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1. Socio-economic factors determine maternal and neonatal outcomes in women with peripartum cardiomyopathy: A study of the ESC EORP PPCM registry

Author

Sliwa, Karen, van der Meer, Peter, Viljoen, Charle, Jackson, Alice M., Petrie, Mark C., Mebazaa, Alexandre, Hilfiker-Kleiner, Denise, Maggioni, Aldo P., Laroche, Cecile, Regitz-Zagrosek, Vera, Tavazzi, Luigi, Roos-Hesselink, Jolien W., Hamdan, Righab, Frogoudaki, Alexandra, Ibrahim, Bassem, Farhan, Hasan Ali Farhan, Mbakwem, Amam, Seferovic, Petar, Böhm, Michael, Pieske, Burkert, Johnson, Mark R., and Bauersachs, Johann

Published
2024
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4. Living with peripartum cardiomyopathy: A statement from the Heart Failure Association and the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology.

Author

Sliwa, Karen, Rakisheva, Amina, Viljoen, Charle, Pfeffer, Tobias, Simpson, Maggie, Jackson, Alice M., Petrie, Mark C., van der Meer, Peter, Al Farhan, Hasan, Jovanova, Silvana, Mbakwem, Amam, Sinagra, Gianfranco, Van Craenenbroeck, Emeline, Hoevelmann, Julian, Johnson, Mark R., Mindham, Richard, Chioncel, Ovidiu, Kahl, Kai G., Rosano, Giuseppe, and Tschöpe, Carsten

Subjects
CARDIOVASCULAR nurses, SOCIAL workers, HEART failure, EXTENDED families, QUALITY of life
Abstract

This statement focuses on the fact that women with peripartum cardiomyopathy (PPCM) have a substantial mortality and morbidity rate. Less than 50% of patients have full recovery of their cardiac function within 6 months of diagnosis. Also, patients with recovered cardiac function often suffer from comorbidities, such as hypertension or arrhythmias, which require long‐term treatment. This has major implications which extend beyond the life of the patient, as it may also substantially impact her family. Women with a new diagnosis of PPCM should be involved in the decision‐making processes regarding therapies, e.g. the recommendation to abstain from breastfeeding, or the use of cardiac implantable electronic devices. Women living with PPCM face the uncertainty of not knowing for some time whether their cardiac function will recover to allow them a near‐to‐normal life expectancy. This not only impacts their ability to work, which may have financial implications, but may also affect mental health and quality of life for the extended family. Women living with PPCM must be informed that a future pregnancy always carries a substantial risk and, in case of poor cardiac recovery, is associated with a high morbidity and mortality. Patients with PPCM are best managed by an interdisciplinary and multiprofessional approach including e.g. a cardiologist, a gynaecologist, nurses, a psychologist, and social workers. The scope of this document encompasses contemporary challenges and approaches for the management of women diagnosed with PPCM. [ABSTRACT FROM AUTHOR]

Published
2024
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6. Socio-economic factors determine maternal and neonatal outcomes in women with peripartum cardiomyopathy:A study of the ESC EORP PPCM registry

Author

Sliwa, Karen, van der Meer, Peter, Viljoen, Charle, Jackson, Alice M., Petrie, Mark C., Mebazaa, Alexandre, Hilfiker-Kleiner, Denise, Maggioni, Aldo P., Laroche, Cecile, Regitz-Zagrosek, Vera, Tavazzi, Luigi, Roos-Hesselink, Jolien W., Hamdan, Righab, Frogoudaki, Alexandra, Ibrahim, Bassem, Farhan, Hasan Ali Farhan, Mbakwem, Amam, Seferovic, Petar, Böhm, Michael, Pieske, Burkert, Johnson, Mark R., Bauersachs, Johann, Sliwa, Karen, van der Meer, Peter, Viljoen, Charle, Jackson, Alice M., Petrie, Mark C., Mebazaa, Alexandre, Hilfiker-Kleiner, Denise, Maggioni, Aldo P., Laroche, Cecile, Regitz-Zagrosek, Vera, Tavazzi, Luigi, Roos-Hesselink, Jolien W., Hamdan, Righab, Frogoudaki, Alexandra, Ibrahim, Bassem, Farhan, Hasan Ali Farhan, Mbakwem, Amam, Seferovic, Petar, Böhm, Michael, Pieske, Burkert, Johnson, Mark R., and Bauersachs, Johann

Abstract

Background: Peripartum cardiomyopathy (PPCM) is a global disease with substantial morbidity and mortality. The aim of this study was to analyze to what extent socioeconomic factors were associated with maternal and neonatal outcomes. Methods: In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global PPCM registry, under the auspices of the ESC EORP Programme. We investigated the characteristics and outcomes of women with PPCM and their babies according to individual and country-level sociodemographic factors (Gini index coefficient [GINI index], health expenditure [HE] and human developmental index [HDI]). Results: 739 women from 49 countries (Europe [33%], Africa [29%], Asia-Pacific [15%], Middle East [22%]) were enrolled. Low HDI was associated with greater left ventricular (LV) dilatation at time of diagnosis. However, baseline LV ejection fraction did not differ according to sociodemographic factors. Countries with low HE prescribed guideline-directed heart failure therapy less frequently. Six-month mortality was higher in countries with low HE; and LV non-recovery in those with low HDI, low HE and lower levels of education. Maternal outcome (death, re-hospitalization, or persistent LV dysfunction) was independently associated with income. Neonatal death was significantly more common in countries with low HE and low HDI, but was not influenced by maternal income or education attainment.Conclusions: Maternal and neonatal outcomes depend on country-specific socioeconomic characteristics. Attempts should therefore be made to allocate adequate resources to health and education, to improve maternal and fetal outcomes in PPCM.

Published
2024

8. A novel score to predict left ventricular recovery in peripartum cardiomyopathy derived from the ESC EORP Peripartum Cardiomyopathy Registry.

Author

Jackson, Alice M, Goland, Sorel, Farhan, Hasan Ali, Yaseen, Israa Fadhil, Prameswari, Hawani Sasmaya, Böhm, Michael, Jhund, Pardeep S, Maggioni, Aldo P, van der Meer, Peter, Sliwa, Karen, Bauersachs, Johann, and Petrie, Mark C

Subjects
PERIPARTUM cardiomyopathy, ECLAMPSIA, HUMAN Development Index, PROGNOSTIC models, HEART failure, SYMPTOMS
Abstract

Background and Aims There are no established clinical tools to predict left ventricular (LV) recovery in women with peripartum cardiomyopathy (PPCM). Using data from women enrolled in the ESC EORP PPCM Registry, the aim was to derive a prognostic model to predict LV recovery at 6 months and develop the 'ESC EORP PPCM Recovery Score'—a tool for clinicians to estimate the probability of LV recovery. Methods From 2012 to 2018, 752 women from 51 countries were enrolled. Eligibility included (i) a peripartum state, (ii) signs or symptoms of heart failure, (iii) LV ejection fraction (LVEF) ≤ 45%, and (iv) exclusion of alternative causes of heart failure. The model was derived using data from participants in the Registry and internally validated using bootstrap methods. The outcome was LV recovery (LVEF ≥50%) at six months. An integer score was created. Results Overall, 465 women had a 6-month echocardiogram. LV recovery occurred in 216 (46.5%). The final model included baseline LVEF, baseline LV end diastolic diameter, human development index (a summary measure of a country's social and economic development), duration of symptoms, QRS duration and pre-eclampsia. The model was well-calibrated and had good discriminatory ability (C -statistic 0.79, 95% confidence interval [CI] 0.74–0.83). The model was internally validated (optimism-corrected C -statistic 0.78, 95% CI 0.73–0.82). Conclusions A model which accurately predicts LV recovery at 6 months in women with PPCM was derived. The corresponding ESC EORP PPCM Recovery Score can be easily applied in clinical practice to predict the probability of LV recovery for an individual in order to guide tailored counselling and treatment. [ABSTRACT FROM AUTHOR]

Published
2024
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9. A 20-year population study of peripartum cardiomyopathy

Author

Jackson, Alice M, primary, Macartney, Mark, additional, Brooksbank, Katriona, additional, Brown, Carolyn, additional, Dawson, Dana, additional, Francis, Mark, additional, Japp, Alan, additional, Lennie, Vera, additional, Leslie, Stephen J, additional, Martin, Thomas, additional, Neary, Paul, additional, Venkatasubramanian, Sowmya, additional, Vickers, Debra, additional, Weir, Robin A, additional, McMurray, John J V, additional, Jhund, Pardeep S, additional, and Petrie, Mark C, additional

Published
2023
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11. Outcomes at one year in women with peripartum cardiomyopathy: Findings from the ESC EORP PPCM Registry.

