Pub Date : 2010-09-01DOI: 10.1111/J.1751-7133.2010.00173.X
S. Harris, D. Tepper, Randy J. Ip
Abstract. Objectives. We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI). Background. Use of clopidogrel after AMI is low in patients with HF, despite the fact that clopidogrel is associated with absolute mortality reduction in AMI patients. Methods. All patients hospitalized with first-time AMI (2000 through 2005) and not undergoing PCI within 30 days from discharge were identified in national registers. Patients with HF treated with clopidogrel were matched by propensity score with patients not treated with clopidogrel. Similarly, 2 groups without HF were identified. Risks of all-cause death were obtained by the Kaplan–Meier method and Cox regression analyses. Results. We identified 56,944 patients with first-time AMI. In the matched cohort with HF (n=5050) and a mean follow-up of 1.50 years (SD=1.2), 709 (28.1%) and 812 (32.2%) deaths occurred in patients receiving and not receiving clopidogrel treatment, respectively (P=.002). The corresponding numbers for patients without HF (n=6092), with a mean follow-up of 2.05 years (SD=1.3), were 285 (9.4%) and 294 (9.7%), respectively (P=.83). Patients with HF receiving clopidogrel demonstrated reduced mortality (hazard ratio, 0.86; 95% confidence interval, 0.78–0.95) compared with patients with HF not receiving clopidogrel. No difference was observed among patients without HF (hazard ratio, 0.98; 95% confidence interval, 0.83–1.16). Conclusions. Clopidogrel was associated with reduced mortality in patients with HF who do not undergo PCI after their first-time AMI, whereas this association was not apparent in patients without HF. Further studies of the benefit of clopidogrel in patients with HF and AMI are warranted.—Bonde L, Sorensen R, Fosbol EL, et al. Increased mortality associated with low use of clopidogrel in patients with heart failure and acute myocardial infarction not undergoing percutaneous coronary intervention: a nationwide study. J Am Coll Cardiol. 2010;55:1300–1307.
{"title":"Increased Mortality Associated With Low Use of Clopidogrel in Patients With Heart Failure and Acute Myocardial Infarction Not Undergoing Percutaneous Coronary Intervention","authors":"S. Harris, D. Tepper, Randy J. Ip","doi":"10.1111/J.1751-7133.2010.00173.X","DOIUrl":"https://doi.org/10.1111/J.1751-7133.2010.00173.X","url":null,"abstract":"Abstract. Objectives. We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI). \u0000 \u0000 \u0000 \u0000Background. Use of clopidogrel after AMI is low in patients with HF, despite the fact that clopidogrel is associated with absolute mortality reduction in AMI patients. \u0000 \u0000 \u0000 \u0000Methods. All patients hospitalized with first-time AMI (2000 through 2005) and not undergoing PCI within 30 days from discharge were identified in national registers. Patients with HF treated with clopidogrel were matched by propensity score with patients not treated with clopidogrel. Similarly, 2 groups without HF were identified. Risks of all-cause death were obtained by the Kaplan–Meier method and Cox regression analyses. \u0000 \u0000 \u0000 \u0000Results. We identified 56,944 patients with first-time AMI. In the matched cohort with HF (n=5050) and a mean follow-up of 1.50 years (SD=1.2), 709 (28.1%) and 812 (32.2%) deaths occurred in patients receiving and not receiving clopidogrel treatment, respectively (P=.002). The corresponding numbers for patients without HF (n=6092), with a mean follow-up of 2.05 years (SD=1.3), were 285 (9.4%) and 294 (9.7%), respectively (P=.83). Patients with HF receiving clopidogrel demonstrated reduced mortality (hazard ratio, 0.86; 95% confidence interval, 0.78–0.95) compared with patients with HF not receiving clopidogrel. No difference was observed among patients without HF (hazard ratio, 0.98; 95% confidence interval, 0.83–1.16). \u0000 \u0000 \u0000 \u0000Conclusions. Clopidogrel was associated with reduced mortality in patients with HF who do not undergo PCI after their first-time AMI, whereas this association was not apparent in patients without HF. Further studies of the benefit of clopidogrel in patients with HF and AMI are warranted.—Bonde L, Sorensen R, Fosbol EL, et al. Increased mortality associated with low use of clopidogrel in patients with heart failure and acute myocardial infarction not undergoing percutaneous coronary intervention: a nationwide study. J Am Coll Cardiol. 2010;55:1300–1307.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"26 1","pages":"239-239"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86086757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-09-01DOI: 10.1111/J.1751-7133.2010.00179.X
M. Silver
Following your need to always fulfil the inspiration to obtain everybody is now simple. Connecting to the internet is one of the short cuts to do. There are so many sources that offer and connect us to other world condition. As one of the products to see in internet, this website becomes a very available place to look for countless heart failure current clinical understanding sources. Yeah, sources about the books from countries in the world are provided.
