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Carrillo-Aleman L, Agamez-Luengas AA, Guia M, Renedo-Villarroya A, Alonso-Fernández N, Lopez-Gomez L, Bayoumy-Delis P, Sanchez-Nieto JM, Pascual-Figal D, Carrillo-Alcaraz A. Effectiveness and safety of non-invasive ventilation in the management of cardiogenic shock. Rev Port Cardiol 2024; 43:259-273. [PMID: 37949366 DOI: 10.1016/j.repc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/11/2023] [Accepted: 08/14/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiogenic shock (CS) has long been considered a contraindication for the use of non-invasive ventilation (NIV). The main objective of this study was to analyze the effectiveness, measured as NIV success, in patients with respiratory failure due to CS. As secondary objective, we studied risk factors for NIV failure and compared the outcome of patients treated with NIV versus invasive mechanical ventilation (IMV). METHODS Retrospective study on a prospective database, over a period of 25 years, of all consecutively patients admitted to an intensive care unit, with a diagnosis of CS and treated with NIV. A comparison was made between patients on NIV and patients on IMV using propensity score matching analysis. RESULTS Three hundred patients were included, mean age 73.8 years, mean SAPS II 49. The main cause of CS was acute myocardial infarction (AMI): 164 (54.7%). NIV failure occurred in 153 (51%) cases. Independent factors for NIV failure included D/E stages of CS, AMI, NIV related complications, and being transferred from the ward. In the propensity analysis, hospital mortality (OR 1.69, 95% CI 1.09-2.63) and 1 year mortality (OR 1.61, 95% CI 1.04-2.51) was higher in IMV. Mortality was lower with NIV (vs. EIT-IMV) in C stage (10.1% vs. 32.9%; p<0.001) but did not differ in D stage or E stage. CONCLUSIONS NIV seems to be relatively effective and safe in the treatment of early-stage CS.
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Affiliation(s)
| | | | - Miguel Guia
- Sleep and Non-invasive Ventilation Unit, Thorax Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; ISAMB, Instituto de Saúde Ambiental da Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
| | | | | | | | | | | | - Domingo Pascual-Figal
- Cardiology Department, Virgen de la Arrixaca Hospital, Ctra. Madrid-Cartagena, Murcia, Spain
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Zuriaga MA, Pascual-Figal D, Fuster JJ. Clonal haematopoiesis and cardiac arrythmias: rhythm-altering mutations. Eur Heart J 2024; 45:806-808. [PMID: 38320247 DOI: 10.1093/eurheartj/ehae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Affiliation(s)
- María A Zuriaga
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Domingo Pascual-Figal
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain
- Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - José J Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain
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Straburzynska-Migaj E, Senni M, Wachter R, Fonseca C, Witte KK, Mueller C, Lonn E, Butylin D, Noe A, Schwende H, Lawrence D, Suryawanshi B, Pascual-Figal D. Early Initiation of Sacubitril/Valsartan in Patients With Acute Heart Failure and Renal Dysfunction: An Analysis of the TRANSITION Study. J Card Fail 2024; 30:425-435. [PMID: 37678704 DOI: 10.1016/j.cardfail.2023.08.021] [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: 04/04/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Treatment of patients with heart failure with reduced ejection fraction (HFrEF) and renal dysfunction (RD) is challenging owing to the risk of further deterioration in renal function, especially after acute decompensated HF (ADHF). METHODS AND RESULTS We assessed the effect of RD (estimated glomerular filtration rate of ≥30 to <60 mL/min/1.73 m2) on initiation, up-titration, and tolerability of sacubitril/valsartan in hemodynamically stabilized patients with HFrEF admitted for ADHF (RD, n = 476; non-RD, n = 483). At week 10, the target dose of sacubitril/valsartan (97/103 mg twice daily) was achieved by 42% patients in RD subgroup vs 54% in non-RD patients (P < .001). Sacubitril/valsartan was associated with greater estimated glomerular filtration rate improvements in RD subgroup than non-RD (change from baseline least squares mean 4.1 mL/min/1.73 m2, 95% confidence interval 2.2-6.1, P < .001). Cardiac biomarkers improved significantly in both subgroups; however, compared with the RD subgroup, the improvement was greater in those without RD (N-terminal pro-brain natriuretic peptide, -28.6% vs -44.8%, high-sensitivity troponin T -20.3% vs -33.9%) (P < .001). Patients in the RD subgroup compared with those without RD experienced higher rates of hyperkalemia (16.3% vs 6.5%, P < .001), investigator-reported cardiac failure (9.7% vs 5.6%, P = .029), and renal impairment (6.4% vs 2.1%, P = .002). CONCLUSIONS Most patients with HFrEF and concomitant RD hospitalized for ADHF tolerated early initiation of sacubitril/valsartan and showed significant improvements in estimated glomerular filtration rate and cardiac biomarkers. CLINICAL TRIAL REGISTRATION NCT02661217.
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Affiliation(s)
- Ewa Straburzynska-Migaj
- Poznan University of Medical Sciences, Poznan, University Hospital in Poznan, Poznan, Poland.
| | - M Senni
- Cardiovascular Department and Cardiology Unit, ASST Papa Giovanni XXIII, University of Milano-Bicocca, Bergamo, Italy
| | - R Wachter
- Clinic and polyclinic for cardiology, Leipzig University Hospital, Leipzig, Germany
| | - C Fonseca
- Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, and NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - K K Witte
- Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds, UK
| | - C Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Heart Center Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - E Lonn
- Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Canada
| | - D Butylin
- Novartis Pharma AG, Basel, Switzerland
| | - A Noe
- Novartis Pharma AG, Basel, Switzerland
| | | | | | | | - D Pascual-Figal
- Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain & Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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Pascual-Figal D, Fuster JJ, Bayes-Genis A. Personalizing anti-inflammatory therapy in heart failure: A new way. Eur J Heart Fail 2023; 25:1933-1935. [PMID: 37792725 DOI: 10.1002/ejhf.3052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Domingo Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Universidad de Murcia, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER en Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Jose Javier Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER en Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Antoni Bayes-Genis
- CIBER en Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
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Escobar C, Pascual-Figal D, Manzano L, Nuñez J, Camafort M. Current Role of SLGT2 Inhibitors in the Management of the Whole Spectrum of Heart Failure: Focus on Dapagliflozin. J Clin Med 2023; 12:6798. [PMID: 37959263 PMCID: PMC10649290 DOI: 10.3390/jcm12216798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Heart failure (HF) is associated with a high morbidity and mortality burden. In light of more recent evidence, SGLT2 inhibitors are currently recommended as first-line therapy in managing patients with HF, regardless of ejection fraction, to reduce HF burden. The DAPA-HF and DELIVER trials, and particularly, the pooled analysis of both studies, have shown that dapagliflozin significantly reduces the risk of cardiovascular death, all-cause death, total HF hospitalizations, and MACE in the whole spectrum of HF, with sustained benefits over time. Recent data have shown that the full implementation of dapagliflozin in clinical practice would translate into a robust reduction in hospitalizations for HF and death in real-life populations. Many pathophysiological mechanisms have been involved in these benefits, particularly the positive effects of dapagliflozin on reversing cardiac (atrial and ventricular) remodeling, reducing cardiac fibrosis and inflammation, and improving endothelial dysfunction. In this manuscript, we reviewed from a practical point of view the role of dapagliflozin in the management of the whole spectrum of patients with HF.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, University Hospital La Paz, 28046 Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Clinico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
- Spanish National Cardiovascular Research Centre (CNIC), 28029 Madrid, Spain
- Department of Medicine, Universidad de Murcia, 30100 Murcia, Spain
| | - Luis Manzano
- Internal Medicine Department, University Hospital Ramon y Cajal, Alcala de Henares University, 28034 Madrid, Spain;
| | - Julio Nuñez
- Cardiology Department, University Hospital Clínico of Valencia, Instituto de Investigación Sanitaria (INCLIVA), 46010 Valencia, Spain;
- CIBER Cardiovascular, 28029 Madrid, Spain
| | - Miguel Camafort
- Internal Medicine Department, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain;
- CIBER OBN, ISCIII (Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III), 28222 Madrid, Spain
- Working Group of Cardiovascular Risk, Nutrition, and Aging, IDIBAPS (Instituto de Investigaciones Biomédicas August Pi i Sunyer), 08036 Barcelona, Spain
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Arnaldos-Carrillo M, Noguera-Velasco JA, Martínez-Ardil IM, Riquelme-Pérez A, Cebreiros-López I, Hernández-Vicente Á, Ros-Lucas JA, Khan A, Bayes-Genís A, Pascual-Figal D. Value of increased soluble suppressor tumorigenicity biomarker 2 (sST2) on admission as an indicator of severity in patients with COVID-19. Med Clin (Barc) 2023; 161:185-191. [PMID: 37137804 PMCID: PMC10086099 DOI: 10.1016/j.medcli.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Soluble suppressor of tumorigenicity-2 (sST2) is a biomarker for heart failure and pulmonary injury. We hypothesize that sST2 could help predict severity of SARS-CoV-2 infections. METHODS sST2 was analyzed in patients consecutively admitted for SARS-CoV-2 pneumonia. Other prognostic markers were also measured. In-hospital complications were registered, including death, ICU admission, and respiratory support requirements. RESULTS 495 patients were studied (53% male, age: 57.6±17.6). At admission, median sST2 concentrations was 48.5ng/mL [IQR, 30.6-83.1ng/mL] and correlated with male gender, older age, comorbidities, other severity biomarkers, and respiratory support requirements. sST2 levels were higher in patients who died (n=45, 9.1%) (45.6 [28.0, 75.9]ng/mL vs. 144 [82.6, 319] ng/mL, p<0.001) and those admitted to ICU (n=46, 9.3%) (44.7 [27.5, 71.3] ng/mL vs. 125 [69.0, 262]ng/mL, p<0.001). sST2 levels>210ng/mL were a strong predictor of complicated in-hospital courses, with higher risk of death (OR, 39.3, CI95% 15.9, 103) and death/ICU (OR 38.3, CI95% 16.3-97.5) after adjusting for all other risk factors. The addition of sST2 enhanced the predictive capacity of mortality risk models. CONCLUSIONS sST2 represents a robust severity predictor in COVID-19 and could be an important tool for identifying at-risk patients who may benefit from closer follow-up and specific therapies.
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Affiliation(s)
- María Arnaldos-Carrillo
- Clinical Laboratory Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Universidad de Murcia, Murcia, Spain
| | - José Antonio Noguera-Velasco
- Clinical Laboratory Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Universidad de Murcia, Murcia, Spain; IMIB Pascual Parrilla, Murcia, Spain
| | | | | | - Iria Cebreiros-López
- Clinical Laboratory Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Universidad de Murcia, Murcia, Spain; IMIB Pascual Parrilla, Murcia, Spain
| | | | - José Antonio Ros-Lucas
- Pneumology Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - Amjad Khan
- Nuffield Division of Clinical Laboratory Sciences (NDCLS), Radcliffe Department of Medicine, John Radcliffe hospital, University of Oxford, Oxford, UK
| | - Antoni Bayes-Genís
- CIBER Cardiovascular, Madrid, Spain; Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Domingo Pascual-Figal
- Universidad de Murcia, Murcia, Spain; IMIB Pascual Parrilla, Murcia, Spain; Cardiology Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER Cardiovascular, Madrid, Spain.
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Pascual-Figal D, Lax A, Asensio López MC. Circulating ST2, from biomarker to pathogenic mediator. Rev Esp Cardiol (Engl Ed) 2023; 76:672-674. [PMID: 37085116 DOI: 10.1016/j.rec.2023.02.012] [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] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Domingo Pascual-Figal
- Servicio de Cardiología, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Antonio Lax
- Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
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8
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Bayes-Genis A, Pascual-Figal D. Making STRONGer the transition phase: personalized GDMT through NT-proBNP monitoring. Eur Heart J 2023; 44:2963-2965. [PMID: 37220888 DOI: 10.1093/eurheartj/ehad356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/25/2023] Open
Affiliation(s)
- Antoni Bayes-Genis
- Heart Institute, University Hospital Germans Trias i Pujol, Crta. Canyet s/n, 08916 Badalona, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Domingo Pascual-Figal
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, University of Murcia, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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9
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Lax A, Soler F, Fernandez del Palacio MJ, Pascual-Oliver S, Ballester MR, Fuster JJ, Pascual-Figal D, Asensio-Lopez MDC. Silencing of microRNA-106b-5p prevents doxorubicin-mediated cardiotoxicity through modulation of the PR55α/YY1/sST2 signaling axis. Mol Ther Nucleic Acids 2023; 32:704-720. [PMID: 37234747 PMCID: PMC10208836 DOI: 10.1016/j.omtn.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
Clinical use of doxorubicin (Dox), an anthracycline with potent anti-tumor effects, is limited because of its highly chemotherapy-induced cardiotoxicity (CIC). After myocardial infarction (MI), we have recently identified Yin Yang-1 (YY1) and histone deacetylase 4 (HDAC4) as two factors involved in the overexpression of the isoform soluble suppression of tumorigenicity 2 (sST2) protein, which acts as a decoy receptor blocking the favorable effects of IL-33. Therefore, high levels of sST2 are associated with increased fibrosis, remodeling, and worse cardiovascular outcomes. No data exist on the role of the YY1/HDAC4/sST2 axis in CIC. This study aimed to evaluate the pathophysiological implication of the molecular YY1/HDAC4/sST2 axis in remodeling that is developed in patients treated with Dox as well as to suggest a novel molecular therapy to prevent anthracycline-induced cardiotoxicity. Here, we have characterized a novel nexus between miR106b-5p (miR-106b) levels and the YY1/HDAC4 axis in relation to the cardiac expression of sST2 using two experimental models with Dox-induced cardiotoxicity. The addition of Dox (5 μM) to human induced pluripotent stem cell-derived cardiomyocytes induced cellular apoptotic death via upregulation of miR-106b-5p (miR-106b), which was confirmed by specific mimic sequences. A functional blockage of miR-106b using the locked nucleic acid antagomir inhibited Dox-induced cardiotoxicity.
