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1.
Objectives
To investigate the different clinical and echocardiographic predictors of evolving PH in patients with heart failure with and without reduced ejection fraction.Methods and Results
The study included 153 heart failure patients with reduced ejection fraction (HFrEF) (n = 89) and preserved ejection fraction (HFpEF) (n = 64) both of which were subdivided into 2 subgroups according to the presence of PH. All patients were subjected to detailed clinical assessment and full transthoracic echocardiogram. There were significant differences between the 2 HFrEF subgroups regarding systolic BP, presence of diabetes, dyslipidemia, diuretics usage, all LV parameters, LAD, LAV and LAV indexed to BSA, E/A ratio, DT and severity of TR. Using multivariate analysis, the presence of diabetes (P = 0.04), diuretics usage (P = 0.04), LAV (P = 0.007) and TR grade (P < 0.001) were significant independent predictors for the development of PH among HFrEF patients. There were significant differences between the 2 HFpEF subgroups regarding presence of hypertension, diuretics usage, LAD, LAA, TR severity. Using multivariate analysis, only diuretics usage (P = 0.02) and TR grade (P < 0.0001) were significant independent predictors for the development of PH among HFpEF patients.Conclusion
Neither the decrease in EF among HFrEF patients nor the DD grade in HFpEF patients act as independent predictor for evolving PH. Common independent predictors for evolving PH in both HFrEF and HFpEF patients are TR grade and use of diuretics. Other independent predictors in HFrEF and not HFpEF patients are the presence of diabetes and increased LAV. 相似文献2.
Lauren G. Gilstrap David Snipelisky Omar AbouEzzeddine Justin Vader Lauren Cooper Jacob Kelley Antonio Perez Kenneth Varian Anuradha Lala Monica Shah Lynne W. Stevenson 《Journal of cardiac failure》2017,23(10):770-774
Objective
The epidemiology of heart failure (HF) is changing. This study aimed to describe questions that arise during the routine care of HF patients that are unanswered by the current literature and describe how the type and focus of these questions has changed over time.Methods
Investigators from the National Heart, Lung, and Blood Institute–sponsored Heart Failure Apprentice Network collected and categorized questions from 5 academic hospitals over 12 months. A total of 174 unanswered questions were collected and analyzed.Results
Compared with 2004, there were more unanswered questions about “whether” to use therapies and fewer about “how” to use therapies. There were fewer questions about what therapeutic targets, therapy adjustment, and combination therapies. There were more questions about whether or how to stop therapies and how to add therapies back. Newly prominent topics, not observed in 2004, including novel therapeutics, refractory ventricular tachycardia, right heart failure, and nutrition/frailty, accounted for 24% of questions.Conclusions
Compared with 2004, there are fewer unanswered questions about how to use, adjust, and combine therapies. There were more unanswered questions about whether and how to stop therapies. Almost 25% of unanswered questions dealt with topics indicative of more advanced disease which were not observed in 2004. 相似文献3.
4.
Arnold Piek Wouter C. Meijers Nicolas F. Schroten Ron T. Gansevoort Rudolf A. de Boer Herman H.W. Silljé 《Journal of cardiac failure》2017,23(1):12-19
Background
The novel biomarker human epididymis protein 4 (HE4) shows prognostic value in acute heart failure (HF) patients. We measured HE4 levels in patients with chronic heart failure (CHF) and correlated them to HF severity, kidney function, and HF biomarkers, and determined its predictive value.Methods
Serum HE4 levels in patients (n?=?101) with stable CHF with reduced left ventricular ejection fraction (LVEF <45%) from the Vitamin D CHF (VitD-CHF) study (NCT01092130) were compared with those in age- and sex-matched healthy control subjects (n?=?58) from the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study.Results
HE4 levels were higher in CHF compared with control subjects (69.2 pmol/L [interquartile range 55.6-93.8] vs 56.1 pmol/L [46.6-69.0]; P?<?.001) and were higher with increasing New York Heart Association functional class. Levels were associated with HF risk factors, including age, gender, diabetes, smoking and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP). HE4 demonstrated strong associations with kidney function and HF fibrosis biomarkers. In a multivariable model, we identified creatinine, NT-proBNP, galectin-3, high-sensitive troponin T, and smoking as factors associated with HE4. Independently from these factors, HE4 levels predicted death and HF rehospitalization (5-year follow-up, hazard ratio 3.8; confidence interval 1.31–11.1; P?=?.014).Conclusions
HE4 levels are increased in CHF, correlate with HF severity and kidney function, and predict HF outcome. 相似文献5.