Author

Jackson, Alice M., Bauersachs, Johann, Petrie, Mark C., van der Meer, Peter, Laroche, Cecile, Farhan, Hasan Ali, Frogoudaki, Alexandra, Ibrahim, Bassem, Fouad, Doaa A., Damasceno, Albertino, Karaye, Kamilu, Goland, Sorel, Maggioni, Aldo P., Briton, Olivia, and Sliwa, Karen

Subjects
*PERIPARTUM cardiomyopathy, *SYMPTOMS, *STROKE, *HEART failure, *VENTRICULAR ejection fraction, *PATIENT readmissions
Abstract

Aims: There are few prospective reports of 1‐year outcomes for women with peripartum cardiomyopathy (PPCM). We report findings from the European Society of Cardiology EURObservational Research Programme PPCM Registry. Methods and results: The registry enrolled women from 51 countries from 2012 to 2018. Eligibility included: (i) a peripartum state, (ii) signs or symptoms of heart failure, (iii) left ventricular (LV) ejection fraction ≤45%, (iv) exclusion of alternative causes of heart failure. We report mortality, thromboembolism, stroke, rehospitalization, LV recovery and remodelling at 1 year. Differences between regions were compared. One‐year mortality data were available in 535 (71%) women and follow‐up differed across regions. At 1 year, death from any cause occurred in 8.4% of women, with regional variation (Europe 4.9%, Africa 6.5%, Asia‐Pacific 9.2%, Middle East 18.9%; p < 0.001). The frequencies of thromboembolism and stroke were 6.3% and 2.5%, respectively, and were similar across regions. A total of 14.0% of women had at least one rehospitalization and 3.5% had recurrent rehospitalizations (i.e. two or more). Overall, 66.1% of women had recovery of LV function (22% between 6 months and 1 year), with a mean LV ejection fraction increase from baseline of 21.2% (±13.6). Recovery occurred most frequently in Asia‐Pacific (77.5%) and least frequently in the Middle East (32.7%). There were significant regional differences in the use of heart failure pharmacotherapies. Conclusions: Approximately 1 in 12 women with PPCM had died by 1 year and thromboembolism and stroke occurred in 6.3% and 2.5%, respectively. Around 1 in 7 women had been rehospitalized and, in 1 in 3, LV recovery had not occurred. PPCM is associated with substantial mortality and morbidity globally. [ABSTRACT FROM AUTHOR]

Published
2024
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12. Dapagliflozin and Diuretic Use in Patients With Heart Failure and Reduced Ejection Fraction in DAPA-HF

Author

Jackson, Alice M., Dewan, Pooja, Anand, Inder S., Bělohlávek, Jan, Bengtsson, Olof, de Boer, Rudolf A., Böhm, Michael, Boulton, David W., Chopra, Vijay K., DeMets, David L., Docherty, Kieran F., Dukát, Andrej, Greasley, Peter J., Howlett, Jonathan G., Inzucchi, Silvio E., Katova, Tzvetana, Køber, Lars, Kosiborod, Mikhail N., Langkilde, Anna Maria, Lindholm, Daniel, Ljungman, Charlotta E.A., Martinez, Felipe A., O’Meara, Eileen, Sabatine, Marc S., Sjöstrand, Mikaela, Solomon, Scott D., Tereshchenko, Sergey, Verma, Subodh, Jhund, Pardeep S., and McMurray, John J.V.

Published
2020
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14. Effects of Sacubitril-Valsartan Versus Valsartan in Women Compared With Men With Heart Failure and Preserved Ejection Fraction: Insights From PARAGON-HF

Author

McMurray, John J.V., Jackson, Alice M., Lam, Carolyn S.P., Redfield, Margaret M., Anand, Inder S., Ge, Junbo, Lefkowitz, Marty P., Maggioni, Aldo P., Martinez, Felipe, Packer, Milton, Pfeffer, Marc A., Pieske, Burkert, Rizkala, Adel R., Sabarwal, Shalini V., Shah, Amil M., Shah, Sanjiv J., Shi, Victor C., van Veldhuisen, Dirk J., Zannad, Faiez, Zile, Michael R., Cikes, Maja, Goncalvesova, Eva, Katova, Tzvetana, Kosztin, Anamaria, Lelonek, Malgorzata, Sweitzer, Nancy, Vardeny, Orly, Claggett, Brian, Jhund, Pardeep S., and Solomon, Scott D.

Published
2020
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16. Thromboembolic events in peripartum cardiomyopathy: results from the ESC EORP PPCM registry

Author

Tromp, Jasper, Jackson, Alice M, Abdelhamid, Magdy, Fouad, Doaa, Youssef, Ghada, Petrie, Mark C, Bauersachs, Johann, Sliwa, Karen, van der Meer, Peter, Gale, C P, Beleslin, B., Budaj, A., Chioncel, O., Dagres, N., Danchin, N., Emberson, J., Erlinge, D., Glikson, M., Gray, A., Kayikcioglu, M., Maggioni, A P, Nagy, V K, Nedoshivin, A., Petronio, A-S, Roos-Hesselink, J., Wallentin, L., Zeymer, U., Bauersachs, J., Sliwa, K., Boehm, M., Johnson, M., Hilfiker-Kleiner, D., Mbakwem, A., Mebazaa, A., Mouquet, F., Petrie, M., Pieske, B., Regitz-Zagrosek, V., Schaufelberger, M., Seferovic, P M, Tavazzi, L., van der Meer, P., Van Spaendonck-Zwarts, K., Favaloro, R., Favaloro, L., Carballo, M., Peradejordi, M., Renedo, M F, Absi, D., Bertolotti, A., Ratto, R., Talavera, M L, Gomez, R., Lockwood, S., Barton, T., Austin, M-A, Arstall, M., Aldridge, E., Chow, Y Y, Dekker, G., Mahadavan, G., Rose, J., Wittwer, M., Hoppe, U., Sandhofer, A., Bahshaliyev, A., Gasimov, Z., Babayev, A., Niftiyev, P., Hasanova, I., AlBannay, R., AlHaiki, W., Husain, A., Mahdi, N., Kurlianskaya, A., Lukyanchyk, M., Shatova, O., Troyanova-Shchutskaia, T., Anghel, L., De Pauw, M., Gevaert, S., De Backer, J., De Hosson, M., Vervaet, P., Timmermans, P J, Janssen, A., Yameogo, N V, Kagambega, L J, Cumyn, A., Caron, N., Cote, A-M, Sauve, N., Nkulu, D Ngoy, Lez, D Malamba, Yolola, E Ngoy, Krejci, J., Poloczkova, H., Ersboll, A., Gustafsson, F., Elrakshy, Y., Hassanein, M., Hammad, B., Eldin, O Nour, Fouad, D., Salman, S., Zareh, Z., Abdeall, D., Elenin, H Abo, Ebaid, H., El Nagar, A., Farag, S., Saed, M., El Rahman, Y H Abd, Ibrahim, B S, Abdelhamid, M., Hanna, R N W, Youssef, G., Awad, R., Botrous, O L I, Halawa, S Ibrahim, Nasr, G., Saad, A., El Tahlawi, M., Abdelbaset, M., El-Saadawy, M., El-Shorbagy, A., Shalaby, G., Anttonen, O., Tolppanen, H., Hamekoski, S., Menez, T., Noel, A., Lamblin, N., Coulon, C., de Groote, P., Langlois, S., Schurtz, G., Cohen-Solal, A., Fournier, M-C, Louadah, B., Akrout, N., Logeart, D., Leurent, G., Jovanova, S., Arnaudova-Dezulovicj, F., Livrinova, V., Berliner, D., Jungesblut, M., Koenig, T., Moulig, V A, Pfeffer, T J, Böhm, M., Kindermann, I., Schwarz, V., Schmitt, C., Swojanowsky, P., Pettit, S., McAdam, M., Patton, D., Bakhai, A., Krishnamurthy, V., Lim, L., Clifford, P., Bowers, N., Clark, A L, Witte, K., Cullington, D., Oliver, J., Simms, A., Mcginlay, M., McDonagh, T., Shah, A M, Amin-Youssef, G., De Courcey, J., Martin, K., Shaw, S., Vause, S., Wallace, S., Malin, G., Wick, C., Nikolaou, M., Rentoukas, I., Chinchilla, H., Andino, L., Iyengar, S., Chandra, S., Yadav, D K, Babu, R Ravi, Singh, A K, Kumar, S., Karunamay, B B, Chaubey, S K, Dhiman, S R, Jha, V C, Singh, S K, Kodati, D., Dasari, R., Sultana, S., Dewi, T I, Prameswari, H Sasmaya, Al-Farhan, H A, Al-Hussein, A., Yaseen, I F, Al-Azzawi, Falah, Al-Saedi, Ghazi, Mahmood, G M, Mohammed, M K, Ridha, A F, Shotan, A., Vazan, A., Goland, S., Biener, M., Senni, M., Grosu, A., Martin, E., Esposti, D Degli, Bacchelli, S., Borghi, C., Metra, M., Sciatti, E., Orabona, R., Sani, F., Brunetti, N D, Sinagra, G., Bobbo, M., D'Agata Mottolese, B., Gesuete, V., Rakar, S., Ramani, F., Kamiya, C., Barasa, A., Ngunga, M., Bajraktari, G., Hyseni, V., Lleshi, D., Pllana, E., Pllana, T., Noruzbaeva, A., Ismailov, F., Mirrakhimov, E., Abilova, S., Lunegova, O., Kerimkulova, A., Osmankulova, G., Duishenalieva, M., Kurmanbekova, B., Turgunov, M., Mamasaidova, S., Bektasheva, E., Kavoliūnienė, Aušra, Muckienė, Gintarė, Vaitiekienė, Audronė, Čelutkienė, Jelena, Balkevičienė, Laura, Barysienė, Jūratė, Chee, K H, Damasceno, A., Machava, M., van Veldhuisen, D J, van den Berg, M., van Hagen, I., Baris, L., Hurtado, P., Ezeonu, P., Isiguzo, G., Obeka, N., Onoh, R., Asogwa, F., Onyema, C., Otti, K., Ojji, D., Odili, A., Nwankwo, A., Karaye, K., Ishaq, N., Sanni, B., Abubakar, H., Mohammed, B., Sani, M., Kehinde, M., Afolabi, B., Amadi, C., Kilasho, M., Qamar, N., Furnaz, S., Gurmani, S., Kayani, M G A Mahmood, Munir, R., Hussain, S., Malik, S., Mumtaz, S., Saligan, J R, Rubis, P., Biernacka-Fijalkowska, B., Lesniak-Sobelga, A., Wisniowska-Smialek, S., Kasprzak, J D, Lelonek, M., Zycinski, P., Jankowski, L., Grajek, S., Oko-Sarnowska, Z., Rutkowska, A Bartczak, Kaluzna-Oleksy, M., Plaskota, K., Demkow, M., Dzielinska, Z., Henzel, J., Kryczka, K., Moiseeva, O., Irtyuga, O., Karelkina, E., Zazerskaya, I., Milinkovic, I., Živkovic, I., Ristic, A D, Milasinovic, D., Kong, W Kf, Tan, L K, Tan, J L, Thain, S., Poh, K K, Yip, J., Azibani, F., Hovelmann, J., Viljoen, C., Briton, O., Zamora, E., Orcajo, N Alonso, Carbonell, R., Pascual, C., Muncharaz, J Farre, Alonso-Pulpon, L., Cubero, J Segovia, Urquia, M Taibo, Garcia-Pavia, P., Gomez-Bueno, M., Cobo-Marcos, M., Briceno, A., Galvan, E De Teresa, Garcia-Pinilla, J M, Robles-Mezcua, A., Morcillo-Hildalgo, L., Elbushi, A., Suliman, A., Ahamed, N., Jazzar, K., Murtada, M., Goloskokova, V., Hullin, R., Yarol, N., Arrigo, M., Cavusoglu, Y., Eraslan, S., Fak, A S, Enar, S Catirli, Sarac, L., Cankurtaran, B., Gumrukcuoglu, H., Ozturk, F., Omagino, J., Mondo, C., Lwabi, P., Ingabire, P., Nabbaale, J., Nyakoojo, W., Okello, E., Sebatta, E., Ssinabulya, I., Atukunda, E., Kitooleko, S., Semu, T., Salih, B T, Komaranchath, A M, Almahmeed, W A R, Gerges, F., Farook, F S Mohamed, Albakshy, F., Mahmood, N., Wani, S., Freudenberger, R., Islam, N., Quinones, J., Sundlof, D., Beitler, C., Centolanza, L., Cornell, K., Huffaker, S., Matos, L., Marzo, K., Paruchuri, V., Patel, D., Abdullaev, T., Alyavi, B., Mirzarakhimova, S., Tsoy, I., Bekbulatova, R., and Uzokov, J.

