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4. 2-Year Outcomes of an Atrial Shunt Device in HFpEF/HFmrEF: Results From REDUCE LAP-HF II

Author

Gustafsson, Finn, Petrie, Mark C., Komtebedde, Jan, Swarup, Vijendra, Winkler, Sebastian, Hasenfuß, Gerd, Borlaug, Barry A., Mohan, Rajeev C., Flaherty, James D., Sverdlov, Aaron L., Fail, Peter S., Chung, Eugene S., Lurz, Philipp, Lilly, Scott, Kaye, David M., Cleland, John G.F., Cikes, Maja, Leon, Martin B., Cutlip, Donald E., van Veldhuisen, Dirk J., Solomon, Scott D., and Shah, Sanjiv J.

Published
2024
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6. The Impact of Ferric Derisomaltose on Cardiovascular and Noncardiovascular Events in Patients With Anemia, Iron Deficiency, and Heart Failure With Reduced Ejection Fraction

Author

Kalra, Paul, Cowan, Elena, Howe, Serena, Turner, Charlotte, Austin, Rosalynn, Lane, Rebeca, Rogers, Paula, Foley, Paul, Chandrasekaran, Badri, Fraile, Eva, Kyeremeh, Lynsey, Ahmed, Fozia, Petrie, Mark, McGregor, Lorraine, Osmanska, Joanna, Graham, Fraser, Lang, Ninian, Meyer, Barbara, Ahmad, Faheem, Squire, Iain, Fisher, Jude, Kalra, Philip, Summersgill, Christina, Adeniji, Katarzyna, Chinnadurai, Rajkumar, Ludman, Andrew, Massimo, Lisa, Hardman, Clare, Sykes, Daisy, Cowburn, Peter, Frank, Sarah, Smith, Simon, Japp, Alan, Anwar, Mohamed, Whittington, Beth, Seed, Alison, Ray, Robin, Sookhoo, Vennessa, Al-Mohammad, Abdallah, Middle, Janet, Housley, Kay, Clark, Andrew, Bulemfu, Jeanne, Critoph, Christopher, Chong, Victor, Wood, Stephen, Szwejkowski, Benjamin, Lang, Chim, Duff, Jackie, MacDonald, Susan, Schiff, Rebekah, Donnelly, Patrick, Nageh, Thuraia, Kunhunny, Swapna, Gardner, Roy, McAdam, Marion, McPherson, Elizabeth, Banerjee, Prithwish, Sear, Eleanor, Edwards, Nigel, Glover, Jason, Pellicori, Pierpaolo, Murphy, Clare, Cooke, Justin, Spencer, Charles, Francis, Mark, Matthews, Iain, McKie, Hayley, Marshall, Andrew, Large, Janet, Stratford, Jenny, Clifford, Piers, Tavares, Sara, Boos, Christopher, Keeling, Philip, Hughes, Debbie, Wong, Aaron, Jones, Deborah, James, Alex, Williams, Rhys, Leslie, Stephen, Finlayson, Jim, Hannah, Andrew, Campbell, Philip, Walsh, John, Quinn, Jane, Chapman, Callum, Piper, Susan, Gupta, Preeti, Sim, Victor, Knibbs, Lucy, Lyons, Kristopher, Dixon, Lana, Petrie, Colin, Wong, Yuk-ki, Labinjoh, Catherine, Duckett, Simon, Massey, Ian, Savage, Henry, Matias, Sofia, Ramirez, Jonaifah, Manisty, Charlotte, Hussain, Ifza, Sankaranarayanan, Rajiv, Davis, Gershan, McClure, Samuel, Baxter, John, Wicks, Eleanor, Sobolewska, Jolanta, Murphy, Jerry, Elzayat, Ahmed, Cooke, Alastair, Wright, Jay, Williams, Simon, Muthumala, Amal, Chaggar, Parminder, Ellis, Gethin, Welch, Mandie, Bulugahapitiya, Sudantha, Jackson, Thomas, Pakrashi, Tapesh, Bakhai, Ameet, Gamma, Reto, Ellery, Susan, Jenkins, Geraint, Nightingale, Angus, Thomson, Elizabeth, Ford, Ian, Robertson, Michele, Greenlaw, Nicola, Wetherall, Kirsty, Clarke, Ross, Graham, Christopher, Kean, Sharon, Stevenson, Alan, Wilson, Robbie, Boyle, Sarah, McHugh, John, Hall, Lisa, Woollard, Joanne, Brunton, Claire, Dinnett, Eleanor, Reid, Amanda, Nicholls, Jill, Cunnington, Anna, Douglas, Elizabeth, Fegen, Margaret, Jones, Marc, McGowan, Sheila, Ross, Barbara, Sandu, Pamela, Surtees, Pamela, Stuart, Debra, Cleland, John G.F., Ahmed, Fozia Z., Cowburn, Peter J., Critoph, Chris, Kalra, Philip A., Lane, Rebecca E., Petrie, Mark C., Robertson, Michelle, and Kalra, Paul R.