{"title":"Heart Failure: Current Clinical Understanding","authors":"M. Silver","doi":"10.1111/J.1751-7133.2010.00179.X","DOIUrl":"https://doi.org/10.1111/J.1751-7133.2010.00179.X","url":null,"abstract":"Following your need to always fulfil the inspiration to obtain everybody is now simple. Connecting to the internet is one of the short cuts to do. There are so many sources that offer and connect us to other world condition. As one of the products to see in internet, this website becomes a very available place to look for countless heart failure current clinical understanding sources. Yeah, sources about the books from countries in the world are provided.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"5 1","pages":"241-241"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87666985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-09-01DOI: 10.1111/J.1751-7133.2010.00174.X
S. Harris, D. Tepper, Randy J. Ip
Abstract. Primary percutaneous coronary intervention (PCI) and intra-aortic balloon pump counterpulsation (IABP) are established treatment modalities in acute myocardial infarction complicated by cardiogenic shock. We hypothesized that the insertion of the IABP before primary PCI might result in better survival of patients with cardiogenic shock compared with postponing the insertion until after primary PCI. We, therefore, retrospectively studied 48 patients who had undergone primary PCI with IABP because of cardiogenic shock complicating acute myocardial infarction (26 patients received the IABP before and 22 patients after primary PCI). No significant differences were present in the baseline clinical characteristics between the 2 groups. The mean number of diseased vessels was greater in the group of patients treated with the IABP before primary PCI (2.8±0.5 vs 2.3±0.7, P=.012), but the difference in the number of treated vessels was not significant. The peak creatine kinase and creatine kinase-MB levels were lower in patients treated with the IABP before primary PCI (median, 1077; interquartile range, 438–2067 vs median, 3299; interquartile range, 695–6834; P=.047 and median, 95; interquartile range, 34–196 vs median, 192; interquartile range, 82–467; P=.048, respectively). In-hospital mortality and the overall incidence of major adverse cardiac and cerebrovascular events were significantly lower in the group of patients receiving the IABP before primary PCI (19% vs 59% and 23% vs 77%, P=.007 and P=.0004, respectively). Multivariate analysis identified renal failure (odds ratio, 15.2; 95% confidence interval, 3.13–73.66) and insertion of the IABP after PCI (odds ratio, 5.2; 95% confidence interval, 1.09–24.76) as the only independent predictors of in-hospital mortality. In conclusion, the results of the present study suggest that patients with cardiogenic shock complicating acute myocardial infarction who undergo primary PCI assisted by IABP have a more favorable in-hospital outcome and lower in-hospital mortality than patients who receive IABP after PCI. Abdel-Wahab M, Saad M, Kynast J, et al. Comparison of hospital mortality with intra-aortic balloon counterpulsation insertion before versus after primary percutaneous coronary intervention for cardiogenic shock complicating acute myocardial infarction. Am J Cardiol. 2010;105:967–971.
