United Kingdom
| | - J Stehlik
- University of Utah, Salt Lake City, United States of America
| | | | - A.F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - C.S.P Lam
- National Heart Centre Singapore, Duke-National University of Singapore, Singapore, Singapore
| | | | - C.M O'Connor
- Inova Heart and Vascular Institute, Falls Church, United States of America
| | - B Pieske
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | | | - A.A Voors
- University Medical Center Groningen, Groningen, Netherlands (The)
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Solola S, Luy L, Herrera-Theut K, Zabala L, Torabzadeh E, Bedrick EJ, Yee E, Larsen A, Stone J, McEwen M, Calhoun E, Crist JD, Hebdon M, Pool N, Carnes M, Sweitzer N, Breathett K. Race and Gender-Based Perceptions of Older Adults: Will the Youth Lead the Way? J Racial Ethn Health Disparities 2020; 8:1415-1423. [PMID: 33145664 DOI: 10.1007/s40615-020-00903-7] [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: 06/29/2020] [Revised: 09/13/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Older individuals encounter the greatest racial/gender biases. It is unknown whether younger generations, who often lead culture shifts, have racial and gender biases against older populations. METHODS Using Amazon's Mechanical Turk's crowdsourcing, we identified how an individual's race and gender are associated with perceptions of individuals aged mid-60s. Participants were asked to rate photograph appearances on Likert Scale (1-10). Interactions between participant and photograph race and gender were assessed with mixed effects models. Delta represents rating differences (positive value higher rating for Whites or women, negative value higher rating for African-Americans or men). RESULTS Among 1563 participants (mean 35 years ± 12), both non-Hispanic White (WP) and all Other race/ethnicity (OP) participants perceived African-American photos as more trustworthy [Delta WP -0.60(95%CI-0.83, - 0.37); Delta OP - 0.51(- 0.74,-0.28), interaction p = 0.06], more attractive [Delta non-Hispanic White participants - 0.63(- 0.97, - 0.29); Delta Other race/ethnicity participants - 0.40 (- 0.74, - 0.28), interaction p < 0.001], healthier [Delta WP -0.31(- 0.53, - 0.08); Delta OP -0.24(- 0.45, -0.03), interaction p = 1.00], and less threatening than White photos [Delta WP 0.79(0.36,1.22); Delta OP 0.60(0.17,1.03), interaction p < 0.001]. Compared with OP, WP perceived African-American photos more favorably for intelligence (interaction p < 0.001). Both genders perceived photos of women as more trustworthy [Delta Women Participants (WmP) 0.50(0.27,0.73); Delta Men Participants(MnP) 0.31(0.08,0.54); interaction p < 0.001] and men as more threatening [Delta WmP -0.84(-1.27, -0.41), Delta MnP - 0.77(- 1.20, - 0.34), interaction p = 0.93]. Compared with MnP, WmP perceived photos of women as happier and more attractive than men (interaction p < 0.001). Compared with WmP, MnP perceived men as healthier than women (interaction p < 0.001). CONCLUSIONS Among a young generation, older African-Americans were perceived more favorably than Whites. Gender perceptions followed gender norms. This suggests a decline in implicit bias against older minorities, but gender biases persist. Future work should investigate whether similar patterns are observed in healthcare.
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Affiliation(s)
- Sade Solola
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Luis Luy
- University of Rochester, Rochester, NY, USA
| | | | - Leanne Zabala
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Elmira Torabzadeh
- Statistics Consulting Lab, Bio5 Institute, University of Arizona, Tucson, AZ, USA
| | - Edward J Bedrick
- Statistics Consulting Lab, Bio5 Institute, University of Arizona, Tucson, AZ, USA
| | - Erika Yee
- Sarver Heart Center, Clinical Research Office, University of Arizona, Tucson, AZ, USA
| | - Ashley Larsen
- Sarver Heart Center, Clinical Research Office, University of Arizona, Tucson, AZ, USA
| | - Jeff Stone
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Marylyn McEwen
- Department of Nursing, University of Arizona, Tucson, AZ, USA
| | - Elizabeth Calhoun
- Center for Population Health Sciences, University of Arizona, Tucson, AZ, USA
| | - Janice D Crist
- Department of Nursing, University of Arizona, Tucson, AZ, USA
| | - Megan Hebdon
- Department of Nursing, University of Arizona, Tucson, AZ, USA
| | - Natalie Pool
- Department of Nursing, University of Arizona, Tucson, AZ, USA
| | - Molly Carnes
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Nancy Sweitzer
- Division of Cardiology, Department of Medicine, Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, PO Box 245046, Tucson, AZ, 85724, USA
| | - Khadijah Breathett
- Division of Cardiology, Department of Medicine, Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, PO Box 245046, Tucson, AZ, 85724, USA.
