88 results on '"Lewis, Basil S."'
Search Results
2. Are SGLT2 inhibitors effective against 'all' heart failure with preserved ejection fraction?
- Author
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Hasegawa K and Lewis BS
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- Humans, Stroke Volume, Ventricular Function, Left, Heart Failure diagnosis, Heart Failure drug therapy, Sodium-Glucose Transporter 2 Inhibitors adverse effects
- Published
- 2022
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3. Vericiguat in patients with coronary artery disease and heart failure with reduced ejection fraction.
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Saldarriaga C, Atar D, Stebbins A, Lewis BS, Abidin IZ, Blaustein RO, Butler J, Ezekowitz JA, Hernandez AF, Lam CSP, O'Connor CM, Pieske B, Ponikowski P, Roessig L, Voors AA, Anstrom KJ, and Armstrong PW
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- Humans, Male, Pyrimidines, Stroke Volume, Coronary Artery Disease complications, Coronary Artery Disease drug therapy, Heart Failure complications, Heart Failure epidemiology, Heart Failure therapy, Heterocyclic Compounds, 2-Ring therapeutic use, Ventricular Dysfunction, Left drug therapy
- Abstract
Aims: Coronary artery disease (CAD) portends worse outcomes in heart failure (HF). We aimed to characterize patients with CAD and worsening HF with reduced ejection fraction (HFrEF) and evaluate post hoc whether vericiguat treatment effect varied according to CAD., Methods and Results: Cox proportional hazards were generated for the primary endpoint of cardiovascular death or HF hospitalization (CVD/HFH). CAD was defined as previous myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting. Of 5048 patients in VICTORIA with available data on CAD status, 2704 had CAD and were older, were more frequently male, diabetic, and had a lower glomerular filtration rate than those without CAD (all p <0.0001). Use of implantable cardioverter defibrillators and cardiac resynchronization therapy (CRT) was higher in patients with versus without CAD (33.5% vs. 21.1%; p <0.0001 and 16.3% vs. 12.8%; p = 0.0006). The primary endpoint of CVD/HFH was higher in those with versus without CAD (40.6 vs. 30.1/100 patient-years; adjusted hazard ratio [HR] 1.23; p <0.001) as was all-cause mortality (17.9% vs. 12.7%; adjusted HR 1.32; p <0.001). The primary outcome of CVD/HFH associated with vericiguat in patients with or without CAD was 38.8 versus 27.6 per 100 patient-years and for placebo was 42.6 versus 32.7 per 100 patient-years (interaction p = 0.78)., Conclusion: In this post hoc study, CAD was associated with more CVD and HFH in patients with HFrEF and worsening HF. Vericiguat was beneficial and safe regardless of concomitant CAD., (© 2022 European Society of Cardiology.)
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- 2022
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4. Potentially inappropriate prescriptions in heart failure with reduced ejection fraction: ESC position statement on heart failure with reduced ejection fraction-specific inappropriate prescribing.
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El Hadidi S, Rosano G, Tamargo J, Agewall S, Drexel H, Kaski JC, Niessner A, Lewis BS, Coats AJS, and Savarese G
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- Humans, Inappropriate Prescribing prevention & control, Polypharmacy, Stroke Volume, Cardiology, Heart Failure diagnosis, Heart Failure drug therapy
- Abstract
Heart failure (HF) is a chronic debilitating and potentially life-threatening condition. HF patients are usually at high risk of polypharmacy and consequently, potentially inappropriate prescribing leading to poor clinical outcomes. Based on the published literature, a comprehensive HF-specific prescribing review tool is compiled to avoid medications that may cause HF or harm HF patients and to optimize the prescribing practice of HF guideline-directed medical therapies. Recommendations are made in line with the last versions of European Society of Cardiology (ESC) guidelines, ESC position papers, scientific evidence, and experts' opinions., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2022
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5. The role of pharmacogenomics in contemporary cardiovascular therapy: a position statement from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy.
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Magavern EF, Kaski JC, Turner RM, Drexel H, Janmohamed A, Scourfield A, Burrage D, Floyd CN, Adeyeye E, Tamargo J, Lewis BS, Kjeldsen KP, Niessner A, Wassmann S, Sulzgruber P, Borry P, Agewall S, Semb AG, Savarese G, Pirmohamed M, and Caulfield MJ
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- Europe, Humans, Pharmacogenetics, Cardiology, Cardiovascular System, Heart Failure
- Abstract
There is a strong and ever-growing body of evidence regarding the use of pharmacogenomics to inform cardiovascular pharmacology. However, there is no common position taken by international cardiovascular societies to unite diverse availability, interpretation, and application of such data, nor is there recognition of the challenges of variation in clinical practice between countries within Europe. Aside from the considerable barriers to implementing pharmacogenomic testing and the complexities of clinically actioning results, there are differences in the availability of resources and expertise internationally within Europe. Diverse legal and ethical approaches to genomic testing and clinical therapeutic application also require serious thought. As direct-to-consumer genomic testing becomes more common, it can be anticipated that data may be brought in by patients themselves, which will require critical assessment by the clinical cardiovascular prescriber. In a modern, pluralistic and multi-ethnic Europe, self-identified race/ethnicity may not be concordant with genetically detected ancestry and thus may not accurately convey polymorphism prevalence. Given the broad relevance of pharmacogenomics to areas, such as thrombosis and coagulation, interventional cardiology, heart failure, arrhythmias, clinical trials, and policy/regulatory activity within cardiovascular medicine, as well as to genomic and pharmacology subspecialists, this position statement attempts to address these issues at a wide-ranging level., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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6. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy.
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, and Witte KK
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- Cardiac Pacing, Artificial, Humans, Stroke Volume, Atrial Fibrillation therapy, Cardiac Resynchronization Therapy adverse effects, Heart Failure diagnosis, Heart Failure therapy
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- 2022
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7. The effect of intravenous ferric carboxymaltose on health-related quality of life in iron-deficient patients with acute heart failure: the results of the AFFIRM-AHF study.
- Author
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Jankowska EA, Kirwan BA, Kosiborod M, Butler J, Anker SD, McDonagh T, Dorobantu M, Drozdz J, Filippatos G, Keren A, Khintibidze I, Kragten H, Martinez FA, Metra M, Milicic D, Nicolau JC, Ohlsson M, Parkhomenko A, Pascual-Figal DA, Ruschitzka F, Sim D, Skouri H, van der Meer P, Lewis BS, Comin-Colet J, von Haehling S, Cohen-Solal A, Danchin N, Doehner W, Dargie HJ, Motro M, Friede T, Fabien V, Dorigotti F, Pocock S, and Ponikowski P
- Subjects
- Humans, Ferric Compounds therapeutic use, Iron therapeutic use, Maltose therapeutic use, Stroke Volume, Treatment Outcome, Ventricular Function, Left, Anemia, Iron-Deficiency drug therapy, Heart Failure complications, Heart Failure drug therapy, Quality of Life
- Abstract
Aims: Patients with heart failure (HF) and iron deficiency experience poor health-related quality of life (HRQoL). We evaluated the impact of intravenous (IV) ferric carboxymaltose (FCM) vs. placebo on HRQoL for the AFFIRM-AHF population., Methods and Results: The baseline 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12), which was completed for 1058 (535 and 523) patients in the FCM and placebo groups, respectively, was administered prior to randomization and at Weeks 2, 4, 6, 12, 24, 36, and 52. The baseline KCCQ-12 overall summary score (OSS) mean ± standard error was 38.7 ± 0.9 (FCM group) and 37.1 ± 0.8 (placebo group); corresponding values for the clinical summary score (CSS) were 40.9 ± 0.9 and 40.1 ± 0.9. At Week 2, changes in OSS and CSS were similar for FCM and placebo. From Week 4 to Week 24, patients assigned to FCM had significantly greater improvements in OSS and CSS scores vs. placebo [adjusted mean difference (95% confidence interval, CI) at Week 4: 2.9 (0.5-5.3, P = 0.018) for OSS and 2.8 (0.3-5.3, P = 0.029) for CSS; adjusted mean difference (95% CI) at Week 24: 3.0 (0.3-5.6, P = 0.028) for OSS and 2.9 (0.2-5.6, P = 0.035) for CSS]. At Week 52, the treatment effect had attenuated but remained in favour of FCM., Conclusion: In iron-deficient patients with HF and left ventricular ejection fraction <50% who had stabilized after an episode of acute HF, treatment with IV FCM, compared with placebo, results in clinically meaningful beneficial effects on HRQoL as early as 4 weeks after treatment initiation, lasting up to Week 24., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2021
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8. Relationship between baseline cardiac biomarkers and cardiovascular death or hospitalization for heart failure with and without sodium-glucose co-transporter 2 inhibitor therapy in DECLARE-TIMI 58.
- Author
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Zelniker TA, Morrow DA, Mosenzon O, Goodrich EL, Jarolim P, Murphy SA, Bhatt DL, Leiter LA, McGuire DK, Wilding J, Bode C, Lewis BS, Gause-Nilsson I, Langkilde AM, Fredriksson M, Raz I, Sabatine MS, and Wiviott SD
- Subjects
- Biomarkers, Female, Glucose, Hospitalization, Humans, Male, Middle Aged, Natriuretic Peptide, Brain, Peptide Fragments, Sodium, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 drug therapy, Diabetes Mellitus, Type 2 epidemiology, Heart Failure drug therapy, Heart Failure epidemiology, Sodium-Glucose Transporter 2 Inhibitors, Symporters
- Abstract
Aims: Dapagliflozin reduced the risk of the composite of cardiovascular (CV) death or hospitalization for heart failure (HHF) in patients with type 2 diabetes mellitus in DECLARE-TIMI 58. We hypothesized that baseline N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hsTnT) levels would help identify patients who are at higher baseline risk and we describe the treatment effects of dapagliflozin in patients according to their baseline NT-proBNP and hsTnT levels., Methods and Results: This was a pre-specified biomarker study from DECLARE-TIMI 58, a randomized, double-blind, placebo-controlled CV outcomes trial of dapagliflozin. Baseline NT-proBNP and hsTnT levels were measured in the TIMI Clinical Trials Laboratory in 14 565 patients. Among the included patients, 9143 patients (62.8%) were male, 1464 (10.1%) had a history of heart failure and the mean age was 63.9 years. The median baseline NT-proBNP and hsTnT levels were 75 pg/mL [interquartile range (IQR) 35-165] and 10.2 pg/mL (IQR 6.9-15.5), respectively. Patients with higher NT-proBNP and hsTnT quartiles had higher rates of CV death/HHF (Q4 vs. Q1: NT-proBNP: 4-year Kaplan-Meier event rates 13.7% vs. 1.0%; hsTnT: 11.8% vs. 1.4%; P-trend <0.001). Dapagliflozin consistently reduced the relative risk of CV death/HHF regardless of baseline NT-proBNP (P-interaction 0.72) or hsTnT quartiles (P-interaction 0.93). Given their higher baseline risk, patients with NT-proBNP and/or hsTnT levels above the median derived larger absolute risk reductions with dapagliflozin (NT-proBNP 1.9% vs. 0%, P-interaction 0.010; hsTnT 1.8% vs. 0.1%, P-interaction 0.026)., Conclusion: Patients with type 2 diabetes mellitus and higher NT-proBNP or hsTnT levels are at increased risk of CV death and HHF. Dapagliflozin reduced the relative risk of CV death/HHF irrespective of NT-proBNP and hsTnT levels, with greater absolute risk reductions seen in patients with higher baseline biomarker levels., (© 2020 European Society of Cardiology.)