摘要原发性经皮冠状动脉介入治疗(PCI)和主动脉内球囊泵反搏(IABP)是急性心肌梗死并发心源性休克的常用治疗方法。我们假设在初次PCI前插入IABP可能比推迟到初次PCI后插入IABP更能提高心源性休克患者的生存率。因此，我们回顾性研究了48例因心源性休克并发急性心肌梗死而接受IABP的初次PCI患者(26例患者在初次PCI前接受IABP, 22例患者在初次PCI后接受IABP)。两组患者的基线临床特征无显著差异。初次PCI前经IABP治疗组的平均病变血管数较多(2.8±0.5 vs 2.3±0.7,P= 0.012)，但治疗血管数差异无统计学意义。初次PCI术前接受IABP治疗的患者，肌酸激酶峰值和肌酸激酶- mb水平较低(中位数，1077;四分位数范围438-2067 vs中位数3299;四分位数范围695-6834;P =。047，中位数95;四分位数范围34-196 vs中位数192;四分位数间距为82-467;P =。048年,分别)。在首次PCI术前接受IABP的患者，住院死亡率和主要心脑血管不良事件的总发生率显著降低(19% vs 59%， 23% vs 77%， P=。007, P=。0004年,分别)。多因素分析发现肾衰竭(优势比15.2;95%可信区间，3.13-73.66)和PCI术后置入IABP(优势比，5.2;95%可信区间(1.09-24.76)为院内死亡率的唯一独立预测因子。综上所述，本研究的结果表明，心源性休克合并急性心肌梗死患者在首次PCI辅助下接受IABP的患者比PCI后接受IABP的患者有更有利的住院预后和更低的住院死亡率。Abdel-Wahab M, Saad M, Kynast J，等。心源性休克合并急性心肌梗死的经皮冠状动脉介入治疗前后主动脉内球囊反搏术住院死亡率的比较中华心血管病杂志。2010;25(5):344 - 344。
{"title":"Comparison of Hospital Mortality With Intra‐Aortic Balloon Counterpulsation Insertion Before vs After Primary Percutaneous Coronary Intervention for Cardiogenic Shock Complicating Acute Myocardial Infarction","authors":"S. Harris, D. Tepper, Randy J. Ip","doi":"10.1111/J.1751-7133.2010.00174.X","DOIUrl":"https://doi.org/10.1111/J.1751-7133.2010.00174.X","url":null,"abstract":"Abstract. Primary percutaneous coronary intervention (PCI) and intra-aortic balloon pump counterpulsation (IABP) are established treatment modalities in acute myocardial infarction complicated by cardiogenic shock. We hypothesized that the insertion of the IABP before primary PCI might result in better survival of patients with cardiogenic shock compared with postponing the insertion until after primary PCI. We, therefore, retrospectively studied 48 patients who had undergone primary PCI with IABP because of cardiogenic shock complicating acute myocardial infarction (26 patients received the IABP before and 22 patients after primary PCI). No significant differences were present in the baseline clinical characteristics between the 2 groups. The mean number of diseased vessels was greater in the group of patients treated with the IABP before primary PCI (2.8±0.5 vs 2.3±0.7, P=.012), but the difference in the number of treated vessels was not significant. The peak creatine kinase and creatine kinase-MB levels were lower in patients treated with the IABP before primary PCI (median, 1077; interquartile range, 438–2067 vs median, 3299; interquartile range, 695–6834; P=.047 and median, 95; interquartile range, 34–196 vs median, 192; interquartile range, 82–467; P=.048, respectively). In-hospital mortality and the overall incidence of major adverse cardiac and cerebrovascular events were significantly lower in the group of patients receiving the IABP before primary PCI (19% vs 59% and 23% vs 77%, P=.007 and P=.0004, respectively). Multivariate analysis identified renal failure (odds ratio, 15.2; 95% confidence interval, 3.13–73.66) and insertion of the IABP after PCI (odds ratio, 5.2; 95% confidence interval, 1.09–24.76) as the only independent predictors of in-hospital mortality. In conclusion, the results of the present study suggest that patients with cardiogenic shock complicating acute myocardial infarction who undergo primary PCI assisted by IABP have a more favorable in-hospital outcome and lower in-hospital mortality than patients who receive IABP after PCI. Abdel-Wahab M, Saad M, Kynast J, et al. Comparison of hospital mortality with intra-aortic balloon counterpulsation insertion before versus after primary percutaneous coronary intervention for cardiogenic shock complicating acute myocardial infarction. Am J Cardiol. 2010;105:967–971.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"40 1","pages":"240-240"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80518702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-07-01DOI: 10.1111/J.1751-7133.2010.00159.X
S. Harris, D. Tepper, Randy J. Ip