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13
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Chirinos JA, Cohen JB, Zhao L, Hanff T, Sweitzer N, Fang J, Corrales-Medina V, Anmar R, Morley M, Zamani P, Bhattacharya P, Brandimarto J, Jia Y, Basso MD, Wang Z, Ebert C, Ramirez-Valle F, Schafer PH, Seiffert D, Gordon DA, Cappola T. Clinical and Proteomic Correlates of Plasma ACE2 (Angiotensin-Converting Enzyme 2) in Human Heart Failure. Hypertension 2020; 76:1526-1536. [PMID: 32981365 PMCID: PMC10681288 DOI: 10.1161/hypertensionaha.120.15829] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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] [Indexed: 12/23/2022]
Abstract
ACE2 (angiotensin-converting enzyme 2) is a key component of the renin-angiotensin-aldosterone system. Yet, little is known about the clinical and biologic correlates of circulating ACE2 levels in humans. We assessed the clinical and proteomic correlates of plasma (soluble) ACE2 protein levels in human heart failure. We measured plasma ACE2 using a modified aptamer assay among PHFS (Penn Heart Failure Study) participants (n=2248). We performed an association study of ACE2 against ≈5000 other plasma proteins measured with the SomaScan platform. Plasma ACE2 was not associated with ACE inhibitor and angiotensin-receptor blocker use. Plasma ACE2 was associated with older age, male sex, diabetes mellitus, a lower estimated glomerular filtration rate, worse New York Heart Association class, a history of coronary artery bypass surgery, and higher pro-BNP (pro-B-type natriuretic peptide) levels. Plasma ACE2 exhibited associations with 1011 other plasma proteins. In pathway overrepresentation analyses, top canonical pathways associated with plasma ACE2 included clathrin-mediated endocytosis signaling, actin cytoskeleton signaling, mechanisms of viral exit from host cells, EIF2 (eukaryotic initiation factor 2) signaling, and the protein ubiquitination pathway. In conclusion, in humans with heart failure, plasma ACE2 is associated with various clinical factors known to be associated with severe coronavirus disease 2019 (COVID-19), including older age, male sex, and diabetes mellitus, but is not associated with ACE inhibitor and angiotensin-receptor blocker use. Plasma ACE2 protein levels are prominently associated with multiple cellular pathways involved in cellular endocytosis, exocytosis, and intracellular protein trafficking. Whether these have a causal relationship with ACE2 or are relevant to novel coronavirus-2 infection remains to be assessed in future studies.
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Affiliation(s)
- Julio A. Chirinos
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jordana B. Cohen
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lei Zhao
- Bristol Myers Squibb Company, Princeton, New Jersey, USA
| | - Thomas Hanff
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nancy Sweitzer
- Sarver Heart Institute, University of Arizona, Tuscon, AZ
| | - James Fang
- University of Utah, Salt Lake City, Utah
| | | | - Ron Anmar
- Bristol Myers Squibb Company, Princeton, New Jersey, USA
| | - Michael Morley
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Payman Zamani
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Priyanka Bhattacharya
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jeff Brandimarto
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Yi Jia
- SomaLogic Inc., Boulder, CO, USA
| | | | - Zhaoqing Wang
- Bristol Myers Squibb Company, Princeton, New Jersey, USA
| | | | | | | | | | | | - Thomas Cappola
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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14
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Cohen JB, Hanff TC, Corrales-Medina V, William P, Renna N, Rosado-Santander NR, Rodriguez-Mori JE, Spaak J, Andrade-Villanueva J, Chang TI, Barbagelata A, Alfonso CE, Bernales-Salas E, Coacalla J, Castro-Callirgos CA, Tupayachi-Venero KE, Medina C, Valdivia R, Villavicencio M, Vasquez CR, Harhay MO, Chittams J, Sharkoski T, Byrd JB, Edmonston DL, Sweitzer N, Chirinos JA. Randomized elimination and prolongation of ACE inhibitors and ARBs in coronavirus 2019 (REPLACE COVID) Trial Protocol. J Clin Hypertens (Greenwich) 2020; 22:1780-1788. [PMID: 32937008 DOI: 10.1111/jch.14011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/31/2020] [Accepted: 07/31/2020] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), is associated with high incidence of multiorgan dysfunction and death. Angiotensin-converting enzyme 2 (ACE2), which facilitates SARS-CoV-2 host cell entry, may be impacted by angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), two commonly used antihypertensive classes. In a multicenter, international randomized controlled trial that began enrollment on March 31, 2020, participants are randomized to continuation vs withdrawal of their long-term outpatient ACEI or ARB upon hospitalization with COVID-19. The primary outcome is a hierarchical global rank score incorporating time to death, duration of mechanical ventilation, duration of renal replacement or vasopressor therapy, and multiorgan dysfunction severity. Approval for the study has been obtained from the Institutional Review Board of each participating institution, and all participants will provide informed consent. A data safety monitoring board has been assembled to provide independent oversight of the project.
