13 results on '"Skali, Hicham"'
Search Results
2. Hyperglycaemia, ejection fraction and the risk of heart failure or cardiovascular death in patients with type 2 diabetes and a recent acute coronary syndrome.
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Shin, Sung‐Hee, Claggett, Brian, Pfeffer, Marc A., Skali, Hicham, Liu, Jiankang, Aguilar, David, Diaz, Rafael, Dickstein, Kenneth, Gerstein, Hertzel C., Køber, Lars V., Lawson, Francesca C., Lewis, Eldrin F., Maggioni, Aldo P., McMurray, John J.V., Probstfield, Jeffrey L., Riddle, Matthew C., Tardif, Jean‐Claude, Solomon, Scott D., Shin, Sung-Hee, and Tardif, Jean-Claude
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ACUTE coronary syndrome ,TYPE 2 diabetes ,HEART failure ,VENTRICULAR ejection fraction ,LEFT heart ventricle ,RESEARCH ,HYPERGLYCEMIA ,RESEARCH methodology ,PROGNOSIS ,MEDICAL cooperation ,EVALUATION research ,COMPARATIVE studies ,HOSPITAL care ,STROKE volume (Cardiac output) ,HEART physiology ,DISEASE complications - Abstract
Aims: Chronic hyperglycaemia, assessed by elevated glycated haemoglobin (A1C), is a known risk factor for heart failure (HF) and cardiovascular (CV) death among subjects with diabetes. Whether this risk varies with left ventricular ejection fraction (LVEF) is unknown. This study evaluated whether A1C influences a composite outcome of either HF hospitalization or CV death differently along the spectrum of LVEF.Methods and Results: We assessed the relationships of baseline A1C and LVEF with a composite outcome of either CV death or HF hospitalization in the 4091 patients with type 2 diabetes and a recent acute coronary syndrome enrolled in the ELIXA trial who had available LVEF. We assessed for interaction between A1C and LVEF as continuous variables with respect to this outcome. During a median follow-up of 25.7 months, 343 patients (8.4%) had HF hospitalization or died of CV causes. In a multivariable model, A1C and LVEF were each associated with an increased risk of HF hospitalization or CV death [adjusted hazard ratio (HR) 1.11, 95% confidence interval (CI) 1.01-1.21 per 1% higher A1C, and adjusted HR 1.39, 95% CI 1.27-1.51 per 10% lower in LVEF]. Both A1C and LVEF were independently and incrementally associated with risk without evidence of interaction (P for interaction = 0.31). Patients with A1C ≥ 8% and LVEF <40% were at threefold higher risk than those with A1C < 7% and LVEF ≥50% (adjusted HR 3.18, 95% CI 2.03-4.98, P < 0.001).Conclusion: In a contemporary cohort of patients with type 2 diabetes and acute coronary syndrome, baseline chronic hyperglycaemia was associated with an increased risk of HF hospitalization or CV death independently of LVEF. [ABSTRACT FROM AUTHOR]- Published
- 2020
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3. Resting Heart Rate and Chronotropic Response to Exercise: Prognostic Implications in Heart Failure Across the Left Ventricular Ejection Fraction Spectrum.
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Santos, Mário, West, Erin, Skali, Hicham, Forman, Daniel E., Nadruz, Wilson, Shah, Amil M., and Nadruz, Wilson Junior
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Background: We studied the relationship between resting heart rate (HR), chronotropic response to exercise, and clinical outcomes in patients with heart failure (HF) across the spectrum of left ventricle ejection fraction (LVEF).Methods and Results: Resting HR and chronotropic index (CIx) were assessed in 718 patients with HF (53 ± 14 years of age, 66% male) referred for exercise testing. Associations with the composite outcome of left ventricular assist device implantation, transplantation, or death (151 events, 4.4 [range 3.0-5.8] years of follow-up) were assessed with the use of Cox models adjusted for age, sex, HF etiology, diabetes, LVEF, beta-blocker use, device therapy, estimated glomerular filtration rate, and peak oxygen uptake. Resting HR was 73 ± 15 beats/min, CIx was 0.60 ± 0.26, LVEF was 34% ± 15%, and 39% had an LVEF ≥40%. Resting HR correlated poorly with CIx (r = 0.08; P = .04) and did not predict (P = .84) chronotropic incompetence (CIx <0.60). Both higher resting HR (per 5 beats/min increase: adjusted hazard ratio [HR] -1.05, 95% confidence interval [CI] 1.00-1.11) and CIx (per SD change: adjusted HR -0.77, 95% CI 0.62-0.94) were independent prognostic markers. No heterogeneity of effect was noted based on LVEF (P >.05).Conclusion: Higher resting HR and lower CIx are both associated with more severe HF, but correlated poorly with each other. They provide independent and additive prognostic information in HF across the LVEF spectrum. [ABSTRACT FROM AUTHOR]- Published
- 2018
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4. Association of heart rate and outcomes in a broad spectrum of patients with chronic heart failure: Results from the CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and morbidity) program
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Castagno, Davide, Skali, Hicham, Takeuchi, Madoka, Swedberg, Karl, Yusuf, Salim, Granger, Christopher B., Michelson, Eric L., Pfeffer, Marc A., McMurray, John J.V., and Solomon, Scott D.