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Affiliation(s)
- Antonio Lax
- Biomedical Research Institute Virgen de la Arrixaca (IMIB-Arrixaca), University of Murcia, 30120 Murcia, Spain
| | - Fernando Soler
- Biomedical Research Institute Virgen de la Arrixaca (IMIB-Arrixaca), University of Murcia, 30120 Murcia, Spain
| | | | - Silvia Pascual-Oliver
- Biomedical Research Institute Virgen de la Arrixaca (IMIB-Arrixaca), University of Murcia, 30120 Murcia, Spain
| | - Miriam Ruiz Ballester
- Biomedical Research Institute Virgen de la Arrixaca (IMIB-Arrixaca), University of Murcia, 30120 Murcia, Spain
| | - Jose Javier Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
| | - Domingo Pascual-Figal
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
- Cardiology Department, Hospital Virgen de la Arrixaca, IMIB-Arrixaca and University of Murcia, 30120 Murcia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
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Vicent L, Álvarez-García J, Vazquez-Garcia R, González-Juanatey JR, Rivera M, Segovia J, Pascual-Figal D, Bover R, Worner F, Fernández-Avilés F, Ariza-Sole A, Martínez-Sellés M. Coronary Artery Disease and Prognosis of Heart Failure with Reduced Ejection Fraction. J Clin Med 2023; 12:3028. [PMID: 37109365 PMCID: PMC10143946 DOI: 10.3390/jcm12083028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Our aim was to determine the prognostic impact of coronary artery disease (CAD) on heart failure with reduced ejection fraction (HFrEF) mortality and readmissions. From a prospective multicenter registry that included 1831 patients hospitalized due to heart failure, 583 had a left ventricular ejection fraction of <40%. In total, 266 patients (45.6%) had coronary artery disease as main etiology and 137 (23.5%) had idiopathic dilated cardiomyopathy (DCM), and they are the focus of this study. Significant differences were found in Charlson index (CAD 4.4 ± 2.8, idiopathic DCM 2.9 ± 2.4, p < 0.001), and in the number of previous hospitalizations (1.1 ± 1, 0.8 ± 1.2, respectively, p = 0.015). One-year mortality was similar in the two groups: idiopathic DCM (hazard ratio [HR] = 1), CAD (HR 1.50; 95% CI 0.83-2.70, p = 0.182). Mortality/readmissions were also comparable: CAD (HR 0.96; 95% CI 0.64-1.41, p = 0.81). Patients with idiopathic DCM had a higher probability of receiving a heart transplant than those with CAD (HR 4.6; 95% CI 1.4-13.4, p = 0.012). The prognosis of HFrEF is similar in patients with CAD etiology and in those with idiopathic DCM. Patients with idiopathic DCM were more prone to receive heart transplant.
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Affiliation(s)
- Lourdes Vicent
- Cardiology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain (M.M.-S.)
| | - Jesús Álvarez-García
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, 08025 Barcelona, Spain
| | | | - José R. González-Juanatey
- Cardiology Department, Hospital Clínico Universitario de Santiago, CIBERCV, 15076 Santiago de Compostela, Spain
| | - Miguel Rivera
- Cardiology Department, University Hospital La Fe, 46026 Valencia, Spain
| | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, 28222 Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, Department of Medicine, University of Murcia, 30120 Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), 28029 Madrid, Spain
| | - Ramón Bover
- Cardiology Department, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Fernando Worner
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain (M.M.-S.)
- Cardiology Department, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, CIBERCV, 28007 Madrid, Spain
| | - Albert Ariza-Sole
- Cardiology Department, Bellvitge University Hospital General, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain (M.M.-S.)
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
- Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Facultad de Medicina, Universidad Europea, 28670 Madrid, Spain
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Pascual-Figal D, Lax A, López MCA. ST2 circulante: un patógeno, más que un biomarcador. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2023.02.010] [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: 02/25/2023]
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Palau P, Amiguet M, Domínguez E, Sastre C, Mollar A, Seller J, Pinilla JMG, Larumbe A, Valle A, Doblas JJG, de la Espriella R, Miñana G, Mezcua AR, Santas E, Bodí V, Sanchis J, Pascual-Figal D, Górriz JL, Baýes-Genís A, Núñez J. Short-term Effects of Dapagliflozin on Maximal Functional Capacity in Heart Failure with Reduced Ejection Fraction (DAPA-VO 2 ): A Randomized Clinical Trial. Eur J Heart Fail 2022; 24:1816-1826. [PMID: 35604416 DOI: 10.1002/ejhf.2560] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS This study aimed to evaluate the effect of dapagliflozin on 1 and 3-month maximal functional capacity in patients with stable heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS In this multicenter, randomized, double-blinded clinical trial, 90 stable patients with HFrEF were randomly assigned to receive either dapagliflozin (n=45) or placebo (n=45) (http://clinicaltrials.gov identifier: NCT04197635). The primary outcome was a change in peak oxygen consumption (peakVO2 ) at 1 and 3-month. Secondary endpoints were changes at 1 and 3-month in the distance walked in 6 minutes (6MWT), quality of life (Minnesota Living with Heart Failure Questionnaire -MLHFQ-), and echocardiographic parameters (diastolic function, left chambers volumes, and left ventricular ejection fraction). We used linear mixed regression analysis to compare endpoints changes. Estimates were adjusted for multiple comparisons. The mean age was 67.1 ± 10.7 years, 63 (76.7%) were men, 29 (32.2%) had type-2 diabetes, and 80 (89.9%) were on NYHA II. The baseline means of peakVO2 , 6MWT and MLHFQ were 13.2±3.5 mL/kg/min, 363±110 meters, and 23.1±16.2, respectively. The median (p25%-p75%) of N-terminal pro-brain natriuretic peptide was 1221 pg/ml (889-2100). Most patients were on treatment with sacubitril/valsartan (88.9%), beta-blockers (91.1%), and aldosterone receptor antagonists (74.4%). PeakVO2 significantly increased in patients on treatment with dapagliflozin (1-month: +Δ 1.09 mL/kg/min, CI 95%=0.14-2.04; p=0.021 and 3-month: +Δ 1.06 mL/kg/min, CI 95%=0.07-2.04; p=0.032). Similar positive findings were found when evaluating changes from baseline. We did not find significant differences in secondary endpoints. CONCLUSIONS Among patients with stable HFrEF, dapagliflozin resulted in a significant improvement in peakVO2 at 1 and 3-month.
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Affiliation(s)
- Patricia Palau
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | | | | | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Julia Seller
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Jose Manuel Garcia Pinilla
- Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, España.,CIBER Cardiovascular
| | - Ainoha Larumbe
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Alfonso Valle
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Juan Jose Gómez Doblas
- Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, España.,CIBER Cardiovascular
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain.,CIBER Cardiovascular
| | - Ainhoa Robles Mezcua
- Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, España.,CIBER Cardiovascular
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain.,CIBER Cardiovascular
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain.,CIBER Cardiovascular
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Jose Luis Górriz
- Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain
| | - Antonio Baýes-Genís
- CIBER Cardiovascular.,Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de València, INCLIVA, Valencia, Spain.,CIBER Cardiovascular
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13
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Carrillo-Alemán L, López-Martínez A, Carrillo-Alcaraz A, Guia M, Renedo-Villarroya A, Alonso-Fernández N, Martínez-Pérez V, Sánchez-Nieto JM, Esquinas-Rodríguez A, Pascual-Figal D. Evolución de los pacientes con insuficiencia cardiaca aguda secundaria a infarto agudo de miocardio tratados con ventilación mecánica no invasiva. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2020.10.009] [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: 11/24/2022]
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14
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García-García A, Alvarez-Sala-Walther LA, Lee HY, Sierra C, Pascual-Figal D, Camafort M. Is there sufficient evidence to justify changes in dietary habits in heart failure patients? A systematic review. Korean J Intern Med 2022; 37:37-47. [PMID: 34482681 PMCID: PMC8747930 DOI: 10.3904/kjim.2020.623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/08/2021] [Indexed: 11/27/2022] Open
Abstract
The incidence and prevalence of heart failure (HF) is increasing worldwide, leading to high morbidity and mortality. The global management of HF involves lifestyle changes in addition to pharmacological treatments. Changes include exercise and dietary recommendations, mainly salt and fluid restriction, but without any clear evidence. We conducted a systematic review to analyse the degree of evidence for these dietary recommendations in HF. Only randomized controlled trials (RCT), and observational studies in humans were selected. Studies were considered eligible if they included participants with HF and sodium and/or fluid restriction. Publications in languages other than English or Spanish were excluded. We included 15 studies related to sodium or fluid restriction. Nine RCT and six observational studies showed some improvements in symptoms and quality of life and a degree of reduction in new hospitalizations, but the results are based on limited population groups, applying different methodologies, and with different restriction goals. We found a lack of clear evidence of the benefits of sodium/fluid restriction in chronic HF. The evidence is limited to few studies with conflicting results. Randomized clinical trials are needed to fill this gap in our knowledge.
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Affiliation(s)
- Alejandra García-García
- Department of Internal Medicine, "Gregorio Marañon" University General Hospital, Madrid,
Spain
| | | | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Cristina Sierra
- Department of Internal Medicine-ICMiD, Hospital Clinic, University of Barcelona, Barcelona,
Spain
| | - Domingo Pascual-Figal
- Department of Cardiology, "Virgen de la Arrixaca" University General Hospital, University of Murcia, Murcia,
Spain
| | - Miguel Camafort
- Department of Internal Medicine-ICMiD, Hospital Clinic, University of Barcelona, Barcelona,
Spain
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15
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Carrillo-Alemán L, López-Martínez A, Carrillo-Alcaraz A, Guia M, Renedo-Villarroya A, Alonso-Fernández N, Martínez-Pérez V, Sánchez-Nieto JM, Esquinas-Rodríguez A, Pascual-Figal D. Outcome of patients with acute heart failure secondary to acute myocardial infarction treated with noninvasive mechanical ventilation. Rev Esp Cardiol (Engl Ed) 2022; 75:50-59. [PMID: 33257215 DOI: 10.1016/j.rec.2020.10.003] [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] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/08/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES Noninvasive ventilation (NIV) has been shown to reduce the rate of endotracheal intubation and mortality in patients with acute heart failure (AHF). However, patients with AHF secondary to acute coronary syndrome/acute myocardial infarction (ACS-AMI) have been excluded from many clinical trials. The purpose of this study was to compare the effectiveness of NIV between patients with AHF triggered by ACS-AMI and by other etiologies. METHODS Prospective cohort study of all patients with AHF treated with NIV admitted to the intensive care unit for a period of 20 years. Patients were divided according to whether they had ACS-AMI as the cause of the AHF episode. NIV failure was defined as the need for endotracheal intubation or death. RESULTS A total of 1009 patients were analyzed, 403 (40%) showed ACS-AMI and 606 (60%) other etiologies. NIV failure occurred in 61 (15.1%) in the ACS-AMI group and in 64 (10.6%) in the other group (P=.031), without differences in in-hospital mortality (16.6% and 14.9%, respectively; P=.478). CONCLUSIONS The presence of ACS-AMI as the triggering cause of AHF did not influence patients with acute respiratory failure requiring noninvasive respiratory support.