Published
2023

17. Report from the Annual Conference of the British Society of Echocardiography, November 2017, Edinburgh International Conference Centre, Edinburgh

Author

Sharma, Vishal, Stout, Martin, Pearce, Keith, Klein, Allan L., Alsharqi, Maryam, Nihoyannopoulos, Petros, Khan, Jamal Nasir, Griffiths, Timothy, Sandhu, Kully, Cabezon, Sinead, Kwok, Chun Shing, Baig, Shanat, Naneishvili, Tamara, Lee, Vetton Chee Kay, Pasricha, Arron, Robins, Emily, Kanagala, Prathap, Fatima, Tamseel, Mihai, Andreea, Butler, Robert, Duckett, Simon, Heatlie, Grant, Gu, Haotian, Chowienczyk, Phil, Arnold, Linda, Coffey, Sean, Loudon, Margaret, Wilson, Jo, Kennedy, Andrew, Myerson, Saul G., Prendergast, Bernard, Jackson, Alice M., Lennie, Vera, Luke, Peter Lee, Eggett, Christopher James, Spyridopoulos, Loakim, Irvine, Timothy Simon, Ismail, Nashwah, Macnab, Anita, Bleakley, Caroline, Eskandari, Mehdi, Aldalati, Omar, Whittaker, Almira, Huang, Marilou, Monaghan, Mark J., Turner, Thomas J., Steele, Conor, Barton, Anna, Cameron, Alan C., Sonecki, Piotr, Phang, Gyee Vuei, Voukalis, Christos, Teh, Hwee Phen, Apostolakis, Stavros, Wong, Chih, Lee, Matthew M. Y., Goodfield, Nicolas E. R., Lane, Emma, Slessor, David, Crawley, Richard, Ntoskas, Theodoros, Ahmad, Farhanda, Woodmansey, Paul, Fletcher, Andrew J., Robinson, Shaun, Rana, Bushra S., Batchelor, Liam, McAdam, Brogan, Coats, Caroline J., Mayall, Louise C., Campbell, Niall G., and Garnett, Hannah

Published
2019
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18. Reply

Author

Jackson, Alice M., primary and Lund, Lars H., additional

Published
2022
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19. Diabetes and pre-diabetes in patients with heart failure and preserved ejection fraction

Author

Jackson, Alice M., Rørth, Rasmus, Liu, Jiankang, Kristensen, Søren Lund, Anand, Inder S., Claggett, Brian L., Cleland, John G.F., Chopra, Vijay K., Desai, Akshay S., Ge, Junbo, Gong, Jianjian, Lam, Carolyn S.P., Lefkowitz, Martin P., Maggioni, Aldo P., Martinez, Felipe, Packer, Milton, Pfeffer, Marc A., Pieske, Burkert, Redfield, Margaret M., Rizkala, Adel R., Rouleau, Jean L., Seferović, Petar M., Tromp, Jasper, Van Veldhuisen, Dirk J., Yilmaz, Mehmet B., Zannad, Faiez, Zile, Michael R., Køber, Lars, Petrie, Mark C., Jhund, Pardeep S., Solomon, Scott D., McMurray, John J.V., Jackson, Alice M., Rørth, Rasmus, Liu, Jiankang, Kristensen, Søren Lund, Anand, Inder S., Claggett, Brian L., Cleland, John G.F., Chopra, Vijay K., Desai, Akshay S., Ge, Junbo, Gong, Jianjian, Lam, Carolyn S.P., Lefkowitz, Martin P., Maggioni, Aldo P., Martinez, Felipe, Packer, Milton, Pfeffer, Marc A., Pieske, Burkert, Redfield, Margaret M., Rizkala, Adel R., Rouleau, Jean L., Seferović, Petar M., Tromp, Jasper, Van Veldhuisen, Dirk J., Yilmaz, Mehmet B., Zannad, Faiez, Zile, Michael R., Køber, Lars, Petrie, Mark C., Jhund, Pardeep S., Solomon, Scott D., and McMurray, John J.V.