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- 2021
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9. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial.
- Author
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Ponikowski P, Kirwan BA, Anker SD, McDonagh T, Dorobantu M, Drozdz J, Fabien V, Filippatos G, Göhring UM, Keren A, Khintibidze I, Kragten H, Martinez FA, Metra M, Milicic D, Nicolau JC, Ohlsson M, Parkhomenko A, Pascual-Figal DA, Ruschitzka F, Sim D, Skouri H, van der Meer P, Lewis BS, Comin-Colet J, von Haehling S, Cohen-Solal A, Danchin N, Doehner W, Dargie HJ, Motro M, Butler J, Friede T, Jensen KH, Pocock S, and Jankowska EA
- Subjects
- Administration, Intravenous, Aged, Aged, 80 and over, Double-Blind Method, Female, Ferric Compounds administration & dosage, Heart Failure complications, Heart Failure mortality, Hospitalization statistics & numerical data, Humans, Male, Maltose administration & dosage, Maltose therapeutic use, Middle Aged, Patient Discharge, Treatment Outcome, Ventricular Function, Left, Anemia, Iron-Deficiency drug therapy, Ferric Compounds therapeutic use, Heart Failure drug therapy, Maltose analogs & derivatives
- Abstract
Background: Intravenous ferric carboxymaltose has been shown to improve symptoms and quality of life in patients with chronic heart failure and iron deficiency. We aimed to evaluate the effect of ferric carboxymaltose, compared with placebo, on outcomes in patients who were stabilised after an episode of acute heart failure., Methods: AFFIRM-AHF was a multicentre, double-blind, randomised trial done at 121 sites in Europe, South America, and Singapore. Eligible patients were aged 18 years or older, were hospitalised for acute heart failure with concomitant iron deficiency (defined as ferritin <100 μg/L, or 100-299 μg/L with transferrin saturation <20%), and had a left ventricular ejection fraction of less than 50%. Before hospital discharge, participants were randomly assigned (1:1) to receive intravenous ferric carboxymaltose or placebo for up to 24 weeks, dosed according to the extent of iron deficiency. To maintain masking of patients and study personnel, treatments were administered in black syringes by personnel not involved in any study assessments. The primary outcome was a composite of total hospitalisations for heart failure and cardiovascular death up to 52 weeks after randomisation, analysed in all patients who received at least one dose of study treatment and had at least one post-randomisation data point. Secondary outcomes were the composite of total cardiovascular hospitalisations and cardiovascular death; cardiovascular death; total heart failure hospitalisations; time to first heart failure hospitalisation or cardiovascular death; and days lost due to heart failure hospitalisations or cardiovascular death, all evaluated up to 52 weeks after randomisation. Safety was assessed in all patients for whom study treatment was started. A pre-COVID-19 sensitivity analysis on the primary and secondary outcomes was prespecified. This study is registered with ClinicalTrials.gov, NCT02937454, and has now been completed., Findings: Between March 21, 2017, and July 30, 2019, 1525 patients were screened, of whom 1132 patients were randomly assigned to study groups. Study treatment was started in 1110 patients, and 1108 (558 in the carboxymaltose group and 550 in the placebo group) had at least one post-randomisation value. 293 primary events (57·2 per 100 patient-years) occurred in the ferric carboxymaltose group and 372 (72·5 per 100 patient-years) occurred in the placebo group (rate ratio [RR] 0·79, 95% CI 0·62-1·01, p=0·059). 370 total cardiovascular hospitalisations and cardiovascular deaths occurred in the ferric carboxymaltose group and 451 occurred in the placebo group (RR 0·80, 95% CI 0·64-1·00, p=0·050). There was no difference in cardiovascular death between the two groups (77 [14%] of 558 in the ferric carboxymaltose group vs 78 [14%] in the placebo group; hazard ratio [HR] 0·96, 95% CI 0·70-1·32, p=0·81). 217 total heart failure hospitalisations occurred in the ferric carboxymaltose group and 294 occurred in the placebo group (RR 0·74; 95% CI 0·58-0·94, p=0·013). The composite of first heart failure hospitalisation or cardiovascular death occurred in 181 (32%) patients in the ferric carboxymaltose group and 209 (38%) in the placebo group (HR 0·80, 95% CI 0·66-0·98, p=0·030). Fewer days were lost due to heart failure hospitalisations and cardiovascular death for patients assigned to ferric carboxymaltose compared with placebo (369 days per 100 patient-years vs 548 days per 100 patient-years; RR 0·67, 95% CI 0·47-0·97, p=0·035). Serious adverse events occurred in 250 (45%) of 559 patients in the ferric carboxymaltose group and 282 (51%) of 551 patients in the placebo group., Interpretation: In patients with iron deficiency, a left ventricular ejection fraction of less than 50%, and who were stabilised after an episode of acute heart failure, treatment with ferric carboxymaltose was safe and reduced the risk of heart failure hospitalisations, with no apparent effect on the risk of cardiovascular death., Funding: Vifor Pharma., (Copyright © 2020 Elsevier Ltd. All rights reserved.)
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- 2020
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10. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology.
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Seferovic PM, Ponikowski P, Anker SD, Bauersachs J, Chioncel O, Cleland JGF, de Boer RA, Drexel H, Ben Gal T, Hill L, Jaarsma T, Jankowska EA, Anker MS, Lainscak M, Lewis BS, McDonagh T, Metra M, Milicic D, Mullens W, Piepoli MF, Rosano G, Ruschitzka F, Volterrani M, Voors AA, Filippatos G, and Coats AJS
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- Europe, Evidence-Based Medicine, Humans, Cardiology methods, Disease Management, Heart Failure therapy
- Abstract
The European Society of Cardiology (ESC) has published a series of guidelines on heart failure (HF) over the last 25 years, most recently in 2016. Given the amount of new information that has become available since then, the Heart Failure Association (HFA) of the ESC recognized the need to review and summarise recent developments in a consensus document. Here we report from the HFA workshop that was held in January 2019 in Frankfurt, Germany. This expert consensus report is neither a guideline update nor a position statement, but rather a summary and consensus view in the form of consensus recommendations. The report describes how these guidance statements are supported by evidence, it makes some practical comments, and it highlights new research areas and how progress might change the clinical management of HF. We have avoided re-interpretation of information already considered in the 2016 ESC/HFA guidelines. Specific new recommendations have been made based on the evidence from major trials published since 2016, including sodium-glucose co-transporter 2 inhibitors in type 2 diabetes mellitus, MitraClip for functional mitral regurgitation, atrial fibrillation ablation in HF, tafamidis in cardiac transthyretin amyloidosis, rivaroxaban in HF, implantable cardioverter-defibrillators in non-ischaemic HF, and telemedicine for HF. In addition, new trial evidence from smaller trials and updated meta-analyses have given us the chance to provide refined recommendations in selected other areas. Further, new trial evidence is due in many of these areas and others over the next 2 years, in time for the planned 2021 ESC guidelines on the diagnosis and treatment of acute and chronic heart failure., (© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.)
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- 2019
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11. Digoxin Use and Subsequent Clinical Outcomes in Patients With Atrial Fibrillation With or Without Heart Failure in the ENGAGE AF-TIMI 48 Trial.
- Author
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Eisen A, Ruff CT, Braunwald E, Hamershock RA, Lewis BS, Hassager C, Chao TF, Le Heuzey JY, Mercuri M, Rutman H, Antman EM, and Giugliano RP
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- Aged, Atrial Fibrillation mortality, Double-Blind Method, Female, Heart Failure mortality, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Treatment Outcome, Anti-Arrhythmia Agents therapeutic use, Atrial Fibrillation drug therapy, Digoxin therapeutic use, Heart Failure drug therapy
- Abstract
Background: Digoxin is widely used in patients with atrial fibrillation despite the lack of randomized controlled trials. Observational studies report conflicting results regarding its association with mortality, perhaps because of residual confounding by the presence of heart failure (HF)., Methods and Results: In the ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48) trial, clinical outcomes of patients with atrial fibrillation with and without HF were examined by baseline digoxin use during a median follow-up of 2.8 years. HF was defined at baseline as prior or current clinical stage C or D HF. Of 21 105 patients enrolled, 6327 (30%) were treated with digoxin at baseline. Among patients without HF (n=8981), digoxin use (20%) was independently associated with sudden cardiac death (adjusted hazard ratio, 1.51; 95% CI, 1.10-2.08), with no significant interaction by age, sex, left ventricular ejection fraction, renal function, or concomitant medications ( P >0.05 for each). Consistent results were observed using propensity matching (adjusted hazard ratio for sudden cardiac death, 1.90; 95% CI, 1.36-2.65). Among patients with HF (n=12 124), digoxin use (37%) was associated with an increase in all-cause death, cardiovascular death, sudden cardiac death, and death caused by HF/cardiogenic shock ( P <0.01 for each), but not with noncardiovascular death, stroke/systemic embolism, or myocardial infarction., Conclusions: In this observational analysis of patients with atrial fibrillation without investigator-reported HF, digoxin use was significantly associated with sudden cardiac death. While residual confounding cannot be excluded, the association between digoxin use and worse clinical outcomes highlights the need to examine digoxin use, particularly when prescribed to control heart rate in patients with atrial fibrillation in a randomized trial., Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00781391., (© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)
- Published
- 2017
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12. Cardiac Computed Tomography Angiographic Findings as Predictors of Late Heart Failure in an Asymptomatic Diabetic Cohort: An 8-Year Prospective Follow-Up Study.