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Affiliation(s)
- Luna Carrillo-Alemán
- Servicio de Medicina Intensiva, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Antonia López-Martínez
- Servicio de Medicina Intensiva, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Andrés Carrillo-Alcaraz
- Servicio de Medicina Intensiva, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Miguel Guia
- Serviço de Pneumologia, Hospital Professor Doutor Fernando Fonseca, Amadora, Lisbon, Portugal.
| | - Ana Renedo-Villarroya
- Servicio de Medicina Intensiva, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Nuria Alonso-Fernández
- Servicio de Medicina Intensiva, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Víctor Martínez-Pérez
- Departamento de Psicología Básica y Metodología, Universidad de Murcia, Murcia, Spain
| | | | | | - Domingo Pascual-Figal
- Departamento de Cardiología, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
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16
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Pascual-Figal D, Bayés-Genis A, Beltrán-Troncoso P, Caravaca-Pérez P, Conde-Martel A, Crespo-Leiro MG, Delgado JF, Díez J, Formiga F, Manito N. Sacubitril-Valsartan, Clinical Benefits and Related Mechanisms of Action in Heart Failure With Reduced Ejection Fraction. A Review. Front Cardiovasc Med 2021; 8:754499. [PMID: 34859070 PMCID: PMC8631913 DOI: 10.3389/fcvm.2021.754499] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/06/2021] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is a clinical syndrome characterized by the presence of dyspnea or limited exertion due to impaired cardiac ventricular filling and/or blood ejection. Because of its high prevalence, it is a major health and economic burden worldwide. Several mechanisms are involved in the pathophysiology of HF. First, the renin-angiotensin-aldosterone system (RAAS) is over-activated, causing vasoconstriction, hypertension, elevated aldosterone levels and sympathetic tone, and eventually cardiac remodeling. Second, an endogenous compensatory mechanism, the natriuretic peptide (NP) system is also activated, albeit insufficiently to counteract the RAAS effects. Since NPs are degraded by the enzyme neprilysin, it was hypothesized that its inhibition could be an important therapeutic target in HF. Sacubitril/valsartan is the first of the class of dual neprilysin and angiotensin receptor inhibitors (ARNI). In patients with HFrEF, treatment with sacubitril/valsartan has demonstrated to significantly reduce mortality and the rates of hospitalization and rehospitalization for HF when compared to enalapril. This communication reviews in detail the demonstrated benefits of sacubitril/valsartan in the treatment of patients with HFrEF, including reduction of mortality and disease progression as well as improvement in cardiac remodeling and quality of life. The hemodynamic and organic effects arising from its dual mechanism of action, including the impact of neprilysin inhibition at the renal level, especially relevant in patients with type 2 diabetes mellitus, are also reviewed. Finally, the evidence on the demonstrated safety and tolerability profile of sacubitril/valsartan in the different subpopulations studied has been compiled. The review of this evidence, together with the recommendations of the latest clinical guidelines, position sacubitril/valsartan as a fundamental pillar in the treatment of patients with HFrEF.
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Affiliation(s)
- Domingo Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Antoni Bayés-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Autonomous University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain
| | | | - Pedro Caravaca-Pérez
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain.,Cardiology Service, Hospital Universitario 12 de Octubre, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | | | - Maria G Crespo-Leiro
- Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.,Institute of Biomedical Research (INIBIC), A Coruña, Spain
| | - Juan F Delgado
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain.,Cardiology Service, Hospital Universitario 12 de Octubre, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Javier Díez
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, Carlos III Institute of Health, Madrid, Spain.,Cardiovascular Diseases Programme, Centre of Applied Medical Research, University of Navarra, Pamplona, Spain.,Departments of Nephrology, Cardiology, and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain.,Navarra Institute for Health Research, Pamplona, Spain
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Nicolás Manito
- Heart Failure and Heart Transplantation Unit, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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17
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Álvarez-García J, García-Osuna Á, Vives-Borrás M, Ferrero-Gregori A, Martínez-Sellés M, Vázquez R, González-Juanatey JR, Rivera M, Segovia J, Pascual-Figal D, Bover R, Bascompte R, Delgado J, Grau Sepúlveda A, Bardají A, Pérez-Villa F, Zamorano JL, Crespo-Leiro M, Sánchez PL, Ordoñez-Llanos J, Cinca J. A 3-Biomarker 2-Point-Based Risk Stratification Strategy in Acute Heart Failure. Front Physiol 2021; 12:708890. [PMID: 34744758 PMCID: PMC8569896 DOI: 10.3389/fphys.2021.708890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/04/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction and Objectives: Most multi-biomarker strategies in acute heart failure (HF) have only measured biomarkers in a single-point time. This study aimed to evaluate the prognostic yielding of NT-proBNP, hsTnT, Cys-C, hs-CRP, GDF15, and GAL-3 in HF patients both at admission and discharge. Methods: We included 830 patients enrolled consecutively in a prospective multicenter registry. Primary outcome was 12-month mortality. The gain in the C-index, calibration, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) was calculated after adding each individual biomarker value or their combination on top of the best clinical model developed in this study (C-index 0.752, 0.715-0.789) and also on top of 4 currently used scores (MAGGIC, GWTG-HF, Redin-SCORE, BCN-bioHF). Results: After 12-month, death occurred in 154 (18.5%) cases. On top of the best clinical model, the addition of NT-proBNP, hs-CRP, and GDF-15 above the respective cutoff point at admission and discharge and their delta during compensation improved the C-index to 0.782 (0.747-0.817), IDI by 5% (p < 0.001), and NRI by 57% (p < 0.001) for 12-month mortality. A 4-risk grading categories for 12-month mortality (11.7, 19.2, 26.7, and 39.4%, respectively; p < 0.001) were obtained using combination of these biomarkers. Conclusion: A model including NT-proBNP, hs-CRP, and GDF-15 measured at admission and discharge afforded a mortality risk prediction greater than our clinical model and also better than the most currently used scores. In addition, this 3-biomarker panel defined 4-risk categories for 12-month mortality.
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Affiliation(s)
- Jesús Álvarez-García
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.,Cardiology Department, Hospital Ramón y Cajal, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Álvaro García-Osuna
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Barcelona, Spain
| | - Miquel Vives-Borrás
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Andreu Ferrero-Gregori
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rafael Vázquez
- Cardiology Department, Hospital Puerta del Mar, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Cádiz, Spain
| | - José R González-Juanatey
- Cardiology Department, Hospital Clínico, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, Spain
| | - Miguel Rivera
- Cardiology Department, Hospital La Fe, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - Javier Segovia
- Cardiology Department, Hospital Puerta de Hierro-Majadahonda, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Murcia, Spain
| | - Ramón Bover
- Cardiology Department, Hospital Clínico San Carlos, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ramón Bascompte
- Cardiology Department, Hospital Arnau de Vilanova, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Lleida, Spain
| | - Juan Delgado
- Cardiology Department, Hospital 12 de Octubre, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Andrés Grau Sepúlveda
- Cardiology Department, Hospital Universitario Son Espases, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Palma de Mallorca, Spain
| | - Alfredo Bardají
- Cardiology Department, Hospital Juan XXIII, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Tarragona, Spain
| | - Félix Pérez-Villa
- Cardiology Department, Hospital Clinic, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - José Luis Zamorano
- Cardiology Department, Hospital Ramón y Cajal, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Marisa Crespo-Leiro
- Cardiology Department, Hospital Universitario A Coruna, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), A Coruna, Spain
| | - Pedro Luis Sánchez
- Cardiology Department, Hospital Clínico Universitario, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Salamanca, Spain
| | - Jordi Ordoñez-Llanos
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Barcelona, Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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18
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Palomo L, Santiago-Vacas E, Pascual-Figal D, Fuster JJ, Solé F, Bayés-Genís A. Prevalencia y características de la hematopoyesis clonal en insuficiencia cardiaca. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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19
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Vicent L, Alvarez-Garcia J, Gonzalez-Juanatey JR, Rivera M, Segovia J, Worner F, Bover R, Pascual-Figal D, Vázquez R, Cinca J, Fernandez-Aviles F, Martinez-Sellés M. Prognostic impact of hyponatraemia and hypernatraemia at admission and discharge in heart failure patients with preserved, mid-range and reduced ejection fraction. Intern Med J 2021; 51:930-938. [PMID: 32237007 DOI: 10.1111/imj.14836] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/04/2019] [Revised: 02/27/2020] [Accepted: 03/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hyponatraemia is common in patients with acute heart failure (HF). AIMS To determine the impact of sodium disturbances on mortality and readmissions in HF with reduced left ventricular ejection fraction (HFrEF), preserved ejection fraction (HFpEF) and mid-range ejection fraction (HFmrEF). METHODS This study was a prospective multicentre consecutive registry in 20 hospitals, including patients admitted due to acute HF in cardiology departments. Sodium <135 mmol/L was considered hyponatraemia, >145 mmol/L hypernatraemia and 135-145 mmol/L normal. RESULTS A total of 1309 patients was included. Mean age was 72.0 ± 11.9 years, and 810 (61.9%) were male. Mean serum sodium level was 138.6 ± 4.7 mmol/L at hospital admission and 138.1 ± 4.1 mmol/L at discharge. The evolution of sodium levels was: normal-at-admission/normal-at-discharge 941 (71.9%), abnormal-at-admission/normal-at-discharge 127 (9.7%), normal-at-admission/abnormal-at-discharge 155 (11.8%) and abnormal-at-admission/abnormal-at-discharge 86 (6.6%). Hyponatraemia at discharge was more common in HFrEF (109 (20.7%)) than in HFpEF (79 (13.9%)) and HFmrEF (27 (12%)), P = 0.003. The prevalence of hypernatraemia at discharge was similar in the three groups: HFrEF (10 (1.9%)), HFpEF (12 (2.1%)) and HFmrEF (4 (1.9%)), P = 0.96. In multivariate analysis, abnormal sodium concentrations at hospital admission (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.15-1.76, P = 0.001) and discharge (HR 1.33, 95% CI 1.08-1.64, P = 0.007) were both independently associated with increased mortality and readmissions at 12 months. CONCLUSIONS Hyponatraemia and hypernatraemia at admission and discharge predict a poor outcome in patients with acute HF regardless of left ventricular ejection fraction. Hyponatraemia at discharge is more frequent in HFrEF than in the other groups.
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Affiliation(s)
- Lourdes Vicent
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Jesús Alvarez-Garcia
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Barcelona, Spain
| | - José Ramón Gonzalez-Juanatey
- Cardiology and Coronary Care Unit Department, Complexo Hospitalario Universitario de Santiago de Compostela, CIBERCV, A Coruña, Spain
| | - Miguel Rivera
- Cardiology Department, University Hospital La Fe, Valencia, Spain
| | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Madrid, Spain
| | - Fernando Worner
- Cardiology Department, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
| | - Ramón Bover
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Spain
| | - Rafael Vázquez
- Cardiology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Barcelona, Spain
| | - Francisco Fernandez-Aviles
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Complutense, Madrid, Spain
| | - Manuel Martinez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Universidad Europea, Madrid, Spain
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20
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Rossello X, Raposeiras-Roubin S, Latini R, Dominguez-Rodriguez A, Barrabés JA, Sánchez PL, Anguita M, Fernández-Vázquez F, Pascual-Figal D, De la Torre Hernandez JM, Ferraro S, Vetrano A, Pérez-Rivera JA, Prada-Delgado O, Escalera N, Staszewsky L, Pizarro G, Agüero J, Pocock S, Ottani F, Fuster V, Ibáñez B. Rationale and design of the pragmatic clinical trial tREatment with Beta-blockers after myOcardial infarction withOut reduced ejection fracTion (REBOOT). Eur Heart J Cardiovasc Pharmacother 2021; 8:291-301. [PMID: 34351426 DOI: 10.1093/ehjcvp/pvab060] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/15/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is a lack of evidence regarding the benefits of β-blocker treatment after invasively managed acute myocardial infarction (MI) without reduced left ventricular ejection fraction (LVEF). METHODS AND RESULTS TREatment with Beta-blockers after myOcardial infarction withOut reduced ejection fraction (REBOOT) trial is a pragmatic, controlled, prospective, randomized, open-label blinded endpoint (PROBE design) clinical trial testing the benefits of β-blocker maintenance therapy in patients discharged after MI with or without ST-segment elevation. Patients eligible for participation are those managed invasively during index hospitalization (coronary angiography), with LVEF >40%, and no history of heart failure (HF). At discharge, patients will be randomized 1:1 to β-blocker therapy (agent and dose according to treating physician) or no β-blocker therapy. The primary endpoint is a composite of all-cause death, nonfatal reinfarction, or HF hospitalization over a median follow-up period of 2.75 years (minimum 2 years, maximum 3 years). Key secondary endpoints include the incidence of the individual components of the primary composite endpoint, the incidence of cardiac death, and incidence of malignant ventricular arrhythmias or resuscitated cardiac arrest. The primary endpoint will be analyzed according to the intention-to-treat principle. CONCLUSION The REBOOT trial will provide robust evidence to guide the prescription of β-blockers to patients discharged after MI without reduced LVEF.
