“Dose-dependent” Impact of Recurrent Cardiac Events on Mortality in Patients with Heart Failure

2009 ◽  
Vol 122 (2) ◽  
pp. 162.e1-162.e9 ◽  
Author(s):  
Douglas S. Lee ◽  
Peter C. Austin ◽  
Thérèse A. Stukel ◽  
David A. Alter ◽  
Alice Chong ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Events ◽  
Patients With Heart Failure ◽  
Dose Dependent

Abstract 3103: A Cardiopulmonary Exercise Testing Score for Predicting Risk in Patients with Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jonathan Myers ◽  
Ross Arena ◽  
Daniel Bensimhon ◽  
Joshua Abella ◽  
Leon Hsu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Proportional Hazards ◽  
Heart Rate Recovery ◽  
Full Range ◽  
Cardiopulmonary Exercise Testing ◽  
Relative Weight ◽  
Cox Proportional Hazards ◽  
Cardiac Events ◽  
Cardiopulmonary Exercise ◽  
Patients With Heart Failure

Background. Cardiopulmonary exercise test (CPX) responses, including markers of ventilatory inefficiency (eg. the VE/VCO 2 slope and oxygen uptake efficiency slope [OUES]), and hemodynamic responses, such as heart rate recovery (HRR) and chronotropic incompetence (CRI) predict outcomes in patients with heart failure (HF). However, multivariate risk models integrating the full range of CPX variables have not been fully explored. Methods: 710 HF patients (568 male/142 female, mean age 56±13 years, EF 33±14%) underwent CPX and were followed for major cardiac events (death, transplant, LVAD implantation) for a mean of 29± 25 months. The age-adjusted prognostic power of peak VO 2 , VE/VCO 2 slope, OUES (VO 2 = a log 10 VE + b), resting end-tidal CO 2 pressure (PetCO 2 ), HRR, and CRI were determined using Cox proportional hazards, optimal cutpoints were determined, the variables were weighted, and a multivariate score was derived. Results. There were 111 composite outcomes. Multivariately, only CRI was not a significant predictor of risk. The VE/VCO 2 slope (≥ 34) was the strongest predictor, and was attributed a relative weight of 7, with weighted scores for abnormal HRR (≤6 beats at 1 min), OUES (>1.4), PetCO2 (<33mmHg), and peak VO 2 (≤14 ml/kg/min) having scores of 5, 3, 3, and 2, respectively. A Kaplan-Meier curve illustrating the incremental scores is presented in the figure ; a score >15 was associated with an annual mortality rate of 26% and a relative risk of 15. Conclusion . A score using CPX responses provides a simple and integrated method that powerfully predicts outcomes in patients with HF.

scholarly journals Insomnia and Cardiac Events in Patients With Heart Failure　– Reply –

2017 ◽  
Vol 81 (1) ◽  
pp. 126
Author(s):  
Akiomi Yoshihisa ◽  
Yuki Kanno ◽  
Yasuchika Takeishi
Keyword(s):  
Heart Failure ◽  
Cardiac Events ◽  
Patients With Heart Failure

Effect of testosterone on ex vivo vascular reactivity in man

2006 ◽  
Vol 111 (4) ◽  
pp. 265-274 ◽  
Author(s):  
Christopher J. Malkin ◽  
Richard D. Jones ◽  
T. Hugh Jones ◽  
Kevin S. Channer
Keyword(s):  
Heart Failure ◽  
Vascular Reactivity ◽  
Ex Vivo ◽  
Testosterone Replacement ◽  
Androgen Deficiency ◽  
Resistance Arteries ◽  
Patients With Heart Failure ◽  
Dose Dependent ◽  
Concentration Curves

Testosterone is reported to have an acute vasodilating action in vitro, an effect that may impart a favourable haemodynamic response in patients with chronic heart failure. However, the effect of chronic testosterone exposure on general vascular reactivity is poorly described. In the present study, fresh subcutaneous resistance arteries were obtained from patients with heart failure (n=10), healthy controls (n=9) and men with androgen-deficiency (n=17). All arteries were studied using a wire myograph to examine the effect of cumulative additions of testosterone (1 nmol/l–100 μmol/l) compared with vehicle control following maximal pre-constriction with KCl (1–100 μmol/l). The vascular reactivity of arteries from androgen-deficient patients was examined further by recording tension concentration curves to cumulative additions of noradrenaline (1 nmol/l–100 μmol/l) and U46619 (1–300 nmol/l), followed by relaxation concentration curves to additions of ACh (acetylcholine; 10 nmol/l–30 μmol/l) and SNP (sodium nitroprusside; 10 nmol–30 μmol/l) respectively. In all cases, statistical analysis was performed by ANOVA. Patients with proven androgen-deficiency were treated according to clinical recommendations for a minimum of 3 months and further arteries (n=19) were taken for experimentation using the same protocol. In all groups, testosterone was confirmed to be an acute concentration-dependent vasodilator at concentrations ≥1 μmol/l (P=0.0001). The dilating effect of testosterone was augmented in patients with androgen-deficiency prior to treatment, and this effect was abrogated following appropriate testosterone replacement. Testosterone therapy significantly reduced the normal vascular dilating response to ACh and SNP (P<0.01) and significantly increased the contractile response to noradrenaline (P<0.01), but not U46619. Testosterone is an acute dose-dependent vasodilator of resistance arteries. Physiological testosterone replacement attenuates general vascular reactivity in androgen-deficient subjects. The numerous perceived benefits of testosterone replacement may be offset by a decline in vascular reactivity and, therefore, further studies and careful monitoring of patients is recommended.