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Halon DA, Ayman J, Rubinshtein R, Zafrir B, Azencot M, and Lewis BS
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- Aged, Cardiac Volume, Female, Follow-Up Studies, Humans, Israel epidemiology, Male, Middle Aged, Multivariate Analysis, Prognosis, Prospective Studies, Risk Assessment, Risk Factors, Sex Distribution, Survival Analysis, Computed Tomography Angiography, Diabetes Mellitus, Type 2 complications, Heart Atria diagnostic imaging, Heart Failure diagnostic imaging, Heart Failure mortality
- Abstract
Objectives: Predictive models for heart failure (HF) in heterogeneous populations have had limited success. We examined cardiac computed tomography angiography (CTA) predictors of HF or cardiovascular death (HF-CVD) in a prospective study of asymptomatic diabetics undergoing baseline assessment by CTA., Methods: The subjects (n = 735, aged 55-74 years, 51.2% women) had no clinical history of cardiovascular disease at study entry. Coronary artery calcium (CAC) score, CTA-defined coronary atherosclerosis, cardiac chamber volumes, and clinical data were collected and late outcome events recorded over 8.4 ± 0.6 years (range 7.3-9.3)., Results: HF-CVD occurred in 41 (5.6%) subjects, with HF occurring mostly (19/23, 82.6%) in subjects without preceding myocardial infarction. Baseline univariate clinical outcome predictors of HF-CVD included older age (p = 0.027), the duration of diabetes (p = 0.004), HbA1c (p < 0.0001), microvascular disease (retinopathy, microalbuminuria) (p < 0.0001), and systolic blood pressure (p = 0.035). Baseline univariate CTA predictors included CAC score (p = 0.004), coronary stenosis (p = 0.047), and a CTA-defined left/right atrial (LA/RA) volume ratio >1 (p < 0.0001). Independent predictors were an LA/RA volume ratio >1, microvascular disease, and systolic blood pressure (model C-statistic 0.792, 95% CI 0.758-0.824). Measures of the extent of coronary artery disease (CAD) were not independent predictors of HF-CVD., Conclusions: In a low- to moderate-risk asymptomatic diabetic population, CTA LA enlargement (LA/RA volume ratio) but not the extent of CAD had independent prognostic value for HF-CVD in addition to the clinical variables., (© 2017 S. Karger AG, Basel.)
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- 2017
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13. Response to Letter Regarding Article, "Heart Failure, Saxagliptin and Diabetes Mellitus: Observations From the SAVOR-TIMI 53 Randomized Trial".
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Scirica BM, Braunwald E, Raz I, Cavender MA, Morrow DA, Jarolim P, Udell JA, Mosenzon O, Im K, Umez-Eronini AA, Pollack PS, Hirshberg B, Frederich R, Lewis BS, McGuire DK, Davidson J, Steg G, and Bhatt DL
- Subjects
- Female, Humans, Male, Adamantane analogs & derivatives, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 drug therapy, Dipeptides adverse effects, Heart Failure chemically induced, Heart Failure complications
- Published
- 2015
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14. Heart failure, saxagliptin, and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial.
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Scirica BM, Braunwald E, Raz I, Cavender MA, Morrow DA, Jarolim P, Udell JA, Mosenzon O, Im K, Umez-Eronini AA, Pollack PS, Hirshberg B, Frederich R, Lewis BS, McGuire DK, Davidson J, Steg PG, and Bhatt DL
- Subjects
- Adamantane administration & dosage, Adamantane adverse effects, Aged, C-Reactive Protein metabolism, Dipeptides administration & dosage, Dipeptidyl-Peptidase IV Inhibitors administration & dosage, Dipeptidyl-Peptidase IV Inhibitors adverse effects, Female, Follow-Up Studies, Heart Failure metabolism, Hospitalization, Humans, Male, Middle Aged, Multivariate Analysis, Natriuretic Peptide, Brain blood, Peptide Fragments blood, Risk Assessment, Troponin T blood, Adamantane analogs & derivatives, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 drug therapy, Dipeptides adverse effects, Heart Failure chemically induced, Heart Failure complications
- Abstract
Background: Diabetes mellitus and heart failure frequently coexist. However, few diabetes mellitus trials have prospectively evaluated and adjudicated heart failure as an end point., Methods and Results: A total of 16 492 patients with type 2 diabetes mellitus and a history of, or at risk of, cardiovascular events were randomized to saxagliptin or placebo (mean follow-up, 2.1 years). The primary end point was the composite of cardiovascular death, myocardial infarction, or ischemic stroke. Hospitalization for heart failure was a predefined component of the secondary end point. Baseline N-terminal pro B-type natriuretic peptide was measured in 12 301 patients. More patients treated with saxagliptin (289, 3.5%) were hospitalized for heart failure compared with placebo (228, 2.8%; hazard ratio, 1.27; 95% confidence intercal, 1.07-1.51; P=0.007). Corresponding rates at 12 months were 1.9% versus 1.3% (hazard ratio, 1.46; 95% confidence interval, 1.15-1.88; P=0.002), with no significant difference thereafter (time-varying interaction, P=0.017). Subjects at greatest risk of hospitalization for heart failure had previous heart failure, an estimated glomerular filtration rate ≤60 mL/min, or elevated baseline levels of N-terminal pro B-type natriuretic peptide. There was no evidence of heterogeneity between N-terminal pro B-type natriuretic peptide and saxagliptin (P for interaction=0.46), although the absolute risk excess for heart failure with saxagliptin was greatest in the highest N-terminal pro B-type natriuretic peptide quartile (2.1%). Even in patients at high risk of hospitalization for heart failure, the risk of the primary and secondary end points were similar between treatment groups., Conclusions: In the context of balanced primary and secondary end points, saxagliptin treatment was associated with an increased risk or hospitalization for heart failure. This increase in risk was highest among patients with elevated levels of natriuretic peptides, previous heart failure, or chronic kidney disease., Clinical Trial Registration Url: http://www.clinicaltrials.gov. Unique identifier: NCT01107886., (© 2014 American Heart Association, Inc.)
- Published
- 2014
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15. Left ventricular systolic dysfunction, heart failure, and the risk of stroke and systemic embolism in patients with atrial fibrillation: insights from the ARISTOTLE trial.
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McMurray JJ, Ezekowitz JA, Lewis BS, Gersh BJ, van Diepen S, Amerena J, Bartunek J, Commerford P, Oh BH, Harjola VP, Al-Khatib SM, Hanna M, Alexander JH, Lopes RD, Wojdyla DM, Wallentin L, and Granger CB
- Subjects
- Aged, Anticoagulants therapeutic use, Atrial Fibrillation drug therapy, Comorbidity, Embolism prevention & control, Female, Heart Failure physiopathology, Humans, Male, Middle Aged, Pyrazoles therapeutic use, Pyridones therapeutic use, Retrospective Studies, Risk Assessment, Warfarin therapeutic use, Atrial Fibrillation epidemiology, Embolism epidemiology, Heart Failure epidemiology, Stroke epidemiology, Ventricular Dysfunction, Left epidemiology
- Abstract
Background: We examined the risk of stroke or systemic embolism (SSE) conferred by heart failure (HF) and left ventricular systolic dysfunction (LVSD) in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation Trial (ARISTOTLE), as well as the effect of apixaban versus warfarin., Methods and Results: The risk of a number of outcomes, including the composite of SSE or death (to take account of competing risks) and composite of SSE, major bleeding, or death (net clinical benefit) were calculated in 3 patient groups: (1) no HF/no LVSD (n=8728), (2) HF/no LVSD (n=3207), and (3) LVSD with/without symptomatic HF (n=2736). The rate of both outcomes was highest in patients with LVSD (SSE or death 8.06; SSE, major bleeding, or death 10.46 per 100 patient-years), intermediate for HF but preserved LV systolic function (5.32; 7.24), and lowest in patients without HF or LVSD (1.54; 5.27); each comparison P<0.0001. Each outcome was less frequent in patients treated with apixaban: in all ARISTOTLE patients, the apixaban/warfarin hazard ratio for SSE or death was 0.89 (95% confidence interval, 0.81-0.98; P=0.02); for SSE, major bleed, or death it was 0.85 (0.78-0.92; P<0.001). There was no heterogeneity of treatment effect across the 3 groups., Conclusions: Patients with LVSD (with/without HF) had a higher risk of SSE or death (but similar rate of SSE) compared with patients with HF but preserved LV systolic function; both had a greater risk than patients without either HF or LVSD. Apixaban reduced the risk of both outcomes more than warfarin in all 3 patient groups., Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984.
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- 2013
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16. Risk score model for predicting mortality in advanced heart failure patients followed in a heart failure clinic.
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Zafrir B, Goren Y, Paz H, Wolff R, Salman N, Merhavi D, Lavi I, Lewis BS, and Amir O
- Subjects
- Aged, Biomarkers, Cross-Sectional Studies, Disease Progression, Female, Health Status Indicators, Heart Failure epidemiology, Heart Failure pathology, Humans, Israel epidemiology, Kaplan-Meier Estimate, Male, Prognosis, Prospective Studies, Statistics as Topic, Cardiac Care Facilities statistics & numerical data, Heart Failure mortality, Models, Theoretical, Risk Assessment methods
- Abstract
The prevalence of heart failure (HF) in the population is increasing, concomitant with high incidence of rehospitalizations and mortality. The aim of this study was to characterize a prognostic risk score model for patients with chronic HF. A total of 500 patients followed at the HF clinic were evaluated by clinical, functional, laboratory, imaging, and therapeutic variables that were correlated to mortality during a follow-up period of 25 months. Risk stratification was carried out by applying a risk score model based on multivariate analysis. Predictors correlated with mortality during follow-up were systolic blood pressure <110 mm Hg, male sex, age older than 70 years, 6-minute walk distance <300 m, lack of β-blocker therapy, hyperuricemia (>7.5 mg/dL), hyponatremia, and prolonged QTc interval (>450 ms). Based on these variables, a risk score model (score 0-55) was established and included low risk, score <21 (9% mortality during 2-year follow-up); moderate risk, 21 to 29 (22%); high risk, 30 to 35 (35%), and very high risk: ≥36 points (62% 2-year mortality). The risk model had good discrimination ability (concordance index 0.75), which was better than the performance of the Seattle Heart Failure Model on our cohort (0.69). Simple noninvasive characteristics examined during the initial admission to the HF clinic can serve as prognostic markers for mortality and may help in the process of therapeutic decision-making in patients with HF., (© 2012 Wiley Periodicals, Inc.)
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- 2012
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17. Long-term assessment of nocturnal Cheyne-Stokes respiration in patients with heart failure.
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Amir O, Barak-Shinar D, Wolff R, Paz H, Dori G, Smart FW, and Lewis BS
- Subjects
- Aged, Algorithms, Cheyne-Stokes Respiration classification, Cheyne-Stokes Respiration physiopathology, Disease Progression, Female, Follow-Up Studies, Heart Failure classification, Heart Failure physiopathology, Hemodynamics physiology, Humans, Male, Middle Aged, Prognosis, Cheyne-Stokes Respiration diagnosis, Heart Failure diagnosis, Polysomnography methods
- Abstract
Purpose: Cheyne-Stokes respiration (CSR) is a known controversial prognostic marker in patients with heart failure (HF). Little is known, moreover, about the development and progress of CSR in such patients. The CSR progress over time may be indicative for clinical deterioration in patients with HF disease, Methods: Prospective cohort sleep studies, with algorithm-based analyses of continuously or periodically monitored changes over time using standard pulse oximeter. Home testing for 4 months of patients recruited from the cardiology department of a large community medical center in Haifa, Israel. A total of 36 patients, 31 men and five women, aged between 50 and 74 years, with symptomatic chronic HF., Results: Out of the 36 patients, 15 (42%) patients were found to have CSR. The CSR cycle length was chosen as the characteristic parameter which determines the periodicity of the event and its length. Analyses of CSR cycle length and duration in the 15 patients showed changes over time in the length of the CSR event only in patient with New York Heart Association (NYHA) 4 classification., Conclusions: Nocturnal CSR in patients with HF show small variations over time in the prevalence or duration of the cycle length and could be a marker for entering stage 4 or deterioration in the NYHA class of HF patient. Moreover, it may take years for HF patients to develop CSR or to increase the length of the cycle length of existing CSR, if they develop it at all.