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heart rate ,heart failure ,atrial fibrillation ,prognosis ,ejection fraction - Abstract
ObjectivesThe aim of this study was to explore the relationship between baseline resting heart rate and outcomes in patients with chronic heart failure (HF) according to baseline left ventricular ejection fraction (LVEF) and cardiac rhythm.BackgroundElevated resting heart rate is associated with worse outcomes in patients with HF and reduced LVEF. Whether this association is also found in patients with HF and preserved LVEF is uncertain, as is the predictive value of heart rate in patients in atrial fibrillation (AF).MethodsPatients enrolled in the CHARM (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) Program were divided into groups by tertiles of baseline heart rate. Cox proportional hazard models were used to investigate the association between heart rate and pre-specified outcomes in the overall population as well as in subgroups defined according to LVEF (≤40% vs. >40%) and presence (or absence) of AF at baseline.ResultsAfter adjusting for predictors of poor prognosis, patients in the highest heart rate tertile had worse outcomes when compared with those in the lowest heart rate group (e.g., for the composite of cardiovascular death or HF hospital stay hazard ratio: 1.23, 95% confidence interval: 1.11 to 1.36, p < 0.001). The relationship between heart rate and outcomes was similar across LVEF categories and was not influenced by beta-blocker use (p value for interaction >0.10 for both endpoints). However, amongst patients in AF at baseline, heart rate had no predictive value (p value for interaction
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- 2012
5. Prognostic value of coronary CTAvs. exercise treadmilltesting: results fromthePartnersregistry.
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Cheezum, Michael K., Subramaniyam, Prem Srinivas, Bittencourt, Marcio S., Hulten, Edward A., Ghoshhajra, Brian B., Shah, Nishant R., Forman, Daniel E., Hainer, Jon, Leavitt, Marcia, Padmanabhan, Ram, Skali, Hicham, Dorbala, Sharmila, Hoffmann, Udo, Abbara, Suhny, Carli, Marcelo F. Di, Gewirtz, Henry, and Blankstein, Ron
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CORONARY artery stenosis ,CORONARY heart disease complications ,CORONARY disease ,DIAGNOSIS ,DIAGNOSIS of diabetes ,HYPERTENSION ,CARDIOVASCULAR disease diagnosis ,CARDIOLOGY ,CARDIOPULMONARY system ,COMPUTED tomography ,DIAGNOSTIC imaging ,REPORTING of diseases ,ECHOCARDIOGRAPHY ,EXERCISE tests ,CARDIAC patients ,HYPERLIPIDEMIA ,EVALUATION of medical care ,MEDICAL referrals ,MEDICAL technology ,RISK assessment ,COMORBIDITY ,DATA analysis ,DESCRIPTIVE statistics ,CORONARY angiography - Abstract
Aims We sought to compare the complementary prognostic value of exercise treadmill testing (ETT) and coronary computed tomographic angiography (CTA) among patients referred for both exams. Methods and results We studied 582 patients without known coronary artery disease (CAD) who were clinically referred for ETT and CTA within 6 months. Patientswere followed for cardiovascular (CV) death, non-fatal myocardial infarction (MI), or late revascularization (.90 days), stratified by Duke Treadmill Score (DTS) and CAD severity (≥50% stenosis). Mean age was 54+13 years (63% male). In median follow-up of 40 months, therewere 3 CV deaths, 7 non-fatal MIs, and 26 late revascularizations. ETTwas inconclusive in 23%, positive in 31%, and negative in 46%.CTAdemonstrated noCADin 37%, nonobstructive CADin 28%, and obstructive CADin 35%. Among low-risk ETT patients (n ¼ 326), therewere 3 MI, 10 late revascularizations, and the frequent presence of non-obstructive (32%, n ¼ 105) and obstructive CAD (27%, n ¼ 88). When present, ETT features (i.e. angina, DTS, ischaemic electrocardiogram changes, and exercise capacity) individually failed to predict CV death/MI after adjustment for Morise score. Conversely, both obstructive CAD [HR 4.9 (1.0-23.3), P ¼ 0.048] and CAD extent by segment involvement score .4 [HR 3.9 (1.0-15.2), P ¼ 0.049] predicted increased risk for CV death or MI. Conclusion Patients with a low-risk ETT have an excellent prognosis at 40 months, despite the frequent presence of non-obstructive (32%) and obstructive (27%) CAD. In patients with an intermediate- to high-risk ETT (DTS ,5), CTA can provide incremental risk stratification for future CV events. [ABSTRACT FROM AUTHOR]
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- 2015
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6. Prognosis and response to therapy of first inpatient and outpatient heart failure event in a heart failure clinical trial: MADIT-CRT.