. Background. Indications for implantable cardioverter-defibrillators (ICDs) in heart failure (HF) are expanding and may include more than 1 million patients. This study examined patient expectations from ICDs for primary prevention of sudden death in HF. Methods and Results. Study participants (n=105) had an ejection fraction <35% and symptomatic HF without history of ventricular tachycardia/fibrillation or syncope. Participants completed a written survey about perceived ICD benefits, survival expectations, and circumstances under which they might deactivate defibrillation. Mean age was 58 years, mean left ventricular ejection fraction was 21%, 40% had New York Heart Association class III or IV disease, and 65% already had a primary prevention ICD. Most patients anticipated more than 10 years’ survival despite symptomatic HF. Nearly 54% expected an ICD to save ≥50 lives per 100 during 5 years. ICD recipients expressed more confidence that the device would save their own lives compared with those without an ICD (P<.001). Despite understanding the ease of deactivation, 70% of ICD recipients indicated they would keep the ICD on even if dying of cancer, 55% even if having daily shocks, and none would inactivate defibrillation even if experiencing constant dyspnea at rest. Conclusions. HF patients anticipate long survival, overestimate survival benefits conferred by ICDs, and express reluctance to deactivate their devices even for end-stage disease.—Stewart GC, Weintraub JR, Pratibhu PP, et al. Patient expectations from implantable defibrillators to prevent death in heart failure. J Card Fail. 2010;16:106–113.
{"title":"Patient Expectations From Implantable Defibrillators to Prevent Death in Heart Failure","authors":"S. Harris, D. Tepper, Randy J. Ip","doi":"10.1111/J.1751-7133.2010.00159.X","DOIUrl":"https://doi.org/10.1111/J.1751-7133.2010.00159.X","url":null,"abstract":". Background. Indications for implantable cardioverter-defibrillators (ICDs) in heart failure (HF) are expanding and may include more than 1 million patients. This study examined patient expectations from ICDs for primary prevention of sudden death in HF. \u0000 \u0000 \u0000 \u0000Methods and Results. Study participants (n=105) had an ejection fraction <35% and symptomatic HF without history of ventricular tachycardia/fibrillation or syncope. Participants completed a written survey about perceived ICD benefits, survival expectations, and circumstances under which they might deactivate defibrillation. Mean age was 58 years, mean left ventricular ejection fraction was 21%, 40% had New York Heart Association class III or IV disease, and 65% already had a primary prevention ICD. Most patients anticipated more than 10 years’ survival despite symptomatic HF. Nearly 54% expected an ICD to save ≥50 lives per 100 during 5 years. ICD recipients expressed more confidence that the device would save their own lives compared with those without an ICD (P<.001). Despite understanding the ease of deactivation, 70% of ICD recipients indicated they would keep the ICD on even if dying of cancer, 55% even if having daily shocks, and none would inactivate defibrillation even if experiencing constant dyspnea at rest. \u0000 \u0000 \u0000 \u0000Conclusions. HF patients anticipate long survival, overestimate survival benefits conferred by ICDs, and express reluctance to deactivate their devices even for end-stage disease.—Stewart GC, Weintraub JR, Pratibhu PP, et al. Patient expectations from implantable defibrillators to prevent death in heart failure. J Card Fail. 2010;16:106–113.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"31 1","pages":"189-189"},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75862044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-07-01DOI: 10.1111/J.1751-7133.2010.00158.X
S. Harris, D. Tepper, Randy J. Ip
Abstract. Objectives. This study sought to determine whether serial measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in com-munity-dwelling elderly people would provide additional prognostic information to that from traditional risk factors. Background. Accurate cardiovascular risk stratification is challenging in elderly people. Methods. NT-proBNP was measured at baseline and 2 to 3 years later in 2975 community-dwelling older adults free of heart failure in the longitudinal Cardiovascular Health Study (CHS). This investigation examined the risk of new-onset heart failure (HF) and death from cardiovascular causes associated with baseline NT-proBNP and changes in NT-proBNP levels, adjusting for potential confounders. Results. NT-proBNP levels in the highest quintile (>267.7 pg/mL) were