Ahmet Ilker Tekkesin Göksel Çinier Yasin Cakilli Mert İlker Hayıroğlu Ahmet Taha Alper 《Journal of electrocardiology》2017,50(2):234-237
Background
Interatrial block which is defined as P wave duration longer than 120 milliseconds is underappreciated but highly prevalent electrocardiographic abnormality and associated with atrial tachyarrhythmias and ischemic stroke. Impaired left atrial mechanics and atrial fibrillation are potential mechanisms contributing to the embolic events associated with interatrial block. Detection of atrial high rate episodes by cardiac implantable electronic devices provides clinicians to diagnose asymptomatic atrial fibrillation. The relation between interatrial block and asymptomatic atrial fibrillation can provide an insight to the increased risk of ischemic stroke in patients with interatrial block.Methods
We prospectively evaluated 367 patients who were implanted dual chamber pacemaker due to sinus node dysfunction (SND) between January 2015 and December 2015. Twelve lead electrocardiograms were analyzed to diagnose interatrial block before pacemaker implantation. Six months after the implantation, pacemakers were interrogated to detect atrial high rate episodes. Patients were divided into two groups in terms of presence or absence of atrial high rate episodes.Results
Atrial high rate episodes were detected in 107 (30.1%) patients during their device interrogation. Interatrial block was found in 115 (32.4%) patients out of total study population. Sixty-seven (27.0%) patients in AHRE (?) group had interatrial block while 48 (44.9%) patients had in AHRE (+) group. Prevalence of interatrial block was statistically significantly higher in AHRE (+) patients (P < 0.01).Conclusion
Occurrence of atrial high rate episodes, a surrogate for asymptomatic atrial fibrillation, is statistically significantly higher in patients with interatrial block. 相似文献6.
Bartłomiej Paleczny Martyna Olesińska Agnieszka Siennicka Piotr Niewiński Ewa A. Jankowska Beata Ponikowska Waldemar Banasiak Stephan Von Haehling Stefan D. Anker Piotr Ponikowski 《Journal of cardiac failure》2017,23(1):83-87
Background
Clinical and prognostic consequences of enhanced central chemosensitivity in the contemporary optimally treated patients with chronic heart failure (CHF) are unknown.Methods and Results
We studied central chemosensitivity (defined as hypercapnic ventilatory response [HCVR; L/min/mmHg]) in 161 CHF patients (mean left ventricular ejection fraction [LVEF] 31?±?6%, all receiving a combination of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and beta-blocker) and 55 sex- and age-matched healthy controls. HCVR did not differ between CHF patients and controls (median 0.63 vs 0.57?L/min?1/mmHg?1, P?=?.76). When the CHF patients were divided into tertiles according to their HCVR values, there were no significant differences in clinical characteristics (except for ischemic etiology, which was more frequent in those with the highest HCVR), results of the cardiopulmonary exercise testing, and indices of heart rate variability. During the follow-up (median 28 months, range 1–48 months, ≥15 months in all survivors), 21 patients died. HCVR was not related to survival in the Cox proportional hazards analysis.Conclusions
Central chemosensitivity is not enhanced in contemporary, optimally treated CHF patients and its assessment does not provide significant clinical or prognostic information. 相似文献7.
