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2. Empagliflozin in the treatment of heart failure with reduced ejection fraction in addition to background therapies and therapeutic combinations (EMPEROR-Reduced): a post-hoc analysis of a randomised, double-blind trial

Author

Packer, M, Anker, S, Butler, J, Filippatos, G, Pocock, S, Zannad, F, Ferreira, JP, Brueckmann, M, George, J, Jamal, W, Welty, FK, Palmer, M, Clayton, T, Parhofer, KG, Pedersen, TR, Greenberg, B, Konstam, MA, Lees, KR, Carson, P, Doehner, W, Miller, A, Haas, M, Pehrson, S, Komajda, M, Anand, I, Teerlink, J, Rabinstein, A, Steiner, T, Kamel, H, Tsivgoulis, G, Lewis, J, Freston, J, Kaplowitz, N, Mann, J, Petrie, J, Perrone, S, Nicholls, S, Janssens, S, Bocchi, E, Giannetti, N, Verma, S, Zhang, J, Spinar, J, Seronde, M-F, Boehm, M, Merkely, B, Chopra, V, Senni, M, Taddi, S, Tsutsui, H, Choi, D-J, Chuquiure, E, La Rocca, HPB, Ponikowski, P, Juanatey, JRG, Squire, I, Januzzi, J, Pina, I, Bernstein, R, Cheung, A, Green, J, Kaul, S, Lam, C, Lip, G, Marx, N, McCullough, P, Mehta, C, Rosenstock, J, Sattar, N, Scirica, B, Shah, S, Wanner, C, Aizenberg, D, Cartasegna, L, Colombo Berra, F, Colombo, H, Fernandez Moutin, M, Glenny, J, Alvarez Lorio, C, Anauch, D, Campos, R, Facta, A, Fernandez, A, Ahuad Guerrero, R, Lobo Márquez, L, Leon de la Fuente, RA, Mansilla, M, Hominal, M, Hasbani, E, Najenson, M, Moises Azize, G, Luquez, H, Guzman, L, Sessa, H, Amuchástegui, M, Salomone, O, Perna, E, Piskorz, D, Sicer, M, Perez de Arenaza, D, Zaidman, C, Nani, S, Poy, C, Resk, J, Villarreal, R, Majul, C, Smith Casabella, T, Sassone, S, Liberman, A, Carnero, G, Caccavo, A, Berli, M, Budassi, N, Bono, J, Alvarisqueta, A, Amerena, J, Kostner, K, Hamilton, A, Begg, A, Beltrame, J, Colquhoun, D, Gordon, G, Sverdlov, A, Vaddadi, G, Wong, J, Coller, J, Prior, D, Friart, A, Leone, A, Vervoort, G, Timmermans, P, Troisfontaines, P, Franssen, C, Sarens, T, Vandekerckhove, H, Van De Borne, P, Chenot, F, De Sutter, J, De Vuyst, E, Debonnaire, P, Dupont, M, Pereira Dutra, O, Canani, LH, Vieira Moreira, MdC, de Souza, W, Backes, LM, Maia, L, De Souza Paolino, B, Manenti, ER, Saporito, W, Villaça Guimarães Filho, F, Franco Hirakawa, T, Saliba, LA, Neuenschwander, FC, de Freitas Zerbini, CA, Gonçalves, G, Gonçalves Mello, Y, Ascenção de Souza, J, Beck da Silva Neto, L, Bocchi, EA, Da Silveira, J, de Moura Xavier