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- 2011
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18. Mortality rates and modes of death in heart failure patients with reduced versus preserved systolic function.
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Zafrir B, Paz H, Wolff R, Salman N, Merhavi D, Lewis BS, and Amir O
- Subjects
- Aged, Arrhythmias, Cardiac mortality, Confidence Intervals, Female, Follow-Up Studies, Heart Function Tests, Hospitals, University, Humans, Israel epidemiology, Male, Medical Records, Middle Aged, Odds Ratio, Risk Assessment, Risk Factors, Survival Rate, Ventricular Dysfunction, Left mortality, Ventricular Dysfunction, Left physiopathology, Heart Failure mortality, Heart Failure physiopathology
- Abstract
Background: There are conflicting reports regarding the characteristics and mortality rates of heart failure patients with preserved (HFPSF) vs. reduced systolic left ventricular function (SHF)., Methods: We evaluated the clinical profiles, mortality rates and modes of death in 481 consecutive symptomatic heart failure patients. In 317(66%) patients LVEF was <40% (SHF), and in 164(34%) LVEF≥40% (HFPSF)., Results: Compared to the HFPSF group, SHF patients were predominantly younger males with ischemic etiology and less cardiovascular comorbidities such as obesity, hypertension, diabetes mellitus and atrial fibrillation. Over a mean follow-up period of 2 years, 148(31%) patients died. Overall mortality was similar between the two groups: 53(32%) HFPSF patients and 95(30%) SHF patients died (p=0.6), even after adjusting for baseline variables, including age, gender and comorbidities (hazard ratio 1.09; 95% confidence interval 0.74-1.61; p=0.67). In contrast to the similar mortality rates, the modes of death were different. SHF patients had higher death rates due to pump failure compared to the HFPSF group {32/95(34%) vs. 9/53(17%) patients, p=0.03}. A trend towards higher rate of non-cardiac death was observed in HFPSF group {33/53(62%) patients vs. 45/95(47%) patients, respectively, p=0.08}. The prevalence of arrhythmic death was similar in both groups {17/95(18%) vs. 10/53(19%) patients, p=0.9}., Conclusions: Although the characteristics of HFPSF and SHF patients are distinctively different, the mortality rates are similar. The mode of death is different among the two groups of patients, as pump failure death is significantly higher in SHF patients, while non-cardiac mortality is more prevalent in HFPSF patients., (Copyright © 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)
- Published
- 2011
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19. Increased serum levels of oxidative stress are associated with hospital readmissions due to acute heart failure.
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Rogowski O, Shnizer S, Wolff R, Lewis BS, and Amir O
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- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Recurrence, Heart Failure blood, Oxidative Stress, Patient Readmission statistics & numerical data
- Abstract
Objectives: Inflammation and serum oxidative stress (OS) are important components in heart failure (HF) deterioration. In this study we tested the hypothesis that an increase in patients' sera OS levels is associated with acute HF (AHF) readmissions., Methods: Thirty consecutive patients (mean age 71 ± 10 years) admitted with AHF were included in the study. Serum OS in these patients was measured in-hospital and repeatedly after discharge over a period of 8 weeks of follow-up in which we reordered patients' HF readmissions. Of the 30 patients, 13 (43%) were readmitted (RAD group) and 17 (57%) did not require readmission (NRAD group)., Results: OS levels before discharge from the first hospital admission in the 2 groups were similar (p = 0.84 and p = 0.56, respectively). However, using repeated measures ANOVA, we found that the interaction between the time points and the 2 groups of patients (RAD and NRAD) was statistically significant (p = 0.037). It is important to note that OS serum levels were more predictive of HF readmissions than were repeated simultaneous serum measurements of NT-proBNP (p = 0.97)., Conclusions: Increased OS levels in AHF patients, after they have been discharged from the hospital, are associated with higher HF readmission rates. In AHF, OS is a dynamic parameter associated with HF deterioration., (Copyright © 2011 S. Karger AG, Basel.)
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- 2011
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20. Predictors of long-term (4-year) mortality in elderly and young patients with acute heart failure.
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Barsheshet A, Shotan A, Cohen E, Garty M, Goldenberg I, Sandach A, Behar S, Zimlichman E, Lewis BS, and Gottlieb S
- Subjects
- Age Factors, Aged, Aged, 80 and over, Confidence Intervals, Female, Glomerular Filtration Rate, Health Surveys, Heart Failure epidemiology, Hospital Mortality, Humans, Israel epidemiology, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Prevalence, Prospective Studies, Registries, Risk Assessment, Stroke Volume, Time Factors, Ventricular Function, Left, Heart Failure mortality
- Abstract
Aims: The present study was designed to identify and compare predictors of short- and long-term mortality in elderly and young patients hospitalized with acute heart failure (HF)., Methods and Results: The risk of in-hospital, 1- and 4-year mortality was assessed among 2336 acute HF patients in a prospective national survey. Interaction-term analysis was utilized to identify and compare independent risk factors between elderly (>75 years [n = 1182]) and younger (< or =75 years [n = 1154]) study patients. Elderly patients exhibited a 1.8-fold (P = 0.004), 1.4-fold (P < 0.001), and 1.7-fold (P < 0.001) increase in the adjusted risk of in-hospital, 1-year, and 4-year mortality, respectively, as compared with younger patients. Independent risk factors for 4-year mortality among elderly patients included NYHA functional Class III-IV before admission (HR = 1.46, P < 0.001), systolic blood pressure <115 mmHg (HR = 1.45, P = 0.002), renal dysfunction ([eGFR < 60 mL/min/1.73 m(2)] HR = 1.35, P = 0.002), diabetes mellitus (HR = 1.28, P = 0.006), and anaemia (HR = 1.25, P = 0.012). In the young group, but not in the elderly group, left ventricle ejection fraction (LVEF) <50% and hyponatraemia (sodium <136 mmol/L) were significant predictors of 4-year mortality. (LVEF <50%, HR = 1.47 for the young and 1.04 for the elderly, P for interaction = 0.025; hyponatraemia HR = 1.59 for the young and 1.17 for the elderly, P for interaction = 0.035)., Conclusion: Elderly patients exhibit different risk factors for long-term mortality as compared with young patients with acute HF. In contrast to younger patients, mortality risk in the older population is not decreased among those with preserved LVEF.
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- 2010
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21. Atrial fibrillation and long-term prognosis in patients hospitalized for heart failure: results from heart failure survey in Israel (HFSIS).
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Shotan A, Garty M, Blondhein DS, Meisel SR, Lewis BS, Shochat M, Grossman E, Porath A, Boyko V, Zimlichman R, Caspi A, and Gottlieb S
- Subjects
- Aged, Chronic Disease, Female, Heart Failure complications, Heart Failure mortality, Hospitalization statistics & numerical data, Humans, Male, Prognosis, Prospective Studies, Thromboembolism prevention & control, Ventricular Dysfunction, Left etiology, Ventricular Dysfunction, Left mortality, Atrial Fibrillation complications, Heart Failure therapy
- Abstract
Aims: Atrial fibrillation (AF) and heart failure (HF) commonly coexist, and each adversely affects the other. The aim of the study was to prospectively evaluate the impact of AF and its subtypes on management, and early and long-term outcome of hospitalized HF patients., Methods and Results: Data were prospectively collected on HF patients hospitalized in all public hospitals in Israel as part of a national survey (HFSIS). Atrial fibrillation patients were subdivided into intermittent and chronic AF subgroups. During March-April 2003, we enrolled 4102 HF patients, of whom 1360 (33.2%) had AF [600 (44.1%) intermittent, 562 (41.3%) chronic]. Patients with AF were older (76.9 +/- 10.5 vs. 71.7 +/- 12.6 years, P = 0.0001), males, with preserved LV systolic function. Crude mortality rates for AF patients were progressively and consistently higher during hospitalization and during the 4-year follow-up period, especially in the chronic AF group (P = 0.0001). After covariate adjustment, AF was associated with increased 1-year mortality [HR 1.19, 95% CI (1.03-1.36)]., Conclusion: AF was present in a third of hospitalized HF patients, and identified a population with increased mortality risk, largely due to co-morbidities.
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- 2010
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22. Relation between AT1R gene polymorphism and long-term outcome in patients with heart failure.
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Amir O, Amir RE, Paz H, Attias E, Sagiv M, and Lewis BS
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- Aged, Female, Haplotypes, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Prognosis, Renin-Angiotensin System genetics, Heart Failure genetics, Heart Failure mortality, Polymorphism, Genetic, Receptor, Angiotensin, Type 1 genetics
- Abstract
Objectives: Angiotensin II plays a key role in the pathophysiology of heart failure (HF). This study examined the angiotensin II type 1 receptor (AT1R) polymorphism in patients with systolic HF and its relation to clinical manifestations and patient outcome., Methods: We genotyped 134 patients with HF and reduced systolic function for the AT1R A1166C genotype using polymerase chain reaction and restriction fragment length polymorphism. We analyzed the relationship between the AT1R A1166C polymorphism and clinical, electrocardiographic, echocardiographic and laboratory parameters in patients with ischemic and non-ischemic etiology and examined the relation between the AT1R genotype and long-term (30 months) patient survival., Results: In HF patients, frequency of the AT1R 1166C allele and specifically the CC genotype was similar to the general population, but associated with an ischemic and not a non-ischemic etiology (p = 0.02). The CC genotype was associated with more advanced disease and more severe abnormalities of renal function (p = 0.008). Survival analysis showed that AT1R CC homozygous patients had significantly higher mortality (p = 0.008; adjusted odds ratio for mortality 6.35, 95% confidence interval 1.49-11.21, p = 0.01)., Conclusion: The CC AT1R genotype was associated with poor prognostic markers and increased mortality. The findings support the principle of genome-based therapies in the future treatment of HF patients., ((c) 2008 S. Karger AG, Basel.)
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- 2009
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23. Aldosterone synthase gene polymorphism as a determinant of atrial fibrillation in patients with heart failure.