Chiara Melloni Allison Dunning Christopher B. Granger Laine Thomas Michel G. Khouri David A. Garcia Elaine M. Hylek Michael Hanna Lars Wallentin Bernard J. Gersh Pamela S. Douglas John H. Alexander Renato D. Lopes 《The American journal of medicine》2017,130(12):1440-1448.e1
Background
Cancer is associated with a prothrombotic state and increases the risk of thrombotic events in patients with atrial fibrillation. We described the clinical characteristics and outcomes and assessed the safety and efficacy of apixaban versus warfarin in patients with atrial fibrillation and cancer in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial.Methods
The association between cancer and clinical outcomes was assessed using Cox regression models. At baseline, 1236 patients (6.8%) had a history of cancer; 12.7% had active cancer, and 87.3% had remote cancer.Results
There were no significant associations between history of cancer and stroke/systemic embolism, major bleeding, or death. The effect of apixaban versus warfarin for the prevention of stroke/systemic embolism was consistent among patients with a history of cancer (event/100 patient-years = 1.4 vs 1.2; hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.53-2.26) and no cancer (1.3 vs 1.6; HR, 0.77; 95% CI, 0.64-0.93) (P interaction = .37). The safety and efficacy of apixaban versus warfarin were preserved among patients with and without active cancer. Apixaban was associated with a greater benefit for the composite of stroke/systemic embolism, myocardial infarction, and death in active cancer (HR, 0.30; 95% CI, 0.11-0.83) versus without cancer (HR, 0.86; 95% CI, 0.78-0.95), but not in remote cancer (HR, 1.46; 95% CI, 1.01-2.10) (interaction P = .0028).Conclusions
Cancer was not associated with a higher risk of stroke. The superior efficacy and safety of apixaban versus warfarin were consistent in patients with and without cancer. Our positive findings regarding apixaban use in patients with atrial fibrillation and cancer are exploratory and promising, but warrant further evaluation. 相似文献8.
Ayodele Odutayo Christopher X. Wong Rashida Williams Benjamin Hunn Connor A. Emdin 《Journal of cardiac failure》2017,23(1):56-62
Background
Atrial fibrillation (AF) is common among adults with congestive heart failure (CHF). We conducted a meta-analysis to summarize the risk of mortality and cardiovascular disease associated with AF in CHF and stratified our analyses by AF timing and pattern.Methods
We searched MEDLINE and EMBASE for observational studies examining the association of AF with cardiovascular disease and death. Eligible studies had a minimum of 50 participants with AF and 50 participants without AF, and a median follow-up of 6 months.Results
Thirty-three studies involving 114,204 adults (43,549 with AF) were included in this meta-analysis. AF was associated with an increased risk of mortality and this risk varied between incident and prevalent AF (relative risk 2.21, 95% confidence interval 1.96–2.49 vs relative risk 1.19, 95% confidence interval 1.03–1.38, respectively; P?<?.001 for interaction). The risk of mortality associated with incident AF was consistent in adults with CHF with reduced and preserved ejection fraction. The relative risk of mortality did not vary between paroxysmal and chronic AF. Finally, AF was associated with an increased risk of cardiovascular mortality and stroke.Limitation
Use of anticoagulation was infrequently reported in included studies.Conclusions
AF was associated with an increased risk of cardiovascular disease and death and, notably, the risk of mortality varied by AF timing. 相似文献9.
Ashley E. Wivel Kate Lapane Christi Kleoudis Burton H. Singer Ralph I. Horwitz 《The American journal of medicine》2017,130(11):1290-1297.e6
Background
To guide management decisions for an index patient, evidence is required from comparisons between approximate matches to the profile of the index case, where some matches contain responses to treatment and others act as controls.Methods
We describe a method for constructing clinically relevant histories/profiles using data collected but unreported from 2 recent phase 3 randomized controlled trials assessing belimumab in subjects with clinically active and serologically positive systemic lupus erythematosus. Outcome was the Systemic lupus erythematosus Responder Index (SRI) measured at 52 weeks.Results
Among 1175 subjects, we constructed an algorithm utilizing 11 trajectory variables including 4 biological, 2 clinical, and 5 social/behavioral. Across all biological and social/behavioral variables, the proportion of responders based on the SRI whose value indicated clinical worsening or no improvement ranged from 27.5% to 42.3%. Kappa values suggested poor agreement, indicating that each biological and patient-reported outcome provides different information than gleaned from the SRI.Conclusion
The richly detailed patient profiles needed to guide decision-making in clinical practice are sharply at odds with the limited information utilized in conventional randomized controlled trial analyses. 相似文献10.