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Skali, Hicham, Dwyer, Edward M., Goldstein, Robert, Haigney, Mark, Krone, Ronald, Kukin, Marrick, Lichstein, Edgar, McNitt, Scott, Moss, Arthur J., Pfeffer, Marc A., and Solomon, Scott D.
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HEART failure treatment , *HEART failure , *OUTPATIENT medical care , *CLINICAL trials , *RANDOMIZED controlled trials , *FOLLOW-up studies (Medicine) , *HEALTH outcome assessment , *PROGNOSIS - Abstract
Aims Hospitalization for worsening heart failure ( HF) is known to increase mortality and morbidity risk and has been frequently used as an endpoint in randomized clinical trials. Whether outpatient management of HF exacerbation carries similar prognostic and therapeutic information is less well known, but could be important for the design of trials that use HF hospitalization as an endpoint. Methods and results MADIT-CRT randomized patients with mild HF symptoms to resynchronization therapy vs. control with an average follow-up of 3.3 years and a total of 191 deaths. HF events were centrally adjudicated for receiving i.v. decongestive therapy in an outpatient setting, or an augmented HF regimen during a hospital stay. Patients were compared according to whether their first HF was an out- or inpatient event. The first primary event was non-fatal outpatient HF, non-fatal inpatient HF, and death in 52, 331, and 78 patients, respectively. Patients with inpatient HF tended to be older and more likely to have HF of ischaemic aetiology than subjects who developed outpatient HF events. The risk of death following either type of non-fatal HF events was extremely high [hazard ratio ( HR) 12.4, 95% confidence interval ( CI) 9.1-16.9 for inpatient HF; HR 10.7, 95% CI 6.1-18.7 for outpatient HF] compared with subjects without non-fatal HF events. Allocation to CRT-D was associated with significant reduction in both types of HF. Conclusion Outpatient management of worsening HF portends a high risk of death, similar to inpatient HF events, and may be equally sensitive to the effects of therapy. These findings suggest that outpatient HF events should be considered in publicly reported outcomes measures and future HF clinical trials. Trial Registration NCT01294449. [ABSTRACT FROM AUTHOR]
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- 2014
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7. Prognostic Implications of Left Ventricular Mass and Geometry Following Myocardial Infarction: The VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study.
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Verma, Anil, Meris, Alessandra, Skali, Hicham, Ghali, Jalal K., Arnold, J. Malcolm O., Bourgoun, Mikhail, Velazquez, Eric J., McMurray, John J.V., Kober, Lars, Pfeffer, Marc A., Califf, Robert M., and Solomon, Scott D.