Abstract

Aim: There is an association between heart failure with preserved ejection fraction (HFpEF) and insulin resistance, but less is known about the diabetic continuum, and in particular about pre-diabetes, in HFpEF. We examined characteristics and outcomes of participants with diabetes or pre-diabetes in PARAGON-HF. Methods and results: Patients aged ≥50 years with left ventricular ejection fraction ≥45%, structural heart disease and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) were eligible. Patients were classified according to glycated haemoglobin (HbA1c): (i) normal HbA1c, <6.0%; (ii) pre-diabetes, 6.0%–6.4%; (iii) diabetes, ≥6.5% or history of diabetes. The primary outcome was a composite of cardiovascular (CV) death and total heart failure hospitalizations (HFH). Of 4796 patients, 50% had diabetes and 18% had pre-diabetes. Compared to patients with normal HbA1c, patients with pre-diabetes and diabetes more often were obese, had a history of myocardial infarction and had lower Kansas City Cardiomyopathy Questionnaire scores, while patients with diabetes had more clinical evidence of congestion, but similar NT-proBNP concentrations. The risks of the primary composite outcome (rate ratio [RR] 1.59, 95% confidence interval [CI] 1.35–1.88), total HFH (RR 1.67, 95% CI 1.39–2.02) and CV death (hazard ratio [HR] 1.35, 95% CI 1.07–1.71) were higher among patients with diabetes, compared to those with normal HbA1c. Patients with pre-diabetes had a higher risk (which was intermediate between that of patients with diabetes and those with normal HbA1c) of the primary outcome (HR 1.27, 95% CI 1.00–1.60) and HFH (HR 1.35, 95% CI 1.03–1.77), but not of CV death (HR 1.02, 95% CI 0.75–1.40). Patients with diabetes treated with insulin had worse outcomes than those not, and those with ‘lean diabetes’ had similar mortality rates to those with a higher body mass index, but lower rates of HFH. Conclusion: Pre-diabetes is common in patients with HFpEF and is asso

Published
2022

20. 2012 APSA Teaching and Learning Conference and Track Summaries

Author

Mealy, Kimberly A., Cruise, Rebecca JoAnn, Forren, John, Smith, Robbin E., Bennion, Elizabeth, Davis, Shari, Mayer, Russell, Newton, Cynthia, Speakman, June S., Paczynska, Agnieszka, Gentry, Bobbi, Aubin, Jessica, Wu, Joshua Su-Ya, Karjala, Aleisha, McClellan, Fletcher, Young, Candace C., Hummer, Jill Abraham, Mulcare, Daniel, Parsons, Tara N., Ricks, Boris E., Okura, Masako Rachel, Jackson, Alice M., Bertrand, Julia M. Lau, Harkness, Suzan, Dounoucos, Victoria, Vidal, Logan, Roberts, Joseph W., Sachleben, Mark, Ward, Deborah E., Maxwell, Jewerl, Ivanov, Ivan Dinev, Ross, Jon, Emenaker, Ryan, Hedrick, James, Johnson, Shaen, Betsalel, Kenneth, Biser, Ashley, Nordquist, Michael, Selby, David, Bachner, Jennifer, and Commins, Margaret

Published
2012

21. Effect of sacubitril/valsartan on investigator‐reported ventricular arrhythmias in PARADIGM‐HF

Author

Curtain, James P., primary, Jackson, Alice M., additional, Shen, Li, additional, Jhund, Pardeep S., additional, Docherty, Kieran F., additional, Petrie, Mark C., additional, Castagno, Davide, additional, Desai, Akshay S., additional, Rohde, Luis E., additional, Lefkowitz, Martin P., additional, Rouleau, Jean‐Lucien, additional, Zile, Michael R., additional, Solomon, Scott D., additional, Swedberg, Karl, additional, Packer, Milton, additional, and McMurray, John J.V., additional

Published
2022
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22. Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registry

Author

Jackson, Alice M., Petrie, Mark C., Frogoudaki, Alexandra, Laroche, Cécile, Gustafsson, Finn, Ibrahim, Bassem, Mebazaa, Alexandre, Johnson, Mark R., Seferovic, Petar M., Regitz‐Zagrosek, Vera, Mbakwem, Amam, Böhm, Michael, Prameswari, Hawani Sasmaya, Abdel Gawad, Doaa Ahmed Fouad, Goland, Sorel, Damasceno, Albertino, Karaye, Kamilu, Farhan, Hasan Ali, Hamdan, Righab, Maggioni, Aldo P., Sliwa, Karen, Bauersachs, Johann, Meer, Peter, Favaloro, R., Favaloro, L., Carballo, M., Peradejordi, M., Renedo, M.F., Absi, D., Bertolotti, A., Ratto, R., Talavera, M.L., Gomez, R., Lockwood, S., Barton, T., Austin, M‐A., Arstall, M., Aldridge, E., Chow, Y.Y., Dekker, G., Mahadavan, G., Rose, J., Wittwer, M., Hoppe, U., Sandhofer, A., Bahshaliyev, A., Gasimov, Z., Babayev, A., Niftiyev, P., Hasanova, I., AlBannay, R., AlHaiki, W., Husain, A., Mahdi, N., Kurlianskaya, A., Lukyanchyk, M., Shatova, O., Troyanova‐Shchutskaia, T., Anghel, L., De Pauw, M., Gevaert, S., De Backer, J., De Hosson, M., Vervaet, P., Timmermans, P.J., Janssen, A., Yameogo, N.V., Kagambega, L.J., Cumyn, A., Caron, N., Cote, A‐M., Sauve, N., Nkulu, D. Ngoy, Lez, D. Malamba, Yolola, E. Ngoy, Krejci, J., Poloczkova, H., Ersboll, A., Gustafsson, F., Elrakshy, Y., Hassanein, M., Hammad, B., Eldin, O. Nour, Fouad, D., Salman, S., Zareh, Z., Abdeall, D., Elenin, H. Abo, Ebaid, H., El Nagar, A., Farag, S., Saed, M., El Rahman, Y H Abd, Ibrahim, B.S., Abdelhamid, M., Hanna, R.N. W., Youssef, G., Awad, R., Botrous, O.L. I., Halawa, S. Ibrahim, Nasr, G., Saad, A., El Tahlawi, M., Abdelbaset, M., El‐saadawy, M., El‐shorbagy, A., Shalaby, G., Anttonen, O., Tolppanen, H., Hamekoski, S., Menez, T., Noel, A., Lamblin, N., Mouquet, F., Coulon, C., Groote, P., Langlois, S., Schurtz, G., Cohen‐Solal, A., Mebazaa, A., Fournier, M‐C., Louadah, B., Akrout, N., Logeart, D., Leurent, G., Jovanova, S., Arnaudova‐Dezulovicj, F., Livrinova, V., Bauersachs, J., Hilfiker‐Kleiner, D., Berliner, D., Jungesblut, M., Koenig, T., Moulig, V.A., Pfeffer, T.J., Böhm, M., Kindermann, I., Schwarz, V., Schmitt, C., Swojanowsky, P., Pettit, S., Petrie, M., McAdam, M., Patton, D., Bakhai, A., Krishnamurthy, V., Lim, L., Clifford, P., Bowers, N., Clark, A. L., Witte, K., Cullington, D., Oliver, J., Simms, A., Mcginlay, M., McDonagh, T., Shah, A. M., Amin‐Youssef, G., De Courcey, J., Martin, K., Shaw, S., Vause, S., Wallace, S., Malin, G., Wick, C., Nikolaou, M., Rentoukas, I., Chinchilla, H., Andino, L., Iyengar, S., Chandra, S., Yadav, D.K., Babu, R. Ravi, Singh, A.K., Kumar, S., Karunamay, B.B., Chaubey, S.K., Dhiman, S.R., Jha, V.C., Singh, S.K., Kodati, D., Dasari, R., Sultana, S., Dewi, T.I., Prameswari, H. Sasmaya, Al‐Farhan, H.A., Al‐Hussein, A., Yaseen, I.F., Al‐Azzawi, Falah, Al‐Saedi, Ghazi, Mahmood, G.M., Mohammed, M.K., Ridha, A.F., Shotan, A., Vazan, A., Goland, S., Biener, M., Senni, M., Grosu, A., Martin, E., Esposti, D. Degli, Bacchelli, S., Borghi, C., Metra, M., Sciatti, E., Orabona, R., Sani, F., Brunetti, N.D., Sinagra, G., Bobbo, M., D'Agata Mottolese, B., Gesuete, V., Rakar, S., Ramani, F., Kamiya, C., Barasa, A., Ngunga, M., Bajraktari, G., Hyseni, V., Lleshi, D., Pllana, E., Pllana, T., Noruzbaeva, A., Ismailov, F., Mirrakhimov, E., Abilova, S., Lunegova, O., Kerimkulova, A., Osmankulova, G., Duishenalieva, M., Kurmanbekova, B., Turgunov, M., Mamasaidova, S., Bektasheva, E., Kavoliuniene, A., Muckiene, G., Vaitiekiene, A., Celutkiene, J., Balkevicine, L., Barysiene, J., Chee, K.H., Damasceno, A., Machava, M., Veldhuisen, D.J., Meer, P., Berg, M., Roos‐Hesselink, J., Hagen, I., Baris, L., Hurtado, P., Ezeonu, P., Isiguzo, G., Obeka, N., Onoh, R., Asogwa, F., Onyema, C., Otti, K., Ojji, D., Odili, A., Nwankwo, A., Karaye, K., Ishaq, N., Sanni, B., Abubakar, H., Mohammed, B., Sani, M., Kehinde, M., Mbakwem, A., Afolabi, B., Amadi, C., Kilasho, M., Qamar, N., Furnaz, S., Gurmani, S., Kayani, M.G.A. Mahmood, Munir, R., Hussain, S., Malik, S., Mumtaz, S., Saligan, J.R., Rubis, P., Biernacka‐Fijalkowska, B., Lesniak‐Sobelga, A., Wisniowska‐Smialek, S., Kasprzak, J.D., Lelonek, M., Zycinski, P., Jankowski, L., Grajek, S., Oko‐Sarnowska, Z., Rutkowska, A. Bartczak, Kaluzna‐Oleksy, M., Plaskota, K., Demkow, M., Dzielinska, Z., Henzel, J., Kryczka, K., Moiseeva, O., Irtyuga, O., Karelkina, E., Zazerskaya, I., Seferovic, P.M., Milinkovic, I., Živkovic, I., Ristic, A.D., Milasinovic, D., Kong, W. KF, Tan, L.K., Tan, J.L., Thain, S., Poh, K.K., Yip, J., Sliwa, K., Azibani, F., Hovelmann, J., Viljoen, C., Briton, O., Zamora, E., Orcajo, N. Alonso, Carbonell, R., Pascual, C., Muncharaz, J. Farre, Alonso‐Pulpon, L., Cubero, J. Segovia, Urquia, M. Taibo, Garcia‐Pavia, P., Gomez‐Bueno, M., Cobo‐Marcos, M., Briceno, A., Galvan, E. De Teresa, Garcia‐Pinilla, J.M., Robles‐Mezcua, A., Morcillo‐Hildalgo, L., Elbushi, A., Suliman, A., Ahamed, N., Jazzar, K., Murtada, M., Schaufelberger, M., Goloskokova, V., Hullin, R., Yarol, N., Arrigo, M., Cavusoglu, Y., Eraslan, S., Fak, A.S., Enar, S. Catirli, Sarac, L., Cankurtaran, B., Gumrukcuoglu, H., Ozturk, F., Omagino, J., Mondo, C., Lwabi, P., Ingabire, P., Nabbaale, J., Nyakoojo, W., Okello, E., Sebatta, E., Ssinabulya, I., Atukunda, E., Kitooleko, S., Semu, T., Salih, B.T., Komaranchath, A.M., Almahmeed, W.A.R., Gerges, F., Farook, F.S. Mohamed, Albakshy, F., Mahmood, N., Wani, S., Freudenberger, R., Islam, N., Quinones, J., Sundlof, D., Beitler, C., Centolanza, L., Cornell, K., Huffaker, S., Matos, L., Marzo, K., Paruchuri, V., Patel, D., Abdullaev, T., Alyavi, B., Mirzarakhimova, S., Tsoy, I., Bekbulatova, R., and Uzokov, J.

