1,721,159 research outputs found
Managing Cancer Patients and Survivors With Advanced Heart Failure
No full textPurpose of review The number of cancer patients grows globally. An important subset may develop heart failure. Recent findings A paucity of data exists regarding outcomes and response to traditional intervention in cancer patients who develop heart failure. Advanced HF treatments in this population require special considerations. Since cancer treatment schedules are anticipated, emphasis should be placed on preventive interventions. Once left ventricular dysfunction ensues, early recognition and prompt treatment of heart failure may improve prognosis. Small studies have shown that guideline-directed medical therapies, cardiac resynchronization therapy, and implantable cardiac defibrillators are equally beneficial in cancer patients yet underutilized as a result of late recognition of heart failure and/or misconception of oncologic prognosis. Additionally, in carefully selected cancer survivors, clinical outcome after implantation of a left ventricular assist device and heart transplantation are comparable with other causes of heart failure. Cancer survivors with acceptable prognosis should be evaluated for HF therapies in a timely manner. There remains an urgent need for larger-scale longitudinal studies to determine the best treatment strategies for heart failure in this population
Self-Reported Sodium Intake and Sodium Vulnerability in Heart Failure With Preserved Ejection Fraction
No full textObjective: To determine the pathophysiologic and prognostic meaning of patient self-reported sodium intake in heart failure (HF) with preserved ejection fraction (HFpEF). Methods: This cohort analysis used data from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial of patients enrolled in the Americas. Tertiles of baseline self-reported sodium intake were used to assess the relationship between self-reported sodium intake and clinical presentation/outcome and interactions with treatment effect of spironolactone. Results: Self-reported sodium intake of 1748 patients with HFpEF included in TOPCAT were divided according to tertiles of sodium intake (47% low, 35% moderate, and 18% high sodium intake). After covariate adjustment, lower self-reported sodium intake was associated with higher risk of HF hospital admission (P1/4.009). P 1 / 4 .009). Patients with lower sodium intake had higher E-wave velocity, left ventricular end diastolic volume, and estimated plasma volume (P<.001). P< .001). Lower sodium intake was associated with a larger treatment effect of spironolactone on HF hospitalizations (hazard ratio, 0.69; 95% CI, 0.53 to 0.91) vs the highest tertile (hazard ratio, 1.37; 95% CI, 0.79 to 2.38; interaction P 1 / 4 .030). In addition, linear mixed models indicated larger reductions in blood pressure, dyspnea, and edema (all interaction P< .001) in patients with lower sodium intake receiving spironolactone. Conclusion: Low self-reported sodium level in HFpEF is associated with higher risk of HF hospital admissions and may indicate a sodium-vulnerable state; patients should not be falsely reassured that they are in a lower risk category despite greater adherence to medical recommendations.Belgian American Educational Foundation; Frans Van de Werf Fun
Spontaneous Improvement in Iron Parameters and the Relation With Changes in Functionality in Heart Failure
No full textIron deficiency is associated with reduced functional status , poor exercise performance, and increased cardiovascu-lar risk in patients with heart failure (HF). 1 Treatment with ferric carboxymaltose (FCM) has been shown to improve functional status, cardiac function, and clinical outcomes. 2,3 Although the European and American HF guidelines recommend the use of intravenous iron, periodic screening of patients with HF for the presence of iron deficiency has only been endorsed by European guidelines. 4 It is becoming increasingly recognized that iron parameters can be dynamic and may fluctuate over short periods of time (e.g., from screening to randomization in clinical trials or from discharge to 30 days follow-up after acute HF). 5 Clinicians have been challenged with the question as to what these spontaneous changes in iron parameter mean, why they occur, if they are associated with functional improvement, and if they would alter the treatment effect of FCM. This is a post hoc analysis of 2 published trials of iron supplementation, IRONOUT-HF (The Iron Repletion Effects on Oxygen Uptake in Heart Failure) and IRON-CRT (Effect of Intravenous Ferric Carboxymaltose on Reverse Remodelling Following Cardiac Resynchroniza-tion Therapy), in symptomatic patients with HF and reduced ejection fraction (left ventricular ejection fraction 10% improvement , similar findings were documented for serum iron but less pronounced for the TSAT definition. The addition of interaction fixed effect (spontaneous iron improvement and treatment allocation of oral iron supplementation) generatedBelgian American Educa-tional Foundation; Frans Van de Werf Fun