Published
2024
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7. Cardiovascular and Renal Treatment in Heart Failure Patients With Hyperkalemia or High Risk of Hyperkalemia: Rationale and Design of the CARE-HK in HF Registry

Author

GREENE, STEPHEN J., BÖHM, MICHAEL, BOZKURT, BIYKEM, BUTLER, JAVED, CLELAND, JOHN G.F., COATS, ANDREW J.S., DESAI, NIHAR R., GROBBEE, DIEDERICK E., KELEPOURIS, ELLIE, PINTO, FAUSTO, ROSANO, GIUSEPPE, MORIN, ISABELLE, SZECSÖDY, PETER, FABIEN, SOLENN, WAECHTER, SANDRA, CRESPO-LEIRO, MARIA G., HÜLSMANN, MARTIN, KEMPF, TIBOR, PFISTER, OTMAR, POULEUR, ANNE-CATHERINE, SAUER, ANDREW J., SAXENA, MANISH, SCHULZ, MARTIN, VOLTERRANI, MAURIZIO, ANKER, STEFAN D., and KOSIBOROD, MIKHAIL N.

Published
2024
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12. Global Variations According to Sex in Patients Hospitalized for Heart Failure in the REPORT-HF Registry

Author

Tromp, Jasper, Ezekowitz, Justin A., Ouwerkerk, Wouter, Chandramouli, Chanchal, Yiu, Kai Hang, Angermann, Christiane E., Dahlstrom, Ulf, Ertl, Georg, Hassanein, Mahmoud, Perrone, Sergio V., Ghadanfar, Mathieu, Schweizer, Anja, Obergfell, Achim, Dickstein, Kenneth, Collins, Sean P., Filippatos, Gerasimos, Cleland, John G.F., and Lam, Carolyn S.P.

Published
2023
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14. Percutaneous repair of moderate‐to‐severe or severe functional mitral regurgitation in patients with symptomatic heart failure: Baseline characteristics of patients in the RESHAPE‐HF2 trial and comparison to COAPT and MITRA‐FR trials

Author

Anker, Stefan D., primary, Friede, Tim, additional, von Bardeleben, Ralph Stephan, additional, Butler, Javed, additional, Khan, Muhammad Shahzeb, additional, Diek, Monika, additional, Heinrich, Jutta, additional, Geyer, Martin, additional, Placzek, Marius, additional, Ferrari, Roberto, additional, Abraham, William T., additional, Alfieri, Ottavio, additional, Auricchio, Angelo, additional, Bayes‐Genis, Antoni, additional, Cleland, John G.F., additional, Filippatos, Gerasimos, additional, Gustafsson, Finn, additional, Haverkamp, Wilhelm, additional, Kelm, Malte, additional, Kuck, Karl‐Heinz, additional, Landmesser, Ulf, additional, Maggioni, Aldo P., additional, Metra, Marco, additional, Ninios, Vlasis, additional, Petrie, Mark C., additional, Rassaf, Tienush, additional, Ruschitzka, Frank, additional, Schäfer, Ulrich, additional, Schulze, P. Christian, additional, Spargias, Konstantinos, additional, Vahanian, Alec, additional, Zamorano, Jose Luis, additional, Zeiher, Andreas, additional, Karakas, Mahir, additional, Koehler, Friedrich, additional, Lainscak, Mitja, additional, Öner, Alper, additional, Mezilis, Nikolaos, additional, Theofilogiannakos, Efstratios K, additional, Ninios, Ilias, additional, Chrissoheris, Michael, additional, Kourkoveli, Panagiota, additional, Papadopoulos, Konstantinos, additional, Smolka, Grzegorz, additional, Wojakowski, Wojciech, additional, Reczuch, Krzysztof, additional, Pinto, Fausto J., additional, Zmudka, Krzysztof, additional, Kalarus, Zbigniew, additional, Adamo, Marianna, additional, Santiago‐Vacas, Evelyn, additional, Ruf, Tobias Friedrich, additional, Gross, Michael, additional, Tongers, Joern, additional, Hasenfuß, Gerd, additional, Schillinger, Wolfgang, additional, and Ponikowski, Piotr, additional