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Affiliation(s)
- Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas C Hanff
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vicente Corrales-Medina
- Division of Infectious Diseases, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Preethi William
- Division of Cardiology, University of Arizona, Tucson, AZ, USA
| | - Nicolas Renna
- Hypertension Unit, Department of Pathology, Hospital Español de Mendoza, National University of Cuyo, IMBECU-CONICET, Mendoza, Argentina
| | | | - Juan E Rodriguez-Mori
- Department of Nephrology, Hospital Nacional Alberto Sabogal Sologuren, EsSalud, Lima, Perú
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Tara I Chang
- Division of Nephrology, Stanford University School of Medicine, Stanford, CA, USA
| | - Alejandro Barbagelata
- Universidad Católica de Buenos Aires, Buenos Aires, Argentina.,Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Carlos E Alfonso
- Cardiology Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo Bernales-Salas
- Department of Medicine, Hospital Nacional Carlos Alberto Seguín Escobedo, EsSalud, Arequipa, Perú
| | - Johanna Coacalla
- Department of Medicine, Hospital Nacional Carlos Alberto Seguín Escobedo, EsSalud, Arequipa, Perú
| | | | | | - Carola Medina
- Department of Nephrology, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú
| | - Renzo Valdivia
- Department of Nephrology, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú
| | - Mirko Villavicencio
- Department of Nephrology, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú
| | - Charles R Vasquez
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Palliative and Advanced Illness Research (PAIR) Center and Pulmonary and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jesse Chittams
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tiffany Sharkoski
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James Brian Byrd
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel L Edmonston
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Nancy Sweitzer
- Division of Cardiology, University of Arizona, Tucson, AZ, USA
| | - Julio A Chirinos
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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15
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Breathett K, Yee E, Pool N, Hebdon M, Crist J, Yee R, Knapp S, Solola S, Luy L, Herrera‐Theut K, Zabala L, Stone J, McEwen M, Calhoun E, Sweitzer N. Sex and Race Biases in Allocation of Advanced Heart Failure Therapies. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13397] [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: 12/01/2022] Open
Affiliation(s)
| | - E. Yee
- University of Arizona Tucson AZ United States
| | - N. Pool
- University of Arizona Tucson AZ United States
| | - M. Hebdon
- University of Arizona Tucson AZ United States
| | - J. Crist
- University of Arizona Tucson AZ United States
| | - R. Yee
- University of Arizona Tucson AZ United States
| | - S. Knapp
- University of Arizona Tucson AZ United States
| | - S. Solola
- University of Arizona Tucson AZ United States
| | - L. Luy
- University of Rochester Rochester NY United States
| | | | - L. Zabala
- University of Arizona Tucson AZ United States
| | - J. Stone
- University of Arizona Tucson AZ United States
| | - M. McEwen
- University of Arizona Tucson AZ United States
| | - E. Calhoun
- University of Arizona Tucson AZ United States
| | - N. Sweitzer
- University of Arizona Tucson AZ United States
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16
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Chirinos JA, Zhao L, Jia Y, Frej C, Adamo L, Mann D, Shewale SV, Millar JS, Rader DJ, French B, Brandimarto J, Margulies KB, Parks JS, Wang Z, Seiffert DA, Fang J, Sweitzer N, Chistoffersen C, Dahlbäck B, Car BD, Gordon DA, Cappola TP, Javaheri A. Reduced Apolipoprotein M and Adverse Outcomes Across the Spectrum of Human Heart Failure. Circulation 2020; 141:1463-1476. [PMID: 32237898 PMCID: PMC7200273 DOI: 10.1161/circulationaha.119.045323] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Apo (apolipoprotein) M mediates the physical interaction between high-density lipoprotein (HDL) particles and sphingosine-1-phosphate (S1P). Apo M exerts anti-inflammatory and cardioprotective effects in animal models. METHODS In a subset of PHFS (Penn Heart Failure Study) participants (n=297), we measured apo M by Enzyme-Linked ImmunoSorbent Assay (ELISA). We also measured total S1P by liquid chromatography-mass spectrometry and isolated HDL particles to test the association between apo M and HDL-associated S1P. We confirmed the relationship between apo M and outcomes using modified aptamer-based apo M measurements among 2170 adults in the PHFS and 2 independent cohorts: the Washington University Heart Failure Registry (n=173) and a subset of TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial; n=218). Last, we examined the relationship between apo M and ≈5000 other proteins (SomaScan assay) to identify biological pathways associated with apo M in heart failure. RESULTS In the PHFS, apo M was inversely associated with the risk of death (standardized hazard ratio, 0.56 [95% CI, 0.51-0.61]; P<0.0001) and the composite of death/ventricular assist device implantation/heart transplantation (standardized hazard ratio, 0.62 [95% CI, 0.58-0.67]; P<0.0001). This relationship was independent of HDL cholesterol or apo AI levels. Apo M remained associated with death (hazard ratio, 0.78 [95% CI, 0.69-0.88]; P<0.0001) and the composite of death/ventricular assist device/heart transplantation (hazard ratio, 0.85 [95% CI, 0.76-0.94]; P=0.001) in models that adjusted for multiple confounders. This association was present in both heart failure with reduced and preserved ejection fraction and was replicated in the Washington University cohort and a cohort with heart failure with preserved ejection fraction only (TOPCAT). The S1P and apo M content of isolated HDL particles strongly correlated (R=0.81, P<0.0001). The top canonical pathways associated with apo M were inflammation (negative association), the coagulation system (negative association), and liver X receptor/retinoid X receptor activation (positive association). The relationship with inflammation was validated with multiple inflammatory markers measured with independent assays. CONCLUSIONS Reduced circulating apo M is independently associated with adverse outcomes across the spectrum of human heart failure. Further research is needed to assess whether the apo M/S1P axis is a suitable therapeutic target in heart failure.
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Affiliation(s)
- Julio A. Chirinos
- Perelman School of Medicine. University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | - Lei Zhao
- Bristol-Myers Squibb Company, Lawrenceville, NJ
| | - Yi Jia
- SomaLogic Inc., Boulder, CO
| | | | - Luigi Adamo
- Washington University School of Medicine, St. Louis, MO
| | - Douglas Mann
- Washington University School of Medicine, St. Louis, MO
| | - Swapnil V. Shewale
- Perelman School of Medicine. University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | - John S. Millar
- Perelman School of Medicine. University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | - Daniel J. Rader
- Perelman School of Medicine. University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | - Benjamin French
- Perelman School of Medicine. University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | - Jeff Brandimarto
- Perelman School of Medicine. University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | - Kenneth B. Margulies
- Perelman School of Medicine. University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | - John S. Parks
- Dept. of Internal Medicine-Molecular Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | | | | | - James Fang
- University of Utah. Salt Lake City, Utah
| | - Nancy Sweitzer
- Sarver Heart Institute, University of Arizona, Tuscon, AZ
| | - Christina Chistoffersen
- Dept. of Clinical Biochemistry, Rigshospitalet and Dept. of Biomedical Sciences, Copenhagen, Denmark
| | | | | | | | - Thomas P. Cappola
- Perelman School of Medicine. University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | - Ali Javaheri
- Washington University School of Medicine, St. Louis, MO
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17
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Solomon SD, Vaduganathan M, L. Claggett B, Packer M, Zile M, Swedberg K, Rouleau J, A. Pfeffer M, Desai A, H. Lund L, Kober L, Anand I, Sweitzer N, Linssen G, Merkely B, Luis Arango J, Vinereanu D, Chen CH, Senni M, Sibulo A, Boytsov S, Shi V, Rizkala A, Lefkowitz M, McMurray JJ. Sacubitril/Valsartan Across the Spectrum of Ejection Fraction in Heart Failure. Circulation 2020; 141:352-361. [DOI: 10.1161/circulationaha.119.044586] [Citation(s) in RCA: 206] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background:
While disease-modifying therapies exist for heart failure (HF) with reduced left ventricular ejection fraction (LVEF), few options are available for patients in the higher range of LVEF (>40%). Sacubitril/valsartan has been compared with a renin-angiotensin-aldosterone–system inhibitor alone in 2 similarly designed clinical trials of patients with reduced and preserved LVEF, permitting examination of its effects across the full spectrum of LVEF.