Meta-Analysis and Metaregression of the Treatment Effect of Intravenous Iron in Iron-Deficient Heart Failure
No full textBACKGROUND Guidelines recommend that intravenous iron should be considered to improve symptoms of heart failure (HF) and reduce the risk for HF admissions in patients after acute HF. OBJECTIVES This study sought to analyze the effect of intravenous iron on cardiovascular (CV) death and HF admissions in a broad population of HF patients with iron deficiency and the relation with baseline transferrin saturation (TSAT). METHODS A systematic review of all published randomized controlled trials assessing the effect of intravenous iron in patients with iron deficiency and HF between January 1, 2000, and August 26, 2023, was performed. The overall treatment effect was estimated using a fixed effect model for: 1) CV death; 2) CV death and HF admission; 3) first HF admission; and 4) total HF admissions. Metaregression through a mixed effect model was used to explore the impact of baseline TSAT in case of heterogeneity among trial results. RESULTS A total of 14 randomized controlled trials were identified in the systematic review and retained in the metaanalysis. Aggregate-level data were included on 6,624 HF patients, 3,407 of whom were randomized to intravenous iron and 3,217 to placebo. Treatment with intravenous iron resulted in a lower risk for CV death (OR: 0.867 [95% CI: 0.7550.955]; P = 0.0427), combined CV death and HF admission (OR: 0.838 [95% CI: 0.751-0.936]; P = 0.0015), first HF admission (OR: 0.855 [95% CI: 0.744-0.983]; P = 0.0281), and total HF admissions (rate ratio: 0.739 [95% CI: 0.6610.827]; P < 0.0001). Significant heterogeneity among trial results was observed for first and total HF admissions. Metaregression suggested that some of the heterogeneity was related to the baseline TSAT of the enrolled population, with trials enrolling patients with lower TSAT exhibiting a large effect size on HF-related events. CONCLUSIONS The totality of data suggests that treatment with intravenous iron reduces both CV death and HF-related events in a broad population with HF. A lower baseline TSAT might be important for the effect on HF-related events. (c) 2024 by the American College of Cardiology Foundation
Renal sodium avidity, the prevailing renal target in heart failure
No full textGraphical Abstract Summary findings (A) Pharmacological effect of loop diuretics in healthy individuals showing CPDSR and the breaking phenomenon. (B) Potential therapies targeting sodium avidity in AHF and CHF. (C) Theoretical effect of therapies used in AHF and CHF on renal sodium
excretion throughout the day.P.M. is supported by 1 year support from the Belgian American Educational Foundation (BAEF) and 1 year support from the Frans Van de Werf Fund. W.H.W.T is partially supported by grants from the National Institutes of Health (R01HL126827 and R01HL146754)
Cardiovascular Volume Reserve in Patients with Heart Failure and Reduced Ejection Fraction
No full textThis study aimed to investigate the relationship between intravascular volume and intracardiac filling pressures in stable HF patients with reduced ejection fraction (HFrEF). A total of 40 HFrEF patients (LVEF 36 +/- 10%) (10 subjects with a pulmonary artery catheter) underwent intravascular volume expansion with 1 L hydroxyl-ethyl-starch over 3 h with coinciding intravascular volume measurements (technetium (99 tc)-labeled red blood cell technique). Intravascular blood volume increased from 5.0 +/- 1.0 L to 5.7 +/- 1.0 L (p < 0.0001). No change in clinical status, echocardiographic indices, or cardiac filling pressures was noticed. Invasively measured right atrial pressure and pulmonary arterial wedge pressure increased significantly immediately after start of infusion (4 +/- 2 mmHg to 8 +/- 4 mmHg; p = 0.01 and 10 +/- 3 mmHg to 15 +/- 6 mmHg; p = 0.01, respectively), decreased afterwards, and remained stable for 3 h (6 +/- 2 mmHg and 14 +/- 4 mmHg, respectively). The accuracy of cardiac filling pressure estimates to predict intravascular volume expansion was low (all AUC < 0.65).P.N is supported by The Frans Van de Werf Fund for Clinical Cardiovascular Research. P.N., P.M., and W.M. are researchers for the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk (LSM), Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital. P.N. and M.D. are supported by a research grant provided by Vision4Life-Sciences.Nijst, P (reprint author), Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium, Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium.