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Amir O, Amir RE, Paz H, Mor R, Sagiv M, and Lewis BS
- Subjects
- Age Factors, Aged, DNA analysis, Female, Genotype, Humans, Male, Polymerase Chain Reaction, Polymorphism, Restriction Fragment Length, Regression Analysis, Sex Factors, Atrial Fibrillation genetics, Cytochrome P-450 CYP11B2 genetics, Heart Failure complications, Polymorphism, Genetic
- Abstract
We analyzed the possible association between aldosterone synthase (CYP11B2) T-344C polymorphism, which is associated with increased aldosterone activity, and the prevalence of atrial fibrillation (AF) in 196 consecutive patients who had symptomatic systolic heart failure (HF; left ventricular ejection fraction <40%) for > or =3 months before recruitment. Genomic DNA was extracted from peripheral blood leukocytes using a standard protocol. Subjects were genotyped for the CYP11B2 polymorphism using the polymerase chain reaction/restriction fragment length polymorphism approach. AF was present in 63 patients (33%) with HF. We found the -344 CC genotype to be a strong independent marker for AF. Almost 1/2 (45%) of patients with this genotype had AF compared with 1/4 (27%) with -344 TT and TC genotypes (p = 0.01). A multivariate stepwise logistic regression model that included age, gender, New York Heart Association class, CYP11B2 -344CC genotype, and echocardiographic measurements of left ventricular ejection fraction, left atrial dimension, left ventricular end-diastolic diameter, and mitral regurgitation severity showed that the CYP11B2 CC genotype (adjusted for age and left atrial size) was an independent predictor of AF (adjusted odds ratio 2.35, 95% confidence interval 1.57 to 3.51, p = 0.03). In conclusion, CYP11B2 T-344C promoter polymorphism predisposes to clinical AF in patients with HF.
- Published
- 2008
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24. Prevalence and significance of unrecognized renal insufficiency in patients with heart failure.
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Amsalem Y, Garty M, Schwartz R, Sandach A, Behar S, Caspi A, Gottlieb S, Ezra D, Lewis BS, and Leor J
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- Aged, Epidemiologic Methods, Female, Glomerular Filtration Rate physiology, Heart Failure complications, Humans, Male, Prevalence, Renal Insufficiency complications, Heart Failure mortality, Renal Insufficiency mortality
- Abstract
Aims: Renal insufficiency (RI) is a strong predictor of adverse outcome in patients with heart failure (HF). We aimed to determine the prevalence of RI being unrecognized and its significance in patients hospitalized with HF., Methods and Results: We analysed data from a prospective survey of 4102 hospitalized patients with HF. RI [defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2] was present in 2145 (57%) patients but, based on medical records, was unrecognized in 872 [41%, 95% confidence interval (CI) 39-43%] of them. Patients with unrecognized RI were more likely to be women, elderly, and with better functional class, compared with patients with recognized RI. In-hospital and 1 year mortality was significantly higher among patients with recognized and unrecognized RI compared with patients without RI: 6.5 and 7.1 vs. 2.1%, and 38.8 and 30.9 vs. 18.8% (P < 0.001), respectively. After adjustment, recognized and unrecognized RI comparably predicted increased in-hospital mortality: odds ratio (OR) and 95% CI of 2.34 (1.43-3.87), P < 0.001, and 2.30 (1.45-3.72), P < 0.001. After 1 year, recognized RI remained an independent predictor for mortality: OR 1.79 (1.45-2.20), P < 0.001, whereas there was a trend for increased mortality predicted by unrecognized RI: OR 1.22 (0.97-1.53), P = 0.08., Conclusion: A high proportion of RI remains unrecognized among hospitalized patients with HF. As co-morbid RI has important prognostic and therapeutic implications, patients with HF may benefit from routine assessment of GFR.
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- 2008
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25. Usefulness and predictive value of circulating NT-proBNP levels to stratify patients for referral and priority treatment in a specialized outpatient heart failure center.
- Author
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Amir O, Paz H, Ammar R, Yaniv N, Schliamser JE, and Lewis BS
- Subjects
- Biomarkers blood, Female, Follow-Up Studies, Heart Failure mortality, Humans, Immunoenzyme Techniques, Israel epidemiology, Male, Middle Aged, Predictive Value of Tests, Protein Precursors, Survival Rate trends, Time Factors, Heart Failure blood, Heart Failure therapy, Natriuretic Peptide, Brain blood, Outpatient Clinics, Hospital, Peptide Fragments blood, Referral and Consultation, Risk Assessment methods
- Abstract
Background: Serum natriuretic peptide levels are useful diagnostic and prognostic markers in patients with acute decompensated heart failure, but have been little used to stratify urgency of treatment in the outpatient situation., Objectives: To examine the use of natriuretic peptide to guide priority of patient referral to a heart failure center., Methods: We analyzed data from 70 consecutive patients with chronic heart failure (NYHA class 2-4) referred for first evaluation in a specialized outpatient heart failure center. Serum NT-proBNP was measured at the initial patient visit. We examined correlates and predictive value of mid- and upper tertile NT-proBNP for mortality in comparison with other known prognostic indicators using univariate and multivariate logistic regression analysis., Results: Mortality at 6 months was 26.0% in patients with upper tertile (> 1958 pg/ml) NT-proBNP, 8.7% in the middle tertile group and 0% in the lowest tertile (P=0.017). Patients with upper tertile serum NT-proBNP levels (group 3) had lower left ventricular ejection fraction, were more often in atrial fibrillation (P=0.04) and more often had renal failure (P=0.03). Age-adjusted logistic regression analysis identified upper tertile serum NT-proBNP level as the strongest independent predictor of 6 month mortality with a sixfold risk of early death (adjusted odds ratio 6.08, 95% confidence interval 1.58-47.13, P=0.04). NT-proBNP was a more powerful predictor of prognosis than ejection fraction and other traditional outcome markers., Conclusions: In heart failure patients referred to an outpatient specialized heart failure center, an upper tertile NT-proBNP level identified patients at high risk for mortality. A single high > 550 pg/ml NT-proBNP measurement appears to be useful for selecting patients for care in a heart failure center, and a level > 2000 pg/ml for assigning patients to high priority management.
- Published
- 2008
26. Permanent left ventricular assist device for end-stage heart failure: first successful implantation of the axial flow HeartMate II rotary pump as destination therapy for heart failure in Israel.
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Amir O, Aravot D, Pizov R, Orlov B, Eden A, Shiran A, Karkabi B, Sabbag L, Zlotnick AY, Ammar R, Halon DA, and Lewis BS
- Subjects
- Aged, Heart Failure physiopathology, Hemodynamics, Humans, Israel, Male, Prosthesis Design, Quality of Life, Heart Failure therapy, Heart-Assist Devices
- Published
- 2007
27. Late mortality and determinants in patients with heart failure and preserved systolic left ventricular function: the Israel Nationwide Heart Failure Survey.
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Lewis BS, Shotan A, Gottlieb S, Behar S, Halon DA, Boyko V, Leor J, Grossman E, Zimlichman R, Porath A, Mittelman M, Caspi A, and Garty M
- Subjects
- Aged, Echocardiography, Female, Follow-Up Studies, Heart Failure diagnostic imaging, Heart Failure physiopathology, Humans, Inpatients, Israel epidemiology, Male, Prospective Studies, Sex Distribution, Survival Rate trends, Systole, Time Factors, Heart Failure mortality, Myocardial Contraction physiology, Population Surveillance, Ventricular Function, Left physiology
- Abstract
Background: Heart failure with preserved systolic left ventricular function is a major cause of cardiac disability., Objectives: To examine the prevalence, characteristics and late clinical outcome of patients hospitalized with HF-PSF on a nationwide basis in Israel., Methods: The Israel nationwide HF survey examined prospectively 4102 consecutive HF patients admitted to 93 internal medicine and 24 cardiology departments in all 25 public hospitals in the country. Echocardiographic LV function measurements were available in 2845 patients (69%). The present report relates to the 1364 patients who had HF-PSF (LV ejection fraction > or = 40%)., Results: Mortality of HF-PSF patients was high (in-hospital 3.5%, 6 months 14.2%, 12 months 22.0%), but lower than in patients with reduced systolic function (all P < 0.01). Mortality was higher in patients with HF as the primary hospitalization diagnosis (16.0% vs. 12.5% at 6 months, P = 0.07 and 26.2% vs. 18.0% at 12 months, P = 0.0002). Patients with HF-PSF who died were older (78 +/- 10 vs. 71 +/- 12 years, P < 0.001), more often female (P = 0.05) and had atrial fibrillation more frequently (44% vs. 33%, P < 0.01). There was also a relationship between mortality and pharmacotherapy: after adjustment for age and co-morbid conditions, mortality was lower in patients treated with angiotensin-converting enzyme inhibitors (P = 0.0003) and angiotensin receptor blockers (P = 0.002) and higher in those receiving digoxin (P = 0.003) and diuretic therapy (P = 0.009)., Conclusions: This nationwide survey highlights the very high late mortality rates in patients hospitalized for HF without a decrease in systolic function. The findings mandate a focus on better evidence-based treatment strategies to improve outcome in HF-PSF patients.
- Published
- 2007
28. The management, early and one year outcome in hospitalized patients with heart failure: a national Heart Failure Survey in Israel--HFSIS 2003.
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Garty M, Shotan A, Gottlieb S, Mittelman M, Porath A, Lewis BS, Grossman E, Behar S, Leor J, Green MS, Zimlichman R, and Caspi A
- Subjects
- Age Distribution, Aged, Cardiac Catheterization, Echocardiography, Female, Follow-Up Studies, Heart Failure diagnosis, Heart Failure mortality, Hospital Mortality trends, Humans, Israel epidemiology, Male, Middle Aged, Prognosis, Prospective Studies, Severity of Illness Index, Sex Distribution, Time Factors, Heart Failure therapy, Inpatients
- Abstract
Background: Despite improved management of heart failure patients, their prognosis remains poor., Objectives: To characterize hospitalized HF patients and to identify factors that may affect their short and long-term outcome in a national prospective survey., Methods: We recorded stages B-D according to the American College of Cardiology/American Heart Association definition of HF patients hospitalized in internal medicine and cardiology departments in all 25 public hospitals in Israel., Results: During March-April 2003, 4102 consecutive patients were recorded. Their mean age was 73 +/- 12 years and 57% were males; 75.3% were hypertensive, 50% diabetic and 59% dyslipidemic; 82% had coronary artery disease, 33% atrial fibrillation, 41% renal failure (creatinine > or = 1.5 mg/dl), and 49% anemia (hemoglobin < or = 12 g/dl). Mortality rates were 4.7% in-hospital, 7.6% at 30 days, 18.7% at 6 months and 28.1% at 12 months. Multiple logistic regression analysis revealed that increased 1 year mortality rate was associated with NYHA III-IV (odds ratio 2.07, 95% confidence interval 1.78-2.41), age (for 10 year increment) (OR 1.41, 95% CI 1.31-1.52), renal failure (1.79, 1.53-2.09), anemia (1.50, 1.29-1.75), stroke (1.50, 1.21-1.85), chronic obstructive pulmonary disease (1.25, 1.04-1.50) and atrial fibrillation (1.20, 1.02-1.40)., Conclusions: This nationwide heart failure survey indicates a high risk of long-term mortality and the urgent need to develop more effective management strategies for patients with heart failure discharged from hospitals.