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Affiliation(s)
- Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Cardiology Department, Hospital Universitari Son Espases - IDISBA, Palma de Mallorca, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Sergio Raposeiras-Roubin
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Roberto Latini
- Department of Cardiovascular Medicine. Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alberto Dominguez-Rodriguez
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Servicio de Cardiología, Hospital Universitario de Canarias, Tenerife, Spain
| | - José A Barrabés
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma, Barcelona, Spain
| | - Pedro L Sánchez
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, University Hospital of Salamanca, Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Manuel Anguita
- Department of Cardiology, Hospital Universitario Reina Sofía de Cordoba, Córdoba, Spain
| | | | - Domingo Pascual-Figal
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital Virgen de la Arrixaca, IMIB-Arrixaca and University of Murcia, Murcia, Spain
| | | | - Stefano Ferraro
- Cardiology Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Alfredo Vetrano
- Cardiology Department, Ospedale S. Anna e S. Sebastiano, Caserta, Italy
| | | | | | - Noemí Escalera
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Lidia Staszewsky
- Department of Cardiovascular Medicine. Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Gonzalo Pizarro
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital Ruber Juan Bravo Quironsalud UEM, Madrid, Spain
| | - Jaume Agüero
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital Universtitari i Politecnic La Fe, Valencia, Spain
| | - Stuart Pocock
- London School of Hygiene & Tropical Medicine, London, UK
| | - Filippo Ottani
- Cardiology Department, Ospedale Vizzolo Predabissi di Melegnano, Milan, Italy
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,IIS-Fundación Jiménez Díaz University Hospital
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21
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Palomo L, Santiago-Vacas E, Pascual-Figal D, Fuster JJ, Solé F, Bayés-Genís A. Prevalence and characteristics of clonal hematopoiesis in heart failure. Rev Esp Cardiol (Engl Ed) 2021; 74:996-999. [PMID: 34119438 DOI: 10.1016/j.rec.2021.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/04/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Laura Palomo
- Grup de Síndromes Mielodisplàsiques, Institut de Recerca Contra la Leucèmia Josep Carreras-Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Evelyn Santiago-Vacas
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Programa de Recerca "Insuficiència Cardíaca i Regeneració Cardíaca" (ICREC), Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Domingo Pascual-Figal
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina, Universidad de Murcia, Murcia, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - José Javier Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Francesc Solé
- Grup de Síndromes Mielodisplàsiques, Institut de Recerca Contra la Leucèmia Josep Carreras-Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
| | - Antoni Bayés-Genís
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Programa de Recerca "Insuficiència Cardíaca i Regeneració Cardíaca" (ICREC), Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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22
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Bayes-Genis A, Iborra-Egea O, Spitaleri G, Domingo M, Revuelta-López E, Codina P, Cediel G, Santiago-Vacas E, Cserkóová A, Pascual-Figal D, Núñez J, Lupón J. Decoding empagliflozin's molecular mechanism of action in heart failure with preserved ejection fraction using artificial intelligence. Sci Rep 2021; 11:12025. [PMID: 34103605 PMCID: PMC8187349 DOI: 10.1038/s41598-021-91546-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/27/2021] [Indexed: 01/09/2023] Open
Abstract
The use of sodium-glucose co-transporter 2 inhibitors to treat heart failure with preserved ejection fraction (HFpEF) is under investigation in ongoing clinical trials, but the exact mechanism of action is unclear. Here we aimed to use artificial intelligence (AI) to characterize the mechanism of action of empagliflozin in HFpEF at the molecular level. We retrieved information regarding HFpEF pathophysiological motifs and differentially expressed genes/proteins, together with empagliflozin target information and bioflags, from specialized publicly available databases. Artificial neural networks and deep learning AI were used to model the molecular effects of empagliflozin in HFpEF. The model predicted that empagliflozin could reverse 59% of the protein alterations found in HFpEF. The effects of empagliflozin in HFpEF appeared to be predominantly mediated by inhibition of NHE1 (Na+/H+ exchanger 1), with SGLT2 playing a less prominent role. The elucidated molecular mechanism of action had an accuracy of 94%. Empagliflozin’s pharmacological action mainly affected cardiomyocyte oxidative stress modulation, and greatly influenced cardiomyocyte stiffness, myocardial extracellular matrix remodelling, heart concentric hypertrophy, and systemic inflammation. Validation of these in silico data was performed in vivo in patients with HFpEF by measuring the declining plasma concentrations of NOS2, the NLPR3 inflammasome, and TGF-β1 during 12 months of empagliflozin treatment. Using AI modelling, we identified that the main effect of empagliflozin in HFpEF treatment is exerted via NHE1 and is focused on cardiomyocyte oxidative stress modulation. These results support the potential use of empagliflozin in HFpEF.
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Affiliation(s)
- Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet S/N, 08916, Badalona, Spain. .,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain.
| | - Oriol Iborra-Egea
- Heart Institute, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet S/N, 08916, Badalona, Spain
| | - Giosafat Spitaleri
- Heart Institute, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet S/N, 08916, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Domingo
- Heart Institute, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet S/N, 08916, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain
| | - Elena Revuelta-López
- Heart Institute, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet S/N, 08916, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain
| | - Pau Codina
- Heart Institute, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet S/N, 08916, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain
| | - Germán Cediel
- Heart Institute, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet S/N, 08916, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain
| | - Evelyn Santiago-Vacas
- Heart Institute, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet S/N, 08916, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain
| | - Adriana Cserkóová
- Heart Institute, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet S/N, 08916, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Domingo Pascual-Figal
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital Virgen de la Arrixaca, IMIB-Arrixaca and University of Murcia, Murcia, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Josep Lupón
- Heart Institute, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet S/N, 08916, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, (CIBERCV), Madrid, Spain
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23
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Asensio-Lopez MC, Sassi Y, Soler F, Fernandez Del Palacio MJ, Pascual-Figal D, Lax A. The miRNA199a/SIRT1/P300/Yy1/sST2 signaling axis regulates adverse cardiac remodeling following MI. Sci Rep 2021; 11:3915. [PMID: 33594087 PMCID: PMC7887255 DOI: 10.1038/s41598-021-82745-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/25/2021] [Indexed: 01/14/2023] Open
Abstract
Left ventricular remodeling following myocardial infarction (MI) is related to adverse outcome. It has been shown that an up-regulation of plasma soluble ST2 (sST2) levels are associated with lower pre-discharge left ventricular (LV) ejection fraction, adverse cardiovascular outcomes and mortality outcome after MI. The mechanisms involved in its modulation are unknown and there is not specific treatment capable of lowering plasma sST2 levels in acute-stage HF. We recently identified Yin-yang 1 (Yy1) as a transcription factor related to circulating soluble ST2 isoform (sST2) expression in infarcted myocardium. However, the underlying mechanisms involved in this process have not been thoroughly elucidated. This study aimed to evaluate the pathophysiological implication of miR-199a-5p in cardiac remodeling and the expression of the soluble ST2 isoform. Myocardial infarction (MI) was induced by permanent ligation of the left anterior coronary artery in C57BL6/J mice that randomly received antimiR199a therapy, antimiR-Ctrl or saline. A model of biomechanical stretching was also used to characterize the underlying mechanisms involved in the activation of Yy1/sST2 axis. Our results show that the significant upregulation of miR-199a-5p after myocardial infarction increases pathological cardiac hypertrophy by upregulating circulating soluble sST2 levels. AntimiR199a therapy up-regulates Sirt1 and inactivates the co-activator P300 protein, thus leading to Yy1 inhibition which decreases both expression and release of circulating sST2 by cardiomyocytes after myocardial infarction. Pharmacological inhibition of miR-199a rescues cardiac hypertrophy and heart failure in mice, offering a potential therapeutic approach for cardiac failure.
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Affiliation(s)
- Maria Carmen Asensio-Lopez
- Biomedical Research Institute Virgen de la Arrixaca (IMIB-Arrixaca), University of Murcia, Murcia, Spain
| | - Yassine Sassi
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Fernando Soler
- Biochemical and Molecular Biology Department, University of Murcia, Murcia, Spain
| | | | - Domingo Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, Murcia, Spain.
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
- CIBERCV, Madrid, Spain.
| | - Antonio Lax
- Biomedical Research Institute Virgen de la Arrixaca (IMIB-Arrixaca), University of Murcia, Murcia, Spain.
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24
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Villalba-Orero M, Marti-Gomez-Aldaravi C, Lopez-Olaneta M, Camarero-Cadenas C, Gonzalez-Garcia M, Hernandez-Luzardo A, Martin-Torres J, Camafeita-Fernandez E, Garcia-Pavia P, Pascual-Figal D, Vazquez J, Lara-Pezzi E. Heart and lung aquaporins play a major role in severity of heart failure with preserved ejection fraction in mice and differs between comorbidities. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Heart failure (HF) is a major public health problem worldwide. To date, HF with preserved ejection fraction (EF, HFpEF) represents half of all HF patients and its prevalence is increasing. HFpEF is associated with multiple comorbidities, including diabetes mellitus, pulmonary and systemic hypertension and obesity, mainly in elderly population. Accurately phenotyping HFpEF is crucial for the development of new therapies, appropriate patient stratification and the implementation of a personalised medicine. Cardiac and pulmonary remodelling play a major role in HFpEF severity but the specific mechanisms underlying cardiac failure and lung congestion, the last stage in HFpEF, in each comorbidity are incompletely understood, precluding the development of effective therapies. Aquaporins (AQP) are membrane proteins serving as water channels across the plasma membrane and control intra- and extracellular fluid volume and prompt to tissue oedema in many organs. However, its specific contribution in HFpEF has not been explored.
Purpose
We aimed to identify cardiac and pulmonary molecular changes associated to dysfunction and oedema in HFpEF, specific for each comorbidity.
Methods
A total of 48 C57BL/6 mice 10 weeks old were randomised to the following groups: control (Ctl; n=9), type I diabetes (Db; n=9), chronic hypoxia (PAH; n=10), obesity (Ob; n=10) and systemic arterial hypertension (SAH; n=10). Mice were followed for up to 2.5 years by echocardiography and lung ultrasound until they developed pulmonary oedema (HF) or died naturally. Lungs and heart were extracted and changes were determined by proteomic, immunohistochemistry and qRT-PCR.
Results
Diastolic dysfunction was observed in all comorbidities and above 50% of those mice developed HF. Db presented the highest ratio in developing HF. Db also showed the earliest mortality (47 weeks), whereas PAH, Ob and SAH mice survived for 82, 92 and 99 weeks, respectively (p<0.001 vs Ctl). A common finding in all groups was the development of different degrees o perivascular fibrosis. Db mice, the HFpEF severest group, showed an increase in pulmonary AQP1 and 5 (p<0.05 and p<0.001, respectively, vs Ctl). Upregulation of AQPs correlated with increased ventricular filling pressures (E/E', r2=07). Cardiac AQP4 was also markedly elevated in Db mice in left and right ventricle (p<0.001 and p=0.01, respectively, vs Ctl).
Conclusion
Increased AQPs in the lung is associated with a more aggressive development of congestion and HFpEF. In addition, increased AQP4 in the heart in the most aggressive form of HFpEF suggests a relevant role in cardiac oedema. Targeting AQPs in HFpEF may prevent oedema and decompensation.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported from the Spanish Ministerio de Economía y Competitividad (RTI2018-096961-B-I00, SAF2015-65722-R and SAF2012-31451 to E.L-P. and Juan de la Cierva Incorporaciόn to M,V-O). The CNIC is supported by the Ministerio de Ciencia, Innovaciόn y Universidades (MCNU) and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505).
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Affiliation(s)
- M Villalba-Orero
- National Centre for Cardiovascular Research (CNIC), Madrid, Spain
| | | | - M Lopez-Olaneta
- National Centre for Cardiovascular Research (CNIC), Madrid, Spain
| | | | | | | | | | | | - P Garcia-Pavia
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - J Vazquez
- National Centre for Cardiovascular Research (CNIC), Madrid, Spain
| | - E Lara-Pezzi
- National Centre for Cardiovascular Research (CNIC), Madrid, Spain
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25
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Pascual-Figal D, Wachter R, Senni M, Bao W, Noè A, Schwende H, Butylin D, Prescott MF. NT-proBNP Response to Sacubitril/Valsartan in Hospitalized Heart Failure Patients With Reduced Ejection Fraction: TRANSITION Study. JACC Heart Fail 2020; 8:822-833. [PMID: 32800508 DOI: 10.1016/j.jchf.2020.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study examined the effects of sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and determined patient characteristics associated with favorable NT-proBNP reduction response. BACKGROUND NT-proBNP levels reflect cardiac wall stress and predict event risk in patients with acute decompensated heart failure (ADHF). METHODS Post-hoc analysis of the TRANSITION (Comparison of Pre- and Post-discharge Initiation of Sacubitril/Valsartan Therapy in HFrEF Patients After an Acute Decompensation Event) study, including stabilized ADHF patients with reduced ejection fraction, randomized to open-label sacubitril/valsartan initiation in-hospital (pre-discharge) versus post-discharge. NT-proBNP was measured at randomization (baseline), discharge, and 4 and 10 weeks post-randomization. A favorable NT-proBNP response was defined as reduction to ≤1,000 pg/ml or >30% from baseline. RESULTS In patients receiving sacubitril/valsartan in-hospital, NT-proBNP was reduced by 28% at discharge, with 46% of patients obtaining favorable NT-proBNP reduction response compared with a 4% reduction and 18% favorable response rate in patients initiated post-discharge (p < 0.001). NT-proBNP was reduced similarly in patients initiating sacubitril/valsartan pre- and post-discharge (reduction at 4 weeks: 25%/22%; 10 weeks: 38%/34%) with comparable favorable response rates (46%/42% and 51%/48% at 4 and 10 weeks, respectively). NT-proBNP favorable response at 4 weeks was associated with lower risk of first heart failure (HF) rehospitalization or cardiovascular death through 26 weeks (hazard ratio: 0.57; 95% confidence interval [CI]: 0.38 to 0.86; p = 0.007). Predictors of a favorable response at 4 weeks were starting dose ≥49/51 mg twice daily, higher baseline NT-proBNP, lower baseline serum creatinine, de novo HF, no atrial fibrillation, angiotensin-converting enzyme inhibitor-naive or angiotensin receptor blocker-naive, and no prior myocardial infarction. CONCLUSIONS In-hospital initiation of sacubitril/valsartan produced rapid reductions in NT-proBNP, statistically significant at discharge. A favorable NT-proBNP response over time was associated with a better prognosis and predicted by higher starting dose and predisposing clinical profile. (Comparison of Pre- and Post-discharge Initiation of LCZ696 Therapy in HFrEF Patients After an Acute Decompensation Event [TRANSITION]; NCT02661217).