Abstract

Aims: \ud Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy.\ud \ud Methods: \ud The European Society of Cardiology PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: 1) women without hypertension (‘PPCM-noHTN’); 2) women with hypertension but without pre-eclampsia (‘PPCM-HTN’); 3) women with pre-eclampsia (‘PPCM-PE’). Maternal (6-month) and neonatal outcomes were compared.\ud \ud Results: \ud Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (NYHA IV in 44.4% and 29.9%, p

Published
2021

24. Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

Author

Sliwa, Karen, Meer, Peter, Petrie, Mark C., Frogoudaki, Alexandra, Johnson, Mark R., Hilfiker‐Kleiner, Denise, Hamdan, Righab, Jackson, Alice M., Ibrahim, Bassem, Mbakwem, Amam, Tschöpe, Carsten, Regitz‐Zagrosek, Vera, Omerovic, Elmir, Roos‐Hesselink, Jolien, Gatzoulis, Michael, Tutarel, Oktay, Price, Susanna, Heymans, Stephane, Coats, Andrew JS, Müller, Christian, Chioncel, Ovidiu, Thum, Thomas, Boer, Rudolf A., Jankowska, Ewa, Ponikowski, Piotr, Lyon, Alexander R., Rosano, Guiseppe, Seferovic, Petar M., and Bauersachs, Johann

Abstract

This position paper focusses on the pathophysiology, diagnosis and management of women diagnosed with a cardiomyopathy, or at risk of heart failure (HF), who are planning to conceive or present with (de novo or previously unknown) HF during or after pregnancy. This includes the heterogeneous group of heart muscle diseases such as hypertrophic, dilated, arrhythmogenic right ventricular and non-classified cardiomyopathies, left ventricular non-compaction, peripartum cardiomyopathy, Takotsubo syndrome, adult congenital heart disease with HF, and patients with right HF. Also, patients with a history of chemo-/radiotherapy for cancer or haematological malignancies need specific pre-, during and post-pregnancy assessment and counselling. We summarize the current knowledge about pathophysiological mechanisms, including gene mutations, clinical presentation, diagnosis, and medical and device management, as well as risk stratification. Women with a known diagnosis of a cardiomyopathy will often require continuation of drug therapy, which has the potential to exert negative effects on the foetus. This position paper assists in balancing benefits and detrimental effects.

Published
2021

26. Sacubitril–valsartan as a treatment for apparent resistant hypertension in patients with heart failure and preserved ejection fraction

Author

Jackson, Alice M, primary, Jhund, Pardeep S, additional, Anand, Inder S, additional, Düngen, Hans-Dirk, additional, Lam, Carolyn S P, additional, Lefkowitz, Marty P, additional, Linssen, Gerard, additional, Lund, Lars H, additional, Maggioni, Aldo P, additional, Pfeffer, Marc A, additional, Rouleau, Jean L, additional, Saraiva, Jose F K, additional, Senni, Michele, additional, Vardeny, Orly, additional, Wijkman, Magnus O, additional, Yilmaz, Mehmet B, additional, Saito, Yoshihiko, additional, Zile, Michael R, additional, Solomon, Scott D, additional, and McMurray, John J V, additional

Published
2021
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27. Effect of Neprilysin Inhibition on Left Ventricular Remodeling in Patients With Asymptomatic Left Ventricular Systolic Dysfunction Late After Myocardial Infarction

Author

Docherty, Kieran F., primary, Campbell, Ross T., additional, Brooksbank, Katriona J.M., additional, Dreisbach, John G., additional, Forsyth, Paul, additional, Godeseth, Rosemary L., additional, Hopkins, Tracey, additional, Jackson, Alice M., additional, Lee, Matthew M.Y., additional, McConnachie, Alex, additional, Roditi, Giles, additional, Squire, Iain B., additional, Stanley, Bethany, additional, Welsh, Paul, additional, Jhund, Pardeep S., additional, Petrie, Mark C., additional, and McMurray, John J.V., additional

Published
2021
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28. Sacubitril-valsartan as a treatment for apparent resistant hypertension in patients with heart failure and preserved ejection fraction

Author

Jackson, Alice M., Jhund, Pardeep S., Anand, Inder S., Duengen, Hans-Dirk, Lam, Carolyn S. P., Lefkowitz, Marty P., Linssen, Gerard, Lund, Lars H., Maggioni, Aldo P., Pfeffer, Marc A., Rouleau, Jean L., Saraiva, Jose F. K., Senni, Michele, Vardeny, Orly, Wijkman, Magnus, Yilmaz, Mehmet B., Saito, Yoshihiko, Zile, Michael R., Solomon, Scott D., McMurray, John J. V, Jackson, Alice M., Jhund, Pardeep S., Anand, Inder S., Duengen, Hans-Dirk, Lam, Carolyn S. P., Lefkowitz, Marty P., Linssen, Gerard, Lund, Lars H., Maggioni, Aldo P., Pfeffer, Marc A., Rouleau, Jean L., Saraiva, Jose F. K., Senni, Michele, Vardeny, Orly, Wijkman, Magnus, Yilmaz, Mehmet B., Saito, Yoshihiko, Zile, Michael R., Solomon, Scott D., and McMurray, John J. V