independently associated with greater risks of HF (hazard ratio [HR], 3.05; 95% confidence interval [CI], 2.46–3.78) and cardiovascular death (HR, 3.02; 95% CI, 2.36–3.86) compared with the lowest quintile ( 25% increase on follow-up to >190 pg/mL (21%) were at greater adjusted risk for HF (HR, 2.13; 95% CI, 1.68–2.71) and cardiovascular death (HR, 1.91; 95% CI, 1.43–2.53) compared with those with sustained low levels. Among participants with initially high NT-proBNP, those with a >25% increase (40%) were at higher risk for HF (HR, 2.06; 95% CI, 1.56–2.72) and cardiovascular death (HR, 1.88; 95% CI, 1.37–2.57), whereas those with a >25% decrease to ≤190 pg/mL (15%) were at lower risk for HF (HR, 0.58; 95% CI, 0.36–0.93) and cardiovascular death (HR, 0.57; 95% CI, 0.32–1.01) compared with those with unchanged high values. Conclusions. NT-proBNP levels independently predict HF and cardiovascular death in older adults. NT-proBNP levels frequently change over time, and these fluctuations reflect dynamic changes in cardiovascular risk. deFilippi CR, Christenson RH, Gottdiener JS, et al. Dynamic cardiovascular risk assessment in elderly people. The role of repeated N-terminal pro-B-type natriuretic testing. J Am Coll Cardiol. 2010; 55: 441-450.
{"title":"Dynamic Cardiovascular Risk Assessment in Elderly People","authors":"S. Harris, D. Tepper, Randy J. Ip","doi":"10.1111/J.1751-7133.2010.00158.X","DOIUrl":"https://doi.org/10.1111/J.1751-7133.2010.00158.X","url":null,"abstract":"Abstract. Objectives. This study sought to determine whether serial measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in com-munity-dwelling elderly people would provide additional prognostic information to that from traditional risk factors. \u0000 \u0000 \u0000 \u0000Background. Accurate cardiovascular risk stratification is challenging in elderly people. \u0000 \u0000 \u0000 \u0000Methods. NT-proBNP was measured at baseline and 2 to 3 years later in 2975 community-dwelling older adults free of heart failure in the longitudinal Cardiovascular Health Study (CHS). This investigation examined the risk of new-onset heart failure (HF) and death from cardiovascular causes associated with baseline NT-proBNP and changes in NT-proBNP levels, adjusting for potential confounders. \u0000 \u0000 \u0000 \u0000Results. NT-proBNP levels in the highest quintile (>267.7 pg/mL) were independently associated with greater risks of HF (hazard ratio [HR], 3.05; 95% confidence interval [CI], 2.46–3.78) and cardiovascular death (HR, 3.02; 95% CI, 2.36–3.86) compared with the lowest quintile ( 25% increase on follow-up to >190 pg/mL (21%) were at greater adjusted risk for HF (HR, 2.13; 95% CI, 1.68–2.71) and cardiovascular death (HR, 1.91; 95% CI, 1.43–2.53) compared with those with sustained low levels. Among participants with initially high NT-proBNP, those with a >25% increase (40%) were at higher risk for HF (HR, 2.06; 95% CI, 1.56–2.72) and cardiovascular death (HR, 1.88; 95% CI, 1.37–2.57), whereas those with a >25% decrease to ≤190 pg/mL (15%) were at lower risk for HF (HR, 0.58; 95% CI, 0.36–0.93) and cardiovascular death (HR, 0.57; 95% CI, 0.32–1.01) compared with those with unchanged high values. \u0000 \u0000 \u0000 \u0000Conclusions. NT-proBNP levels independently predict HF and cardiovascular death in older adults. NT-proBNP levels frequently change over time, and these fluctuations reflect dynamic changes in cardiovascular risk. \u0000 \u0000 \u0000 \u0000deFilippi CR, Christenson RH, Gottdiener JS, et al. Dynamic cardiovascular risk assessment in elderly people. The role of repeated N-terminal pro-B-type natriuretic testing. J Am Coll Cardiol. 2010; 55: 441-450.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"68 1","pages":"189-190"},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74113122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.1111/J.1751-7133.2009.00131_2.X
S. Harris, D. Tepper, Randy J. Ip