Moraes Junior, JB, de Souza Neto, JD, Hernandes, M, Finimundi, HC, Sampaio, CR, Vasconcellos, E, Neves Mancuso, FJ, Noya Rabelo, MM, Rodrigues Bacci, M, Santos, F, Vidotti, M, Simões, MV, Gomes, FL, Vieira Nascimento, C, Precoma, D, Helfenstein Fonseca, FA, Ribas Fortes, JA, Leães, PE, Campos de Albuquerque, D, Kerr Saraiva, JF, Rassi, S, Alves da Costa, FA, Reis, G, Zieroth, S, Dion, D, Savard, D, Bourgeois, R, Constance, C, Anderson, K, Leblanc, M-H, Yung, D, Swiggum, E, Pliamm, L, Pesant, Y, Tyrrell, B, Huynh, T, Spiegelman, J, Lavoie, J-P, Hartleib, M, Bhargava, R, Straatman, L, Virani, S, Costa-Vitali, A, Hill, L, Heffernan, M, Khaykin, Y, Ricci, J, Senaratne, M, Zhai, A, Lubelsky, B, Toma, M, Yao, L, McKelvie, R, Noronha, L, Babapulle, M, Pandey, A, Curnew, G, Lavoie, A, Berlingieri, J, Kouz, S, Lonn, E, Chehayeb, R, Zheng, Y, Sun, Y, Cui, H, Fan, Z, Han, X, Jiang, X, Tang, Q, Zhou, J, Zheng, Z, Zhang, X, Zhang, N, Zhang, Y, Shen, A, Yu, J, Ye, J, Yao, Y, Yan, J, Xu, X, Wang, Z, Ma, J, Li, Y, Li, S, Lu, S, Kong, X, Song, Y, Yang, G, Yao, Z, Pan, Y, Guo, X, Sun, Z, Dong, Y, Zhu, J, Peng, D, Yuan, Z, Lin, J, Yin, Y, Jerabek, O, Burianova, H, Fiala, T, Hubac, J, Ludka, O, Monhart, Z, Vodnansky, P, Zeman, K, Foldyna, D, Krupicka, J, Podpera, I, Busak, L, Radvan, M, Vomacka, Z, Prosecky, R, Cifkova, R, Durdil, V, Vesely, J, Vaclavik, J, Cervinka, P, Linhart, A, Brabec, T, Miklik, R, Bourhaial, H, Olbrich, H-G, Genth-Zotz, S, Kemala, E, Lemke, B, Böhm, M, Schellong, S, Rieker, W, Heitzer, T, Ince, H, Faghih, M, Birkenfeld, A, Begemann, A, Ghanem, A, Ujeyl, A, von Haehling, S, Dorsel, T, Bauersachs, J, Prull, M, Weidemann, F, Darius, H, Nickenig, G, Wilke, A, Sauter, J, Rauch-Kroehnert, U, Frey, N, Schulze, CP, König, W, Maier, L, Menzel, F, Proskynitopoulos, N, Ebert, H-H, Sarnighausen, H-E, Düngen, H-D, Licka, M, Stellbrink, C, Winkelmann, B, Menck, N, López-Sendón, JL, de la Fuente Galán, L, Delgado Jiménez, JF, Manito Lorite, N, Pérez de Juan Romero, M, Galve Basilio, E, Cereto Castro, F, González Juanatey, JR, Gómez, JJ, Sanmartín Fernández, M, Garcia-Moll Marimon, X, Pascual Figal, D, Bover Freire, R, Bonnefoy Cudraz, E, Jobbe