Abstract

Aims: Patients with heart failure and preserved ejection fraction (HFpEF) frequently have difficult-to-control hypertension. We examined the effect of neprilysin inhibition on apparent resistant hypertension in patients with HFpEF in the PARAGON-HF trial, which compared the effect of sacubitril-valsartan with valsartan. Methods and results: In this post hoc analysis, patients were categorized according to systolic blood pressure at the end of the valsartan run-in (n=4795). Apparent resistant hypertension was defined as systolic blood pressure >= 14 0mmHg (>= 135 mmHg if diabetes) despite treatment with valsartan, a calcium channel blocker, and a diuretic. Apparent mineralocorticoid receptor antagonist (MRA)-resistant hypertension was defined as systolic blood pressure >= 140 mmHg (>= 135 mmHg if diabetes) despite the above treatments and an MRA. The primary outcome in the PARAGON-HF trial was a composite of total hospitalizations for heart failure and death from cardiovascular causes. We examined clinical endpoints and the safety of sacubitril-valsartan according to the hypertension category. We also examined reductions in blood pressure from the end of valsartan run-in to Weeks 4 and 16 after randomization. Overall, 731 patients (15.2%) had apparent resistant hypertension and 135 (2.8%) had apparent MRA-resistant hypertension. The rate of the primary outcome was higher in patients with apparent resistant hypertension [17.3; 95% confidence interval (CI) 15.6-19.1 per 100 person-years] compared to those with a controlled systolic blood pressure (13.4; 12.7-14.3 per 100 person-years), with an adjusted rate ratio of 1.28 (95% CI 1.05-1.57). The reduction in systolic blood pressure at Weeks 4 and 16, respectively, was greater with sacubitril-valsartan vs. valsartan in patients with apparent resistant hypertension [-4.8 (-7.0 to -2.5) and 3.9 (-6.6 to -1.3) mmHg] and apparent MRA-resistant hypertension [-8.8 (-14.0 to -3.5) and -6.3 (-12.5 to, Funding Agencies: A.M.J. is supported by a British Heart Foundation Clinical Research Training Fellowship (FS/18/14/33330) and J.J.V.M. is supported by a British Heart Foundation Centre of Research Excellence Grant (RE/18/6/34217).

Published
2021
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29. Hypertensive disorders in women with peripartum cardiomyopathy:insights from the ESC EORP PPCM Registry

Author

Jackson, Alice M, Petrie, Mark C, Frogoudaki, Alexandra, Laroche, Cécile, Gustafsson, Finn, Ibrahim, Bassem, Mebazaa, Alexandre, Johnson, Mark R., Seferovic, Petar M., Regitz-Zagrosek, Vera, Mbakwem, Amam, Böhm, Michael, Prameswari, Hawani S., Fouad, Doaa A., Goland, Sorel, Damasceno, Albertino, Karaye, Kamilu, Farhan, Hasan A., Hamdan, Righab, Maggioni, Aldo P, Sliwa, Karen, Bauersachs, Johann, van der Meer, Peter, Jackson, Alice M, Petrie, Mark C, Frogoudaki, Alexandra, Laroche, Cécile, Gustafsson, Finn, Ibrahim, Bassem, Mebazaa, Alexandre, Johnson, Mark R., Seferovic, Petar M., Regitz-Zagrosek, Vera, Mbakwem, Amam, Böhm, Michael, Prameswari, Hawani S., Fouad, Doaa A., Goland, Sorel, Damasceno, Albertino, Karaye, Kamilu, Farhan, Hasan A., Hamdan, Righab, Maggioni, Aldo P, Sliwa, Karen, Bauersachs, Johann, and van der Meer, Peter

Abstract

Aims: Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy. Methods and results: The European Society of Cardiology EURObservational Research Programme PPCM Registry enrolled women with PPCM from 2012–2018. Three groups were examined: (i) women without hypertension (PPCM-noHTN); (ii) women with hypertension but without pre-eclampsia (PPCM-HTN); (iii) women with pre-eclampsia (PPCM-PE). Maternal (6-month) and neonatal outcomes were compared. Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (New York Heart Association class IV in 44.4% vs. 29.9%, P < 0.001), more frequent signs of heart failure (pulmonary rales in 70.7% vs. 55.4%, P = 0.002), a higher baseline left ventricular ejection fraction (LVEF) (32.7% vs. 30.7%, P = 0.005) and a smaller left ventricular end-diastolic diameter (57.4 ± 6.7 mm vs. 59.8 ± 8.1 mm, P = 0.001). There were no differences in the frequencies of death from any cause, rehospitalization for any cause, stroke, or thromboembolic events. Compared to women with PPCM-noHTN, women with PPCM-PE had a greater likelihood of left ventricular recovery (LVEF ≥ 50%) (adjusted odds ratio 2.08, 95% confidence interval 1.21–3.57) and an adverse neonatal outcome (composite of termination, miscarriage, low birth weight or neonatal death) (adjusted odds ratio 2.84, 95% confidence interval 1.66–4.87). Conclusion: Differences exist in phenotype, recovery of cardiac function and neonatal outcomes according to hypertensive status in women with PPCM.

Published
2021

30. Global Differences in Heart Failure with Preserved Ejection Fraction:The PARAGON-HF Trial

Author

Tromp, Jasper, Claggett, Brian L., Liu, Jiankang, Jackson, Alice M., Jhund, Pardeep S., Køber, Lars, Widimský, Jiří, Boytsov, Sergey A., Chopra, Vijay K., Anand, Inder S., Ge, Junbo, Chen, Chen-Huan, Maggioni, Aldo P., Martinez, Felipe, Packer, Milton, Pfeffer, Marc A., Pieske, Burkert, Redfield, Margaret M., Rouleau, Jean L., Van Veldhuisen, Dirk J., Zannad, Faiez, Zile, Michael R., Rizkala, Adel R., Inubushi-Molessa, Akiko, Lefkowitz, Martin P., Shi, Victor C., McMurray, John J.V., Solomon, Scott D., Lam, Carolyn S.P., Tromp, Jasper, Claggett, Brian L., Liu, Jiankang, Jackson, Alice M., Jhund, Pardeep S., Køber, Lars, Widimský, Jiří, Boytsov, Sergey A., Chopra, Vijay K., Anand, Inder S., Ge, Junbo, Chen, Chen-Huan, Maggioni, Aldo P., Martinez, Felipe, Packer, Milton, Pfeffer, Marc A., Pieske, Burkert, Redfield, Margaret M., Rouleau, Jean L., Van Veldhuisen, Dirk J., Zannad, Faiez, Zile, Michael R., Rizkala, Adel R., Inubushi-Molessa, Akiko, Lefkowitz, Martin P., Shi, Victor C., McMurray, John J.V., Solomon, Scott D., and Lam, Carolyn S.P.

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) is a global public health problem with important regional differences. We investigated these differences in the PARAGON-HF trial (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in HFpEF), the largest and most inclusive global HFpEF trial. Methods: We studied differences in clinical characteristics, outcomes, and treatment effects of sacubitril/valsartan in 4796 patients with HFpEF from the PARAGON-HF trial, grouped according to geographic region. Results: Regional differences in patient characteristics and comorbidities were observed: patients from Western Europe were oldest (mean 75±7 years) with the highest prevalence of atrial fibrillation/flutter (36%); Central/Eastern European patients were youngest (mean 71±8 years) with the highest prevalence of coronary artery disease (50%); North American patients had the highest prevalence of obesity (65%) and diabetes (49%); Latin American patients were younger (73±9 years) and had a high prevalence of obesity (53%); and Asia-Pacific patients had a high prevalence of diabetes (44%), despite a low prevalence of obesity (26%). Rates of the primary composite end point of total hospitalizations for HF and death from cardiovascular causes were lower in patients from Central Europe (9 per 100 patient-years) and highest in patients from North America (28 per 100 patient-years), which was primarily driven by a greater number of total hospitalizations for HF. The effect of treatment with sacubitril-valsartan was not modified by region (interaction P>0.05). Conclusions: Among patients with HFpEF recruited worldwide in PARAGON-HF, there were important regional differences in clinical characteristics and outcomes, which may have implications for the design of future clinical trials.

Published
2021

31. Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy:a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

Author

Sliwa, Karen, van der Meer, Peter, Petrie, Mark C., Frogoudaki, Alexandra, Johnson, Mark R., Hilfiker-Kleiner, Denise, Hamdan, Righab, Jackson, Alice M., Ibrahim, Bassem, Mbakwem, Amam, Tschöpe, Carsten, Regitz-Zagrosek, Vera, Omerovic, Elmir, Roos-Hesselink, Jolien, Gatzoulis, Michael, Tutarel, Oktay, Price, Susanna, Heymans, Stephane, Coats, Andrew J.S., Müller, Christian, Chioncel, Ovidiu, Thum, Thomas, de Boer, Rudolf A., Jankowska, Ewa, Ponikowski, Piotr, Lyon, Alexander R., Rosano, Giuseppe, Seferovic, Petar M., Bauersachs, Johann, Sliwa, Karen, van der Meer, Peter, Petrie, Mark C., Frogoudaki, Alexandra, Johnson, Mark R., Hilfiker-Kleiner, Denise, Hamdan, Righab, Jackson, Alice M., Ibrahim, Bassem, Mbakwem, Amam, Tschöpe, Carsten, Regitz-Zagrosek, Vera, Omerovic, Elmir, Roos-Hesselink, Jolien, Gatzoulis, Michael, Tutarel, Oktay, Price, Susanna, Heymans, Stephane, Coats, Andrew J.S., Müller, Christian, Chioncel, Ovidiu, Thum, Thomas, de Boer, Rudolf A., Jankowska, Ewa, Ponikowski, Piotr, Lyon, Alexander R., Rosano, Giuseppe, Seferovic, Petar M., and Bauersachs, Johann

Abstract

This position paper focusses on the pathophysiology, diagnosis and management of women diagnosed with a cardiomyopathy, or at risk of heart failure (HF), who are planning to conceive or present with (de novo or previously unknown) HF during or after pregnancy. This includes the heterogeneous group of heart muscle diseases such as hypertrophic, dilated, arrhythmogenic right ventricular and non-classified cardiomyopathies, left ventricular non-compaction, peripartum cardiomyopathy, Takotsubo syndrome, adult congenital heart disease with HF, and patients with right HF. Also, patients with a history of chemo-/radiotherapy for cancer or haematological malignancies need specific pre-, during and post-pregnancy assessment and counselling. We summarize the current knowledge about pathophysiological mechanisms, including gene mutations, clinical presentation, diagnosis, and medical and device management, as well as risk stratification. Women with a known diagnosis of a cardiomyopathy will often require continuation of drug therapy, which has the potential to exert negative effects on the foetus. This position paper assists in balancing benefits and detrimental effects.