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Affiliation(s)
- Domingo Pascual-Figal
- Cardiology Department, Virgen de la Arrixaca University Hospital, Universidad de Murcia, Murcia, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
| | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany; Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany; German Cardiovascular Research Center, partner site Göttingen, Göttingen, Germany
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Weibin Bao
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Adele Noè
- Novartis Pharma AG, Basel, Switzerland
| | - Heike Schwende
- Cardiology Department, Virgen de la Arrixaca University Hospital, Universidad de Murcia, Murcia, Spain
| | - Dmytro Butylin
- Cardiology Department, Virgen de la Arrixaca University Hospital, Universidad de Murcia, Murcia, Spain
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26
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Mohamed-Salem L, Moreno-Monsalve T, Castellón-Sánchez MI, Claver-Valderas MA, Pascual-Figal D. Non-biopsy diagnosis of familial amyloid cardiomyopathy. J Nucl Cardiol 2020; 27:1394-1397. [PMID: 30945209 DOI: 10.1007/s12350-019-01700-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Laroussi Mohamed-Salem
- Department of Nuclear Medicine, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain.
| | - Tatiana Moreno-Monsalve
- Department of Nuclear Medicine, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | - Domingo Pascual-Figal
- Department of Cardiology, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
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27
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Sanchez-Serna J, Hernandez-Vicente A, Garrido-Bravo IP, Pastor-Perez F, Noguera-Velasco JA, Casas-Pina T, Rodriguez-Serrano AI, Núñez J, Pascual-Figal D. Impact of pre-hospital renal function on the detection of acute kidney injury in acute decompensated heart failure. Eur J Intern Med 2020; 77:66-72. [PMID: 32127300 DOI: 10.1016/j.ejim.2020.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/25/2019] [Revised: 02/06/2020] [Accepted: 02/24/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a serious complication in patients hospitalized for decompensated heart failure (HF). Currently, AKI definitions consider creatinine levels at admission as reference of baseline renal function (RF). However, renal impairment may already be present at admission. We aimed to study the impact on AKI detection of considering outpatient RF as reference. METHODS In a cohort of 458 patients hospitalized for decompensated HF, we studied the occurrence of AKI using the standardized KDIGO criteria and grading (stages: 1, 2, 3), and considering two different definitions according to the RF used as reference or baseline: the latest outpatient measurement prior to admission vs. the first measurement at admission. We compared the prevalence, timing and prognostic value for both AKI definitions. RESULTS The definition based on outpatient RF was associated with an increase in overall AKI detection from 20.1% to 33.8% (p < 0.001), and from 3.1% to 5.0% for advanced stages (2-3) (p < 0.001); additionally, 12.5% of patients already had criteria of AKI at admission (36.8% of AKI cases). Both definitions were associated with longer hospital stay. However, only AKI already present at admission, as based on pre-hospital creatinine, was independently associated with all-cause death, in-hospital and after discharge, and death or HF readmission in the follow-up: 1 stage (HR 2.72, 95%CI 1.83-4.06, p < 0.001) and 2-3 stage (HR 7.29, 95%CI, 3.02-17.64, p < 0.001). CONCLUSIONS Evaluation of AKI in patients admitted with HF should consider pre-hospital RF, since it improves early identification of AKI and has implications for risk assessment.
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Affiliation(s)
- Juan Sanchez-Serna
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Alvaro Hernandez-Vicente
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Iris P Garrido-Bravo
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Francisco Pastor-Perez
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | | | - Teresa Casas-Pina
- Servicio de Bioquimica, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ana I Rodriguez-Serrano
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Julio Núñez
- Servicio de Cardiologia, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades (CIBER) Cardiovasculares, Madrid, Spain
| | - Domingo Pascual-Figal
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades (CIBER) Cardiovasculares, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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28
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Vicent L, Cinca J, Vazquez-García R, Gonzalez-Juanatey JR, Rivera M, Segovia J, Pascual-Figal D, Bover R, Worner F, Delgado-Jiménez J, Fernández-Avilés F, Martínez-Sellés M. Discharge treatment with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker after a heart failure hospitalisation is associated with a better prognosis irrespective of left ventricular ejection fraction. Intern Med J 2020; 49:1505-1513. [PMID: 30887642 DOI: 10.1111/imj.14289] [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: 11/19/2018] [Revised: 02/18/2019] [Accepted: 03/05/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Medical therapy could improve the prognosis of real-life patients discharged after a heart failure (HF) hospitalisation. AIM To determine the impact of discharge HF treatment on mortality and readmissions in different left ventricular ejection fraction (LVEF) groups. METHODS Multicentre prospective registry in 20 Spanish hospitals. Patients were enrolled after a HF hospitalisation. RESULTS A total of 1831 patients was included (583 (31.8%) HF with reduced ejection fraction (HFrEF); 227 (12.4%) HF with midrange ejection fraction (HFmrEF); 610 (33.3%) HF with preserved ejection fraction (HFpEF), and 411 (22.4%) with unknown LVEF). Angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB) at discharge were independently associated with a reduction in: (i) all-cause mortality: hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.41-0.74, P < 0.001, with a similar effect in the four groups; (ii) mortality due to refractory HF HR 0.45, 95% CI 0.29-0.64, P < 0.001, with a similar effect in the three groups with known LVEF; (iii) mortality/HF admissions (HR 0.61; 95% CI: 0.50-0.74), more evident in HFrEF (HR 0.54; 95% CI: 0.38-0.78) compared with HRmEF (HR 0.64; 95% CI 0.40-1.02), or HFpEF (HR 0.70; 95% CI 0.53-0.92). In patients with HFrEF triple therapy (ACE inhibitor/ARB + beta blocker + mineralocorticoid receptor antagonist) was associated with the lowest mortality risk (HR 0.21; 95% CI: 0.08-0.57, P = 0.002) compared with patients that received none of these drugs. CONCLUSIONS Discharge treatment with ACE inhibitor/ARB after a HF hospitalisation is associated with a reduction in all-cause and refractory HF mortality, irrespective of LVEF.
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Affiliation(s)
- Lourdes Vicent
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Juan Cinca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Barcelona, Spain
| | | | | | - Miguel Rivera
- Cardiology Department, University Hospital La Fe, Spain
| | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Madrid, Spain
| | - Domingo Pascual-Figal
- Cardiology Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Spain
| | - Ramón Bover
- Cardiology Department, Hospital Clinico San Carlos, Madrid, Spain
| | - Fernando Worner
- Cardiology Department, Hospital Universitari Arnau de Vilanova, Lleida, IRBLLEIDA, Spain
| | | | - Francisco Fernández-Avilés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Cardiology Department, Universidad Complutense, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Cardiology Department, Universidad Complutense, Madrid, Spain.,Universidad Europea, Madrid, Spain
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29
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Revuelta-López E, Núñez J, Gastelurrutia P, Cediel G, Januzzi JL, Ibrahim NE, Emdin M, VanKimmenade R, Pascual-Figal D, Núñez E, Gommans F, Lupón J, Bayés-Genís A. Neprilysin inhibition, endorphin dynamics, and early symptomatic improvement in heart failure: a pilot study. ESC Heart Fail 2020; 7:559-566. [PMID: 32045114 PMCID: PMC7160502 DOI: 10.1002/ehf2.12607] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Aim Sacubitril/valsartan is a first‐in‐class angiotensin receptor‐neprilysin inhibitor developed for the treatment of heart failure with reduced ejection fraction. Its benefits are achieved through the inhibition of neprilysin (NEP) and the specific blockade of the angiotensin receptor AT1. The many peptides metabolized by NEP suggest multifaceted potential consequences of its inhibition. We sought to evaluate the short‐term changes in serum endorphin (EP) values and their relation with patients' physical functioning after initiation of sacubitril/valsartan treatment. Methods and results A total of 105 patients with heart failure with reduced ejection fraction, who were candidates for sacubitril/valsartan treatment, were included in this prospective, observational, multicentre, and international study. In a first visit, and in agreement with current guidelines, treatment with angiotensin‐converting enzyme inhibitors or angiotensin receptor blocker was replaced by sacubitril/valsartan because of clinical indication by the responsible physician. By protocol, patients were reevaluated at 30 days after the start of sacubitril/valsartan. Serum levels of α‐ (α‐EP), γ‐Endorphin (γ‐EP), and soluble NEP (sNEP) were measured using enzyme‐linked immunoassays. New York Heart Association (NYHA) functional class was used as an indicator of patient's functional status. Baseline median levels of circulating α‐EP, γ‐EP, and sNEP were 582 (160–772), 101 (37–287), and 222 pg/mL (124–820), respectively. There was not a significant increase in α‐EP nor γ‐EP serum values after sacubitril/valsartan treatment (P value = 0.194 and 0.102, respectively). There were no significant differences in sNEP values between 30 days and baseline (P value = 0.103). Medians (IQR) of Δα‐EP, Δγ‐EP, and ΔsNEP between 30 days and baseline were 9.3 (−34 − 44), −3.0 (−46.0 − 18.9), and 0 units (−16.4 − 157.0), respectively. In a pre–post sacubitril/valsartan treatment comparison, there was a significant improvement in NYHA class, with 36 (34.3%) patients experiencing improvement by at least one NYHA class category. Δα‐EP and ΔsNEP showed to be significantly associated with NYHA class after 30 days of treatment (P = 0.014 and P < 0.001, respectively). Δα‐EP was linear and significantly associated with NYHA class improvement after 30 days of sacubitril/valsartan treatment. Conclusions These preliminary data suggest that beyond the haemodynamic benefits achieved with sacubitril/valsartan, the altered cleavage of endorphin peptides by NEP inhibition may participate in patients' symptoms improvement.
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Affiliation(s)
- Elena Revuelta-López
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, Spain; INCLIVA; Universitat de València, Valencia, Spain
| | - Paloma Gastelurrutia
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain
| | - Germán Cediel
- Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Massachusetts, MA, USA
| | - Nasrien E Ibrahim
- Division of Cardiology, Massachusetts General Hospital and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Massachusetts, MA, USA
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Roland VanKimmenade
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Domingo Pascual-Figal
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Department, Hospital Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, Spain; INCLIVA; Universitat de València, Valencia, Spain
| | - Frank Gommans
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Josep Lupón
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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30
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Affiliation(s)
- Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Spain.,CIBERCV, Instituto de Salud Carlos III, Spain
| | - Domingo Pascual-Figal
- CIBERCV, Instituto de Salud Carlos III, Spain.,Cardiology Department, Hospital Virgen de la Arrixaca, Spain.,Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Spain
| | - Julio Núñez
- CIBERCV, Instituto de Salud Carlos III, Spain.,Cardiology Service, Hospital Clínico Universitario de Valencia, Spain
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31
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Senni M, Wachter R, Witte KK, Straburzynska-Migaj E, Belohlavek J, Fonseca C, Mueller C, Lonn E, Chakrabarti A, Bao W, Noe A, Schwende H, Butylin D, Pascual-Figal D. Initiation of sacubitril/valsartan shortly after hospitalisation for acutely decompensated heart failure in patients with newly diagnosed (de novo) heart failure: a subgroup analysis of the TRANSITION study. Eur J Heart Fail 2019; 22:303-312. [PMID: 31820537 DOI: 10.1002/ejhf.1670] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 06/27/2019] [Revised: 10/01/2019] [Accepted: 10/11/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Sacubitril/valsartan has shown efficacy and tolerability in patients with heart failure (HF) and reduced ejection fraction (HFrEF) in the ambulatory setting (PARADIGM-HF), and following stabilisation of acutely decompensated HF (ADHF) (PIONEER-HF and TRANSITION). However, data are lacking for the initiation of sacubitril/valsartan in newly diagnosed (de novo) HFrEF. Here, we assess the tolerability of initiating sacubitril/valsartan following ADHF in TRANSITION subgroups of patients with a de novo vs. prior diagnosis of HFrEF. METHODS AND RESULTS TRANSITION randomised 1002 patients to pre- and post-discharge initiation of sacubitril/valsartan (analysis set n = 991, following exclusions for mis-randomisation). In this post-hoc analysis, tolerability to sacubitril/valsartan [proportion of patients achieving target dose (97/103 mg b.i.d.) at 10 weeks post-randomisation], adverse events (AEs) and serious AEs (SAEs) were compared in de novo (n = 286) and prior HFrEF (n = 705) subgroups. More de novo than prior HFrEF patients achieved target dose at Week 10 (56% vs. 45%; relative risk ratio 1.30, 95% confidence interval 1.12-1.52, P < 0.001), and fewer had SAEs and permanent treatment discontinuations. Initiation of sacubitril/valsartan did not prevent the concomitant initiation and up-titration of guideline-directed HF therapies. De novo patients showed faster and greater decreases in N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin-T, and lower rates of HF and all-cause rehospitalisation vs. prior HFrEF. CONCLUSIONS After ADHF, first-line initiation of sacubitril/valsartan in de novo HFrEF, alongside the initiation of other guideline-directed therapies, is feasible and is associated with a better risk-benefit profile than in patients with prior HFrEF. Early intervention with sacubitril/valsartan may be considered to delay disease progression in patients with de novo HFrEF. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02661217.