- Published
- 2007
29. Adherence to guidelines for patients hospitalized with heart failure: a nationwide survey.
- Author
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Jotkowitz AB, Porath A, Shotan A, Mittelman M, Grossman E, Zimlichman R, Lewis BS, Caspi A, Gottlieb S, and Garty M
- Subjects
- Aged, Aged, 80 and over, Calcium Channel Blockers therapeutic use, Diuretics therapeutic use, Female, Health Care Surveys, Heart Failure physiopathology, Humans, Israel, Male, Middle Aged, Mineralocorticoid Receptor Antagonists therapeutic use, Myocardial Ischemia drug therapy, Myocardial Ischemia physiopathology, Patient Admission, Patient Discharge, Prospective Studies, Spironolactone therapeutic use, Adrenergic beta-Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Drug Utilization Review, Guideline Adherence statistics & numerical data, Heart Failure drug therapy, Hospitals, Public standards, Practice Guidelines as Topic, Quality of Health Care
- Abstract
Background: Despite significant advances in the therapy of heart failure, many patients still do not receive optimal treatment., Objectives: To document the standard of care that patients hospitalized with HF in Israel received during a 2 month period., Methods: The Heart Failure Survey in Israel 2003 was a prospective 2 month survey of patients admitted to all 25 public hospitals in Israel with a diagnosis of HF., Results: The mean age of the 4102 patients was 73 years and 43% were female. The use of angiotensin-converting enzyme/angiotensin receptor blockers and beta blockers both declined from NYHA class I to IV (68.8% to 50.6% for ACE-inhibitor/ARB and 64.1% to 52.9% for beta blockers, P < 0.001 for comparisons). The percentage of patients by NYHA class taking an ACE-inhibitor or ARB and a beta blocker at hospital discharge also declined from NYHA class I to IV (47.5% to 28.8%, P < 0.002 for comparisons). The strongest predictor of being discharged with an ACE-inhibitor or ARB was the use of these medications at hospital admission. Negative predictors for their usage were age, creatinine, disease severity class, and functional status., Conclusions: Despite the dissemination of guidelines many patients did not receive optimal care for HF. Reasons for this discrepancy need to be identified and modified.
- Published
- 2006
30. Admission blood glucose level and mortality among hospitalized nondiabetic patients with heart failure.
- Author
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Barsheshet A, Garty M, Grossman E, Sandach A, Lewis BS, Gottlieb S, Shotan A, Behar S, Caspi A, Schwartz R, Tenenbaum A, and Leor J
- Subjects
- Aged, Aged, 80 and over, Biomarkers blood, Female, Heart Failure blood, Hospital Mortality, Humans, Male, Patient Admission, Prognosis, Prospective Studies, Blood Glucose metabolism, Heart Failure mortality
- Abstract
Background: The significance of admission blood glucose level in nondiabetic patients with heart failure (HF) is unknown. We examined the possible association between admission glucose levels and outcome in a large cohort of hospitalized patients with HF., Methods: We analyzed the data of 4102 patients with HF, who were hospitalized during a prospective national survey. The present study focuses on a subgroup of 1122 nondiabetic patients with acute HF who were admitted because of acute HF or exacerbation of chronic HF., Results: In-hospital mortality was twice as high in patients with admission blood glucose levels in the third tertile (7.2%) compared with the first (3%) and second (4%) tertiles (P = .02). Furthermore, mortality risk was correlated with admission glucose levels; each 18-mg/dL (1-mmol/L) increase in glucose level was associated with a 31% increased risk of in-hospital mortality (adjusted odds ratio, 1.31; 95% confidence interval, 1.10-1.57; P = .003) and a 12% increase in 60-day mortality (adjusted hazard ratio, 1.12; 95% confidence interval, 1.01-1.25; P = .04). Admission blood glucose levels remained an independent predictor of in-hospital and 60-day mortality even after the exclusion of 315 patients (28%) with acute myocardial infarction and HF. The 6- and 12-month mortality rates were similar in patients with and without abnormal admission blood glucose levels., Conclusions: Elevated admission blood glucose levels are associated with increased in-hospital and 60-day mortality, but not 6-month or 1-year mortality, in nondiabetic patients hospitalized because of HF.
- Published
- 2006
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31. Heart failure overview.
- Author
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Cokkinos DV and Lewis BS
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- Humans, Heart Failure diagnosis, Heart Failure therapy
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- 2006
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32. Anaemia and heart failure: statement of the problem.
- Author
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Lewis BS, Karkabi B, Jaffe R, Yuval R, Flugelman MY, and Halon DA
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- Adult, Aged, Aged, 80 and over, Anemia drug therapy, Erythropoietin therapeutic use, Heart Failure physiopathology, Humans, Iron therapeutic use, Middle Aged, Prevalence, Ventricular Dysfunction, Left etiology, Ventricular Dysfunction, Left physiopathology, Anemia complications, Anemia etiology, Heart Failure etiology
- Abstract
While advances in treatment strategies and pharmacotherapy have produced a dramatic reduction in the mortality of patients with heart failure during the past 15 years, there is still a major challenge to improve patient well being, reduce hospitalizations and reduce mortality further. The prevalence of heart failure is not decreasing, and heart failure is currently a cause for hospitalization in >25% of admissions to internal medicine and cardiology departments. It has recently become apparent that anaemia is present in 20-30% of patients with heart failure, and the severity of anaemia has important implications regarding outcome and prognosis. Anaemia may be due to a number of causes, including iron and vitamin deficiency, insidious blood loss, haemodilution, renal impairment and bone marrow depression with resistance to erythropoietin. In the presence of a damaged heart and often coronary artery disease, anaemia may worsen contractile ability and systolic function, while the necessary volume load and ventricular hypertrophy which accompany anaemia contribute to diastolic dysfunction. Preliminary data show that appropriate treatment of anaemia, based on correction of the underlying cause, with, in most patients, the addition of exogenous erythropoietin and iron therapy, improves ventricular function and clinical status. Treatment of anaemia has opened a new frontier in the management of heart failure. We await the results of ongoing clinical trials for more detailed information regarding appropriate haemoglobin targets, choice of medication and dosing and the degree of improvement that may be expected when the issue of anaemia is properly addressed.
- Published
- 2005
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33. Hemodynamic and clinical effects of tezosentan, an intravenous dual endothelin receptor antagonist, in patients hospitalized for acute decompensated heart failure.
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Torre-Amione G, Young JB, Colucci WS, Lewis BS, Pratt C, Cotter G, Stangl K, Elkayam U, Teerlink JR, Frey A, Rainisio M, and Kobrin I
- Subjects
- Aged, Dose-Response Relationship, Drug, Double-Blind Method, Female, Heart Failure drug therapy, Hemodynamics drug effects, Humans, Infusions, Intravenous, Male, Middle Aged, Pulmonary Wedge Pressure drug effects, Pyridines administration & dosage, Pyridines therapeutic use, Tetrazoles administration & dosage, Tetrazoles therapeutic use, Endothelin Receptor Antagonists, Heart Failure physiopathology, Pyridines pharmacology, Tetrazoles pharmacology
- Abstract
Objectives: We sought to investigate the efficacy and safety of tezosentan, a dual endothelin receptor antagonist, in patients hospitalized for acute heart failure (HF)., Background: Tezosentan has been previously shown to improve hemodynamics in patients with stable chronic HF., Methods: In a double-blind fashion, 292 patients (cardiac index < or =2.5 l/min per m(2) and pulmonary capillary wedge pressure (PCWP) > or =15 mm Hg) who were admitted to the hospital and in need of intravenous treatment for acute HF and central hemodynamic monitoring were randomized to 24-h intravenous treatment with tezosentan (50 or 100 mg/h) or placebo. Central hemodynamic variables, the dyspnea score, and safety variables were measured., Results: After 6 h of treatment, significantly greater increases in the cardiac index and decreases in PCWP were observed with both tezosentan dosages than with placebo (mean treatment effects at 0.38 and 0.37 l/min per m(2) with 50 and 100 mg/h and -3.9 mm Hg for each dose, respectively; p < 0.0001). This effect was maintained during the remaining infusion and for > or =6 h after treatment cessation. A tendency for an improved dyspnea score and a decreased risk of clinical worsening was observed after 24 h of treatment with each tezosentan dose. Adverse events, more frequent with tezosentan than with placebo (headache, asymptomatic hypotension, early worsening of renal function, nausea, vomiting), were dose-related., Conclusions: Intravenous tezosentan rapidly and effectively improved hemodynamics in these patients. The similar beneficial effects of the two dosages and the increased dose-related adverse events with the higher dosage suggest that the optimal dosing regimen is <50 mg/h.
- Published
- 2003
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34. Prediction of Death and Hospital Admissions Via Innovative Detection of Cheyne-Stokes Breathing in Heart Failure Patients
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Amir, Offer, Barak-Shinar, Deganit, Wolff, Rafael, Smart, Frank W., and Lewis, Basil S.