Published
2021

32. Reply to 'Breaking down peripartum cardiomyopathy: A learning adventure'.

Author

Bauersachs, Johann, Jackson, Alice M, and Sliwa, Karen

Subjects
*PERIPARTUM cardiomyopathy, *HEART failure, *ADVENTURE education, *HEART valve diseases, *CONGENITAL heart disease
Abstract

The article discusses the EURObservational Research Programme (EORP) Registry on peripartum cardiomyopathy (PPCM), a disease that affects women during pregnancy or shortly after giving birth. The registry included over 700 patients and provided valuable research opportunities. However, due to the lack of financial incentives, the registry had limitations in terms of follow-up data. The article also mentions the potential for using electrocardiographic and echocardiographic data from the registry for deep learning-based screening, but highlights the need for data from healthy peripartum controls. The lack of a circulating biomarker for PPCM is also discussed, along with the importance of early diagnosis. The article concludes by mentioning ongoing research on heart failure treatments and the potential use of microRNA-146a as a biomarker. [Extracted from the article]

Published
2024
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33. Healthcare disparities for women hospitalised with myocardial infarction and angina

Author

Jackson, Alice M., Zhang, Ruiqi, Findlay, Iain, Robertson, Keith, Lindsay, Mitchell, Morris, Tamsin, Forbes, Brian, Papworth, Richard, McConnachie, Alex, Mangion, Kenneth, Jhund, Pardeep S., McCowan, Colin, and Berry, Colin

Abstract

Aims:\ud Ischaemic heart disease persists as the leading cause of death in both men and women in most countries and sex disparities, defined as differences in health outcomes and their determinants, may be relevant. We examined sex disparities in presenting characteristics, treatment and all-cause mortality in patients hospitalized with myocardial infarction (MI) or angina.\ud \ud Methods and results:\ud We conducted a cohort study of all patients admitted with MI or angina (01 October 2013 to 30 June 2016) from a secondary care acute coronary syndrome e-Registry in NHS Scotland linked with national registers of community drug dispensation and mortality data. A total of 7878 patients hospitalized for MI or angina were prospectively included; 3161 (40%) were women. Women were older, more deprived, had a greater burden of comorbidity, were more often treated with guideline-recommended therapy preadmission and less frequently received immediate invasive management. Men were more likely to receive coronary angiography [adjusted odds ratio (OR) 1.52, confidence interval (CI) 1.37–1.68] and percutaneous coronary intervention (adjusted OR 1.68, CI 1.52–1.86). Women were less comprehensively treated with evidence-based therapies post-MI. Women had worse crude survival, primarily those with ST-elevation myocardial infarction (14.3% vs. 8.0% at 1 year, P

Published
2020

34. Effects of Sacubitril-Valsartan, versus Valsartan, in Women Compared to Men with Heart Failure and Preserved Ejection Fraction: Insights from PARAGON-HF

Author

McMurray, John J.V., Jackson, Alice M., Lam, Carolyn S.P., Redfield, Margaret M., Anand, Inder S., Ge, Junbo, Lefkowitz, Marty P., Maggioni, Aldo P., Martinez, Felipe, Packer, Milton, Pfeffer, Marc A., Pieske, Burkert, Rizkala, Adel R., Sabarwal, Shalini V., Shah, Amil M., Shah, Sanjiv J., Shi, Victor C., van Veldhuisen, Dirk J., Zannad, Faiez, Zile, Michael R., Cikes, Maja, Goncalvesova, Eva, Katova, Tzvetana, Kosztin, Annamaria, Lelonek, Malgorzata, Sweitzer, Nancy K., Vardeny, Orly, Claggett, Brian, Jhund, Pardeep S., and Solomon, Scott D.

Abstract

Unlike heart failure with reduced ejection fraction, there is no approved treatment for heart failure with preserved ejection fraction (HFpEF), the predominant phenotype in women. Therefore, there is a greater heart failure therapeutic deficit in women, compared with men. In a pre-specified subgroup analysis, we examined outcomes according to sex in the PARAGON-HF trial which compared sacubitril-valsartan and valsartan in patients with HFpEF. The primary outcome was a composite of first and recurrent hospitalizations for heart failure and death from cardiovascular causes. We also report secondary efficacy and safety outcomes. Overall, 2479 women (51.7%) and 2317 men (48.3%) were randomized. Women were older, had more obesity, less coronary disease, and lower estimated glomerular filtration rate and NT-proBNP levels than men. For the primary outcome, the rate ratio for sacubitril-valsartan versus valsartan was 0.73 (95% CI 0.59-0.90) in women and 1.03 (0.84-1.25) in men; P interaction=0.017. The benefit from sacubitril-valsartan was due to reduction in heart failure hospitalization. The improvement in NYHA class and renal function with sacubitril-valsartan was similar in women and men, whereas the improvement in KCCQ-CSS was less in women than in men. The difference in adverse events, between sacubitril-valsartan and valsartan, was similar in women and men. As compared with valsartan, sacubitril-valsartan seemed to reduce the risk of heart failure hospitalization more in women than in men. While the possible sex-related modification of the effect of treatment has several potential explanations, the present study does not provide a definite mechanistic basis for this finding. URL: https://clinicaltrials.gov Unique Identifier: NCT01920711.

Published
2020

35. Effects of Sacubitril-Valsartan Versus Valsartan in Women Compared With Men With Heart Failure and Preserved Ejection Fraction

Author

McMurray, John J.V., Jackson, Alice M., Lam, Carolyn S.P., Redfield, Margaret M., Anand, Inder S., Ge, Junbo, Lefkowitz, Marty P., Maggioni, Aldo P., Martinez, Felipe, Packer, Milton, Pfeffer, Marc A., Pieske, Burkert, Rizkala, Adel R., Sabarwal, Shalini V., Shah, Amil M., Shah, Sanjiv J., Shi, Victor C., van Veldhuisen, Dirk J., Zannad, Faiez, Zile, Michael R., Cikes, Maja, Goncalvesova, Eva, Katova, Tzvetana, Kosztin, Anamaria, Lelonek, Malgorzata, Sweitzer, Nancy, Vardeny, Orly, Claggett, Brian, Jhund, Pardeep S., and Solomon, Scott D.

Subjects
heart failure, hospitalization, neprilysin, women
Abstract

BACKGROUND: Unlike heart failure with reduced ejection fraction, there is no approved treatment for heart failure with preserved ejection fraction, the predominant phenotype in women. Therefore, there is a greater heart failure therapeutic deficit in women compared with men. METHODS: In a prespecified subgroup analysis, we examined outcomes according to sex in the PARAGON- HF trial (Prospective Comparison of ARNI With ARB Global Outcomes in Heart Failure With Preserved Ejection Fraction), which compared sacubitril- valsartan and valsartan in patients with heart failure with preserved ejection fraction. The primary outcome was a composite of first and recurrent hospitalizations for heart failure and death from cardiovascular causes. We also report secondary efficacy and safety outcomes. RESULTS: Overall, 2479 women (51.7%) and 2317 men (48.3%) were randomized. Women were older and had more obesity, less coronary disease, and lower estimated glomerular filtration rate and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels than men. For the primary outcome, the rate ratio for sacubitril-valsartan versus valsartan was 0.73 (95% CI, 0.59-0.90) in women and 1.03 (95% CI, 0.84-1.25) in men (P interaction = 0.017). The benefit from sacubitril-valsartan was attributable to reduction in heart failure hospitalization. The improvement in New York Heart Association class and renal function with sacubitril-valsartan was similar in women and men, whereas the improvement in Kansas City Cardiomyopathy Questionnaire clinical summary score was less in women than in men. The difference in adverse events between sacubitril-valsartan and valsartan was similar in women and men. CONCLUSIONS: As compared with valsartan, sacubitril-valsartan seemed to reduce the risk of heart failure hospitalization more in women than in men. Whereas the possible sex-related modification of the effect of treatment has several potential explanations, the present study does not provide a definite mechanistic basis for this finding.