Published
2024
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16. Precision Phenotyping of Dilated Cardiomyopathy Using Multidimensional Data

Author

Tayal, Upasana, Verdonschot, Job A.J., Hazebroek, Mark R., Howard, James, Gregson, John, Newsome, Simon, Gulati, Ankur, Pua, Chee Jian, Halliday, Brian P., Lota, Amrit S., Buchan, Rachel J., Whiffin, Nicola, Kanapeckaite, Lina, Baruah, Resham, Jarman, Julian W.E., O’Regan, Declan P., Barton, Paul J.R., Ware, James S., Pennell, Dudley J., Adriaans, Bouke P., Bekkers, Sebastiaan C.A.M., Donovan, Jackie, Frenneaux, Michael, Cooper, Leslie T., Januzzi, James L., Jr., Cleland, John G.F., Cook, Stuart A., Deo, Rahul C., Heymans, Stephane R.B., and Prasad, Sanjay K.

Published
2022
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17. The Effect of Spironolactone in Patients With Obesity at Risk for Heart Failure: Proteomic Insights from the HOMAGE Trial

Author

Verdonschot, Job A.J., Ferreira, JoÃo Pedro, Pizard, Anne, Pellicori, Pierpaolo, Brunner La Rocca, Hans-Peter, Clark, Andrew L., Cosmi, Franco, Cuthbert, Joe, Girerd, Nicolas, Waring, Olivia J., Henkens, Michiel H.T.M., Mariottoni, Beatrice, Petutschnigg, Johannes, Rossignol, Patrick, Hazebroek, Mark R., Cleland, John G.F., Zannad, Faiez, and Heymans, Stephane R.B.

Published
2022
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19. Hospitalization for Heart Failure in the United States, UK, Taiwan, and Japan: An International Comparison of Administrative Health Records on 413,385 Individual Patients

Author

Sundaram, VARUN, NAGAI, TOSHIYUKI, CHIANG, CHERN-EN, REDDY, YOGESH N.V., CHAO, TZE-FAN, ZAKERI, ROSITA, BLOOM, CHLOE, NAKAI, MICHIKAZU, NISHIMURA, KUNIHIRO, HUNG, CHUNG-LIEH, MIYAMOTO, YOSHIHIRO, YASUDA, SATOSHI, BANERJEE, AMITAVA, ANZAI, TOSHIHISA, SIMON, DANIEL I., RAJAGOPALAN, SANJAY, CLELAND, JOHN G.F., SAHADEVAN, JAYAKUMAR, and QUINT, JENNIFER K.

Published
2022
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20. Adjudication of Hospitalizations and Deaths in the IRONMAN Trial of Intravenous Iron for Heart Failure.