Duval, A, Tomasevic, D, Habib, G, Isnard, R, Picard, F, Khanoyan, P, Dubois-Rande, J-L, Galinier, M, Roubille, F, Alexandre, J, Babuty, D, Delarche, N, Berneau, J-B, Girerd, N, Saxena, M, Rosano, G, Yousef, Z, Clifford, C, Arden, C, Bakhai, A, Boos, C, Jenkins, G, Travill, C, Price, D, Koenyves, L, Lakatos, F, Matoltsy, A, Noori, E, Zilahi, Z, Andrassy, P, Kancz, S, Simon, G, Sydo, T, Vorobcsuk, A, Kiss, RG, Toth, K, Szakal, I, Nagy, L, Barany, T, Nagy, A, Szolnoki, E, Chopra, VK, Mandal, S, Rastogi, V, Shah, B, Mullasari, A, Shankar, J, Mehta, V, Oomman, A, Kaul, U, Komarlu, S, Kahali, D, Bhagwat, A, Vijan, V, Ghaisas, NK, Mehta, A, Kashyap, J, Kothari, Y, TaddeI, S, Scherillo, M, Zacà, V, Genovese, S, Salvioni, A, Fucili, A, Fedele, F, Cosmi, F, Volpe, M, Mazzone, C, Esposito, G, Doi, M, Yamamoto, H, Sakagami, S, Oishi, S, Yasaka, Y, Tsuboi, H, Fujino, Y, Matsuoka, S, Watanabe, Y, Himi, T, Ide, T, Ichikawa, M, Kijima, Y, Koga, T, Yuda, S, Fukui, K, Kubota, T, Manita, M, Fujinaga, H, Matsumura, T, Fukumoto, Y, Kato, R, Kawai, Y, Hiasa, G, Kazatani, Y, Mori, M, Ogimoto, A, Inoko, M, Oguri, M, Kinoshita, M, Okuhara, K, Watanabe, N, Ono, Y, Otomo, K, Sato, Y, Matsunaga, T, Takaishi, A, Miyagi, N, Uehara, H, Takaishi, H, Urata, H, Kataoka, T, Matsubara, H, Matsumoto, T, Suzuki, T, Takahashi, N, Imamaki, M, Yoshitama, T, Saito, T, Sekino, H, Furutani, Y, Koda, M, Shinozaki, T, Hirabayashi, K, Tsunoda, R, Yonezawa, K, Hori, H, Yagi, M, Arikawa, M, Hashizume, T, Ishiki, R, Koizumi, T, Nakayama, K, Taguchi, S, Nanasato, M, Yoshida, Y, Tsujiyama, S, Nakamura, T, Oku, K, Shimizu, M, Suwa, M, Momiyama, Y, Sugiyama, H, Kobayashi, K, Inoue, S, Kadokami, T, Maeno, K, Kawamitsu, K, Maruyama, Y, Nakata, A, Shibata, T, Wada, A, Cho, H-J, Na, JO, Yoo, B-S, Choi, J-O, Hong, SK, Shin, J-H, Cho, M-C, Han, SH, Jeong, J-O, Kim, J-J, Kang, SM, Kim, D-S, Kim, MH, Llamas Esperon, G, Illescas Díaz, J, Fajardo Campos, P, Almeida Alvarado, J, Bazzoni Ruiz, A, Echeverri Rico, J, Lopez Alcocer, I, Valle Molina, L, Hernandez Herrera, C, Calvo Vargas, C, Padilla Padilla, FG, Rodriguez Briones, I, Chuquiure Valenzuela, EJJR, Aguilera Real, ME, Carrillo Calvillo, J, Alpizar Salazar, M, Cervantes Escárcega, JL, Velasco Sanchez, R, Al - Windy, N, van Heerebeek, L, Bellersen, L, Brunner-La Rocca, H-P, Post, J, Linssen, GCM, van de Wetering, M, Peters, R, van Stralen, R, Groutars, R, Smits, P, Yilmaz, A, Kok, WEM, Van der Meer, P, Dijkmans, P, Troquay, R, van Alem, AP, Van de Wal, R, Handoko, L, Westendorp, ICD, van Bergen, PFMM, Rensing, BJWM, Hoogslag, P, Kietselaer, B, Kragten, JA, den