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Background: The effect of elevated heart rate (HR) on outcomes after heart transplantation (HT) has not been well established. The aim of this study was to assess predictors of elevated HR following HT and its impact on outcomes., Methods and Results: We retrospectively evaluated 394 patients who underwent HT at 2 academic medical centers from 2005 to 2016. Patients were divided into 2 groups based on HR 1 year after HT: HR ≥95 beats/min (n = 162; 41%) and HR <95 beats/min (n = 232; 59%). Median follow-up time was 6.6 (interquartile range [IQR] 2.2-7.5) years. HR ≥95 beats/min 1 year after HT was associated with younger donor age, whereas HR <95 beats/min was associated with heavy donor alcohol use and African-American recipient race. Left ventricular (LV) end-diastolic dimension, mass, and ejection fraction were lower and E/E' higher in the HR ≥95 group at the time of the last follow up. HR ≥95 beats/min at 1 year after HT was independently associated with the development of cardiac allograft vasculopathy and increased mortality., Conclusions: HR ≥95 beats/min 1 year after HT is associated with a reduction in LV size and function, increased incidence of cardiac allograft vasculopathy, and reduced survival. Studies investigating the effect of medical HR reduction on post-HT outcomes are warranted., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: There are currently no data on the efficacy of angiotensin-converting enzyme inhibitors (ACEis) in Hispanic patients with heart failure (HF) and reduced ejection fraction (HFrEF). We aimed to investigate the effect of adding ACEis to beta-blockers on mortality and hospitalization for HF exacerbation in patients with HFrEF stratified by race/ethnicity., Methods and Results: From Montefiore Medical Center's 3 large hospitals, 618 consecutive patients with HFrEF (left ventricular ejection fraction [LVEF] <35%) who were on a beta-blocker were retrospectively identified. Patients were divided into 2 groups based on whether or not they were on an ACEi for 24 consecutive months. Propensity score matching including all baseline characteristics was performed and patients were then categorized into 3 groups: African Americans, Hispanics, and Whites/Caucasians. We evaluated 2-year all-cause mortality and 2-year hospitalization for HF exacerbation. Of 618 patients, 66% were categorized as ACEi and 34% as no-ACEi. Four hundred twenty-seven patients were matched 2:1 between the ACEi and no-ACEi groups. After matching, overall 2-year mortality and hospitalization rates were similar between ACEi and no-ACEi (12.4% vs 17.8%, hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.38-1.16; P = .14; and 8.1% vs 9.5%, HR 0.84, 95% CI 0.44-1.60; P = .6; respectively). After stratifying patients based on race/ethnicity, ACEi demonstrated a lower 2-year mortality compared with no-ACEi in Hispanics (9.8% vs 28.4%, HR 0.33, 95% CI 0.13-0.87; P = .018) but not in African Americans (17.0% vs 11.8%, HR 0.94, 95% CI 0.34-2.65; P = .91) or Whites (9.2% vs 10.3%, HR 0.89, 95% CI 0.29-2.74; P = .83). Two-year hospitalization was not different between ACEi and no-ACEi in Hispanics, African Americans, or Whites (all P = NS). In multivariate analysis, ACEi therapy was an independent predictor of lower 2-year mortality (HR 0.33, 95% CI 0.12-0.89; P = .028) in Hispanics only., Conclusions: In this retrospective propensity-matched study of patients with HFrEF who were on a beta-blocker, ACEi therapy was associated with greater mortality reduction in Hispanic patients compared with African Americans and Whites. These findings need to be confirmed in large national studies that include a significant fraction of Hispanic patients., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Heart failure with preserved ejection fraction (HFpEF) has been increasingly recognized as a leading cause of pulmonary hypertension (HFpEF-PH). It remains unknown how HFpEF-PH fares in relation to systolic HF (reduced ejection fraction)-induced PH (HFrEF-PH). Therefore, we sought to determine the long-term morbidity and mortality of HFpEF-PH and HFrEF-PH., Methods and Results: We studied all patients over a 6-year period with symptomatic HF and severe PH (PASP ≥65 mm Hg) in The Bronx, New York. We classified patients as having either preserved (≥50%) or reduced (≤35%) left ventricular ejection fraction. Trends in mortality and HF readmission rates were defined in 650 patients (HFrEF-PH: n = 277; HFpEF-PH: n = 373). HFpEF-PH patients were older and more often female and white. HFrEF-PH patients were more often black, had ischemic cardiomyopathy, and were on typical HF drug regimens. Patients with HFpEF-PH had a significantly increased all-cause 5-year mortality (52% vs 42%; P = .024). HFpEF-PH was a significant predictor of mortality (adjusted hazard ratio 1.70; P = .012). Patients with HFrEF-PH had more HF readmissions (≥1) than patients with HFpEF-PH (28.6% vs 15%; P = .003), especially within the 1st year (9.1% vs 1.7%; P = .005)., Conclusions: Patients with HFrEF-PH and HFpEF-PH have a significantly elevated long-term mortality, with HFpEF-PH having a higher 5-year mortality rate. These findings testify to the overall poor prognosis of World Health Organization Group II PH, especially HFpEF-PH., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Hyponatremia is known to be an important marker and prognosticator in left-sided heart failure. However, less is known about the significance of hyponatremia in pulmonary hypertension, particularly in the absence of left ventricular dysfunction., Methods and