Author

Cleland, John G.F., Pellicori, Pierpaolo, Graham, Fraser J., Lane, Rebecca, Petrie, Mark C., Ahmed, Fozia, Squire, Iain B., Ludman, Andrew, Japp, Alan, Al-Mohammad, Abdallah, Clark, Andrew L., Szwejkowski, Ben, Critoph, Chris, Chong, Victor, Schiff, Rebekah, Nageh, Thuraia, Glover, Jason, McMurray, John J.V., Thomson, Elizabeth A., and Robertson, Michele

Subjects
*HEART failure, *HOSPITAL care, *IRON, *IRON deficiency
Published
2024
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21. Implantable Cardioverter Defibrillator and Resynchronization Therapy in Patients With Overt Chronic Kidney Disease: JACC State-of-the-Art Review.

Author

Varga, Cecilia R., Cleland, John G.F., Abraham, William T., Lip, Gregory Y.H., Leyva, Francisco, and Hatamizadeh, Parta

Subjects
*CHRONIC kidney failure, *CARDIO-renal syndrome, *CARDIAC pacing, *PATIENT selection, *ARRHYTHMIA, *IMPLANTABLE cardioverter-defibrillators
Abstract

Heart failure and chronic kidney disease are common and clinically important conditions that regularly coexist. Electrophysiologic changes of advanced heart failure often result in abnormal conduction, causing dyssynchronous contraction, and development of ventricular arrhythmias, which can lead to sudden cardiac arrest. In the last 2 decades, implantable cardioverter-defibrillator and cardiac resynchronization therapy devices have been developed to address these complications. However, when the coexisting chronic kidney disease is advanced, the associated pathophysiologic cardiovascular changes can alter the efficacy and safety of those interventions and complicate the management. This review explores the impact of comorbid advanced heart failure and advanced chronic kidney disease on the efficacy and safety of implantable cardioverter-defibrillator and cardiac resynchronization therapy, the currently available evidence, and potential future directions. [Display omitted] • The efficacy and safety of ICD and CRT devices have not been established for patients with advanced CKD, and available data suggest that they may be less favorable than in patients without advanced CKD. • Factors limiting the effectiveness of these devices in patients with advanced CKD include the frequency of nonshockable arrhythmias, increased defibrillation thresholds, noncapture, myocardial fibrosis, coexisting atrial fibrillation, limited use of guideline-directed therapies for heart failure, and relatively high rates of nonarrhythmic mortality. • Randomized trials are needed to improve selection of patients with advanced CKD for these device-based therapies. [ABSTRACT FROM AUTHOR]

Published
2024
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23. Prognostic Significance of Nonischemic Myocardial Fibrosis in Patients With Normal LV Volumes and Ejection-Fraction

Author

Lota, Amrit S., Tsao, Adam, Owen, Ruth, Halliday, Brian P., Auger, Dominique, Vassiliou, Vassilios S., Tayal, Upasana, Almogheer, Batool, Vilches, Silvia, Al-Balah, Amer, Patel, Akhil, Mouy, Florence, Buchan, Rachel, Newsome, Simon, Gregson, John, Ware, James S., Cook, Stuart A., Cleland, John G.F., Pennell, Dudley J., and Prasad, Sanjay K.

Published
2021
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31. Proteomic and Mechanistic Analysis of Spironolactone in Patients at Risk for HF

Author

Ferreira, João Pedro, Verdonschot, Job, Wang, Ping, Pizard, Anne, Collier, Timothy, Ahmed, Fozia Z., Brunner-La-Rocca, Hans-Peter, Clark, Andrew L., Cosmi, Franco, Cuthbert, Joe, Díez, Javier, Edelmann, Frank, Girerd, Nicolas, González, Arantxa, Grojean, Stéphanie, Hazebroek, Mark, Khan, Javed, Latini, Roberto, Mamas, Mamas A., Mariottoni, Beatrice, Mujaj, Blerim, Pellicori, Pierpaolo, Petutschnigg, Johannes, Pieske, Burkert, Rossignol, Patrick, Rouet, Philippe, Staessen, Jan A., Cleland, John G.F., Heymans, Stephane, and Zannad, Faiez

Published
2021
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32. Impact of Geographic Region on the COMMANDER-HF Trial

Author

Ferreira, João Pedro, Cleland, John G.F., Lam, Carolyn S.P., van Veldhuisen, Dirk J., Byra, William M., La Police, David A., Anker, Stefan D., Mehra, Mandeep R., Leroy, Céline, Eschwege, Valerie, Toussaint-Hacquard, Marie, Rossignol, Patrick, Greenberg, Barry, and Zannad, Faiez