Daniel Rosen Janice D. McCall Brian A. Primack 《The American journal of medicine》2017,130(11):1326-1330
Background
Congestive heart failure is the leading cause of hospital readmissions. We aimed to assess adherence to and effectiveness of a telehealth protocol designed to prevent hospital admissions for congestive heart failure.Methods
We recruited a random sample of 50 patients with congestive heart failure (mean age 61 years) from a managed care organization. We developed a telehealth platform allowing for daily, real-time reporting of health status and video conferencing. We defined adherence as the percentage of days on which the patient completed the daily check-in protocol. To assess efficacy, we compared admission and readmission rates between the 6-month intervention period and the prior 6 months. Primary outcomes were admissions and readmissions due to congestive heart failure, and secondary outcomes were admissions and readmissions due to any cause.Results
Forty-eight patients (96%) completed the protocol. Approximately half (46%) were at high risk for readmission according to standardized measures. Median 120-day adherence was 96% (interquartile range, 92%-98%), and adherence did not significantly differ across sex, race, age, living situation, depression, cognitive ability, or risk for readmission. Approximately equal proportions of patients were admitted for all causes during the 6-month intervention period versus the comparison period (37% vs 43%; P = .32). Half as many patients were admitted for congestive heart failure during the 6-month intervention period compared with the comparison period (12% vs 25%; P = .11).Conclusion
Adherence to this telehealth protocol was excellent and consistent, even among high-risk patients. Future research should test the protocol using a more rigorous randomized design. 相似文献11.
Robert L. Gottlieb Teena Sam Suzanne Y. Wada James F. Trotter Sumeet K. Asrani Brian Lima Susan M. Joseph Gonzalo V. Gonzalez-Stawinski Shelley A. Hall 《Journal of cardiac failure》2017,23(10):765-767
Background
Donors with hepatitis C (HCV) viremia are rarely used for orthotopic heart transplantation (HT) owing to post-transplantation risks. New highly effective HCV antivirals may alter the landscape.Methods
An adult patient unsuitable for bridging mechanical support therapy accepted a heart transplant offer from a donor with HCV viremia. On daily logarithmic rise in HCV viral load and adequate titers to ensure successful genotyping, once daily sofosbuvir (400?mg)–velpatasvir (100?mg) (Epclusa; Gilead) was initiated empirically pending HCV genotype (genotype 3a confirmed after initiation of therapy).Results
We report the kinetics of acute hepatitis C viremia and therapeutic response to treatment with a new pangenotypic antiviral agent after donor-derived acute HCV infection transmitted incidentally with successful cardiac transplantation to an HCV-negative recipient. Prompt resolution of viremia was noted by the 1st week of a 12 week course of antiviral therapy. Sustained virologic remission continued beyond 12 weeks after completion of HCV therapy (SVR-12).Conclusions
The availability of effective pangenotypic therapy for HCV may expand donor availability. The feasibility of early versus late treatment of HCV remains to be determined through formalized protocols. We hypothesize pharmacoeconomics to be the greatest limitation to widespread availability of this promising tool. 相似文献12.
13.
George R. Luck Terry Eggenberger David Newman Jacqueline Cortizo Derek C. Blankenship Charles H. Hennekens 《The American journal of medicine》2017,130(11):e487-e489
Background
On a daily basis, healthcare providers, especially those dealing with terminally ill patients, such as hospice workers, witness how advance directives help ensure the wishes of patients. They also witness the deleterious consequences when patients fail to document the care they desire at their end of life. To the best of our knowledge there are no data concerning the prevalence of advance directives among hospice healthcare providers. We therefore explored the prevalence and factors influencing completion rates in a survey of hospice healthcare providers.Methods
Surveys that included 32 items to explore completion rates, as well as barriers, knowledge, and demographics, were e-mailed to 2097 healthcare providers, including employees and volunteers, at a nonprofit hospice.Results
Of 890 respondents, 44% reported having completed an advance directive. Ethnicity, age, relationship status, and perceived knowledge were all significant factors influencing the completion rates, whereas years of experience or working directly with patients had no effect. Procrastination, fear of the subject, and costs were common reasons reported as barriers. Upon completion of the survey, 43% said they will now complete an advance directive, and 45% will talk to patients and families about their wishes.Conclusion
The majority of hospice healthcare providers have not completed an advance directive. These results are very similar to those for other healthcare providers treating patients with terminal diseases, specifically oncologists. Because, at completion, 43% said that they would now complete an advance directive, such a survey of healthcare providers may help increase completion rates. 相似文献14.