Results: We identified 635 patients with pulmonary hypertension and preserved ejection fraction who were normonatremic (n = 493) or hyponatremic (n = 142). End points were mortality and readmission at 1 year. Overall, 27% of all of the patients died within 1 year. Hyponatremia was significantly associated with an increased rate of 1-year mortality (hazard ratio [HR] 1.82, 95% confidence interval [CI] 1.27-2.61; P = .001) and trended toward an association with the composite of mortality and readmission (HR 1.25, 95% CI 0.97-1.62; P = .08). Additionally, the severity of hyponatremia was directly related to the rate of 1-year mortality (P < .001)., Conclusions: Hyponatremia is an indicator of poor prognosis in patients with echocardiographic evidence of pulmonary hypertension., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Relative effectiveness of carvedilol and metoprolol succinate has never been compared in patients with heart failure (HF)., Methods and Results: From January 1998 to December 2008, 3,716 consecutive patients with ejection fraction (EF) ≤40%, initiated and maintained on carvedilol or metoprolol succinate, were enrolled and followed until June 2010. The primary end point was all-cause mortality, and the secondary end points were readmissions from HF and follow up EFs at 1, 3, and 5 years. HF etiology (ischemic or nonischemic) was a significant effect modifier, and separate analysis was performed for these subcohorts. Compared with those on carvedilol, patients on metoprolol succinate were less likely to experience mortality in the ischemic HF cohort (adjusted hazard ratio [aHR] 0.54, 95% confidence interval [CI] 0.43-0.66) but were more likely to die in the nonischemic HF cohort (aHR 1.18, 95% CI 1.10-1.28). Follow-up EF was similar by type of beta-blocker used in both ischemic and nonischemic HF cohorts. Furthermore, no significant difference was noted in the incidence of HF hospitalizations by beta-blocker type used in both ischemic and nonischemic HF cohorts., Conclusions: Metoprolol succinate was associated with an improved survival in patients with ischemic HF, and carvedilol was associated with an improved survival in patients with nonischemic HF., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Quality of life (QOL) was a prespecified secondary end point in the Beta-Blocker Evaluation of Survival Trial. The Beta-Blocker Evaluation of Survival Trial used four QOL questionnaires to evaluate patient health status over time in response to treatment with placebo or bucindolol. The goal of the current study was to determine the relationship between the different questionnaires, assess the effect of treatment on health status, and evaluate the association between changes in health status and prognosis., Methods: The San Diego Heart Failure (SDHF), Minnesota Living with Heart Failure (MLHF), Patient Global Assessment (PGA), and Physician Global Assessment (PhyGA) questionnaires were measured at baseline through 48 months of follow-up. For SDHF and MLHF, changes from baseline were calculated. Spearman correlation was used to assess relationships, and Cox Proportional Hazards regression was used to predict time to all-cause mortality, and mortality or heart failure hospitalization, bivariately and multivariately. To determine whether beta-blocker treatment affected QOL, the Wilcoxon rank-sum test was used to compare treatment groups., Results: At 12 months, SDHF (r = +0.56, P = .0001), PGA (r = +0.36, P = .0001), and PhyGA (r = +0.37, P = .0001) correlated with MLHF. SDHF (P = .0001), MLHF (P = .0004), PGA (P = .0001), and PhyGA (P = .0001) were all strongly associated with all-cause mortality, with low values of each associated with a lower hazard. For the combined end point of all-cause mortality or heart failure hospitalization, change in QOL with each instrument had a P value of .0001. At 12 months, bucindolol-treated patients had improvement in both PhyGA and PGA compared with placebo; neither the SDHF nor the MLWF instrument distinguished between the two treatment groups unless a worst-rank assignment was used for patients who died., Conclusion: The four instruments correlate with each other and predict clinical end points, suggesting that each is a valid measure of health status. According to the PGA and the PhyGA, bucindolol improves QOL.

Background: Peak oxygen consumption (VO(2)) is an important criterion for listing patients for cardiac transplantation. Beta-blockers improve survival without affecting peak VO(2). We questioned the value of peak VO(2) in predicting outcome in patients treated with beta-blockers., Methods and Results: We reviewed the records of 127 patients who had peak VO(2) measured at baseline and were subsequently treated with beta-blockers for at least 3 months. We divided the patients into 2 groups with peak oxygen consumption >14 (VO(2) hi) and < or =14 ml.kg.min (VO(2) lo). VO(2) hi had 109 patients and VO(2) lo had 18 patients. The combined end-point of death or cardiac transplantation was compared between groups. Mean peak VO(2) and left ventricular ejection fraction were lower in VO(2) lo versus VO(2) hi: 12.4+/-1.4 ml.kg.min versus 19.1+/-3.9 ml.kg.min and 17+/-8% versus 21+/-9%, respectively. At 30 months, the percentage of patients who did not reach the combined end-point was 94% in VO(2) lo versus 79% in VO(2) hi (P=.47). In multivariate analysis, only changes in heart rate and LVEF from baseline to follow-up were predictive of survival., Conclusions: Current peak VO(2) cutoff does not predict survival without transplantation of patients who tolerate chronic treatment with beta-blockers.