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MYOCARDIAL infarction ,ECHOCARDIOGRAPHY ,LEFT heart ventricle ,HYPERTROPHY - Abstract
Objectives: This study sought to understand prognostic implications of increased baseline left ventricular (LV) mass and geometric patterns in a high risk acute myocardial infarction. Background: The LV hypertrophy and alterations in LV geometry are associated with an increased risk of adverse cardiovascular events. Methods: Quantitative echocardiographic analyses were performed at baseline in 603 patients from the VALIANT (VALsartan In Acute myocardial iNfarcTion) echocardiographic study. The left ventricular mass index (LVMi) and relative wall thickness (RWT) were calculated. Patients were classified into 4 mutually exclusive groups based on RWT and LVMi as follows: normal geometry (normal LVMi and normal RWT), concentric remodeling (normal LVMi and increased RWT), eccentric hypertrophy (increased LVMi and normal RWT), and concentric hypertrophy (increased LVMi and increased RWT). Cox proportional hazards models were used to evaluate the relationships among LVMi, RWT, LV geometry, and clinical outcomes. Results: Mean LVMi and RWT were 98.8 ± 28.4 g/m
2 and 0.38 ± 0.08. The risk of death or the composite end point of death from cardiovascular causes, reinfarction, heart failure, stroke, or resuscitation after cardiac arrest was lowest for patients with normal geometry, and increased with concentric remodeling (hazard ratio [HR]: 3.0; 95% confidence interval [CI]: 1.9 to 4.9), eccentric hypertrophy (HR: 3.1; 95% CI: 1.9 to 4.8), and concentric hypertrophy (HR: 5.4; 95% CI: 3.4 to 8.5), after adjusting for baseline covariates. Also, baseline LVMi and RWT were associated with increased mortality and nonfatal cardiovascular outcomes (HR: 1.22 per 10 g/m2 increase in LVMi; 95% CI: 1.20 to 1.30; p < 0.001) (HR: 1.60 per 0.1-U increase in RWT; 95% CI: 1.30 to 1.90; p < 0.001). Increased risk associated with RWT was independent of LVMi. Conclusions: Increased baseline LV mass and abnormal LV geometry portend an increased risk for morbidity and mortality following high-risk myocardial infarction. Concentric LV hypertrophy carries the greatest risk of adverse cardiovascular events including death. Higher RWT was associated with an increased risk of cardiovascular complications after high-risk myocardial infarction. [Copyright &y& Elsevier]- Published
- 2008
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8. Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: prognostic significance and relation to ventricular size and function.
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Amigoni, Maria, Meris, Alessandra, Thune, Jens Jakob, Mangalat, Deepa, Skali, Hicham, Bourgoun, Mikhail, Warnica, J. Wayne, Barvik, Stale, Arnold, J. Malcolm O., Velazquez, Eric J., Van de Werf, Frans, Ghali, Jalal, McMurray, John J.V., Køber, Lars, Pfeffer, Marc A., and Solomon, Scott D.
- Abstract
Aims Mitral regurgitation (MR) confers independent risk in patients with acute myocardial infarction. We utilized data from the VALsartan In Acute myocardial iNfarcTion echo study to relate baseline MR to left ventricular (LV) size, shape, and function, and to assess the relationship between baseline MR and progression of MR and cardiovascular (CV) outcomes. [ABSTRACT FROM PUBLISHER]
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- 2007
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9. Prognostic use of echocardiography 1 year after a myocardial infarction.
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Skali, Hicham, Zornoff, Leonardo A.M., Pfeffer, Marc A., Arnold, Malcolm O., Lamas, Gervasio A., Moyé, Lemuel A., Plappert, Ted, Rouleau, Jean L., Sussex, Bruce A., St John Sutton, Martin, Braunwald, Eugene, Solomon, Scott D., Moyé, Lemuel A, and Survival and Ventricular Enlargement (SAVE) Investigators
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MYOCARDIAL infarction ,CORONARY disease ,DIAGNOSTIC ultrasonic imaging ,HEART failure ,MYOCARDIAL infarction-related mortality ,COMPARATIVE studies ,HEART ventricles ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,PROGNOSIS ,RESEARCH ,TIME ,ULTRASONIC imaging ,EVALUATION research ,PHYSIOLOGY - Abstract
Background: Left ventricular (LV) and right ventricular (RV) function are known predictors of morbidity and mortality after an acute myocardial infarction (MI). However, the prognostic use of a late evaluation of cardiac function after an MI remains unclear.Methods: We analyzed echocardiograms obtained 1 year after MI in patients with LV dysfunction at baseline (ejection fraction [EF] < or = 40%) from 291 patients enrolled in the SAVE echocardiographic substudy who did not develop heart failure (HF) or a recurrent MI during this first year. Left ventricular EF and RV fractional area change were assessed.Results: After a median follow-up of 22 months after the 1-year echocardiogram, a low LVEF (< 30%) at 1 year was associated with an increased risk of death and/or HF (hazards ratio [HR] 2.7, 95% CI 1.3-5.3). Presence of RV dysfunction was also associated with an increased risk of death (HR 8.9, 95% CI 3.5-22.1), development of HF (HR 7.1, 95% CI 3.4-15.0), and the composite end point of death or HF (HR 7.6, 95% CI 4.1-14.2). In multivariate analyses, both low LVEF and RV dysfunction remained independently predictive of the composite end point of death or HF. Patients with biventricular dysfunction were at the greatest risk of death and/or HF (HR 19.4, 95% CI 8.2-46.0) in follow-up.Conclusions: In a stable population of survivors of MI, impaired LV and RV function at 1 year after MI are independently and additively predictive of increased risk of HF or death. [ABSTRACT FROM AUTHOR]- Published
- 2005
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10. Prognostic Implications of Left Ventricular Mass and Geometry Following Myocardial Infarction The VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study
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Verma, Anil, Meris, Alessandra, Skali, Hicham, Ghali, Jalal K., Arnold, J. Malcolm O., Bourgoun, Mikhail, Velazquez, Eric J., McMurray, John J.V., Kober, Lars, Pfeffer, Marc A., Califf, Robert M., and Solomon, Scott D.