Methods:
We combined data from PARADIGM-HF (LVEF eligibility≤40%; n=8399) and PARAGON-HF (LVEF eligibility≥45%; n=4796) in a prespecified pooled analysis. We divided randomized patients into LVEF categories: ≤22.5% (n=1269), >22.5% to 32.5% (n=3987), >32.5% to 42.5% (n=3143), > 42.5% to 52.5% (n=1427), > 52.5% to 62.5% (n=2166), and >62.5% (n=1202). We assessed time to first cardiovascular death and HF hospitalization, its components, and total heart failure hospitlizations, all-cause mortality, and noncardiovascular mortality. Incidence rates and treatment effects were examined across categories of LVEF.
Results:
Among 13 195 randomized patients, we observed lower rates of cardiovascular death and HF hospitalization, but similar rates of noncardiovascular death, among patients in the highest versus the lowest groups. Overall sacubitril/valsartan was superior to renin-angiotensin-aldosterone–system inhibition for first cardiovascular death or heart failure hospitalization (Hazard Ratio [HR] 0.84 [95% CI, 0.78–0.90]), cardiovascular death (HR 0.84 [95% CI, 0.76–0.92]), heart failure hospitalization (HR 0.84 [95% CI, 0.77–0.91]), and all-cause mortality (HR 0.88 [95% CI, 0.81–0.96]). The effect of sacubitril/valsartan was modified by LVEF (treatment-by-continuous LVEF interaction
P
=0.02), and benefit appeared to be present for individuals with EF primarily below the normal range, although the treatment benefit for cardiovascular death diminished at a lower ejection fraction. We observed effect modification by LVEF on the efficacy of sacubitril/valsartan in both men and women with respect to composite total HF hospitalizations and cardiovascular death, although women derived benefit to higher ejection fractions.
Conclusions:
The therapeutic effects of sacubitril/valsartan, compared with a renin-angiotensin-aldosterone–system inhibitor alone, vary by LVEF with treatment benefits, particularly for heart failure hospitalization, that appear to extend to patients with heart failure and mildly reduced ejection fraction. These therapeutic benefits appeared to extend to a higher LVEF range in women compared with men.
Clinical Trial Registration:
https://www.clinicaltrials.gov
. Unique identifiers: NCT01920711 (PARAGON-HF), NCT01035255 (PARADIGM-HF).
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Affiliation(s)
- Scott D. Solomon
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S., M.V., B.L.C., M.A.P., A.D.)
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S., M.V., B.L.C., M.A.P., A.D.)
| | - Brian L. Claggett
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S., M.V., B.L.C., M.A.P., A.D.)
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.)
- Imperial College, London, United Kingdom (M.P.)
| | - Michael Zile
- Medical University of South Carolina, Charleston (M.Z.)
- Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC (M.Z.)
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.)
- National Heart and Lung Institute, Imperial College, London, United Kingdom (K.S.)
| | - Jean Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.R.)
| | - Marc A. Pfeffer
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S., M.V., B.L.C., M.A.P., A.D.)
| | - Akshay Desai
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.S., M.V., B.L.C., M.A.P., A.D.)
| | - Lars H. Lund
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden (L.H.L.)
| | - Lars Kober
- Department of Cardiology, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (L.K.)
| | - Inder Anand
- Department of Medicine, VA Medical Center and University of Minnesota, Minneapolis (I.A.)
| | - Nancy Sweitzer
- Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.S.)
| | - Gerard Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, The Netherlands (G.L.)
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.)
| | | | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital of Bucharest, Romania (D.V.)
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China (C.-H.C.)
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Hospital Papa Giovanni XXIII, Bergamo, Italy (M.S.)
| | - Antonio Sibulo
- St Luke’s Heart Institute, St. Luke’s Medical Center, Taguig, Philippines (A.S.)
| | - Sergey Boytsov
- National Research Center for Cardiology of the Ministry of Health of the Russian Federation, Moscow (S.B.)
| | - Victor Shi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ (V.S, A.R., M.L.)
| | - Adel Rizkala
- Novartis Pharmaceuticals Corporation, East Hanover, NJ (V.S, A.R., M.L.)
| | - Martin Lefkowitz
- Novartis Pharmaceuticals Corporation, East Hanover, NJ (V.S, A.R., M.L.)
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (J.J.V.M.)