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Affiliation(s)
- Michele Senni
- Cardiology Division, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany.,Clinic for Cardiology and Pneumology, University Medicine Göttingen, Germany and German Cardiovascular Research Center, partner site Göttingen, Göttingen, Germany
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Jan Belohlavek
- General Teaching Hospital, Charles University in Prague, Prague, Czech Republic
| | - Candida Fonseca
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, CHLO, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Eva Lonn
- McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Weibin Bao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Adele Noe
- Novartis Pharma AG, Basel, Switzerland
| | | | | | - Domingo Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
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32
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Iborra-Egea O, Santiago-Vacas E, Yurista SR, Lupón J, Packer M, Heymans S, Zannad F, Butler J, Pascual-Figal D, Lax A, Núñez J, de Boer RA, Bayés-Genís A. Unraveling the Molecular Mechanism of Action of Empagliflozin in Heart Failure With Reduced Ejection Fraction With or Without Diabetes. JACC Basic Transl Sci 2019; 4:831-840. [PMID: 31998851 PMCID: PMC6978551 DOI: 10.1016/j.jacbts.2019.07.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [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: 05/20/2019] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023]
Abstract
Using artificial intelligence, followed by in vivo validation, this study identified the key cardiac mechanism of action of empagliflozin in heart failure in patients with or without diabetes mellitus. The most robust mechanism of action involved the NHE-1 co-transporter with 94.7% accuracy. NHE-1 blockade by empagliflozin administration in rats restored the antiapoptotic activity of XIAP and BIRC5. The beneficial reduction in cardiomyocyte cell death after empagliflozin treatment is independent of the presence of diabetes mellitus. Empagliflozin could emerge as a new treatment for heart failure patients regardless of their glycemic status.
The mechanism of action of empagliflozin in heart failure with reduced ejection fraction (HFrEF) was deciphered using deep learning in silico analyses together with in vivo validation. The most robust mechanism of action involved the sodium-hydrogen exchanger (NHE)-1 co-transporter with 94.7% accuracy, which was similar for diabetics and nondiabetics. Notably, direct NHE1 blockade by empagliflozin ameliorated cardiomyocyte cell death by restoring expression of X-linked inhibitor of apoptosis (XIAP) and baculoviral IAP repeat-containing protein 5 (BIRC5). These results were independent of diabetes mellitus comorbidity, suggesting that empagliflozin may emerge as a new treatment in HFrEF.
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Affiliation(s)
- Oriol Iborra-Egea
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovascualres (CIBERCV), Madrid, Spain
| | - Evelyn Santiago-Vacas
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovascualres (CIBERCV), Madrid, Spain
| | - Salva R Yurista
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Josep Lupón
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovascualres (CIBERCV), Madrid, Spain
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas
| | - Stephane Heymans
- Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Faiez Zannad
- Centre d'Investigation Clinique Plurithématique 1433, INSERM U1116, Université de Lorraine, Centre Hospitalier Régional et Universitaire de Nancy, French Clinical Research Infrastructure Network (F-CRIN), Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (INI-CRCT), Nancy, France
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi
| | - Domingo Pascual-Figal
- Domingo Hospital Universitario Virgen de la Arrixaca, University of Murcia, Centro Nacional de Investigaciones Cardiovasculares, CIBERCV, Murcia, Spain
| | - Antonio Lax
- Domingo Hospital Universitario Virgen de la Arrixaca, University of Murcia, Centro Nacional de Investigaciones Cardiovasculares, CIBERCV, Murcia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, CIBERCV, INCLIVA, Universitat de València, València, Spain
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Antoni Bayés-Genís
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovascualres (CIBERCV), Madrid, Spain
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33
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Pascual-Figal D, Bao W, Senni M, Wachter R, Behlolavek J, Chakrabarti A, Noe A, Schwende H, Butylin D, Prescott M. 1410Clinical predictors of NT-proBNP response to early initiation of sacubitril/valsartan after hospitalisation for decompensated heart failure: An analysis of the TRANSITION study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
NT-proBNP has diagnostic and prognostic value in patients with heart failure (HF). Compared with enalapril, sacubitril/valsartan (S/V) significantly reduced NT-proBNP within 1 week (wk) of administration and reduced HF re-hospitalisation in patients with acute decompensated HF (ADHF) in PIONEER-HF. Identification of predictors of NT-proBNP reduction with S/V could aid prognostication following hospitalisation.
Methods
TRANSITION (NCT02661217) is an open label study in stabilised ADHF patients with HFrEF that compared S/V initiation pre- versus post-discharge (within 2 wk of discharge). Baseline NT-proBNP was measured at randomisation in both S/V groups (n=950). Clinical predictors of favourable response of NT-proBNP to S/V therapy (defined as reduction to <1000 pg/ml or >30% reduction vs. baseline) were studied at discharge, 4 wk and 10 wk post-randomisation.
Results
Median NT-proBNP at randomisation was similar in patients with S/V started pre- and post-discharge (1919 vs 1659 pg/ml). In patients receiving S/V in-hospital, NT-proBNP was reduced by 28% at discharge, compared to a 3% reduction in patients receiving optimised standard of care (between group p<0.001). A favorable response was reached in 46% vs 18% patients at discharge, 46% vs 42% at 4 weeks and 51% vs 48% at 10 weeks in pre- vs post-discharge groups. (Figure 1). Predictors of favourable NT-proBNP response to S/V at discharge were hypertension and shorter time from admission to first S/V dose. At 4 wk after randomisation, NT-proBNP was reduced similarly in patients started on S/V pre- and post-discharge. When the two S/V initiation groups were combined, predictors of favorable NT-proBNP response at 4 wk were higher initial dose of S/V (≥49/51 mg b.i.d.), higher baseline levels of NT-proBNP, de novo HF hospitalisation, ACEI/ARB naïve, lower baseline creatinine, no atrial fibrillation (AFib), no prior myocardial infarction (MI). A further reduction in NT-proBNP was seen at 10 wk post-randomisation in patients started on S/V pre- and post-discharge (38% vs 34%, between group p=0.250). Predictors of favourable NT-proBNP response to S/V were similar at 4 wk and 10 wk post-randomisation.
Conclusion
In-hospital initiation of sacubitril/valsartan shortly after stabilisation was associated with a prompt improvement of NT-proBNP already at discharge, whereas higher baseline levels of NT-proBNP, higher starting dose, absence of AFib and MI history, de novo HF and ACEI/ARB naïve status were associated with favourable NT-proBNP response in the vulnerable phase after discharge.
Acknowledgement/Funding
The TRANSITION study was funded by Novartis
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Affiliation(s)
| | - W Bao
- Novartis Pharmaceuticals, East Hanover, United States of America
| | - M Senni
- Ospedale Papa Giovanni XXIII, Heart Failure and Transplant Unit, Bergamo, Italy
| | - R Wachter
- Leipzig University Hospital, Leipzig, Germany
| | | | | | - A Noe
- Novartis Pharma AG, Basel, Switzerland
| | | | - D Butylin
- Novartis Pharma AG, Basel, Switzerland
| | - M Prescott
- Novartis Pharmaceuticals, East Hanover, United States of America
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34
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Vidal-Perez R, Varela-Roman A, Gomez-Otero I, Pascual-Figal D, Delgado Jimenez J, Agra-Bermejo R, Cordero-Fort A, Ferrero-Gregori A, Alvarez-Garcia J, Worner Diz F, Segovia Cubero J, Cinca Cuscullola J, Fernandez Aviles F, Mazon-Ramos P, Gonzalez-Juanatey JR. P2620PIONEER-HF criteria ready for the prime time? Data from REDINSCOR II registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
New treatment strategies are needed to improve the prognosis in acute heart failure (AHF), recently PIONEER-HF results have been published showing in a selected group of patients a potential use of sacubitril/valsartan with safety in this scenario
Purpose
To evaluate the impact of PIONEER-HF potential indication in daily practice after AHF hospitalization at discharge
Methods
We included a subgroup of 909 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentre, prospective registry with the complete data for this analysis. In the trial left ventricular ejection fraction (LVEF) ≤40% and natriuretic peptides at admission with values of NT-ProBNP≥1600 pg/ml were needed to be included. The clinical and analytic stability at discharge to safely start sacubitril/valsartan was considered as MDRD estimated Glomerular Filtration Rate≥30 mL/min/1.73 m2, Systolic Blood Pressure ≥100 mmHg and Potassium ≤5.2 mmol/L.
Results
The mean age was 72.1±12.01 years. Of these, 373 (38.8%) were female, 734 (76,6%) were hypertensive, 462 (48.2%) had diabetes and 282 (29.9%) coronary artery disease. At admission atrial fibrillation was found in 403 patients (40.1%) and 409 (45%) had reduced LVEF. The mean levels of NT-ProBNP 7259.4±9437.1 pg/ml. In this group of patients, the in-hospital mortality was 28 (2.9%) and the 1 year follow up mortality was 197 (20.5%) and the heart failure rehospitalizations in 1 year were 303 (31,5%). In table 1 the percentage of patients that fulfil the needed criteria for the application of PIONEER HF is shown. In our registry 235 patients (25.9%) could be potential users of sacubitril/valsartan after the acute phase of hospitalization
Table 1 Elements to stablish indication Number of patients (%) NT-ProBNP ≥1600 pg/ml at admission 730 (80.3%) MDRD estimated GFR ≥30 mL/min/1.73 m2 at discharge 798 (87.8%) Systolic Blood Pressure ≥100 mmHg at discharge 755 (83.1%) Serum Potassium ≤5.2 mmol/L at discharge 856 (94.2%) Clinical and analytic stability at discharge 636 (70%) Left ventricular ejection fraction ≤40% 409 (45%) PIONEER HF Criteria 235 (25.9%) GFR: Glomerular Filtration Rate.
Conclusions
In our cohort of AHF patients around 1 out 4 could be treated with sacubitril/valsartan at discharge if we apply the PIONEER HF criteria in a contemporary setting, this finding could have potential implications in the prognosis and current costs of care in a population with high morbidity and mortality.
Acknowledgement/Funding
Heart Failure Program of the Red de Investigaciόn Cardiovascular del Instituto de Salud Carlos III, Madrid, Spain (RD12/0042) and FEDER
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Affiliation(s)
- R Vidal-Perez
- University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - A Varela-Roman
- Hospital Universitario Santiago de Compostela, CIBERCV, Cardiology, Santiago de Compostela, Spain
| | - I Gomez-Otero
- Hospital Universitario Santiago de Compostela, CIBERCV, Cardiology, Santiago de Compostela, Spain
| | - D Pascual-Figal
- Hospital Clinico Universitario Virgen de la Arrixaca, Cardiology, Murcia, Spain
| | | | - R Agra-Bermejo
- Hospital Universitario Santiago de Compostela, CIBERCV, Cardiology, Santiago de Compostela, Spain
| | - A Cordero-Fort
- University Hospital San Juan de Alicante, Cardiology, Alicante, Spain
| | | | - J Alvarez-Garcia
- University Hospital San Juan de Alicante, Cardiology, Alicante, Spain
| | | | - J Segovia Cubero
- University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain
| | | | | | - P Mazon-Ramos
- Hospital Universitario Santiago de Compostela, CIBERCV, Cardiology, Santiago de Compostela, Spain
| | - J R Gonzalez-Juanatey
- Hospital Universitario Santiago de Compostela, CIBERCV, Cardiology, Santiago de Compostela, Spain
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Vicent Alaminos L, Cinca J, Vazquez-Garcia R, Gonzalez-Juanatey JR, Rivera M, Segovia JR, Pascual-Figal D, Bover R, Worner F, Delgado-Jimenez J, Fernandez-Aviles F, Martinez-Selles M. P4535Discharge treatment with ACE inhibitor/ARB after a heart failure hospitalization is associated with a better prognosis irrespectively of left ventricular ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Medical therapy could improve the prognosis of real-life patients discharged after a heart failure (HF) hospitalization.
Purpose
We aimed to determine the impact of discharge HF treatment on mortality and readmissions in different left ventricular ejection fraction (LVEF) groups.
Methods
Multicentre prospective registry in 20 Spanish hospitals. Patients were enrolled after a HF hospitalization.
Results
A total of 1831 patients were included (583 [31.8%] HF with reduced ejection fraction [HFrEF]; 227 [12.4%] HF with midrange ejection fraction [HFmrEF]; 610 [33.3%] HF with preserved ejection fraction [HFpEF], and 411 [22.4%] with unknown LVEF. Angiotensin-converting enzyme (ACE) inhibitors/Angiotensin II receptor blockers (ARB) at discharge were independently associated with a reduction in: i) all-cause mortality: hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.41–0.74, P<0.001, with a similar effect in the four groups; ii) mortality due to refractory HF HR 0.45, 95% CI 0.29–0.64, P<0.001, with a similar effect in the three groups with known LVEF; iii) mortality/HF admissions (HR 0.61; 95% CI: 0.50–0.74), more evident in HFrEF (HR 0.54; 95% CI: 0.38–0.78) compared to HRmEF (HR 0.64; 95% CI 0.40–1.02), orHFpEF (HR 0.70; 95% CI 0.53–0.92).Inpatients with HFrEFtriple therapy (ACE inhibitor/ARB+ betablocker+ mineralocorticoid receptor antagonist) was associated with the lowest mortality risk (HR 0.21; 95% CI: 0.08–0.57, P=0.002) compared to patients that received none of these drugs.