Published
2021
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34. Epidemiology and risk factors for hyperkalaemia in heart failure

Author

Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Grobbee, Diederick E., Filippatos, Gerasimos, Desai, Nihar R., Coats, Andrew J.S., Pinto, Fausto, Rosano, Giuseppe M.C., Cleland, John G.F., Kammerer, Jennifer, de Arellano, Antonio Ramirez, Global Health, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Grobbee, Diederick E., Filippatos, Gerasimos, Desai, Nihar R., Coats, Andrew J.S., Pinto, Fausto, Rosano, Giuseppe M.C., Cleland, John G.F., Kammerer, Jennifer, and de Arellano, Antonio Ramirez

Published
2024

36. A nationwide, population‐based study on specialized care for acute heart failure throughout the COVID‐19 pandemic.

Author

Cannata, Antonio, Mizani, Mehrdad A., Bromage, Daniel I., Piper, Susan E., Hardman, Suzanna M.C., Sudlow, Cathie, de Belder, Mark, Deanfield, John, Gardner, Roy S., Clark, Andrew L., Cleland, John G.F., and McDonagh, Theresa A.

Subjects
COVID-19 pandemic, HEART failure, HEART failure patients, CARDIOVASCULAR disease related mortality, OVERALL survival
Abstract

Aims: The COVID‐19 pandemic disrupted the delivery of care for patients with heart failure (HF), leading to fewer HF hospitalizations and increased mortality. However, nationwide data on quality of care and long‐term outcomes across the pandemic are scarce. Methods and results: We used data from the National Heart Failure Audit (NHFA) linked to national records for hospitalization and deaths. We compared pre‐COVID (2018–2019), COVID (2020), and late/post‐COVID (2021–2022) periods. Data for 227 250 patients admitted to hospital with HF were analysed and grouped according to the admission year and the presence of HF with (HFrEF) or without reduced ejection fraction (non‐HFrEF). The median age at admission was 81 years (interquartile range 72–88), 55% were men (n = 125 975), 87% were of white ethnicity (n = 102 805), and 51% had HFrEF (n = 116 990). In‐hospital management and specialized cardiology care were maintained throughout the pandemic with an increasing percentage of patients discharged on disease‐modifying medications over time (p < 0.001). Long‐term outcomes improved over time (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.90–0.95, p < 0.001), mainly driven by a reduction in cardiovascular death. Receiving specialized cardiology care was associated with better long‐term outcomes both for those who had HFrEF (HR 0.79, 95% CI 0.77–0.82, p < 0.001) and for those who had non‐HFrEF (HR 0.87, 95% CI 0.85–0.90, p < 0.001). Conclusions: Despite the disruption of healthcare systems, the clinical characteristics of patients admitted with HF were similar and the overall standard of care was maintained throughout the pandemic. Long‐term survival of patients hospitalized with HF continued to improve after COVID‐19, especially for HFrEF. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Administration of ferric derisomaltose for iron deficiency and heart failure during hospital admission or at the clinic – insights from the IRONMAN trial.

Author

Lee, Matthew M.Y., Petrie, Mark C., Cleland, John G.F., Donnelly, Patrick, Francis, Mark, Hannah, Andrew, Japp, Alan G., Labinjoh, Catherine, Lang, Ninian N., Manisty, Charlotte, Petrie, Colin J., Piper, Susan E., Williams, Simon G., Ford, Ian, and Kalra, Paul R.

Subjects
HEART failure patients, SYSTOLIC blood pressure, ANGIOTENSIN-receptor blockers, ACE inhibitors, ACUTE coronary syndrome, HEART failure
Published
2024
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43. Impact of Renal Impairment on Beta-Blocker Efficacy in Patients With Heart Failure

Author

Kotecha, Dipak, Gill, Simrat K., Flather, Marcus D., Holmes, Jane, Packer, Milton, Rosano, Giuseppe, Böhm, Michael, McMurray, John J.V., Wikstrand, John, Anker, Stefan D., van Veldhuisen, Dirk J., Manzano, Luis, von Lueder, Thomas G., Rigby, Alan S., Andersson, Bert, Kjekshus, John, Wedel, Hans, Ruschitzka, Frank, Cleland, John G.F., Damman, Kevin, Redon, Josep, and Coats, Andrew J.S.