Abstract. Objectives. The authors sought to investigate the effect of β-blocker (BB) therapy on survival in patients with severe aortic regurgitation (AR) Background BBs are thought to be contraindicated in patients with AR because a slower heart rate increases the duration of diastole, during which AR occurs. But AR also causes neuroendocrine activation similar to a heart failure state, for which BBs are potentially beneficial. Methods This is an observational study. An echocardiographic database was screened for patients with severe AR. Detailed chart reviews were performed for clinical, demographic, and therapeutic data. Mortality data were obtained from the Social Security Death Index and analyzed as a function of BB therapy. Results Overall, 355 (47%) of the 756 patients with severe AR were taking a BB, mean age was 61±18 years, and mean ejection fraction was 54%±19%. Over a mean follow-up of 4.5 years, BB therapy was associated with a higher survival rate (1- and 5-year survival rates of 90% and 70%, respectively) compared with those without (1- and 5-year survival rates of 75% and 55%, respectively) (P=.0009). The Cox regression model showed that BB therapy was an independent predictor of better survival after adjusting for age, sex, heart rate, hypertension, coronary artery disease, diabetes mellitus, heart failure, renal insufficiency, ejection fraction, and aortic valve replacement (hazard ratio, 0.74; 95% confidence interval, 0.58–0.93; P=.01). The survival benefit of BB therapy was further supported by propensity score analysis. Conclusions This observational study strongly suggests that BB therapy is associated with a survival benefit in patients with severe AR.
{"title":"Effect of β-Blocker Therapy on Survival in PatientsWith Severe Aortic Regurgitation: Results From a Cohort of 756 Patients","authors":"S. Harris, D. Tepper, Randy J. Ip","doi":"10.1111/J.1751-7133.2009.00131_2.X","DOIUrl":"https://doi.org/10.1111/J.1751-7133.2009.00131_2.X","url":null,"abstract":"Abstract. Objectives. The authors sought to investigate the effect of β-blocker (BB) therapy on survival in patients with severe aortic regurgitation (AR) \u0000 \u0000 \u0000 \u0000Background BBs are thought to be contraindicated in patients with AR because a slower heart rate increases the duration of diastole, during which AR occurs. But AR also causes neuroendocrine activation similar to a heart failure state, for which BBs are potentially beneficial. \u0000 \u0000 \u0000 \u0000Methods This is an observational study. An echocardiographic database was screened for patients with severe AR. Detailed chart reviews were performed for clinical, demographic, and therapeutic data. Mortality data were obtained from the Social Security Death Index and analyzed as a function of BB therapy. \u0000 \u0000 \u0000 \u0000Results Overall, 355 (47%) of the 756 patients with severe AR were taking a BB, mean age was 61±18 years, and mean ejection fraction was 54%±19%. Over a mean follow-up of 4.5 years, BB therapy was associated with a higher survival rate (1- and 5-year survival rates of 90% and 70%, respectively) compared with those without (1- and 5-year survival rates of 75% and 55%, respectively) (P=.0009). The Cox regression model showed that BB therapy was an independent predictor of better survival after adjusting for age, sex, heart rate, hypertension, coronary artery disease, diabetes mellitus, heart failure, renal insufficiency, ejection fraction, and aortic valve replacement (hazard ratio, 0.74; 95% confidence interval, 0.58–0.93; P=.01). The survival benefit of BB therapy was further supported by propensity score analysis. \u0000 \u0000 \u0000 \u0000Conclusions This observational study strongly suggests that BB therapy is associated with a survival benefit in patients with severe AR.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"67 1","pages":"85-86"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90173445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.1111/J.1751-7133.2009.00131_1.X
S. Harris, D. Tepper, Randy J. Ip