Published
2020
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36. Clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy: An ESC EORP registry

Author

Sliwa, Karen, Petrie, Mark C., van der Meer, Peter, Mebazaa, Alexandre, Hilfiker-Kleiner, Denise, Jackson, Alice M., Maggioni, Aldo P., Laroche, Cecile, Regitz-Zagrosek, Vera, Schaufelberger, Maria, Tavazzi, Luigi, Roos-Hesselink, Jolien W., Seferovic, Petar, van Spaendonck-Zwarts, Karin, Mbakwem, Amam, Böhm, Michael, Mouquet, Frederic, Pieske, Burkert, Johnson, Mark R., Hamdan, Righab, Ponikowski, Piotr, Van Veldhuisen, Dirk J., McMurray, John J. V., Bauersachs, Johann, EurObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum, Cardiomyopathy, Cardiology, Cardiovascular Centre (CVC), and Restoring Organ Function by Means of Regenerative Medicine (REGENERATE)

Subjects
medicine.medical_specialty, Registry, Peripartum cardiomyopathy, Disease, 030204 cardiovascular system & hematology, WORLDWIDE REGISTRY, CARDIOLOGY WORKING GROUP, 03 medical and health sciences, 0302 clinical medicine, Clinical Research, Internal medicine, medicine, Peripartum Period, Humans, 030212 general & internal medicine, Registries, PREDICTORS, Geographic difference, Outcome, HEART-FAILURE ASSOCIATION, Ejection fraction, business.industry, Previous pregnancy, Puerperal Disorders, 16. Peace & justice, medicine.disease, EUROPEAN-SOCIETY, 3. Good health, Heart failure, Female, Presentation (obstetrics), Neonatal death, Cardiology and Cardiovascular Medicine, business, Cardiomyopathies
Abstract

Aims We sought to describe the clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy (PPCM) globally. Methods and results In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EURObservational Research Programme. These societies were tasked with identifying centres who could participate in this registry. In low-income countries, e.g. Mozambique or Burkina Faso, where there are no national societies due to a shortage of cardiologists, we identified potential participants through abstracts and publications and encouraged participation into the study. Seven hundred and thirty-nine women were enrolled in 49 countries in Europe (33%), Africa (29%), Asia-Pacific (15%), and the Middle East (22%). Mean age was 31 ± 6 years, mean left ventricular ejection fraction (LVEF) was 31 ± 10%, and 10% had a previous pregnancy complicated by PPCM. Symptom-onset occurred most often within 1 month of delivery (44%). At diagnosis, 67% of patients had severe (NYHA III/IV) symptoms and 67% had a LVEF ≤35%. Fifteen percent received bromocriptine with significant regional variation (Europe 15%, Africa 26%, Asia-Pacific 8%, the Middle East 4%, P 50%) occurred only in 46%, most commonly in Asia-Pacific (62%), and least commonly in the Middle East (25%). Neonatal death occurred in 5% with marked regional variation (Europe 2%, the Middle East 9%). Conclusion Peripartum cardiomyopathy is a global disease, but clinical presentation and outcomes vary by region. Just under half of women experience myocardial recovery. Peripartum cardiomyopathy is a disease with substantial maternal and neonatal morbidity and mortality.

Published
2020

37. Dapagliflozin and Diuretic Use in Patients With Heart Failure and Reduced Ejection Fraction in DAPA-HF

Author

Jackson, Alice M, Dewan, Pooja, Anand, Inder S, Bělohlávek, Jan, Bengtsson, Olof, de Boer, Rudolf A, Böhm, Michael, Boulton, David W, Chopra, Vijay K, DeMets, David L, Docherty, Kieran F, Dukát, Andrej, Greasley, Peter J, Howlett, Jonathan G, Inzucchi, Silvio E, Katova, Tzvetana, Køber, Lars, Kosiborod, Mikhail N, Langkilde, Anna Maria, Lindholm, Daniel, Ljungman, Charlotta E A, Martinez, Felipe A, O'Meara, Eileen, Sabatine, Marc S, Sjöstrand, Mikaela, Solomon, Scott D, Tereshchenko, Sergey, Verma, Subodh, Jhund, Pardeep S, McMurray, John J V, Jackson, Alice M, Dewan, Pooja, Anand, Inder S, Bělohlávek, Jan, Bengtsson, Olof, de Boer, Rudolf A, Böhm, Michael, Boulton, David W, Chopra, Vijay K, DeMets, David L, Docherty, Kieran F, Dukát, Andrej, Greasley, Peter J, Howlett, Jonathan G, Inzucchi, Silvio E, Katova, Tzvetana, Køber, Lars, Kosiborod, Mikhail N, Langkilde, Anna Maria, Lindholm, Daniel, Ljungman, Charlotta E A, Martinez, Felipe A, O'Meara, Eileen, Sabatine, Marc S, Sjöstrand, Mikaela, Solomon, Scott D, Tereshchenko, Sergey, Verma, Subodh, Jhund, Pardeep S, and McMurray, John J V

Abstract

BACKGROUND: In the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure), the sodium-glucose cotransporter 2 inhibitor dapagliflozin reduced the risk of worsening heart failure and death in patients with heart failure and reduced ejection fraction. We examined the efficacy and tolerability of dapagliflozin in relation to background diuretic treatment and change in diuretic therapy after randomization to dapagliflozin or placebo.METHODS: We examined the effects of study treatment in the following subgroups: no diuretic and diuretic dose equivalent to furosemide <40, 40, and >40 mg daily at baseline. We examined the primary composite end point of cardiovascular death or a worsening heart failure event and its components, all-cause death and symptoms.RESULTS: Of 4616 analyzable patients, 736 (15.9%) were on no diuretic, 1311 (28.4%) were on <40 mg, 1365 (29.6%) were on 40 mg, and 1204 (26.1%) were taking >40 mg. Compared with placebo, dapagliflozin reduced the risk of the primary end point across each of these subgroups: hazard ratios were 0.57 (95% CI, 0.36-0.92), 0.83 (95% CI, 0.63-1.10), 0.77 (95% CI, 0.60-0.99), and 0.78 (95% CI, 0.63-0.97), respectively (P for interaction=0.61). The hazard ratio in patients taking any diuretic was 0.78 (95% CI, 0.68-0.90). Improvements in symptoms and treatment toleration were consistent across the diuretic subgroups. Diuretic dose did not change in most patients during follow-up, and mean diuretic dose did not differ between the dapagliflozin and placebo groups after randomization.CONCLUSIONS: The efficacy and safety of dapagliflozin were consistent across the diuretic subgroups examined in DAPA-HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03036124.

Published
2020

41. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy

Author

Bauersachs, Johann, primary, König, Tobias, additional, Meer, Peter, additional, Petrie, Mark C., additional, Hilfiker‐Kleiner, Denise, additional, Mbakwem, Amam, additional, Hamdan, Righab, additional, Jackson, Alice M., additional, Forsyth, Paul, additional, Boer, Rudolf A., additional, Mueller, Christian, additional, Lyon, Alexander R., additional, Lund, Lars H., additional, Piepoli, Massimo F., additional, Heymans, Stephane, additional, Chioncel, Ovidiu, additional, Anker, Stefan D., additional, Ponikowski, Piotr, additional, Seferovic, Petar M., additional, Johnson, Mark R., additional, Mebazaa, Alexandre, additional, and Sliwa, Karen, additional

Published
2019
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47. Peripartum cardiomyopathy: diagnosis and management.

Author

Jackson, Alice M., Dalzell, Jonathan R., Walker, Niki L., Coats, Caroline J., Jhund, Pardeep S., and Petrie, Mark C.

Subjects
PERIPARTUM cardiomyopathy, HEART failure, CONGENITAL disorders, HEART diseases, HYPERTENSION, ANTICOAGULANTS, BROMOCRIPTINE, TREATMENT of cardiomyopathies, CARDIOTONIC agents, HORMONE antagonists, CARDIAC pacing, CHILDBIRTH, CARDIOVASCULAR diseases in pregnancy, CONTRACEPTION, CONVALESCENCE, DEFIBRILLATORS, DELIVERY (Obstetrics), DIAGNOSIS, FORECASTING, HEART transplantation, MEDICAL errors, MEDICAL prescriptions, CARDIOMYOPATHIES, PRECONCEPTION care, PRENATAL diagnosis, TREATMENT effectiveness, HEART assist devices, PUERPERAL disorders, THERAPEUTICS
Published
2018
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