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left ventricular geometry ,myocardial infarction ,echocardiography ,relative wall thickness ,prognosis ,left ventricular mass - Abstract
ObjectivesThis study sought to understand prognostic implications of increased baseline left ventricular (LV) mass and geometric patterns in a high risk acute myocardial infarction.BackgroundThe LV hypertrophy and alterations in LV geometry are associated with an increased risk of adverse cardiovascular events.MethodsQuantitative echocardiographic analyses were performed at baseline in 603 patients from the VALIANT (VALsartan In Acute myocardial iNfarcTion) echocardiographic study. The left ventricular mass index (LVMi) and relative wall thickness (RWT) were calculated. Patients were classified into 4 mutually exclusive groups based on RWT and LVMi as follows: normal geometry (normal LVMi and normal RWT), concentric remodeling (normal LVMi and increased RWT), eccentric hypertrophy (increased LVMi and normal RWT), and concentric hypertrophy (increased LVMi and increased RWT). Cox proportional hazards models were used to evaluate the relationships among LVMi, RWT, LV geometry, and clinical outcomes.ResultsMean LVMi and RWT were 98.8 ± 28.4 g/m2 and 0.38 ± 0.08. The risk of death or the composite end point of death from cardiovascular causes, reinfarction, heart failure, stroke, or resuscitation after cardiac arrest was lowest for patients with normal geometry, and increased with concentric remodeling (hazard ratio [HR]: 3.0; 95% confidence interval [CI]: 1.9 to 4.9), eccentric hypertrophy (HR: 3.1; 95% CI: 1.9 to 4.8), and concentric hypertrophy (HR: 5.4; 95% CI: 3.4 to 8.5), after adjusting for baseline covariates. Also, baseline LVMi and RWT were associated with increased mortality and nonfatal cardiovascular outcomes (HR: 1.22 per 10 g/m2 increase in LVMi; 95% CI: 1.20 to 1.30; p < 0.001) (HR: 1.60 per 0.1-U increase in RWT; 95% CI: 1.30 to 1.90; p < 0.001). Increased risk associated with RWT was independent of LVMi.ConclusionsIncreased baseline LV mass and abnormal LV geometry portend an increased risk for morbidity and mortality following high-risk myocardial infarction. Concentric LV hypertrophy carries the greatest risk of adverse cardiovascular events including death. Higher RWT was associated with an increased risk of cardiovascular complications after high-risk myocardial infarction.
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11. Changes in Pulmonary Artery Pressure Late in Life: The Atherosclerosis Risk in Communities (ARIC) Study.
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Zierath, Rani, Claggett, Brian, Arthur, Victoria, Yang, Yimin, Skali, Hicham, Matsushita, Kunihiro, Kitzman, Dalane, Konety, Suma, Mosley, Thomas, and Shah, Amil M.