Abstract. Objectives. This study sought to evaluate the use of a continuous-flow rotary left ventricular assist device (LVAD) as a bridge to heart transplant Background LVAD therapy is an established treatment modality for patients with advanced heart failure. Pulsatile LVADs have limitations in design precluding their use for extended support. Continuous-flow rotary LVADs represent an innovative design with potential for small size and greater reliability by simplification of the pumping mechanism. Methods In a prospective multicenter study, 281 patients urgently listed (United Network for Organ Sharing status 1A or 1B) for heart transplant underwent implant of a continuous-flow LVAD. Survival and transplant rates were assessed at 18 months. Patients were assessed for adverse events throughout the study and for quality of life, functional status, and organ function for 6 months. Results Of 281 patients, 222 (79%) underwent transplant or LVAD removal for cardiac recovery or had ongoing LVAD support at 18-month follow-up. Actuarial survival on support was 72% (95% confidence interval, 65%–79%) at 18 months. At 6 months, there were significant improvements in functional status and 6-minute walk test results (from 0% to 83% of patients in New York Heart Association functional class I or II and from 13% to 89% of patients completing a 6-minute walk test) and in quality of life (mean values improved 41% with Minnesota Living With Heart Failure and 75% with Kansas City Cardiomyopathy questionnaires). Major adverse events included bleeding, stroke, right heart failure, and percutaneous lead infection. Pump thrombosis occurred in 4 patients. Conclusions A continuous-flow LVAD provides effective hemodynamic support for at least 18 months in patients awaiting transplant, with improved functional status and quality of life.
{"title":"Extended Mechanical Circulatory Support With a Continuous‐Flow Rotary Left Ventricular Assist Device","authors":"S. Harris, D. Tepper, Randy J. Ip","doi":"10.1111/J.1751-7133.2009.00131_1.X","DOIUrl":"https://doi.org/10.1111/J.1751-7133.2009.00131_1.X","url":null,"abstract":"Abstract. Objectives. This study sought to evaluate the use of a continuous-flow rotary left ventricular assist device (LVAD) as a bridge to heart transplant \u0000 \u0000 \u0000 \u0000Background LVAD therapy is an established treatment modality for patients with advanced heart failure. Pulsatile LVADs have limitations in design precluding their use for extended support. Continuous-flow rotary LVADs represent an innovative design with potential for small size and greater reliability by simplification of the pumping mechanism. \u0000 \u0000 \u0000 \u0000Methods In a prospective multicenter study, 281 patients urgently listed (United Network for Organ Sharing status 1A or 1B) for heart transplant underwent implant of a continuous-flow LVAD. Survival and transplant rates were assessed at 18 months. Patients were assessed for adverse events throughout the study and for quality of life, functional status, and organ function for 6 months. \u0000 \u0000 \u0000 \u0000Results Of 281 patients, 222 (79%) underwent transplant or LVAD removal for cardiac recovery or had ongoing LVAD support at 18-month follow-up. Actuarial survival on support was 72% (95% confidence interval, 65%–79%) at 18 months. At 6 months, there were significant improvements in functional status and 6-minute walk test results (from 0% to 83% of patients in New York Heart Association functional class I or II and from 13% to 89% of patients completing a 6-minute walk test) and in quality of life (mean values improved 41% with Minnesota Living With Heart Failure and 75% with Kansas City Cardiomyopathy questionnaires). Major adverse events included bleeding, stroke, right heart failure, and percutaneous lead infection. Pump thrombosis occurred in 4 patients. \u0000 \u0000 \u0000 \u0000Conclusions A continuous-flow LVAD provides effective hemodynamic support for at least 18 months in patients awaiting transplant, with improved functional status and quality of life.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"18 1","pages":"85-85"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83594214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-11-01DOI: 10.1111/J.1751-7133.2009.00117.X
D. Tepper, S. Harris, Randy J. Ip