Events according to the number of drugs – HFrEF (n=583) 0 (n=14) 1 (n=98) 2 (n=160) 3 (n=294) P Death or heart failure readmissions 10 (71.4) 58 (59.2) 66 (41.3) 106 (36.1) <0.001 All-cause mortality 9 (64.3) 28 (28.6) 31 (19.4) 36 (12.2) <0.001 Mortality due to refractory heart failure 7 (50.0) 14 (14.3) 17 (10.6) 17 (5.8) <0.001 – HFmrEF (n=227) 0 (n=18) 1 (n=57) 2 (n=81) 3 (n=65) P Death or heart failure readmissions 9 (50.0) 35 (61.4) 34 (42.0) 25 (38.5) 0.057 All-cause mortality 5 (27.8) 18 (31.6) 15 (18.5) 11 (16.9) 0.191 Mortality due to refractory heart failure 3 (16.7) 7 (12.3) 7 (8.6) 4 (6.2) 0.475 – HFpEF (n=610) 0 (n=61) 1 (n=242) 2 (n=219) 3 (n=69) P Death or heart failure readmissions 32 (52.5) 97 (40.1) 89 (40.6) 20 (29.0) 0.057 All-cause mortality 20 (32.8) 41 (16.9) 32 (14.6) 10 (14.5) 0.017 Mortality due to refractory heart failure 11 (18.0) 18 (7.4) 13 (5.9) 4 (5.8) 0.041 Outcomes according to the number of medications at discharge.
Kaplan-Meier Curves for study outcomes
Conclusions
Discharge treatment with ACE inhibitor/ARB after a HF hospitalization is associated with a reduction in all-cause and refractory HF mortality, irrespectively of LVEF.
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Affiliation(s)
| | - J Cinca
- Hospital Sant Pau, Barcelona, Spain
| | | | | | - M Rivera
- University Hospital Clinic of Valencia, Valencia, Spain
| | - J R Segovia
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - R Bover
- Hospital Clinic San Carlos, Madrid, Spain
| | - F Worner
- University Hospital Arnau de Vilanova, Valencia, Spain
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Wachter R, Pascual-Figal D, Belohlavek J, Straburzynska-Migaj E, Witte KK, Fonseca C, Cavusoglu Y, Pouleur AC, Goncalvesova E, Lonn E, Noe A, Schwende H, Bao W, Butylin D, Senni M. P773Initiation of sacubitril/valsartan and optimisation of evidence-based heart failure therapies after hospitalisation for acute decompensated heart failure: An analysis of the TRANSITION study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Optimisation of chronic heart failure (HF) therapy remains the key strategy to improve outcomes after hospitalisation for acute decompensated HF (ADHF) with reduced ejection fraction (HFrEF). Initiation and uptitration of disease-modifying therapies is challenging in this vulnerable patient population. We aimed to describe the patterns of treatment optimisation including sacubitril/valsartan (S/V) in the TRANSITION study.
Methods
TRANSITION (NCT02661217) was a randomised, open-label study comparing S/V initiation pre- vs. post-discharge (1–14 days) in patients admitted for ADHF after haemodynamic stabilisation. The primary endpoint was the proportion of patients achieving 97/103 mg S/V twice daily (bid) at 10 weeks post-randomisation. Up-titration of S/V was as per label. Information on dose of S/V and on the use of concomitant HF medication was collected at each study visit up to week 26.
Results
A total of 493 patients received at least one dose of S/V in the pre-discharge arm and 489 patients in the post-discharge arm. One month after randomisation, 45% of patients in the pre-d/c arm vs. 44% in the post-discharge arm used 24/26 mg bid starting dose and 42% vs. 40% were on 49/51 mg S/V bid, respectively. At week 10, 47% of patients had achieved the target dose in the pre-discharge arm vs. 51% in the post-discharge arm. At the end of the follow-up at 26 weeks, the proportion of patients on S/V target dose further increased to 53% in the pre-discharge and 61% in the post-discharge arm (Figure 1). At week 10, the mean dose of S/V was 132 mg in the pre-discharge arm and 136 mg in the post-discharge arm, and at week 26, it was 140 mg and 147 mg, respectively.
Before hospital admission, 52% and 54% of the patients received a beta-blocker (BB) in the pre-discharge and post-discharge group, respectively, and 42% in both arms received a mineralcorticoid receptor antagonist (MRA). At time of discharge, 68% and 71%% of the patients received a BB and 68% and 65% an MRA, in the pre-discharge and post-discharge groups, respectively. These proportions remained stable to week 10 and week 26.
Uptitration of sacubitril/valsartan
Conclusions
In the vulnerable post-ADHF population, initiation of S/V and up-titration to target dose was feasible within 10 weeks in half of the patients alongside with a 20% increase in the use of other disease-modifying medications that remained stable through the end of the 6-month follow-up.
Acknowledgement/Funding
The TRANSITION study was funded by Novartis
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Affiliation(s)
- R Wachter
- Leipzig University Hospital, Leipzig, Germany
| | | | | | | | - K K Witte
- University of Leeds, Leeds, United Kingdom
| | - C Fonseca
- Hospital de Sao Francisco Xavier, Lisbon, Portugal
| | - Y Cavusoglu
- Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - E Goncalvesova
- The National Institute of Cardiovascular Diseases, Bratislava 37, Slovakia
| | - E Lonn
- Hamilton Health Sciences General Site, Hamilton, Canada
| | - A Noe
- Novartis Pharma AG, Basel, Switzerland
| | | | - W Bao
- Novartis Pharmaceuticals, East Hanover, United States of America
| | - D Butylin
- Novartis Pharma AG, Basel, Switzerland
| | - M Senni
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
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Pascual-Figal D, Witte KK, Wachter R, Belohlavek J, Straburzynska-Migaj E, Fonseca C, Cavusoglu Y, Pouleur AC, Mueller C, Lonn E, Noe A, Schwende H, Bao W, Butylin D, Senni M. P1637Rehospitalisations during 26 weeks of follow up from initiation of sacubitril/valsartan after acute decompensated heart failure: An analysis of the TRANSITION study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with acute decompensated heart failure (ADHF) are at high risk of recurrent hospitalisations and death. In-hospital initiation of sacubitril/valsartan (S/V) reduced the risk for HF re-hospitalisation by 44% compared to enalapril in the PIONEER-HF study during the 8-week follow-up period. We aimed to describe the pattern of readmissions and their causes in the TRANSITION study, which randomised participants to pre-discharge or post-discharge initation of S/V.
Methods
TRANSITION (NCT02661217) was a randomised, open-label study comparing S/V initiation pre- vs. post-discharge (1–14 days) in haemodynamically stabilised patients with HF with reduced ejection fraction, admitted for ADHF. The primary endpoint was the proportion of patients achieving 97/103 mg S/V twice daily at 10 weeks post-randomisation. Information on rehospitalisation was collected throughout the study up to 26 weeks.
Results
A total of 493 patients received S/V in the pre-discharge arm and 489 patients in the post-discharge arm. Readmissions due to any cause were reported in 9.7% and 18.1% in the pre-discharge arm vs. 10.6% and 21.3% in the post-discharge arm within 30 days, and 10 weeks respectively. During the 26-weeks follow-up, all-cause readmission was reported in 34.5% of patients in the pre-discharge arm vs. 34.6% in the post-discharge arm. Median time to first rehospitalisation was 67 days in the pre-discharge arm (IQR: 26–110 days) and 50 days (IQR: 23–108 days) in the post-discharge arm. At least one HF hospitalisation was reported in 7.5% of patients in the pre-discharge arm and 7.4% in the post-discharge arm during 10 weeks and in 11.8% and 12.3% of patients, respectively, during 26 weeks of follow-up. Median duration of HF readmission was 7 days (IQR: 4–11 days) in the pre-discharge group and 6.5 days (IQR: 6.5–10 days) in the post-discharge arm. In total 2.6% and 5.5% patients in pre-discharge arm and 3.9% and 7% in the post-discharge arm visited an emergency room during 10 weeks and 26 weeks, respectively.
Conclusions
Initiation of S/V in patients hospitalised for ADHF either before or shortly after discharge, results in comparable rates of all cause and HF rehospitalisations, as well as emergency room visits without hospital admission over the 26 week follow-up period. HF re-hospitalisations rates at 10 weeks in TRANSITION are in line with the 8% in S/V arm reported in PIONEER-HF during the 8-weeks follow-up.
Acknowledgement/Funding
The TRANSITION study was funded by Novartis
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Affiliation(s)
| | - K K Witte
- University of Leeds, Leeds, United Kingdom
| | - R Wachter
- Leipzig University Hospital, Leipzig, Germany
| | | | | | - C Fonseca
- Hospital de Sao Francisco Xavier, Lisbon, Portugal
| | - Y Cavusoglu
- Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - C Mueller
- University Hospital Basel, Basel, Switzerland
| | - E Lonn
- Hamilton Health Sciences, Hamilton, Canada
| | - A Noe
- Novartis Pharma AG, Basel, Switzerland
| | | | - W Bao
- Novartis Pharmaceuticals, East Hanover, United States of America
| | - D Butylin
- Novartis Pharma AG, Basel, Switzerland
| | - M Senni
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
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Vidal-Perez R, Agra-Bermejo R, Pascual-Figal D, Gude Sampedro F, Abou Jokh C, Delgado Jimenez J, Varela-Roman A, Gomez Otero I, Ferrero-Gregori A, Alvarez-Garcia J, Worner Diz F, Segovia J, Cinca J, Fernandez-Aviles F, Gonzalez-Juanatey JR. P6361Prognostic value of discharge heart rate in acute heart failure patients: more relevant in atrial fibrillation? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients.
Purpose
The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (HRD) (admission- discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes.
Methods
We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentric, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission.
Results
The mean age of the study population was 72±12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one-year all-cause mortality (Relative risk (RR)= 1.182, confidence interval (CI) 95% 1.024–1.366, p=0.022) in SR. In AF patients discharge HR was associated with one-year all-cause mortality (RR= 1.276, CI 95% 1.115–1.459, p≤0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction (Figure 1)
Effect of post-discharge heart rate
Conclusions
In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients
Acknowledgement/Funding
Heart Failure Program of the Red de Investigaciόn Cardiovascular del Instituto de Salud Carlos III, Madrid, Spain (RD12/0042) and the Fondo Europeo de
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Affiliation(s)
- R Vidal-Perez
- University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - R Agra-Bermejo
- Hospital Universitario Santiago de Compostela, CIBERCV, Cardiology, Santiago de Compostela, Spain
| | - D Pascual-Figal
- Hospital Universitario Virgen de la Arrixaca, Cardiology, Murcia, Spain
| | - F Gude Sampedro
- Instituto de Investigacion Sanitaria de Santiago, Santiago de Compostela, Spain
| | - C Abou Jokh
- University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - A Varela-Roman
- Hospital Universitario Santiago de Compostela, CIBERCV, Cardiology, Santiago de Compostela, Spain
| | - I Gomez Otero
- Hospital Universitario Santiago de Compostela, CIBERCV, Cardiology, Santiago de Compostela, Spain
| | - A Ferrero-Gregori
- Hospital Universitario Santiago de Compostela, CIBERCV, Cardiology, Santiago de Compostela, Spain
| | - J Alvarez-Garcia
- Hospital de la Santa Creu i Sant Pau, Cardiology, Barcelona, Spain
| | | | - J Segovia
- University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain
| | - J Cinca
- Hospital de la Santa Creu i Sant Pau, Cardiology, Barcelona, Spain
| | | | - J R Gonzalez-Juanatey
- Hospital Universitario Santiago de Compostela, CIBERCV, Cardiology, Santiago de Compostela, Spain
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Wachter R, Senni M, Belohlavek J, Straburzynska-Migaj E, Witte KK, Kobalava Z, Fonseca C, Goncalvesova E, Cavusoglu Y, Fernandez A, Chaaban S, Bøhmer E, Pouleur AC, Mueller C, Tribouilloy C, Lonn E, A L Buraiki J, Gniot J, Mozheiko M, Lelonek M, Noè A, Schwende H, Bao W, Butylin D, Pascual-Figal D. Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge: primary results of the randomised TRANSITION study. Eur J Heart Fail 2019; 21:998-1007. [PMID: 31134724 DOI: 10.1002/ejhf.1498] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [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: 12/07/2018] [Accepted: 04/24/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS To assess tolerability and optimal time point for initiation of sacubitril/valsartan in patients stabilised after acute heart failure (AHF). METHODS AND RESULTS TRANSITION was a randomised, multicentre, open-label study comparing two treatment initiation modalities of sacubitril/valsartan. Patients aged ≥ 18 years, hospitalised for AHF were stratified according to pre-admission use of renin-angiotensin-aldosterone system inhibitors and randomised (n = 1002) after stabilisation to initiate sacubitril/valsartan either ≥ 12-h pre-discharge or between Days 1-14 post-discharge. Starting dose (as per label) was 24/26 mg or 49/51 mg bid with up- or down-titration based on tolerability. The primary endpoint was the proportion of patients attaining 97/103 mg bid target dose after 10 weeks. Median time of first dose of sacubitril/valsartan from the day of discharge was Day -1 and Day +1 in the pre-discharge group and the post-discharge group, respectively. Comparable proportions of patients in the pre- and post-discharge initiation groups met the primary endpoint [45.4% vs. 50.7%; risk ratio (RR) 0.90; 95% confidence interval (CI) 0.79-1.02]. The proportion of patients who achieved and maintained for ≥ 2 weeks leading to Week 10, either 49/51 or 97/103 mg bid was 62.1% vs. 68.5% (RR 0.91; 95% CI 0.83-0.99); or any dose was 86.0% vs. 89.6% (RR 0.96; 95% CI 0.92-1.01). Discontinuation due to adverse events occurred in 7.3% vs. 4.9% of patients (RR 1.49; 95% CI 0.90-2.46). CONCLUSIONS Initiation of sacubitril/valsartan in a wide range of heart failure with reduced ejection fraction patients stabilised after an AHF event, either in hospital or shortly after discharge, is feasible with about half of the patients achieving target dose within 10 weeks. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02661217.