Published
2019
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47. The Impact of Ferric Derisomaltose on Cardiovascular and Noncardiovascular Events in Patients With Anemia, Iron Deficiency, and Heart Failure With Reduced Ejection Fraction.

Author

Ray, Robin, Ford, Ian, Cleland, John G.F., Graham, Fraser, Ahmed, Fozia Z., Al-Mohammad, Abdallah, Cowburn, Peter J., Critoph, Chris, Kalra, Philip A., Lane, Rebecca E., Ludman, Andrew, Pellicori, Pierpaolo, Petrie, Mark C., Robertson, Michelle, Seed, Alison, Squire, Iain, and Kalra, Paul R.

Abstract

• This analysis reports the effects of intravenous ferric derisomaltose (FDI) in a population of patients with heart failure and iron deficiency anemia in the IRONMAN trial. • Intravenous FDI was well-tolerated and improved quality of life and may reduce morbidity and mortality in patients with heart failure, anemia, and iron deficiency. • This will help shared decision-making in the management of patients with heart failure in countries where intravenous FDI is only licensed for the treatment of iron deficiency when accompanied by anemia. In some countries, intravenous ferric derisomaltose (FDI) is only licensed for treating iron deficiency with anemia. Accordingly, we investigated the effects of intravenous FDI in a subgroup of patients with anemia in the IRONMAN (Effectiveness of Intravenous (IV) Iron Treatment Versus Standard Care in Patients With Heart Failure and Iron Deficiency) trial. IRONMAN enrolled patients with heart failure, a left ventricular ejection fraction of ≤45%, and iron deficiency (ferritin <100 µg/L or transferrin saturation of <20%), 771 (68%) of whom had anemia (hemoglobin <12 g/dL for women and <13 g/dL for men). Patients were randomized, open label, to FDI (n = 397) or usual care (n = 374) and followed for a median of 2.6 years. The primary end point, recurrent hospitalization for heart failure and cardiovascular death, occurred less frequently for those assigned to FDI (rate ratio 0.78, 95% confidence interval 0.61–1.01; P =.063). First event analysis for cardiovascular death or hospitalization for heart failure, less affected by the coronavirus disease 2019 pandemic, gave similar results (hazard ratio 0.77, 95% confidence interval 0.62–0.96; P =.022). Patients randomized to FDI reported a better Minnesota Living with Heart Failure quality of life, for overall (P =.013) and physical domain (P =.00093) scores at 4 months. In patients with iron deficiency anemia and heart failure with reduced left ventricular ejection fraction, intravenous FDI improves quality of life and may decrease cardiovascular events. [Display omitted] [ABSTRACT FROM AUTHOR]

Published
2024
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48. Proteomic profiles of left atrial volume and its influence on response to spironolactone: Findings from the HOMAGE trial and STANISLAS cohort.

Author

Kobayashi, Masatake, Ferreira, João Pedro, Duarte, Kevin, Bresso, Emmanuel, Huttin, Olivier, Bozec, Erwan, Brunner La Rocca, Hans‐Peter, Delles, Christian, Clark, Andrew L., Edelmann, Frank, González, Arantxa, Heymans, Stephane, Pellicori, Pierpaolo, Petutschnigg, Johannes, Verdonschot, Job A.J., Rossignol, Patrick, Cleland, John G.F., Zannad, Faiez, and Girerd, Nicolas

Subjects
BRAIN natriuretic factor, LEFT heart atrium, SOMATOMEDIN, PROTEOMICS, SPIRONOLACTONE
Abstract