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PULMONARY artery , *BLACK people , *SYSTOLIC blood pressure , *PROGNOSIS , *ATHEROSCLEROSIS - Abstract
Although the prognostic implications of higher pulmonary artery systolic pressure (PASP) are well established, few data exist regarding longitudinal change in pulmonary pressure in late life. The aim of this study was to quantify changes in PASP over 6 years and determine the relative contributions of cardiac and pulmonary dysfunction. Among 1,420 participants in the ARIC (Atherosclerosis Risk in Communities) study with echocardiographic measures of PASP at both the fifth (2011-2013) and seventh (2018-2019) visits, longitudinal changes in PASP over about 6.5 years were quantified. Multivariable regression was used to determine the extent to which cardiac and pulmonary dysfunction were associated with changes in PASP and to define the relationship of changes in PASP with dyspnea development. The mean age was 75 ± 5 years at visit 5 and 81 ± 5 years at visit 7, 24% of subjects were Black adults, and 68% were women. Over the 6.5 years, PASP increased by 5 ± 8 mm Hg, from 28 ± 5 to 33 ± 8 mm Hg. PASP increased more in older participants. Predictors of greater increases in PASP included worse left ventricular (LV) systolic and diastolic function, pulmonary function, and renal function. Increases in PASP were associated with concomitant increases in measures of LV filling pressure, including E/e′ ratio and left atrial volume index. Each 5 mm Hg increase was associated with 16% higher odds of developing dyspnea (OR: 1.16; 95% CI: 1.07-1.27; P < 0.001). Pulmonary pressure increased over 6.5 years in late life, was associated with concomitant increases in LV filling pressure, and predicted the development of dyspnea. Interventions targeting LV diastolic function may be effective at mitigating age-related increases in PASP. [Display omitted] [ABSTRACT FROM AUTHOR]
- Published
- 2023
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12. PREDICTORS AND PROGNOSIS OF INCIDENT POOR NUTRITIONAL STATUS IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION: INSIGHTS FROM THE PARAGON-HF TRIAL.
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Lu, Henri, Claggett, Brian, Minamisawa, Masatoshi, Karabay, Arzu Kalayci, Seidelmann, Sara Bretschger, Ostrominski, John, Lee, Sahmin, Foà, Alberto, Desai, Akshay S., Shah, Amil M., Pfeffer, Marc A., McMurray, John J.V., Hegde, Sheila M., Solomon, Scott D., and Skali, Hicham
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HEART failure , *NUTRITIONAL status , *HEART failure patients , *VENTRICULAR ejection fraction , *PROGNOSIS - Published
- 2024
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13. Cardiac Positron Emission Tomography Enhances Prognostic Assessments of Patients With Suspected Cardiac Sarcoidosis.
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Blankstein, Ron, Osborne, Michael, Naya, Masanao, Waller, Alfonso, Kim, Chun K., Murthy, Venkatesh L., Kazemian, Pedram, Kwong, Raymond Y., Tokuda, Michifumi, Skali, Hicham, Padera, Robert, Hainer, Jon, Stevenson, William G., Dorbala, Sharmila, and Di Carli, Marcelo F.
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CARDIOGRAPHIC tomography , *POSITRON emission tomography , *SARCOIDOSIS , *VENTRICULAR tachycardia , *ELECTRONIC health records , *QUESTIONNAIRES , *COMPUTED tomography , *PROGNOSIS - Abstract
Objectives: This study sought to relate imaging findings on positron emission tomography (PET) to adverse cardiac events in patients referred for evaluation of known or suspected cardiac sarcoidosis. Background: Although cardiac PET is commonly used to evaluate patients with suspected cardiac sarcoidosis, the relationship between PET findings and clinical outcomes has not been reported. Methods: We studied 118 consecutive patients with no history of coronary artery disease, who were referred for PET, using [18F]fluorodeoxyglucose (FDG) to assess for inflammation and rubidium-82 to evaluate for perfusion defects (PD), following a high-fat/low-carbohydrate diet to suppress normal myocardial glucose uptake. Blind readings of PET data categorized cardiac findings as normal, positive PD or FDG, positive PD and FDG. Images were also used to identify whether findings of extra-cardiac sarcoidosis were present. Adverse events (AE)—death or sustained ventricular tachycardia (VT)—were ascertained by electronic medical records, defibrillator interrogation, patient questionnaires, and telephone interviews. Results: Among the 118 patients (age 52 ± 11 years; 57% males; mean ejection fraction: 47 ± 16%), 47 (40%) had normal and 71 (60%) had abnormal cardiac PET findings. Over a median follow-up of 1.5 years, there were 31 (26%) adverse events (27 VT and 8 deaths). Cardiac PET findings were predictive of AE, and the presence of both a PD and abnormal FDG (29% of patients) was associated with hazard ratio of 3.9 (p < 0.01) and remained significant after adjusting for left ventricular ejection fraction (LVEF) and clinical criteria. Extra-cardiac FDG uptake (26% of patients) was not associated with AE. Conclusions: The presence of focal PD and FDG uptake on cardiac PET identifies patients at higher risk of death or VT. These findings offer prognostic value beyond Japanese Ministry of Health and Welfare clinical criteria, the presence of extra-cardiac sarcoidosis and LVEF. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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