Hartog, FR, Alings, A, Danilowicz-Szymanowicz, L, Raczak, G, Piesiewicz, W, Zmuda, W, Kus, W, Podolec, P, Musial, W, Drelich, G, Kania, G, Miekus, P, Mazur, S, Janik, A, Spyra, J, Peruga, J, Balsam, P, Krakowiak, B, Szachniewicz, J, Ginel, M, Grzybowski, J, Chrustowski, W, Wojewoda, P, Kalinka, A, Zurakowski, A, Koc, R, Debinski, M, Fil, W, Kujawiak, M, Forys, J, Kasprzak, M, Krol, M, Michalski, P, Mirek-Bryniarska, E, Radwan, K, Skonieczny, G, Stania, K, Skoczylas, G, Madej, A, Jurowiecki, J, Firek, B, Wozakowska-Kaplon, B, Cymerman, K, Neutel, J, Adams, K, Balfour, P, Deswal, A, Djamson, A, Duncan, P, Hong, M, Murray, C, Rinde-Hoffman, D, Woodhouse, S, MacNevin, R, Rama, B, Broome-Webster, C, Kindsvater, S, Abramov, D, Barettella, M, Pinney, S, Herre, J, Cohen, A, Vora, K, Challappa, K, West, S, Baum, S, Cox, J, Jani, S, Karim, A, Akhtar, A, Quintana, O, Paukman, L, Goldberg, R, Bhatti, Z, Budoff, M, Bush, E, Potler, A, Delgado, R, Ellis, B, Dy, J, Fialkow, J, Sangrigoli, R, Ferdinand, K, East, C, Falkowski, S, Donahoe, S, Ebrahimi, R, Kline, G, Harris, B, Khouzam, R, Jaffrani, N, Jarmukli, N, Kazemi, N, Koren, M, Friedman, K, Herzog, W, Silva Enciso, J, Cheung, D, Grover-McKay, M, Hauptman, P, Mikhalkova, D, Hegde, V, Hodsden, J, Khouri, S, McGrew, F, Littlefield, R, Bradley, P, McLaurin, B, Lupovitch, S, Labin, I, Rao, V, Leithe, M, Lesko, M, Lewis, N, Lombardo, D, Mahal, S, Malhotra, V, Dauber, I, Banerjee, A, Needell, J, Miller, G, Paladino, L, Munuswamy, K, Nanna, M, McMillan, E, Mumma, M, Napoli, M, Nelson, W, O'Brien, T, Adlakha, A, Onwuanyi, A, Serota, H, Schmedtje, J, Paraschos, A, Potu, R, Sai-Sudhakar, C, Saltzberg, M, Sauer, A, Shah, P, Skopicki, H, Bui, H, Carr, K, Stevens, G, Tahirkheli, N, Tallaj, J, Yousuf, K, Trichon, B, Welker, J, Tolerico, P, Vest, A, Vivo, R, Wang, X, Abadier, R, Dunlap, S, Weintraub, N, Malik, A, Kotha, P, Zaha, V, Kim, G, Uriel, N, Greene, T, Salacata, A, Arora, R, Gazmuri, R, Kobayashi, J, Iteld, B, Vijayakrishnan, R, Dab, R, Mirza, Z, Marques, V, Nallasivan, M, Bensimhon, D, Peart, B, Saint-Jacques, H, Barringhaus, K, Contreras, J, Gupta, A, Koneru, S, Nguyen, V, Verma, Subodh, Dhingra, Nitish K, Butler, Javed, Anker, Stefan D, Ferreira, Joao Pedro, Filippatos, Gerasimos, Januzzi, James L, Lam, Carolyn S P, Sattar, Naveed, Peil, Barbara, Nordaby, Matias, Brueckmann, Martina, Pocock, Stuart J, Zannad, Faiez, and Packer, Milton