Abstract. Background. Screening for asymptomatic left ventricular dysfunction (ALVD) in patients at risk for heart failure (HF) can affect clinical management. The aim of the present study is to examine the role of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in the diagnosis of ALVD in patients with hypertension and diabetes from primary care. Methods and Results. A total of 1012 patients with hypertension and/or diabetes and no symptoms or signs of HF were assessed by NT-pro-BNP assay and echocardiography. Diastolic dysfunction was present in 368 of 1012 patients (36.4%): 327 (32.4%) with mild diastolic dysfunction and 41 (4%) with a moderate to severe diastolic dysfunction. Systolic dysfunction was present in 11 of 1012 patients (1.1%). NT-pro-BNP levels were 170±206 and 859±661 pg/mL, respectively, in diastolic and systolic dysfunction and 92±169 in healthy patients (P<.0001). Pooling moderate to severe diastolic with systolic dysfunction, a total of 52 patients (5.1%) were obtained: the best cutoff of NT-pro-BNP was 125 pg/mL (men younger than 67 years: sensitivity, 87.5%; specificity, 92.7%; negative predictive value [NPV], 99.5%; positive predictive value [PPV], 33.3%; women younger than 67 years: sensitivity, 100%; specificity, 84.1%; NPV, 100%; PPV, 33.3%; men 67 years or older: sensitivity, 100%; specificity, 77.1%; NPV, 100%; PPV, 32.5%; women 67 years or older: sensitivity, 100%; specificity, 59.9%; NPV, 100%; PPV, 23%). Conclusions. The prevalence of ALVD in patients at risk for HF is 5.1%. Because of its excellent NPV, NT-pro-BNP assessment can be used by general practitioners to rule out ALVD in hypertensive or diabetic patients.—Betti I, Castelli G, Barchielli A, et al. The role of N-terminal Pro-brain natriuretic peptide and echocardiography for screening asymptomatic left ventricular dysfunction in a population at high risk for heart failure. The PROBE-HF study. J Card Fail. 2009;15:377–384.
{"title":"The Role of N-Terminal Pro-Brain Natriuretic Peptide and Echocardiography for Screening Asymptomatic Left Ventricular Dysfunction in a Population at High Risk for Heart Failure: The PROBE-HF Study","authors":"D. Tepper, S. Harris, Randy J. Ip","doi":"10.1111/J.1751-7133.2009.00117.X","DOIUrl":"https://doi.org/10.1111/J.1751-7133.2009.00117.X","url":null,"abstract":"Abstract. Background. Screening for asymptomatic left ventricular dysfunction (ALVD) in patients at risk for heart failure (HF) can affect clinical management. The aim of the present study is to examine the role of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in the diagnosis of ALVD in patients with hypertension and diabetes from primary care. \u0000 \u0000 \u0000 \u0000Methods and Results. A total of 1012 patients with hypertension and/or diabetes and no symptoms or signs of HF were assessed by NT-pro-BNP assay and echocardiography. Diastolic dysfunction was present in 368 of 1012 patients (36.4%): 327 (32.4%) with mild diastolic dysfunction and 41 (4%) with a moderate to severe diastolic dysfunction. Systolic dysfunction was present in 11 of 1012 patients (1.1%). NT-pro-BNP levels were 170±206 and 859±661 pg/mL, respectively, in diastolic and systolic dysfunction and 92±169 in healthy patients (P<.0001). Pooling moderate to severe diastolic with systolic dysfunction, a total of 52 patients (5.1%) were obtained: the best cutoff of NT-pro-BNP was 125 pg/mL (men younger than 67 years: sensitivity, 87.5%; specificity, 92.7%; negative predictive value [NPV], 99.5%; positive predictive value [PPV], 33.3%; women younger than 67 years: sensitivity, 100%; specificity, 84.1%; NPV, 100%; PPV, 33.3%; men 67 years or older: sensitivity, 100%; specificity, 77.1%; NPV, 100%; PPV, 32.5%; women 67 years or older: sensitivity, 100%; specificity, 59.9%; NPV, 100%; PPV, 23%). \u0000 \u0000 \u0000 \u0000Conclusions. The prevalence of ALVD in patients at risk for HF is 5.1%. Because of its excellent NPV, NT-pro-BNP assessment can be used by general practitioners to rule out ALVD in hypertensive or diabetic patients.—Betti I, Castelli G, Barchielli A, et al. The role of N-terminal Pro-brain natriuretic peptide and echocardiography for screening asymptomatic left ventricular dysfunction in a population at high risk for heart failure. The PROBE-HF study. J Card Fail. 2009;15:377–384.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"810 1","pages":"296-296"},"PeriodicalIF":0.0,"publicationDate":"2009-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72658948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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