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Affiliation(s)
- Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, and Clinic for Cardiology, University Medicine Göttingen and German Cardiovascular Research Center, Partner Site, Göttingen, Germany
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Jan Belohlavek
- General Teaching Hospital, Charles University in Prague, Prague, Czech Republic
| | | | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Zhanna Kobalava
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - Candida Fonseca
- Heart Failure Unit, Internal Medicine Department, Hospital de São Francisco Xavier, CHLO, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Yuksel Cavusoglu
- Eskişehir Osmangazi University Medical Faculty, Eskişehir, Turkey
| | | | - Said Chaaban
- Hammoud Hospital University Medical Center, Saida, Lebanon
| | | | | | | | | | - Eva Lonn
- McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | | | - Jacek Gniot
- SP ZOZ Szpital Specjalistyczny, Pulawy, Poland
| | - Maria Mozheiko
- Yaroslavl Regional Hospital of Veterans of Wars, Yaroslavl, Russia
| | - Malgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland
| | - Adele Noè
- Novartis Pharma AG, Basel, Switzerland
| | | | - Weibin Bao
- Novartis Pharmaceuticals, East Hanover, NJ, USA
| | | | - Domingo Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
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Wachter R, Michele S, Witte K, Straburzynska-Migaj E, Belohlavek J, Fonseca C, Mueller C, Lonn E, Bao W, Noe A, Schwende H, Butylin D, Pascual-Figal D. In-Hospital Initiation of Sacubitril/Valsartan in Stabilised Patients with Heart Failure and Reduced Ejection Fraction Naïve to Renin-Angiotensin System Blocker: An Analysis of the Transition Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.102] [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: 10/26/2022]
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Wachter R, Michele S, Witte K, Straburzynska-Migaj E, Belohlavek J, Fonseca C, Mueller C, Lonn E, Bao W, Noe A, Schwende H, Butylin D, Pascual-Figal D. Initiation of Sacubitril/Valsartan in Patients with De Novo Heart Failure with Reduced Ejection Fraction: An Analysis of the Transition Study. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.103] [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: 10/26/2022]
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Wachter R, Senni M, Belohlavek J, Butylin D, Noe A, Pascual-Figal D. P886Initiation of sacubitril/valsartan in hospitalized patients with heart failure with reduced ejection fraction after hemodynamic stabilization: primary results of the TRANSITION study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p886] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Wachter
- Leipzig University Hospital, Clinic and Policlinic for Cardiology, Leipzig, Germany
| | - M Senni
- Ospedale Papa Giovanni XXIII, Cardiology Division, Cardiovascular Department, Bergamo, Italy
| | - J Belohlavek
- Charles University of Prague, General Teaching Hospital, Prague, Czech Republic
| | - D Butylin
- Novartis Pharma AG, Basel, Switzerland
| | - A Noe
- Novartis Pharma AG, Basel, Switzerland
| | - D Pascual-Figal
- Hospital Clínico Univeristario Virgen de la Arrixaca, Cardiology Department, Murcia, Spain
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Wachter R, Senni M, Belohlavek J, Butylin D, Noe A, Pascual-Figal D. Sacubitril/Valsartan Initiated in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction after Hemodynamic Stabilization: Primary Results of the TRANSITION Study. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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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Senni M, Wachter R, Belohlavek J, Witte K, Strabuzynska-Migaj E, Kobalava Z, Fonseca C, Noe A, Butylin D, Schwende H, Pascual-Figal D. P6531Initiation of sacubitril/valsartan in hospitalized patients with HFrEF after hemodynamic stabilization: baseline characteristics of the TRANSITION study compared with TITRATION and PARADIGM-HF. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Senni
- Ospedale Papa Giovanni XXIII, Heart Failure and Transplant Unit, Bergamo, Italy
| | - R Wachter
- Leipzig University Hospital, Clinic and Policlinic for Cardiology, Leipzig, Germany
| | - J Belohlavek
- Charles University of Prague, Prague, Czech Republic
| | - K Witte
- University of Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | | | - Z Kobalava
- Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - C Fonseca
- Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), Heart Failure Unit, Internal Medicine Department, Lisboa, Portugal
| | - A Noe
- Novartis Pharma AG, Basel, Switzerland
| | - D Butylin
- Novartis Pharma AG, Basel, Switzerland
| | | | - D Pascual-Figal
- Hospital Clínico Univeristario Virgen de la Arrixaca, Cardiology Department, Murcia, Spain
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Restrepo Cordoba MA, Barton PJ, Bayes-Genis A, Govind R, Serrano I, Midwinter W, Pascual-Figal D, Wilk A, Garcia Pinilla JM, Cook SA, Provencio M, Lyon A, Alonso-Pulpon L, Ware JS, Garcia-Pavia P. P1503Genetic predisposing factors in chemotherapy-induced cardiomyopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - P J Barton
- Royal Brompton Hospital, London, United Kingdom
| | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Badalona (Barcelona), Spain
| | - R Govind
- Royal Brompton Hospital, London, United Kingdom
| | - I Serrano
- Hospital Universitario Joan XXIII, Tarragona, Spain
| | - W Midwinter
- Royal Brompton Hospital, London, United Kingdom
| | - D Pascual-Figal
- Hospital Clínico Univeristario Virgen de la Arrixaca, Murcia, Spain
| | - A Wilk
- Royal Brompton Hospital, London, United Kingdom
| | | | - S A Cook
- Royal Brompton Hospital, London, United Kingdom
| | - M Provencio
- University Hospital Puerta de Hierro Majadahonda, Medical Oncology Department, Madrid, Spain
| | - A Lyon
- Royal Brompton Hospital, London, United Kingdom
| | - L Alonso-Pulpon
- University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain
| | - J S Ware
- Royal Brompton Hospital, London, United Kingdom
| | - P Garcia-Pavia
- University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain
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Affiliation(s)
- Domingo Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, Department of Medicine, University of Murcia, Murcia, Spain.,Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,CIBERCV, Madrid, Spain
| | - Antoni Bayes-Genis
- CIBERCV, Madrid, Spain.,Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Comín-Colet J, Manito N, Segovia-Cubero J, Delgado J, García Pinilla JM, Almenar L, Crespo-Leiro MG, Sionis A, Blasco T, Pascual-Figal D, Gonzalez-Vilchez F, Lambert-Rodríguez JL, Grau M, Bruguera J. Efficacy and safety of intermittent intravenous outpatient administration of levosimendan in patients with advanced heart failure: the LION-HEART multicentre randomised trial. Eur J Heart Fail 2018; 20:1128-1136. [PMID: 29405611 DOI: 10.1002/ejhf.1145] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [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] [Received: 11/07/2016] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 11/07/2022] Open
Abstract
AIMS The LION-HEART study was a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial evaluating the efficacy and safety of intravenous administration of intermittent doses of levosimendan in outpatients with advanced chronic heart failure. METHODS AND RESULTS Sixty-nine patients from 12 centres were randomly assigned at a 2:1 ratio to levosimendan or placebo groups, receiving treatment by a 6-hour intravenous infusion (0.2 μg/kg/min without bolus) every 2 weeks for 12 weeks. The primary endpoint was the effect on serum concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) throughout the treatment period in comparison with placebo. Secondary endpoints included evaluation of safety, clinical events and health-related quality of life (HRQoL). The area under the curve (AUC, pg.day/mL) of the levels of NT-proBNP over time for patients who received levosimendan was significantly lower than for the placebo group (344 × 103 [95% Confidence Interval (CI) 283 × 103 -404 × 103 ] vs. 535 × 103 [443 × 103 -626 × 103 ], p = 0.003). In comparison with the placebo group, the patients on levosimendan experienced a reduction in the rate of heart failure hospitalisation (hazard ratio 0.25; 95% CI 0.11-0.56; P = 0.001). Patients on levosimendan were less likely to experience a clinically significant decline in HRQoL over time (P = 0.022). Adverse event rates were similar in the two treatment groups. CONCLUSIONS In this small pilot study, intermittent administration of levosimendan to ambulatory patients with advanced systolic heart failure reduced plasma concentrations of NT-proBNP, worsening of HRQoL and hospitalisation for heart failure. The efficacy and safety of this intervention should be confirmed in larger trials.
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Affiliation(s)
- Josep Comín-Colet
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), and Universitat Autònoma de Barcelona, Barcelona, Spain.,Heart Diseases Institute, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Nicolás Manito
- Heart Diseases Institute, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | | | - Juan Delgado
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain
| | | | - Luis Almenar
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María G Crespo-Leiro
- Complexo Hospitalario Universitario de A Coruña (CHUAC) e Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña (UDC), A Coruña, Spain
| | - Alessandro Sionis
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teresa Blasco
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - José Luis Lambert-Rodríguez
- Unidad de Trasplante Cardiaco e Insuficiencia Cardiaca Avanzada, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - María Grau
- Cardiovascular Epidemiology & Genetics, IMIM (Hospital del Mar Medical Research Institute) and University of Barcelona, Barcelona, Spain
| | - Jordi Bruguera
- Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), and Universitat Autònoma de Barcelona, Barcelona, Spain
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48
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Sánchez-Más J, Saura-Guillén E, Asensio-López MC, Soriano-Filiu Á, Carmen Sánchez-Pérez M, Hernandez-Martinez AM, Lax A, Pascual-Figal D. Temporal characterization of cardiac expression of glucose transporters SGLT and GLUT in an experimental model of myocardial infarction. Diabetes Metab 2017; 45:201-204. [PMID: 29097004 DOI: 10.1016/j.diabet.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/25/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Affiliation(s)
- J Sánchez-Más
- Departamento de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Moncada, Valencia, Spain
| | - E Saura-Guillén
- Servicio de Endocrinología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M C Asensio-López
- IMIB-Arrixaca, Facultad de Medicina, Universidad de Murcia, Muricia, Spain
| | - Á Soriano-Filiu
- IMIB-Arrixaca, Facultad de Medicina, Universidad de Murcia, Muricia, Spain
| | | | | | - A Lax
- IMIB-Arrixaca, Facultad de Medicina, Universidad de Murcia, Muricia, Spain.
| | - D Pascual-Figal
- IMIB-Arrixaca, Facultad de Medicina, Universidad de Murcia, Muricia, Spain; Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.
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Serratosa-Fernández L, Pascual-Figal D, Masiá-Mondéjar MD, Sanz-de la Garza M, Madaria-Marijuan Z, Gimeno-Blanes JR, Adamuz C. Comentarios a los nuevos criterios internacionales para la interpretación del electrocardiograma del deportista. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2017.06.004] [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]
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Serratosa-Fernández L, Pascual-Figal D, Masiá-Mondéjar MD, Sanz-de la Garza M, Madaria-Marijuan Z, Gimeno-Blanes JR, Adamuz C. Comments on the New International Criteria for Electrocardiographic Interpretation in Athletes. ACTA ACUST UNITED AC 2017; 70:983-990. [PMID: 28928069 DOI: 10.1016/j.rec.2017.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/09/2017] [Indexed: 01/28/2023]
Abstract
Sudden cardiac death is the most common medical cause of death during the practice of sports. Several structural and electrical cardiac conditions are associated with sudden cardiac death in athletes, most of them showing abnormal findings on resting electrocardiogram (ECG). However, because of the similarity between some ECG findings associated with physiological adaptations to exercise training and those of certain cardiac conditions, ECG interpretation in athletes is often challenging. Other factors related to ECG findings are race, age, sex, sports discipline, training intensity, and athletic background. Specific training and experience in ECG interpretation in athletes are therefore necessary. Since 2005, when the first recommendations of the European Society of Cardiology were published, growing scientific evidence has increased the specificity of ECG standards, thus lowering the false-positive rate while maintaining sensitivity. New international consensus guidelines have recently been published on ECG interpretation in athletes, which are the result of consensus among a group of experts in cardiology and sports medicine who gathered for the first time in February 2015 in Seattle, in the United States. The document is an important milestone because, in addition to updating the standards for ECG interpretation, it includes recommendations on appropriate assessment of athletes with abnormal ECG findings. The present article reports and discusses the most novel and relevant aspects of the new standards. Nevertheless, a complete reading of the original consensus document is highly recommended.
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Affiliation(s)
- Luis Serratosa-Fernández
- Servicio de Rehabilitación, Fisioterapia y Medicina del Deporte, Unidad de Cardiología del Deporte, Hospital Universitario Quirónsalud, Pozuelo de Alarcón, Madrid, Spain.
| | - Domingo Pascual-Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | | | - Zigor Madaria-Marijuan
- Unidad de Rehabilitación Cardiaca y Valoración Funcional, Hospital Universitario de Basurto, Unidad de Rehabilitación Cardiaca del IMQ, Bilbao, Vizcaya, Spain
| | | | - Carmen Adamuz
- Department of Sports Medicine, ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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