Parul U. Gandhi Sheryl L. Chow Thomas S. Rector Henry Krum Hanna K. Gaggin John J. McMurray Michael R. Zile Michel Komajda Robert S. McKelvie Peter E. Carson James L. Januzzi Inder S. Anand 《Journal of cardiac failure》2017,23(1):20-28
Background
The prognostic merit of insulin-like growth factor-binding protein 7 (IGFBP7) is unknown in heart failure and preserved ejection fraction (HFpEF).Methods and Results
Baseline IGFBP7 (BL-IGFBP7; n?=?302) and 6-month change (Δ; n?=?293) were evaluated in the Irbesartan in Heart Failure and Preserved Ejection Fraction (I-PRESERVE) trial. Primary outcome was all-cause mortality or cardiovascular hospitalization with median follow-up of 3.6 years; secondary outcomes included HF events. Median BL-IGFBP7 concentration was 218?ng/mL. BL-IGFBP7 was significantly correlated with age (R2?=?0.13; P?<?.0001), amino-terminal pro-B-type NP (R2?=?0.22; P?<?.0001), and estimated glomerular filtration rate (eGFR; R2?=?0.14; P?<?.0001), but not with signs/symptoms of HFpEF. BL-IGFBP7 was significantly associated with the primary outcome (hazard ratio [HR]?=?1.007 per ng/mL; P?<?.001), all-cause mortality (HR?=?1.008 per ng/mL; P?<?.001), and HF events (HR?=?1.007 per ng/mL; P?<?.001). IGFBP7 remained significant for each outcome after adjustment for ln amino-terminal pro-B-type NP and eGFR but not all variables in the I-PRESERVE prediction model. After 6 months, IGFBP7 did not change significantly in either treatment group. ΔIGFBP7 was significantly associated with decrease in eGFR in patients randomized to irbesartan (R2?=?0.09; P?=?.002). ΔIGFBP7 was not independently associated with outcome.Conclusions
Higher concentrations of IGFBP7 were associated with increased risk of cardiovascular events, but after multivariable adjustment this association was no longer present. Further studies of IGFBP7 are needed to elucidate its mechanism.15.
Thomas T. Poels Suzanne Kats Leo Veenstra Vincent van Ommen Jos G. Maessen Frits W. Prinzen 《Journal of electrocardiology》2017,50(2):261-267
Background
The Selvester QRS score (S-score) estimates myocardial scar using electrocardiographic criteria. We evaluated the S-score for left bundle branch block (LBBB).Material and methods
Studied were 36 patients who developed persistent LBBB upon transcatheter aortic valve implantation (TAVI, TAVI-LBBB group) and 36 matched patients with persistent narrow QRS (TAVI-nQRS group). Electrocardiograms were recorded before and briefly after TAVI and during ~6 months follow-up. S-score was calculated using criteria for hypertrophic (in absence of LBBB) or LBBB hearts.Results
In TAVI-LBBB patients correlation between S-scores pre-TAVI and post-TAVI was absent (R2 = 0.023). High S-scores post-TAVI occurred in patients with low pre-TAVI scores. Pre-post TAVI scores correlated weakly in TAVI-nQRS (R2 = 0.182), indicating a possible influence of ventricular unloading by TAVI. In both groups S-scores at post-TAVI and follow-up compared reasonably (R2 = 0.389 and R2 = 0.386), indicating reproducibility in more stable conditions.Conclusion
This study indicates that the use of the LBBB S-score criteria overestimates scar size and that caution is recommended in the use of the score in patients with LBBB. 相似文献16.
17.