Published
2022
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3. Major low anterior resection syndrome has equivalent health-related quality of life implications as having a permanent colostomy.

Author

Koneru, S., Builth-Snoad, L., Rickard, M. J. F. X., Keshava, A., Chapuis, P. H., and Ng, K.-S.

Subjects
*COLOSTOMY, *QUALITY of life, *ABDOMINOPERINEAL resection
Abstract

Background: The literature is inconclusive when comparing health-related quality of life following restorative anterior resection (AR) compared with abdominoperineal resection (APR). Consideration of functional outcomes may explain this inconsistency. The aim of this study was to compare health-related quality of life in patients post-anterior resection, stratified by low anterior resection syndrome score, and post-abdominoperineal resection patients. Methods: A cross-sectional study of consecutive patients post APR and AR for rectal or sigmoid adenocarcinoma at a tertiary centre in Sydney, Australia (Jan 2012- Dec 2021) was performed. HRQoL outcomes (SF36v2 physical [PCS] and mental component summary [MCS] scores) were compared between APR and AR patients, with subgroup analyses stratifying AR patients according to LARS score (no/minor/major). Age- and gender-adjusted comparisons were performed by linear regression. Results: Overall, 248 post-AR patients (57.3% male, mean age 70.8 years, SD 11.6) and 64 post-APR patients (62.5% male, mean age 68.1 years, SD 13.1) participated. When stratified by LARS, 'major LARS' had a similar negative effect on age-and sex-adjusted PCS scores as APR. 'No LARS' (p < 0.001) and 'minor LARS' (p < 0.001) patients had higher PCS scores compared to post-APR patients. 'Major LARS' had a similarly negative effect on MCS scores compared with post-APR patients. MCS scores were higher in 'no LARS' (p = 0.006) compared with APR patients. Conclusions: Postoperative bowel dysfunction significantly impacts health-related quality of life. Patients with 'major LARS' have health-related quality of life as poor as those following APR. This requires consideration when counselling patients on postoperative health-related quality of life, especially where poor postoperative bowel function is anticipated following restorative surgery. [ABSTRACT FROM AUTHOR]

Published
2023
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5. Patient-controlled analgesia and oral mucositis pain in hematological malignancies

Author

Koneru S, Lukas N, Doane M, Pattullo G, MacPherson R, Koneru S, Lukas N, Doane M, Pattullo G, and MacPherson R

Abstract

Oral mucositis (OM) pain is an anticipated complication of immunosuppressive therapies for hematological malignancies. Opioids are effective for OM-associated pain and dysfunction that is refractory to simple measures. At the study institution, parenteral opioids are preferentially prescribed for the treatment of complicated OM. This audit explores the efficacy of opioids for the management of OM pain using morphine, oxycodone, and fentanyl patient-controlled analgesia (PCA). Pain scores, opioid consumption, resumption of oral intake, and the duration of admission were retrospectively analyzed from patient records over an 18-month period. Two-thirds of included patients had ceased PCA therapy by day 6, by which time there was a meaningful 35.4 percent reduction in pain scores, with very few side effects reported. Interagent comparison demonstrated no significant differences in mean daily pain scores; however, a larger sample size would facilitate an investigation of clinically significant nuances in treatment differences, if they exist.

Published
2022

6. Empagliflozin in the treatment of heart failure with reduced ejection fraction in addition to background therapies and therapeutic combinations (EMPEROR-Reduced): a post-hoc analysis of a randomised, double-blind trial