- Published
- 2010
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35. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS) : The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)
- Author
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Konstantinides, Stavros V., Meyer, Guy, Bueno, Hector, Galié, Nazzareno, Gibbs, J. Simon R., Ageno, Walter, Agewall, Stefan, Almeida, Ana G., Andreotti, Felicita, Barbato, Emanuele, Baumbach, Andreas, Beygui, Farzin, Carlsen, Jørn, De Carlo, Marco, Delcroix, Marion, Subias, Pilar Escribano, Gaine, Sean, Goldhaber, Samuel Z., Gopalan, Deepa, Habib, Gilbert, Jenkins, David, Kjellström, Barbro, Lainscak, Mitja, Lee, Geraldine, Le Gal, Grégoire, Messas, Emmanuel, Morais, Joao, Piepoli, Massimo Francesco, Price, Susanna, Salvi, Aldo, Sanchez, Olivier, Stortecky, Stefan, Thielmann, Matthias, Noordegraaf, Anton Vonk, Becattini, Cecilia, Bueno, Héctor, Geersing, Geert Jan, Harjola, Veli Pekka, Huisman, Menno V., Humbert, Marc, Jennings, Catriona Sian, Jiménez, David, Kucher, Nils, Lang, Irene Marthe, Lankeit, Mareike, Lorusso, Roberto, Mazzolai, Lucia, Meneveau, Nicolas, Áinle, Fionnuala Ní, Prandoni, Paolo, Pruszczyk, Piotr, Righini, Marc, Torbicki, Adam, Van Belle, Eric, Zamorano, José Luis, Windecker, Stephan, Aboyans, Victor, Baigent, Colin, Collet, Jean Philippe, Dean, Veronica, Delgado, Victoria, Fitzsimons, Donna, Gale, Chris P., Grobbee, Diederick E., Hindricks, Gerhard, Iung, Bernard, Jüni, Peter, Katus, Hugo A., Landmesser, Ulf, Leclercq, Christophe, Lettino, Maddalena, Lewis, Basil S., Merkely, Bela, Mueller, Christian, Petersen, Steffen E., Petronio, Anna Sonia, Richter, Dimitrios J., Roffi, Marco, Shlyakhto, Evgeny, Simpson, Iain A., Sousa-Uva, Miguel, Touyz, Rhian M., Hammoudi, Naima, Hayrapetyan, Hamlet, Mascherbauer, Julia, Ibrahimov, Firdovsi, Polonetsky, Oleg, Lancellotti, Patrizio, Tokmakova, Mariya, Skoric, Bosko, Michaloliakos, Ioannis, Hutyra, Martin, Mellemkjaer, Søren, Mansour, Mostafa, Reinmets, Julia, Jääskeläinen, Pertti, Angoulvant, Denis, Bauersachs, Johann, Giannakoulas, George, Zima, Endre, Vizza, Carmine Dario, Sugraliyev, Akhmetzhan, Bytyçi, Ibadete, Maca, Aija, Ereminiene, Egle, Huijnen, Steve, Xuereb, Robert, Diaconu, Nadejda, Bulatovic, Nebojsa, Asfalou, Ilyasse, Bosevski, Marijan, Halvorsen, Sigrun, Sobkowicz, Bozena, Ferreira, Daniel, Petris, Antoniu Octavian, Moiseeva, Olga, Zavatta, Marco, Obradovic, Slobodan, Šimkova, Iveta, Radsel, Peter, Ibanez, Borja, Wikström, Gerhard, Aujesky, Drahomir, Kaymaz, Cihangir, Parkhomenko, Alexander, and Pepke-Zaba, Joanna
- Subjects
thrombolysis ,pulmonary embolism ,treatment ,diagnosis ,education ,venous thromboembolism ,biomarkers ,heart failure ,shock ,Embolectomy ,Guidelines ,dyspnoea ,right ventricle ,humanities ,Anticoagulation ,Pregnancy ,Venous thrombosis ,Journal Article ,echocardiography ,Cardiology and Cardiovascular Medicine ,health care economics and organizations ,Risk assessment - Abstract
Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.
- Published
- 2020
36. Cardiac Computed Tomography Angiographic Findings as Predictors of Late Heart Failure in an Asymptomatic Diabetic Cohort: An 8-Year Prospective Follow-Up Study.
- Author
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Ayman, Jubran, Zafrir, Barak, Azencot, Mali, Halon, David A., Rubinshtein, Ronen, and Lewis, Basil S.
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HEART failure ,DIABETES ,COMPUTED tomography ,MYOCARDIAL infarction ,ATHEROSCLEROSIS - Abstract
Objectives: Predictive models for heart failure (HF) in heterogeneous populations have had limited success. We examined cardiac computed tomography angiography (CTA) predictors of HF or cardiovascular death (HF-CVD) in a prospective study of asymptomatic diabetics undergoing baseline assessment by CTA. Methods: The subjects (n = 735, aged 55-74 years, 51.2% women) had no clinical history of cardiovascular disease at study entry. Coronary artery calcium (CAC) score, CTA-defined coronary atherosclerosis, cardiac chamber volumes, and clinical data were collected and late outcome events recorded over 8.4 ± 0.6 years (range 7.3-9.3). Results: HF-CVD occurred in 41 (5.6%) subjects, with HF occurring mostly (19/23, 82.6%) in subjects without preceding myocardial infarction. Baseline univariate clinical outcome predictors of HF-CVD included older age (p = 0.027), the duration of diabetes (p = 0.004), HbA1c (p < 0.0001), mi-crovascular disease (retinopathy, microalbuminuria) (p < 0.0001), and systolic blood pressure (p = 0.035). Baseline univariate CTA predictors included CAC score (p = 0.004), coronary stenosis (p = 0.047), and a CTA-defined left/right atrial (LA/RA) volume ratio >1 (p < 0.0001). Independent predictors were an LA/RA volume ratio >1, microvascular disease, and systolic blood pressure (model C-statistic 0.792, 95% CI 0.758-0.824). Measures of the extent of coronary artery disease (CAD) were not independent predictors of HF-CVD. Conclusions: In a low- to moderate-risk asymptomatic diabetic population, CTA LA enlargement (LA/RA volume ratio) but not the extent of CAD had independent prognostic value for HF-CVD in addition to the clinical variables. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
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37. Absence of the α2c-Adrenoceptor Del322–325 Allele is Associated With Increased Mortality in Patients With Chronic Systolic Heart Failure.
- Author
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Amir, Offer, Smith, Yoav, Zafrir, Barak, Azzam, Naiel, Lewis, Basil S., and Fares, Fuad
- Abstract
Abstract: Objective: The Del322–325 polymorphism of the α
2c -adrenoceptor is considered to be a possible risk factor for heart failure (HF). We investigated the possible clinical association between the presence or absence of the deletion allele and mortality. Methods and Results: Of 261 chronic systolic HF patients evaluated, 216 (83%) carried no α2c -adrenoceptor Del322–325 alleles (designated II); 28 patients (11%) were heterozygous (ID) and 17 patients (6%) homozygous (DD) for the deletion. Similar genetic distribution of α2c -adrenoceptor Del322–325 subgroups was found in a control group of 96 healthy individuals. Mortality was significantly higher in HF patients in whom the deletion allele was absent than in HF patients who carried it: 67 (31%) patients in the II subgroup died compared with 7 (15.5%) in the ID/DD subgroup (P = .01). The odds ratio for death in HF patients who carried no α2c -adrenoceptor Del322–325 alleles compared with HF patients with ≥1 allele was 2.45 (95% confidence interval 1.04‒5.74). There were no differences in other relevant clinical parameters between the 2 subgroups of HF patients. Conclusions: The mortality rate of chronic systolic HF patients carrying no α2c -adrenoceptor Del322–325 alleles was significantly higher (almost 2.5-fold) than that of HF patients carrying ≥1 allele. [Copyright &y& Elsevier]- Published
- 2012
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38. Serum levels of microRNAs in patients with heart failure.
- Author
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Goren, Yaron, Kushnir, Michal, Zafrir, Barak, Tabak, Sarit, Lewis, Basil S., and Amir, Offer
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SERUM ,NON-coding RNA ,HEART failure ,GENE expression ,POLYMERASE chain reaction ,NATRIURETIC peptides ,BIOMARKERS ,DIAGNOSIS - Abstract
Aims Diagnosis and risk stratification of patients with heart failure remain a challenge. The small non-coding RNAs known as microRNAs regulate gene expression and seem to play an important role in the pathogenesis of heart failure. In the current study, we aim to characterize the levels of microRNAs in the sera of chronic systolic heart failure patients vs. controls and assess the possible correlation between elevation in the levels of specific microRNAs and clinical prognostic parameters in heart failure patients. Methods and results The levels of 186 microRNAs were measured in the sera of 30 stable chronic systolic heart failure patients and 30 controls using quantitative reverse transcription–polymerase chain reaction (qRT–PCR). The differences in microRNA levels between the two groups were characterized, and a score, based on the levels of four specific microRNAs with the most significant increase in the heart failure group (miR-423-5p, miR-320a, miR-22, and miR-92b), was defined. The score was used to discriminate heart failure patients from controls with a sensitivity and specificity of 90%. Moreover, in the heart failure group, there was a significant association between the score and important clinical prognostic parameters such as elevated serum natriuretic peptide levels, a wide QRS, and dilatation of the left ventricle and left atrium (r = 0.63, P = 3e-4; P = 0.009; P = 0.03; and P = 0.01, respectively). Conclusions Elevated serum levels of specific microRNAs: miR-423-5p, miR-320a, miR-22, and miR-92b, identify systolic heart failure patients and correlate with important clinical prognostic parameters. [ABSTRACT FROM PUBLISHER]
- Published
- 2012
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39. Relation between AT1R Gene Polymorphism and Long-Term Outcome in Patients with Heart Failure.
- Author
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Amir, Offer, Amir, Ruthie E., Paz, Hagar, Attias, Eric, Sagiv, Michael, and Lewis, Basil S.
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GENETIC research ,GENETIC polymorphisms ,MORTALITY ,ISCHEMIA ,ANGIOTENSINS ,CARDIAC arrest ,POLYMERASE chain reaction ,HEART failure - Abstract
Objectives: Angiotensin II plays a key role in the pathophysiology of heart failure (HF). This study examined the angiotensin II type 1 receptor (AT1R) polymorphism in patients with systolic HF and its relation to clinical manifestations and patient outcome. Methods: We genotyped 134 patients with HF and reduced systolic function for the AT1R A1166C genotype using polymerase chain reaction and restriction fragment length polymorphism. We analyzed the relationship between the AT1R A1166C polymorphism and clinical, electrocardiographic, echocardiographic and laboratory parameters in patients with ischemic and non-ischemic etiology and examined the relation between the AT1R genotype and long-term (30 months) patient survival. Results: In HF patients, frequency of the AT1R 1166C allele and specifically the CC genotype was similar to the general population, but associated with an ischemic and not a non-ischemic etiology (p = 0.02). The CC genotype was associated with more advanced disease and more severe abnormalities of renal function (p = 0.008). Survival analysis showed that AT1R CC homozygous patients had significantly higher mortality (p = 0.008; adjusted odds ratio for mortality 6.35, 95% confidence interval 1.49–11.21, p = 0.01). Conclusion: The CC AT1R genotype was associated with poor prognostic markers and increased mortality. The findings support the principle of genome-based therapies in the future treatment of HF patients. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]
- Published
- 2008
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40. Perceived benefit after participating in positive or negative/neutral heart failure trials: the patients' perspective.
- Author
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Yuval, Rita, Uziel, Klari, Gordon, Nomi, Merdler, Amnon, Khader, Nader, Karkabi, Basheer, Flugelman, Moshe Y., Halon, David A., Lewis, Basil S., Yuval, R, Uziel, K, Gordon, N, Merdler, A, Khader, N, Karkabi, B, Flugelman, M Y, Halon, D A, and Lewis, B S
- Subjects
HEART failure ,CLINICAL trials ,CANDESARTAN ,REGRESSION analysis ,PLACEBOS ,CARDIOTONIC agents ,COMPARATIVE studies ,RESEARCH methodology ,MEDICAL cooperation ,PATIENT education ,PATIENT satisfaction ,RESEARCH ,PATIENT participation ,EVALUATION research ,TREATMENT effectiveness - Published
- 2001
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41. Effect of Isosorbide-5-Mononitrate on Exercise Performance and Clinical Status in Patients with Congestive Heart Failure.
- Author
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Rabinowitz, Babeth, Schlesinger, Zwi, Caspi, Abraham, Markiewicz, Walter, Rosenfeld, Tiberio, Sclarovsky, Samuel, Ermer, Wolfgang, and Lewis, Basil S.