Aims: High left ventricular filling pressure increases left atrial volume and causes myocardial fibrosis, which may decrease with spironolactone. We studied clinical and proteomic characteristics associated with left atrial volume indexed by body surface area (LAVi), and whether LAVi influences the response to spironolactone on biomarker expression and clinical variables. Methods and results: In the HOMAGE trial, where people at risk of heart failure were randomized to spironolactone or control, we analysed 421 participants with available LAVi and 276 proteomic measurements (Olink) at baseline, month 1 and 9 (mean age 73 ± 6 years; women 26%; LAVi 32 ± 9 ml/m2). Circulating proteins associated with LAVi were also assessed in asymptomatic individuals from a population‐based cohort (STANISLAS; n = 1640; mean age 49 ± 14 years; women 51%; LAVi 23 ± 7 ml/m2). In both studies, greater LAVi was significantly associated with greater left ventricular masses and volumes. In HOMAGE, after adjustment and correction for multiple testing, greater LAVi was associated with higher concentrations of matrix metallopeptidase‐2 (MMP‐2), insulin‐like growth factor binding protein‐2 (IGFBP‐2) and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) (false discovery rates [FDR] <0.05). These associations were externally replicated in STANISLAS (all FDR <0.05). Among these biomarkers, spironolactone decreased concentrations of MMP‐2 and NT‐proBNP, regardless of baseline LAVi (pinteraction > 0.10). Spironolactone also significantly reduced LAVi, improved left ventricular ejection fraction, lowered E/e', blood pressure and serum procollagen type I C‐terminal propeptide (PICP) concentration, a collagen synthesis marker, regardless of baseline LAVi (pinteraction > 0.10). Conclusion: In individuals without heart failure, LAVi was associated with MMP‐2, IGFBP‐2 and NT‐proBNP. Spironolactone reduced these biomarker concentrations as well as LAVi and PICP, irrespective of left atrial size. [ABSTRACT FROM AUTHOR]

Published
2024
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49. High Risk of Stroke in Patients With Worsening Heart Failure, Reduced Ejection Fraction, Coronary Heart Disease and Sinus Rhythm: Risk Prediction Score Analysis From the COMMANDER-HF Trial.

Author

MONZO, LUCA, GIRERD, NICOLAS, FERREIRA, JOÃO PEDRO, LAMIRAL, ZOHRA, ANKER, STEFAN D., CLELAND, JOHN G.F., KONDO, TORU, MCMURRAY, JOHN J.V., LAM, CAROLYN S.P., MEHRA, MANDEEP R., VELDHUISEN, DIRK J. VAN, GREENBERG, BARRY, and ZANNAD, FAIEZ

Abstract

• Clinical settings influence stroke prediction scores in HFrEF with sinus rhythm. • Rivaroxaban is associated with a reduced stroke risk in HFrEF with sinus rhythm and high D-dimer. • The predictive value of stroke risk score should be evaluated further. Patients with heart failure with reduced ejection fraction (HFrEF) and sinus rhythm have a heightened risk of stroke. Whether anticoagulation benefits these patients is uncertain. In this post hoc analysis of the A Study to Assess the Effectiveness and Safety of Rivaroxaban in Reducing the Risk of Death, Myocardial Infarction, or Stroke in Participants with Heart Failure and Coronary Artery Disease Following an Episode of Decompensated Heart Failure (COMMANDER-HF) trial we evaluated how a previously validated risk model consisting of 3 variables (history of prior stroke, insulin-treated diabetes, and N-terminal pro-B-type natriuretic peptide level) would perform, compared with plasma d -dimer, for stroke prediction and estimation of the benefit of low-dose rivaroxaban. Stroke risk and treatment effect were computed across risk score and plasma d -dimer tertiles. Risk score was available in 58% of the COMMANDER-HF population (n = 2928). Over a median follow-up of 512 days (range 342–747 days), 60 patients experienced a stroke (14.6 per 1000 patient-years). The risk model did not identify patients at higher risk of stroke and showed a low overall prognostic performance (C-index = 0.53). The effect of rivaroxaban on stroke was homogeneous across risk score tertiles (P -interaction =.67). Among patients in whom the risk score was estimated, d -dimer was available in 2343 (80%). d -dimer had an acceptable discrimination performance for stroke prediction (C-index = 0.66) and higher plasma d -dimer concentrations were associated with higher rates of stroke (ie, tertile 3 vs tertile 1, hazard ratio 3.65, 95% confidence interval 1.59–8.39, P =.002). Treatment with low-dose rivaroxaban reduced the incidence of stroke in patients at highest risk by d -dimer levels (ie, >515 ng/mL, hazard ratio 0.42, 95% confidence interval 0.18–0.95, P -interaction =.074), without any safety concerns. In our analysis, plasma d -dimer concentrations performed better than a previously described 3-variable risk score for stroke prediction in patients with heart failure with reduced ejection fraction, a recent clinical worsening and sinus rhythm as enrolled in the COMMANDER-HF trial. In these patients, a raised plasma d -dimer concentration identified patients who might benefit most from rivaroxaban. [ABSTRACT FROM AUTHOR]