Author

Verma, Subodh, primary, Dhingra, Nitish K, additional, Butler, Javed, additional, Anker, Stefan D, additional, Ferreira, Joao Pedro, additional, Filippatos, Gerasimos, additional, Januzzi, James L, additional, Lam, Carolyn S P, additional, Sattar, Naveed, additional, Peil, Barbara, additional, Nordaby, Matias, additional, Brueckmann, Martina, additional, Pocock, Stuart J, additional, Zannad, Faiez, additional, Packer, Milton, additional, Packer, M, additional, Anker, S, additional, Butler, J, additional, Filippatos, G, additional, Pocock, S, additional, Zannad, F, additional, Ferreira, JP, additional, Brueckmann, M, additional, George, J, additional, Jamal, W, additional, Welty, FK, additional, Palmer, M, additional, Clayton, T, additional, Parhofer, KG, additional, Pedersen, TR, additional, Greenberg, B, additional, Konstam, MA, additional, Lees, KR, additional, Carson, P, additional, Doehner, W, additional, Miller, A, additional, Haas, M, additional, Pehrson, S, additional, Komajda, M, additional, Anand, I, additional, Teerlink, J, additional, Rabinstein, A, additional, Steiner, T, additional, Kamel, H, additional, Tsivgoulis, G, additional, Lewis, J, additional, Freston, J, additional, Kaplowitz, N, additional, Mann, J, additional, Petrie, J, additional, Perrone, S, additional, Nicholls, S, additional, Janssens, S, additional, Bocchi, E, additional, Giannetti, N, additional, Verma, S, additional, Zhang, J, additional, Spinar, J, additional, Seronde, M-F, additional, Boehm, M, additional, Merkely, B, additional, Chopra, V, additional, Senni, M, additional, Taddi, S, additional, Tsutsui, H, additional, Choi, D-J, additional, Chuquiure, E, additional, La Rocca, HPB, additional, Ponikowski, P, additional, Juanatey, JRG, additional, Squire, I, additional, Januzzi, J, additional, Pina, I, additional, Bernstein, R, additional, Cheung, A, additional, Green, J, additional, Kaul, S, additional, Lam, C, additional, Lip, G, additional, Marx, N, additional, McCullough, P, additional, Mehta, C, additional, Rosenstock, J, additional, Sattar, N, additional, Scirica, B, additional, Shah, S, additional, Wanner, C, additional, Aizenberg, D, additional, Cartasegna, L, additional, Colombo Berra, F, additional, Colombo, H, additional, Fernandez Moutin, M, additional, Glenny, J, additional, Alvarez Lorio, C, additional, Anauch, D, additional, Campos, R, additional, Facta, A, additional, Fernandez, A, additional, Ahuad Guerrero, R, additional, Lobo Márquez, L, additional, Leon de la Fuente, RA, additional, Mansilla, M, additional, Hominal, M, additional, Hasbani, E, additional, Najenson, M, additional, Moises Azize, G, additional, Luquez, H, additional, Guzman, L, additional, Sessa, H, additional, Amuchástegui, M, additional, Salomone, O, additional, Perna, E, additional, Piskorz, D, additional, Sicer, M, additional, Perez de Arenaza, D, additional, Zaidman, C, additional, Nani, S, additional, Poy, C, additional, Resk, J, additional, Villarreal, R, additional, Majul, C, additional, Smith Casabella, T, additional, Sassone, S, additional, Liberman, A, additional, Carnero, G, additional, Caccavo, A, additional, Berli, M, additional, Budassi, N, additional, Bono, J, additional, Alvarisqueta, A, additional, Amerena, J, additional, Kostner, K, additional, Hamilton, A, additional, Begg, A, additional, Beltrame, J, additional, Colquhoun, D, additional, Gordon, G, additional, Sverdlov, A, additional, Vaddadi, G, additional, Wong, J, additional, Coller, J, additional, Prior, D, additional, Friart, A, additional, Leone, A, additional, Vervoort, G, additional, Timmermans, P, additional, Troisfontaines, P, additional, Franssen, C, additional, Sarens, T, additional, Vandekerckhove, H, additional, Van De Borne, P, additional, Chenot, F, additional, De Sutter, J, additional, De Vuyst, E, additional, Debonnaire, P, additional, Dupont, M, additional, Pereira Dutra, O, additional, Canani, LH, additional, Vieira Moreira, MdC, additional, de Souza, W, additional, Backes, LM, additional, Maia, L, additional, De Souza Paolino, B, additional, Manenti, ER, additional, Saporito, W, additional, Villaça Guimarães Filho, F, additional, Franco