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18
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McMurray JJV, Jackson AM, Lam CSP, Redfield MM, Anand IS, Ge J, Lefkowitz MP, Maggioni AP, Martinez F, Packer M, Pfeffer MA, Pieske B, Rizkala AR, Sabarwal SV, Shah AM, Shah SJ, Shi VC, van Veldhuisen DJ, Zannad F, Zile MR, Cikes M, Goncalvesova E, Katova T, Kosztin A, Lelonek M, Sweitzer N, Vardeny O, Claggett B, Jhund PS, Solomon SD. Effects of Sacubitril-Valsartan Versus Valsartan in Women Compared With Men With Heart Failure and Preserved Ejection Fraction: Insights From PARAGON-HF. Circulation 2019; 141:338-351. [PMID: 31736337 DOI: 10.1161/circulationaha.119.044491] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [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: 02/06/2023]
Abstract
BACKGROUND Unlike heart failure with reduced ejection fraction, there is no approved treatment for heart failure with preserved ejection fraction, the predominant phenotype in women. Therefore, there is a greater heart failure therapeutic deficit in women compared with men. METHODS In a prespecified subgroup analysis, we examined outcomes according to sex in the PARAGON-HF trial (Prospective Comparison of ARNI With ARB Global Outcomes in Heart Failure With Preserved Ejection Fraction), which compared sacubitril-valsartan and valsartan in patients with heart failure with preserved ejection fraction. The primary outcome was a composite of first and recurrent hospitalizations for heart failure and death from cardiovascular causes. We also report secondary efficacy and safety outcomes. RESULTS Overall, 2479 women (51.7%) and 2317 men (48.3%) were randomized. Women were older and had more obesity, less coronary disease, and lower estimated glomerular filtration rate and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels than men. For the primary outcome, the rate ratio for sacubitril-valsartan versus valsartan was 0.73 (95% CI, 0.59-0.90) in women and 1.03 (95% CI, 0.84-1.25) in men (P interaction = 0.017). The benefit from sacubitril-valsartan was attributable to reduction in heart failure hospitalization. The improvement in New York Heart Association class and renal function with sacubitril-valsartan was similar in women and men, whereas the improvement in Kansas City Cardiomyopathy Questionnaire clinical summary score was less in women than in men. The difference in adverse events between sacubitril-valsartan and valsartan was similar in women and men. CONCLUSIONS As compared with valsartan, sacubitril-valsartan seemed to reduce the risk of heart failure hospitalization more in women than in men. Whereas the possible sex-related modification of the effect of treatment has several potential explanations, the present study does not provide a definite mechanistic basis for this finding. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.gov. Unique identifier: NCT01920711.
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Affiliation(s)
- John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, UK (J.J.V.M., A.M.J., P.S.J.)
| | - Alice M Jackson
- BHF Cardiovascular Research Centre, University of Glasgow, UK (J.J.V.M., A.M.J., P.S.J.)
| | - Carolyn S P Lam
- National Heart Center Singapore and Duke-National University of Singapore (C.S.P.L.).,Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (C.S.P.L., D.J.v.V.).,The George Institute for Global Health, Newtown, Australia (C.S.P.L.)
| | | | | | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, China (J.G.)
| | - Marty P Lefkowitz
- Novartis Pharmaceuticals, East Hanover, NJ (M.P.L., A.R.R., S.V.S., V.C.S.)
| | - Aldo P Maggioni
- National Association of Hospital Cardiologists Research Center, Florence, Italy (A.P.M.)
| | | | | | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.A.P., A.M.S., B.C., S.D.S.)
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, German Center for Cardiovascular Research Partner Site Berlin, Germany (B.P.)
| | - Adel R Rizkala
- Novartis Pharmaceuticals, East Hanover, NJ (M.P.L., A.R.R., S.V.S., V.C.S.)
| | - Shalini V Sabarwal
- Novartis Pharmaceuticals, East Hanover, NJ (M.P.L., A.R.R., S.V.S., V.C.S.)
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.A.P., A.M.S., B.C., S.D.S.)
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Victor C Shi
- Novartis Pharmaceuticals, East Hanover, NJ (M.P.L., A.R.R., S.V.S., V.C.S.)
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands (C.S.P.L., D.J.v.V.)
| | - Faiez Zannad
- INSERM Centre d'Investigation Clinic 1433 and Universite de Lorraine, Centre Hospitalier Regional et Universitaire, Nancy, France (F.Z.)
| | - Michael R Zile
- Medical University of South Carolina and the Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston (M.R.Z.)
| | - Maja Cikes
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb, Croatia (M.C.)
| | - Eva Goncalvesova
- Department of Heart Failure-Transplantation, National Cardiovascular Institute, Bratislava, Slovakia (E.G.)
| | - Tzvetana Katova
- Clinic of Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.)
| | - Anamaria Kosztin
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary (A.K.)
| | - Malgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Poland (M.L.)
| | | | - Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota (O.V.)
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.A.P., A.M.S., B.C., S.D.S.)
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, UK (J.J.V.M., A.M.J., P.S.J.)
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.A.P., A.M.S., B.C., S.D.S.)