[email protected]
Uptitration of neurohumoral blockers in hospitalized heart failure patients with reduced versus preserved ejection fraction
No full textUptitration of Neurohumoral Blockers in Hospitalized Heart Failure Patients With Reduced versus Preserved Ejection Fraction
No full textEffects of Atrial Fibrillation Ablation for Heart Failure With Preserved Ejection Fraction: Insights From CABANA
No full textBACKGROUND Atrial fibrillation (AF) ablation is Class I recommendation in selected heart failure (HF) patients with reduced ejection fraction; less is known in heart failure with preserved ejection fraction (HFpEF). OBJECTIVES The aim of this study was to investigate the effects of AF ablation in patients with HFpEF. METHODS The CABANA (Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial randomized patients with cardiovascular risk factors for stroke to AF ablation vs drug therapy. The presence of a high likelihood of HFpEF at enrollment was determined by a modified H2FPEF score of >= 6. Treatment effects of baseline HFpEF likelihood on the AF ablation for death and cardiovascular admission, AF recurrence, and functional status were assessed. RESULTS A total of 1,763 patients were included in the analysis. A high modified H2FPEF score (55% of the entire cohort) resulted in a significant treatment effect modulation (P for interaction 1/4 0.027), with a lower risk for cardiovascular hospitalization or death in patients with a high likelihood of HFpEF (HR: 0.82 [95% CI: 0.69-0.98]; P 1/4 0.025), but not in patients without (HR: 1.00 [95% CI: 0.82-1.22]; P 1/4 0.987). Although patients with a high likelihood of HFpEF were at a higher risk for AF recurrence, the greatest treatment effect of AF ablation on AF recurrence was observed in patients with a high likelihood of HFpEF (P for interaction 1/4 0.035). In a sensitivity analysis in a subset of patients with echocardiographic evidence of HFpEF (n 1/4 225), a similar treatment interaction was found. CONCLUSIONS In patients undergoing AF ablation, the presence of underlying HFpEF (either by HFpEF probability or defined by echocardiography) was associated with a larger benefit with AF ablation on clinical outcome, AF recurrence, and functional status. (Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation [CABANA]; NCT00911508) (JACC Heart Fail. 2025;13:785-794) (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Dr Martens is supported by a grant from BAEF (Belgian American Educational Foundation) and by the Frans Van de Werf Fund. The BioLINCC (Biologic Specimen and Data Repository Information Coordinating Center) is funded by the National Institutes of Health. Dr Tang is a consultant for Sequana Medical, Cardiol Therapeutics Inc, Genomics plc, Zehna Therapeutics, Boston Scientific, WhiteSwell, Intellia Therapeutics, CardiaTec Biosciences, Bristol Myers Squibb, Alleviant Medical, Alexion Pharmaceuticals, Salubris Biotherapeutics, and BioCardia Inc; and has received honorarium from Springer, Belvoir Media Group, and the American Board of Internal Medicine. All
other authors have reported that they have no relationships relevant to the contents of this paper to disclose
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