- Subjects
EXERCISE ,TREADMILL exercise tests ,NITRATES ,HEART failure ,DRUG therapy ,ACE inhibitors ,CAPTOPRIL ,FUROSEMIDE ,CARDIOVASCULAR agents ,NITROGLYCERIN ,HEMODYNAMICS ,BLOOD circulation - Abstract
Background and Aims: Nitrate therapy improves hemodynamics in patients with heart failure, but the chronic effects of oral nitrates on exercise performance and clinical status have not been well studied. Methods: Oral isosorbide-5-mononitrate (ISMN) (50 mg once daily) or placebo was administered to 136 patients (NYHA Class 2–3) treated for heart failure, all receiving captopril and most also furosemide. Endpoints were treadmill exercise time at 12 weeks by modified Naughton protocol (primary), with an additional 12-week follow-up period. Secondary endpoints included left ventricular dimensions, ejection fraction, cardiothoracic ratio, functional class, quality of life, hospitalizations and plasma norepinephrine and atrial natriuretic peptide in a four-center substudy. Results: Intention-to-treat analysis showed that mean change in treadmill exercise duration tended to be greater in patients receiving ISMN than placebo (treatment difference +42 s, 95% CI –5, +90 s at 12 weeks and +21 s, 95% CI –25, +74 s after 24 weeks) (NS). Treatment difference was greater in the prespecified subgroup with ejection fraction 31–40% (+55 s, 95% CI –11, +136 s at 12 weeks and +65 s, 95% CI +3, +147 s) (p = 0.035) at 24 weeks. No deleterious effects (i.e. hypotension) were observed with ISMN, although headache was reported in 19% of the active treatment group (p = 0.0001). Conclusions: ISMN added to captopril increased treadmill exercise time in patients with heart failure and a lesser reduction in baseline ejection fraction, although for the group as a whole, the increase in treadmill time was not significant. [ABSTRACT FROM AUTHOR]
- Published
- 1999
42. Left Ventricular Function During Physiological Cardiac Pacing: Relation to Rate, Pacing Mode, and Underlying Myocardial Disease.
- Author
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Shefer, Arie, Rozenman, Yosef, David, Yosef Ben, Flugelman, Moshe Y., Gotsman, Mervyn S., and Lewis, Basil S.
- Subjects
LEFT heart ventricle ,CARDIAC contraction ,CARDIAC pacing ,CARDIOMYOPATHIES ,CONTRACTILITY (Biology) ,HEART beat ,CORONARY disease ,HEART failure - Abstract
The hemodynamic effects of cardiac pacing at different rates and in different modes were studied in 21 patients who were candidates for permanent pacemaker implantation. Nine of these had primary conduction disturbances (PCD), ten had ischemic heart disease (IHD), seven with additional cardiac/failure (CHF), and two had hypertrophic cardiomyopathy (HCM). In patients with PCD, atrial (AOO) and AV sequential (DVI) pacing did not change systolic blood pressure and pulse pressure but ventricular (VVI) pacing caused a progressive fall in these measurements, especially as heart rate increased. Ventricular volume and stroke volume (counts) derived from radionuclide ventriculography (RVG) decreased progressively with higher pacing rates, especially during WI pacing. Cardiac output was maintained during WI pacing by the increase in heart rate: during AOO and DVI pacing, cardiac output increased. Similar but more marked differences were observed in patients with IHD and CHF and the changes were even greater in the patients with HCM. Left ventricular (LV) ejection fraction changed little with increasing heart rate in PCD but decreased progressively with the onset of ischemia in IHD and CHF. There was no difference in ejection fraction in the different pacing modes. Graphs related to LV contractility fend-systolic pressure-volume relations) showed that AOO pacing produced the highest and VVI pacing produced the lowest curves of myocardial contractility in all patient groups, except that at higher rates the AOO curve shifted down again in patients with IHD and CHF, presumably with the onset of myocardial ischemia. This study showed that physiological pacing produced the best hemodynamic results in all patient groups. Higher pacing rates should be avoided in patients with ischemic heart disease while WI pacing should not be used in patients with HCM. Blood pressure and RVG studies during temporary pacing are useful in selecting the optimal pacing system in an individual... [ABSTRACT FROM AUTHOR]
- Published
- 1987
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43. Therapeutic Coronary Reperfusion and Reperfusion Injury: An Introduction.
- Author
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Borer, Jeffrey S. and Lewis, Basil S.
- Subjects
- *
CORONARY disease , *TREATMENT of reperfusion injuries , *PERCUTANEOUS coronary intervention , *HEART failure , *CONFERENCES & conventions - Abstract
Information about the 11th International Congress on Coronary Artery Disease (ICCAD) held in Florence, Italy in 2016 is presented. The conference featured a presentation by professor Roberto Ferrari, dean of the University of Ferrara School of Medicine, about reperfusion injury. The other topics discussed at the conference concerned on coronary artery disease.
- Published
- 2016
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44. Primary Stenting of an Anomalous Left Main Coronary Artery With an Interarterial Course During Cardiac Arrest: Imaging With CT Angiography.
- Author
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Jaffe, Ronen, Shiran, Avinoam, Gaspar, Tamar, Lewis, Basil S., and Halon, David A.
- Subjects
ANGIOCARDIOGRAPHY ,CORONARY arteries ,MYOCARDIAL infarction ,CARDIOPULMONARY resuscitation ,CARDIOGRAPHIC tomography ,HEART failure - Abstract
The article discusses a study which evaluates the application of computed tomography (CT) angiography on a 48-year-old woman with myocardial infarction and cardiac arrest. It notes that an emergent coronary angiography and cardiopulmonary resuscitation (CPR) was executed to the woman. It cites that the woman's left main coronary artery (LCMA) was not recognized initially. It states that is useful in the delineation of the interarterial LMCA course.
- Published
- 2009
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45. Atherothrombotic Risk Stratification and the Efficacy and Safety of Vorapaxar in Patients With Stable Ischemic Heart Disease and Previous Myocardial Infarction.
- Author
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Bohula, Erin A., Bonaca, Marc P., Braunwald, Eugene, Aylward, Philip E., Corbalan, Ramon, De Ferrari, Gaetano M., Ping He, Lewis, Basil S., Merlini, Piera A., Murphy, Sabina A., Sabatine, Marc S., Scirica, Benjamin M., Morrow, David A., and He, Ping
- Subjects
- *
CORONARY disease , *MYOCARDIAL infarction , *DIABETES , *HEART failure , *HYPERTENSION , *THROMBIN receptors , *ATHEROSCLEROSIS complications , *ATHEROSCLEROSIS , *COMPARATIVE studies , *HEMORRHAGE , *RESEARCH methodology , *MEDICAL cooperation , *ORGANIC compounds , *PYRIDINE , *RESEARCH , *RISK assessment , *DISEASE relapse , *EVALUATION research , *TREATMENT effectiveness , *PROPORTIONAL hazards models , *BLIND experiment , *KAPLAN-Meier estimator , *PLATELET aggregation inhibitors , *PREVENTION , *THERAPEUTICS ,DISEASE relapse prevention - Abstract
Background: Patients with stable ischemic heart disease and previous myocardial infarction (MI) vary in their risk for recurrent cardiovascular events. Atherothrombotic risk assessment may be useful to identify high-risk patients who have the greatest potential to benefit from more intensive secondary preventive therapy such as treatment with vorapaxar.Methods: We identified independent clinical indicators of atherothrombotic risk among 8598 stable, placebo-treated patients with a previous MI followed up for 2.5 years (median) in TRA 2°P-TIMI 50 [Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events-TIMI 50]. The efficacy and safety of vorapaxar (SCH 530348; MK-5348) were assessed by baseline risk among patients with previous MI without prior stroke or transient ischemic attack for whom there is a clinical indication for vorapaxar. End points were cardiovascular death, MI, or ischemic stroke and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) severe bleeding.Results: The 9 independent risk predictors were age, diabetes mellitus, hypertension, smoking, peripheral arterial disease, previous stroke, previous coronary bypass grafting, heart failure, and renal dysfunction. A simple integer-based scheme using these predictors showed a strong graded relationship with the rate of cardiovascular death/MI/ischemic stroke and the individual components (P for trend <0.001 for all). High-risk patients (≥3 risk indicators; 20% of population) had a 3.2% absolute risk reduction in cardiovascular disease/MI/ischemic stroke with vorapaxar, and intermediate-risk patients (1-2 risk indicators; 61%) had a 2.1% absolute risk reduction (P<0.001 each), translating to a number needed to treat of 31 and 48. Bleeding increased across risk groups (P for trend<0.01); however, net clinical outcome was increasingly favorable with vorapaxar across risk groups. Fatal bleeding or intracranial hemorrhage was 0.9% with both treatments in high-risk patients.Conclusions: Stratification of baseline atherothrombotic risk can assist with therapeutic decision making for vorapaxar use for secondary prevention after MI.Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00526474. [ABSTRACT FROM AUTHOR]- Published
- 2016
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- View/download PDF
46. Nitrates in Heart Failure
- Author
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Rabinowitz, B., Viefhues, Herbert, editor, Schoene, Wolfgang, editor, Rychlik, R., editor, Kimchi, Asher, editor, Lewis, Basil S., editor, and Weiss, Marija, editor
- Published
- 1991
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47. Effects of Isosorbide-5-Mononitrate on Haemodynamics and Exercise Tolerance in Patients with Heart Failure: Comparisons with Digoxin and Placebo
- Author
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Dews, I., Marks, C., Woodings, D., Stephens, J., VandenBurg, M., Viefhues, Herbert, editor, Schoene, Wolfgang, editor, Rychlik, R., editor, Kimchi, Asher, editor, Lewis, Basil S., editor, and Weiss, Marija, editor
- Published
- 1991
- Full Text
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48. Measuring the Quality of Life in Patients with Heart Failure : Basic Principles, Methods, and Use in Clinical Studies
- Author
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Bullinger, M., Pöppel, E., Viefhues, Herbert, editor, Schoene, Wolfgang, editor, Rychlik, R., editor, Kimchi, Asher, editor, Lewis, Basil S., editor, and Weiss, Marija, editor
- Published
- 1991
- Full Text
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49. The Pathophysiological Basis, Clinical Presentation, and Therapy of Chronic Heart Failure
- Author
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Böhm, M., Erdmann, E., Viefhues, Herbert, editor, Schoene, Wolfgang, editor, Rychlik, R., editor, Kimchi, Asher, editor, Lewis, Basil S., editor, and Weiss, Marija, editor
- Published
- 1991
- Full Text
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50. On the Epidemiology of Heart Failure
- Author
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Viefhues, H., Viefhues, Herbert, editor, Schoene, Wolfgang, editor, Rychlik, R., editor, Kimchi, Asher, editor, Lewis, Basil S., editor, and Weiss, Marija, editor
- Published
- 1991
- Full Text
- View/download PDF
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