Published
2024
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50. Comorbidities and clinical response to cardiac resynchronization therapy: Patient‐level meta‐analysis from eight clinical trials.

Author

Fudim, Marat, Dalgaard, Frederik, Friedman, Daniel J., Abraham, William T., Cleland, John G.F., Curtis, Anne B., Gold, Michael R., Kutyifa, Valentina, Linde, Cecilia, Ali‐Ahmed, Fatima, Tang, Anthony, Olivas‐Martinez, Antonio, Inoue, Lurdes Y.T., Al‐Khatib, Sana M., and Sanders, Gillian D.

Subjects
CARDIAC pacing, HEART failure, CLINICAL trials, CORONARY artery disease, ATRIAL fibrillation, MORTALITY
Abstract

Aims: Patients with heart failure usually have several other medical conditions that might alter the effects of interventions. We investigated whether the burden of comorbidity modified the clinical response to cardiac resynchronization therapy (CRT). Methods and results: Original patient‐level data from eight randomized trials exploring the effects of CRT versus no CRT were pooled (BLOCK‐HF, MIRACLE, MIRACLE‐ICD, MIRACLE‐ICD II, RAFT, COMPANION, MADIT‐CRT and REVERSE). A prior history of the following comorbidities was considered: episodic or persistent atrial fibrillation (n = 920), coronary artery disease (n = 3732), diabetes (n = 2171), and hypertension (n = 3353). Patients were classified into three groups based on the number of comorbidities: 0, 1–2, or ≥3. The outcomes of interest were time to all‐cause mortality and time to the composite outcome of heart failure hospitalization (HFH) or all‐cause mortality. Outcomes were evaluated within each comorbidity group using a Bayesian hierarchical Weibull survival regression model. Of 6324 patients, 970 (15%) had no comorbidities, 4052 (64%) had 1–2 and 1302 (21%) had ≥3 comorbidities. The adjusted hazard ratio (aHR) for CRT versus no CRT for all‐cause mortality in the overall cohort was 0.79 (95% credible interval [CI] 0.68–0.93) (p = 0.010); for no comorbidities the aHR was 0.54 (95% CI 0.34–0.86), for 1–2 comorbidities was 0.81 (95% CI 0.67–0.97) and for ≥3 comorbidities was 0.83 (95% CI 0.64–1.07) (no significant interaction between CRT and comorbidity burden: p = 0.13). For the endpoint of HFH or all‐cause mortality, the aHR for the overall cohort was 0.74 (95% CI 0.65–0.84) (p = 0.001), for no comorbidities was 0.69 (95% CI 0.50–0.94), for 1–2 comorbidities was 0.77 (95% CI 0.66–0.90) and for ≥3 comorbidities was 0.68 (95% CI 0.55–0.82) (no significant interaction between CRT and comorbidity burden: p = 0.081). Conclusion: In a meta‐analysis of patient‐level data from eight major trials, the totality of evidence suggests that CRT reduces HFH and/or all‐cause mortality even when several comorbid diseases are present. Clinical Trial Registration: NCT00271154, NCT00251251, NCT00267098, NCT00180271. [ABSTRACT FROM AUTHOR]

Published
2024
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