Mohamed Abdel Kader Abdel Wahab Mohamed Mohamed Saad Khaled Abdel Ghany Baraka 《Journal of the Saudi Heart Association》2017,29(1):30-36
Background
Microalbuminuria (MA) is a marker of vascular damage. However, many studies have observed an increased risk at lower levels of albuminuria than are currently used to define MA.Aim
To verify early cardiovascular changes occurring before MA in hypertensive patients.Materials and methods
One hundred and fifty hypertensive patients and 60 normotensive individuals were divided into normotensive individuals with normal left ventricular (LV) geometry (Group I), hypertensive patients with normal LV geometry (Group II), and hypertensive patients with abnormal LV geometry (Group III). The LV mass index, ambulatory arterial stiffness index, flow-mediated dilatation of the brachial artery, and intima-media thickness (IMT) of the common carotid were assessed. Urinary albumin/creatinine ratio was determined using a morning spot-urine sample.Results
Compared with Group I, ambulatory arterial stiffness index and IMT were significantly increased and flow-mediated dilatation was significantly decreased in Group II; however, MA did not differ between both groups. These changes were augmented when Group III was compared with Group II. MA significantly increased in Group III compared with Group II. Receiver operating characteristic analysis revealed that MA, with a cut-off value of 19.25 mg/g, predicted increased IMT, and abnormal LV geometry in a statistically significant manner.Conclusion
Many vascular changes, in the form of increased IMT, reduced vasodilator capacity, and increased arterial stiffness, preceded MA and any change in LV geometry. The results presented here strengthen the usefulness of adopting a lower cut-off to define MA. 相似文献18.
Osama A. Smettei Sawsan Sayed Rami M. Abazid 《Journal of the Saudi Heart Association》2017,29(2):84-89
Background
Coronary artery anomalies (CAAs) affect about 1% of the general population based on invasive coronary angiography (ICA) data, computed tomography angiography (CTA) enables better visualization of the origin, course, relation to the adjacent structures, and termination of CAAs compared to ICA.Objective
The aim of our work is to estimate the frequency of CAAs in Qassim province among patients underwent cardiac CTA at Prince Sultan Cardiac Center.Methods
Retrospective analysis of the CTA data of 2235 patients between 2009 and 2015.Results
The prevalence of CAAs in our study was 1.029%. Among the 2235 patients, 241 (10.78%) had CAAs or coronary variants, 198 (8.85%) had myocardial bridging, 34 (1.52%) had a variable location of the Coronary Ostia, Twenty two (0.98%) had a separate origin of left anterior descending (LAD) and left circumflex coronary (LCX) arteries, ten (0.447%) had a separate origin of the RCA and the Conus artery. Seventeen (0.76%) had an anomalous origin of the coronaries. Six (0.268%) had a coronary artery fistula, which is connected mainly to the right heart chambers, one of these fistulas was complicated by acute myocardial infarction.Conclusions
The incidence of CAAs in our patient population was similar to the former studies, CTA is an excellent tool for diagnosis and guiding the management of the CAAs. 相似文献19.
Kevin A. Kerber Brian C. Callaghan Steven A. Telian William J. Meurer Lesli E. Skolarus Wendy Carender James F. Burke 《The American journal of medicine》2017,130(12):1465.e1-1465.e9
Background
The traditional approach to dizziness encourages providers to emphasize the type of dizziness. However, symptom types might substantially overlap in individual patients, thus limiting the clinical value of this approach. We aimed to describe the overlap of types of dizziness using a US nationally representative sample.Methods
The 2008 US National Health Interview Survey was examined for prevalence and overlap of types of dizziness. The data were also separately examined among people who otherwise had typical features of traditionally vertigo-based disorders (ie, benign paroxysmal positional vertigo and Meniere's disease). Data analysis also included exploratory factor analysis.Results
Twelve-month prevalence of problems with dizziness or balance was 14.8%, representing 33.4 million individuals. The mean number of dizziness symptoms was 2.4 (95% confidence interval [CI], 2.3-2.4), with 61.1% reporting more than one type. Of subjects who otherwise had typical features of traditionally vertigo-based disorders, the mean number of dizziness types was 3.1 (95% CI, 3.0-3.3), and only 24.6% (95% CI, 21.0%-28.7%) reported vertigo as the primary type. Exploratory factor analysis found that symptom types loaded onto a single factor without other clinical or demographic variables.Conclusions
Substantial overlap of dizziness types exists among US adults with dizziness. People otherwise having features of traditionally vertigo-based disorders also typically report multiple dizziness types and do not typically report vertigo as the primary type. Symptom types correlate more strongly with each other than with other clinical or demographic variables. These findings suggest that the traditional emphasis on dizziness types is likely of limited clinical utility. 相似文献20.
Devika Nair Laura Kidd N. Kevin Krane 《The American journal of the medical sciences》2017,353(4):320-328