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Slater RE, Strom JG, Methawasin M, Liss M, Gotthardt M, Sweitzer N, Granzier HL. Metformin improves diastolic function in an HFpEF-like mouse model by increasing titin compliance. J Gen Physiol 2018; 151:42-52. [PMID: 30567709 PMCID: PMC6314384 DOI: 10.1085/jgp.201812259] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/14/2018] [Indexed: 12/20/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a syndrome characterized by increased diastolic stiffness, for which effective therapies are lacking. Slater et al. show that metformin lowers titin-based passive stiffness in an HFpEF mouse model and may therefore be of therapeutic benefit. Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome characterized by a preserved ejection fraction but increased diastolic stiffness and abnormalities of filling. Although the prevalence of HFpEF is high and continues to rise, no effective therapies exist; however, the diabetic drug metformin has been associated with improved diastolic function in diabetic patients. Here we determine the therapeutic potential of metformin for improving diastolic function in a mouse model with HFpEF-like symptoms. We combine transverse aortic constriction (TAC) surgery with deoxycorticosterone acetate (DOCA) supplementation to obtain a mouse model with increased diastolic stiffness and exercise intolerance. Echocardiography and pressure–volume analysis reveal that providing metformin to TAC/DOCA mice improves diastolic function in the left ventricular (LV) chamber. Muscle mechanics show that metformin lowers passive stiffness of the LV wall muscle. Concomitant with this improvement in diastolic function, metformin-treated TAC/DOCA mice also demonstrate preserved exercise capacity. No metformin effects are seen in sham operated mice. Extraction experiments on skinned ventricular muscle strips show that the metformin-induced reduction of passive stiffness in TAC/DOCA mice is due to an increase in titin compliance. Using phospho-site-specific antibodies, we assay the phosphorylation of titin’s PEVK and N2B spring elements. Metformin-treated mice have unaltered PEVK phosphorylation but increased phosphorylation of PKA sites in the N2B element, a change which has previously been shown to lower titin’s stiffness. Consistent with this result, experiments with a mouse model deficient in the N2B element reveal that the beneficial effect of metformin on LV chamber and muscle stiffness requires the presence of the N2B element. We conclude that metformin offers therapeutic benefit during HFpEF by lowering titin-based passive stiffness.
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Affiliation(s)
- Rebecca E Slater
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - Joshua G Strom
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - Mei Methawasin
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ
| | - Martin Liss
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Michael Gotthardt
- Neuromuscular and Cardiovascular Cell Biology, Max Delbrück Center for Molecular Medicine, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Nancy Sweitzer
- Sarver Heart Center, College of Medicine, University of Arizona, Tucson, AZ
| | - Henk L Granzier
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ .,Sarver Heart Center, College of Medicine, University of Arizona, Tucson, AZ
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20
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Breathett K, Maffett S, Foraker RE, Sturdivant R, Moon K, Hasan A, Franco V, Smith S, Lampert BC, Emani S, Haas G, Kahwash R, Hershberger RE, Binkley PF, Helmkamp L, Colborn K, Peterson PN, Sweitzer N, Abraham WT. Pilot Randomized Controlled Trial to Reduce Readmission for Heart Failure Using Novel Tablet and Nurse Practitioner Education. Am J Med 2018; 131:974-978. [PMID: 29555457 PMCID: PMC6098971 DOI: 10.1016/j.amjmed.2018.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Heart failure education programs are not standardized. The best form of education is unclear. We evaluated whether addition of a novel tablet application to nurse practitioner (NP) education was superior to NP education alone in reducing 30-day readmission after heart failure hospitalization. METHODS From February 2015-March 2016, patients admitted to a quaternary academic center with primary diagnosis of heart failure were randomized to 1) treatment - NP education plus tablet application (interactive conditional logic program that flags patient questions to medical staff), or 2) control - NP education. The primary outcome was reduction in 30-day readmission rate. Secondary outcomes included satisfaction and education assessed via survey. RESULTS Randomization included 60 patients to treatment and 66 to control. A total of 13 patients withdrew prior to intervention (treatment n = 4, control n = 1) or were lost to follow-up (treatment n = 3, control n = 5). The 30-day readmission rate trended lower for treatment compared with control, but results were not statistically significant (13.2% [7/53], 26.7% [16/60], respectively, P = .08). Similarly, satisfaction trended higher with treatment than control (P = .08). Treatment patients rated explanations from their physicians higher than control (Always: 83.7%, 55.8%, respectively, P = .01). CONCLUSIONS NP education plus tablet use was not associated with significantly lower 30-day readmission rates in comparison with NP alone, but a positive trend was seen. Patient satisfaction trended higher and heart failure explanations were better with NP education plus tablet. A larger study is needed to determine if NP education plus tablet reduces readmission rates following heart failure admission.
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Affiliation(s)
- Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson.
| | - Scott Maffett
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Randi E Foraker
- Institute for Informatics, Washington University in St. Louis School of Medicine, Mo
| | - Rod Sturdivant
- Department of Mathematics and Physics, Azusa Pacific University, Calif
| | - Kristina Moon
- Division of Cardiology, University of Wisconsin, Madison
| | - Ayesha Hasan
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Veronica Franco
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Sakima Smith
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Brent C Lampert
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Sitaramesh Emani
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Garrie Haas
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Rami Kahwash
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Ray E Hershberger
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Philip F Binkley
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Laura Helmkamp
- University of Colorado Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora
| | - Kathryn Colborn
- University of Colorado Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora
| | - Pamela N Peterson
- Division of Cardiology, University of Colorado and Denver Health Medical Center, Denver
| | - Nancy Sweitzer
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson
| | - William T Abraham
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