scholarly journals Cerebral Perfusion and the Occurrence of Nonfocal Transient Neurological Attacks

2019 ◽  
Vol 47 (5-6) ◽  
pp. 303-308
Author(s):  
Eline A. Oudeman ◽  
Esther E. Bron ◽  
Renske M. Van den Berg-Vos ◽  
Jacoba P. Greving ◽  
Geert Jan Biessels ◽  
...  
Keyword(s):  
Heart Failure ◽  
Magnetic Resonance ◽  
Brain Magnetic Resonance Imaging ◽  
Brain Perfusion ◽  
Cerebral Hypoperfusion ◽  
Cardiac Events ◽  
Adjusted Risk ◽  
Total Brain ◽  
Increased Risk ◽  
Patients With Heart Failure

Introduction: Nonfocal transient neurological attacks (TNAs) are associated with an increased risk of cardiac events, stroke and dementia. Their etiology is still unknown. Global cerebral hypoperfusion has been suggested to play a role in their etiology, but this has not been investigated. We assessed whether lower total brain perfusion is associated with a higher occurrence of TNAs. Methods: Between 2015 and 2018, patients with heart failure were included in the Heart Brain Connection study. Patients underwent brain magnetic resonance imaging, including quantitative magnetic resonance angiography (QMRA) to measure cerebral blood flow (CBF). We calculated total brain perfusion of each participant by dividing total CBF by brain volume. Patients were interviewed with a standardized questionnaire on the occurrence of TNAs by physicians who were blinded to QMRA flow status. We assessed the relation between total brain perfusion and the occurrence of TNAs with Poisson regression analysis. Results: Of 136 patients (mean age 70 years, 68% men), 29 (21%) experienced ≥1 TNAs. Nonrotatory dizziness was the most common subtype of TNA. Patients with TNAs were more often female and more often had angina pectoris than patients without TNAs, but total CBF and total brain perfusion were not different between both groups. Total brain perfusion was not associated with the occurrence of TNAs (adjusted risk ratio 1.12, 95% CI 0.88–1.42). Conclusion: We found no association between total brain perfusion and the occurrence of TNAs in patients with heart failure.

Cystatin C, a Novel Measure of Renal Function, Is an Independent Predictor of Cardiac Events in Patients With Heart Failure

2005 ◽  
Vol 11 (8) ◽  
pp. 595-601 ◽  
Author(s):  
Takanori Arimoto ◽  
Yasuchika Takeishi ◽  
Takeshi Niizeki ◽  
Noriaki Takabatake ◽  
Hidenobu Okuyama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Cystatin C ◽  
Independent Predictor ◽  
Cardiac Events ◽  
Patients With Heart Failure

scholarly journals Mechanisms by Which Metformin Improves Mortality and Hospital Readmission in Diabetic Patients with Heart Failure

2017 ◽  
Vol 1 (3) ◽  
pp. 01-02
Author(s):  
David Bell
Keyword(s):  
Heart Failure ◽  
Hospital Readmission ◽  
Meta Analysis ◽  
Total Mortality ◽  
Diabetic Patients ◽  
Cardiac Events ◽  
Develop Heart Failure ◽  
Metformin Monotherapy ◽  
Patients With Heart Failure ◽  
Obese Subjects

From the UKPDS it was concluded that metformin decreased cardiac events. However, this only occurred in a small group of obese subjects while in a larger group failing sulfonylurea therapy the addition of metformin resulted in an increase in cardiac events . Indeed, a meta-analysis of metformin studies has shown that overall metformin does not decrease cardiac events. However, if in this meta-analysis the group utilizing metformin and sulfonylurea combinations were removed from the analysis then there was a significant decrease in cardiac events with metformin monotherapy. The major decrease in cardiac events, cardiac mortality and total mortality with metformin is likely due to a decreased susceptibility to develop heart failure. From Medicare billing records of 16,417 diabetic patients with heart failure discharged from hospital on metformin were compared to those with heart failure discharged on a sulfonylurea or insulin, mortality was reduced by 13% and readmission by 8%.

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