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21
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Breathett K, Maffett S, Foraker R, Sturdivant R, Moon K, Hasan A, Franco V, Smith S, Lampert B, Emani S, Haas G, Kahwash R, Hershberger R, Binkley P, Helmkamp L, Colborn K, Peterson P, Sweitzer N, Abraham W. Pilot Randomized Controlled Trial to Reduce Readmission for Heart Failure Using Novel Tablet and Nurse Practitioner Education. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.807] [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: 11/16/2022] Open
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22
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Vaduganathan M, Claggett B, Anand I, Sweitzer N, Fang J, O’Meara E, Shah SJ, Hegde S, Desai A, Lewis E, Rouleau J, Pitt B, Pfeffer MA, Solomon S. SUDDEN DEATH IN HEART FAILURE WITH PRESERVED EJECTION FRACTION: A COMPETING RISKS ANALYSIS FROM THE TOPCAT TRIAL. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31415-3] [Citation(s) in RCA: 1] [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: 11/26/2022]
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23
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Vazir A, Claggett B, Pitt B, Anand I, Sweitzer N, Fang J, Fleg J, Rouleau J, Shah S, Pfeffer MA, Solomon SD. Prognostic Importance of Temporal Changes in Resting Heart Rate in Heart Failure and Preserved Ejection Fraction: From the TOPCAT Study. JACC Heart Fail 2017; 5:782-791. [PMID: 29032132 DOI: 10.1016/j.jchf.2017.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/15/2017] [Accepted: 08/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to examine the relationship between baseline heart rate (HR), change in HR from a preceding visit, and time-updated HR with subsequent outcomes in patients with heart failure with preserved ejection fraction (HFpEF) in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial. BACKGROUND Higher resting HR and increase in HR over time in patients with heart failure are associated with adverse outcomes. Whether these relationships between HR and prognosis are also observed in patients with HFpEF requires further assessment. METHODS In 1,767 patients enrolled in the TOPCAT trial from the Americas, the associations between baseline resting HR and change in HR from the preceding visit and clinical outcomes were examined using Cox proportional hazards models, along with the association between HR at each visit and outcome. RESULTS Both baseline HR (adjusted hazard ratio: 1.08; 95% confidence interval: 1.04 to 1.12) and change in HR from the preceding visit (adjusted hazard ratio: 1.09; 95% confidence interval: 1.05 to 1.14; p < 0.001 per 5 beats/min higher HR), after adjusting for covariates, were associated with a higher risk for the primary endpoint of cardiovascular death, hospitalization for HF, or aborted cardiac arrest. Time-updated resting HR at each visit was also associated with risk (adjusted hazard ratio: 1.11; 95% confidence interval: 1.07 to 1.15; p < 0.001 per 5 beats/min higher HR). Furthermore, a rise in resting HR of approximately 10 beats/min, beginning approximately 10 days prior to the primary endpoint, was observed. CONCLUSIONS Baseline resting HR and change in HR over time predict outcomes in patients with HFpEF, as does time-updated HR during follow-up. These data suggest that frequent outpatient monitoring of HR, possibly with remote technologies, may identify patients with HFpEF who may be at increased risk for rehospitalization or death.
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Affiliation(s)
- Ali Vazir
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Massachusetts; Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and Institute of Cardiovascular Medicine and Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Massachusetts
| | - Bertram Pitt
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Inder Anand
- Division of Cardiology, University of Minnesota, Minneapolis
| | - Nancy Sweitzer
- Division of Cardiovascular Medicine, University of Arizona, Tucson, Arizona
| | - James Fang
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Jerome Fleg
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, Maryland
| | - Jean Rouleau
- Department of Medicine/Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Sanjiv Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marc A Pfeffer
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Massachusetts
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Massachusetts.
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Biering-Sorensen T, Shah S, Anand I, Sweitzer N, Claggett B, Pitt B, Pfeffer M, Solomon S, Shah A. P6178Prognostic importance of pulmonary pressure in heart failure with preserved ejection fraction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6178] [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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25
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Biering-Sørensen T, Shah SJ, Anand I, Sweitzer N, Claggett B, Liu L, Pitt B, Pfeffer MA, Solomon SD, Shah AM. Prognostic importance of left ventricular mechanical dyssynchrony in heart failure with preserved ejection fraction. Eur J Heart Fail 2017; 19:1043-1052. [PMID: 28322009 DOI: 10.1002/ejhf.789] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 12/24/2022] Open
Abstract
AIMS Left ventricular mechanical dyssynchrony has been described in heart failure with preserved ejection fraction (HFpEF), but its prognostic significance is not known. METHODS AND RESULTS Of 3445 patients with HFpEF enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, dyssynchrony analysis was performed on 424 patients (12%) by multiple speckle tracking echocardiography strain-based criteria. The primary dyssynchrony analysis was the standard deviation of the time to peak longitudinal strain (SD T2P LS). Cox proportional hazards models assessed the association of dyssynchrony with the composite outcome of cardiovascular death or heart failure hospitalization. Mean age was 70 ± 10 years, LVEF was 60 ± 8%, and QRS duration was 101 ± 27 ms. Worse dyssynchrony, reflected in SD T2P LS, was associated with wider QRS, prior myocardial infarction, larger LV volume and mass, and worse systolic (lower LVEF and global longitudinal strain) and diastolic (lower e' and higher E/e') function. During a median follow-up of 2.6 (interquartile range 1.5-3.8) years, 107 patients experienced the composite outcome. Worse dyssynchrony was associated with the composite outcome in unadjusted analysis [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.01-1.07; P = 0.021, per 10 ms increase], but not after adjusting for clinical characteristics, or after further adjustment for LVEF, AF, NYHA class, stroke, heart rate, creatinine, haematocrit, and QRS duration (HR 1.03, 95% CI 0.99-1.06; P = 0.16, per 10 ms increase). CONCLUSION Worse LV mechanical dyssynchrony, assessed by speckle tracking echocardiography, is not an independent predictor of adverse outcomes in HFpEF, suggesting that mechanical dyssynchrony is unlikely to be an important mechanism underlying this syndrome. These findings warrant validation in an independent study specifically designed to assess the prognostic utility of mechanical dyssynchrony in HFpEF. TRIAL REGISTRATION NCT00094302.
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Affiliation(s)
- Tor Biering-Sørensen
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Sanjiv J Shah
- Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Inder Anand
- Cardiovascular Division, VA Medical Center, Minneapolis, MN, USA
| | - Nancy Sweitzer
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Li Liu
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Bertram Pitt
- Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Marc A Pfeffer
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Bajaj NS, Claggett B, Lewis E, Desai A, Fang J, Omeara E, Shah S, Sweitzer N, Fleg J, Pitt B, Rouleau J, Finn P, Pfeffer M, Solomon S. INFLUENCE OF LEFT VENTRICULAR EJECTION FRACTION ON CAUSE-SPECIFIC MORTALITY IN HEART FAILURE WITH PRESERVED EJECTION FRACTION: THE TOPCAT TRIAL. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34273-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Measures of interaction between the left ventricle (LV) and arterial system (ventricular-arterial coupling) are important but under-recognised cardiovascular phenotypes in heart failure. Ventriculo-arterial coupling is commonly assessed in the pressure-volume plane, using the ratio of effective arterial elastance (EA) to LV end-systolic elastance (EES) to provide information on ventricular-arterial system mechanical efficiency and performance when LV ejection fraction is abnormal. These analyses have significant limitations, such as neglecting systolic loading sequence, and are less informative in heart failure with preserved ejection fraction (HFpEF). EA is almost entirely dependent on vascular resistance and heart rate. Assessment of pulsatile arterial haemodynamics and time-resolved myocardial wall stress provide critical incremental physiological information and should be more widely utilised. Pulsatile arterial load represents a promising therapeutic target in HFpEF. Here, we review various approaches to assess ventricular-arterial interactions, and their pathophysiological and clinical implications in heart failure.
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Affiliation(s)
- Julio A Chirinos
- University of Pennsylvania Perelman School of Medicine and Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy Sweitzer
- Tucson and Arizona Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, USA
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Basuray A, French B, Ky B, Vorovich E, Olt C, Sweitzer N, Cappola T, Fang JC. Response to letter regarding article, "Heart failure with recovered ejection fraction: clinical description, biomarkers, and outcomes". Circulation 2015; 131:e344. [PMID: 25815393 DOI: 10.1161/circulationaha.114.012888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lewis EF, Claggett B, Liu J, Boineau R, Desai A, Solomon S, Anand I, Sweitzer N, Rouleau JL, Fang J, Thaik C, O’Meara E, Retta TM, Clausell N, McKinlay S, Pitt B, Pfeffer M. BLACK RACE ASSOCIATED WITH WORSE OUTCOMES IN AMBULATORY HEART FAILURE-PRESERVED EJECTION FRACTION PATIENTS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60837-3] [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: 11/16/2022]
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Vorovich EE, French B, Ky B, Goldberg L, Fang J, Sweitzer N, Cappola T. BIOMARKER PREDICTORS OF CARDIAC HOSPITALIZATION IN CHRONIC HEART FAILURE: A RECURRENT EVENT ANALYSIS. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60734-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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llana S, Chapman C, Sweitzer N, Johnson M, Kohmoto T, Murray D, Murray M, Li Z, Rahko P. BLEEDING AND THROMBOEMBOLIC EVENTS IN PATIENTS WITH A HEARTMATE II LEFT VENTRICULAR ASSIST DEVICE. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60898-6] [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: 11/27/2022]
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Kipp R, Brown B, Hollis Z, Eckhardt L, Sweitzer N, Leal M. Incidence of Ejection Fraction Improvement and Correlation with Outcomes in Recipients of Primary Prevention ICDs. J Card Fail 2013. [DOI: 10.1016/j.cardfail.2013.06.083] [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: 11/30/2022]
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Velez M, Hetzel S, Linde C, Sweitzer N. EFFECT OF DIABETES MELLITUS ON THE REVERSE REMODELING RESPONSE AND CLINICAL OUTCOMES WITH CARDIAC RESYNCHRONIZATION THERAPY IN MILDLY SYMPTOMATIC AND ASYMPTOMATIC HEART FAILURE PATIENTS: A SUB-STUDY OF THE REVERSE TRIAL. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61048-1] [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: 10/28/2022]
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Allana S, Chapman C, Sweitzer N, Kohmoto T, Murray M, Rahko P. BLEEDING AND THROMBOEMBOLIC EVENTS IN PATIENTS WITH HEARTMATE II: ARE THESE RELATED TO THE DEVICE SPEED AND PROTHROMBIN TIME? J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60319-7] [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: 11/27/2022]
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Maursetter L, Jacobson L, Sweitzer N, Nanovic L. 196 Diastolic Blood Pressure May Be an Early Modifiable Risk Factor in Preventing Aortic Stiffness Among Chronic Kidney Disease Patients. Am J Kidney Dis 2011. [DOI: 10.1053/j.ajkd.2011.02.199] [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: 11/11/2022]
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Sweitzer N, Warner Stevenson L. Hospitalization for Heart Failure in the Elderly. Am J Geriatr Cardiol 1999; 8:276-281. [PMID: 11416523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
People over 65 years account for more than 80% of heart failure hospitalizations, with almost half in patients morer than 75. Heart failure hospitalizations accounted for 21% of the annual health care budget for a representative senior program. Heart failure with preserved ejection fraction accounts for over half of heart failure hospitalizations in the elderly. Current therapy for the elderly is directed to relieve congestion by reducing volume overload and hypertension, while addressing exacerbating factors such as ischemia and anemia. Heart rate reduction is critical when sinus rhythm cannot be maintained but can also improve diastolic filling during sinus rhythm. While cardiac transplantation is rarely indicated, other interventions should be actively considered. Most elderly patients admitted with heart failure wish resuscitation. As heart failure progresses, decisions regarding implantable defibrillators or dialysis require careful consideration, and the risk/benefit balance may shift toward therapies to improve quality of life. (c)1999 by CVRR, Inc.
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Affiliation(s)
- Nancy Sweitzer
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA
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