Hirakawa, T, additional, Saliba, LA, additional, Neuenschwander, FC, additional, de Freitas Zerbini, CA, additional, Gonçalves, G, additional, Gonçalves Mello, Y, additional, Ascenção de Souza, J, additional, Beck da Silva Neto, L, additional, Bocchi, EA, additional, Da Silveira, J, additional, de Moura Xavier Moraes Junior, JB, additional, de Souza Neto, JD, additional, Hernandes, M, additional, Finimundi, HC, additional, Sampaio, CR, additional, Vasconcellos, E, additional, Neves Mancuso, FJ, additional, Noya Rabelo, MM, additional, Rodrigues Bacci, M, additional, Santos, F, additional, Vidotti, M, additional, Simões, MV, additional, Gomes, FL, additional, Vieira Nascimento, C, additional, Precoma, D, additional, Helfenstein Fonseca, FA, additional, Ribas Fortes, JA, additional, Leães, PE, additional, Campos de Albuquerque, D, additional, Kerr Saraiva, JF, additional, Rassi, S, additional, Alves da Costa, FA, additional, Reis, G, additional, Zieroth, S, additional, Dion, D, additional, Savard, D, additional, Bourgeois, R, additional, Constance, C, additional, Anderson, K, additional, Leblanc, M-H, additional, Yung, D, additional, Swiggum, E, additional, Pliamm, L, additional, Pesant, Y, additional, Tyrrell, B, additional, Huynh, T, additional, Spiegelman, J, additional, Lavoie, J-P, additional, Hartleib, M, additional, Bhargava, R, additional, Straatman, L, additional, Virani, S, additional, Costa-Vitali, A, additional, Hill, L, additional, Heffernan, M, additional, Khaykin, Y, additional, Ricci, J, additional, Senaratne, M, additional, Zhai, A, additional, Lubelsky, B, additional, Toma, M, additional, Yao, L, additional, McKelvie, R, additional, Noronha, L, additional, Babapulle, M, additional, Pandey, A, additional, Curnew, G, additional, Lavoie, A, additional, Berlingieri, J, additional, Kouz, S, additional, Lonn, E, additional, Chehayeb, R, additional, Zheng, Y, additional, Sun, Y, additional, Cui, H, additional, Fan, Z, additional, Han, X, additional, Jiang, X, additional, Tang, Q, additional, Zhou, J, additional, Zheng, Z, additional, Zhang, X, additional, Zhang, N, additional, Zhang, Y, additional, Shen, A, additional, Yu, J, additional, Ye, J, additional, Yao, Y, additional, Yan, J, additional, Xu, X, additional, Wang, Z, additional, Ma, J, additional, Li, Y, additional, Li, S, additional, Lu, S, additional, Kong, X, additional, Song, Y, additional, Yang, G, additional, Yao, Z, additional, Pan, Y, additional, Guo, X, additional, Sun, Z, additional, Dong, Y, additional, Zhu, J, additional, Peng, D, additional, Yuan, Z, additional, Lin, J, additional, Yin, Y, additional, Jerabek, O, additional, Burianova, H, additional, Fiala, T, additional, Hubac, J, additional, Ludka, O, additional, Monhart, Z, additional, Vodnansky, P, additional, Zeman, K, additional, Foldyna, D, additional, Krupicka, J, additional, Podpera, I, additional, Busak, L, additional, Radvan, M, additional, Vomacka, Z, additional, Prosecky, R, additional, Cifkova, R, additional, Durdil, V, additional, Vesely, J, additional, Vaclavik, J, additional, Cervinka, P, additional, Linhart, A, additional, Brabec, T, additional, Miklik, R, additional, Bourhaial, H, additional, Olbrich, H-G, additional, Genth-Zotz, S, additional, Kemala, E, additional, Lemke, B, additional, Böhm, M, additional, Schellong, S, additional, Rieker, W, additional, Heitzer, T, additional, Ince, H, additional, Faghih, M, additional, Birkenfeld, A, additional, Begemann, A, additional, Ghanem, A, additional, Ujeyl, A, additional, von Haehling, S, additional, Dorsel, T, additional, Bauersachs, J, additional, Prull, M, additional, Weidemann, F, additional, Darius, H, additional, Nickenig, G, additional, Wilke, A, additional, Sauter, J, additional, Rauch-Kroehnert, U, additional, Frey, N, 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additional, Vijan, V, additional, Ghaisas, NK, additional, Mehta, A, additional, Kashyap, J, additional, Kothari, Y, additional, TaddeI, S, additional, Scherillo, M, additional, Zacà, V, additional, Genovese, S, additional, Salvioni, A, additional, Fucili, A, additional, Fedele, F, additional, Cosmi, F, additional, Volpe, M, additional, Mazzone, C, additional, Esposito, G, additional, Doi, M, additional, Yamamoto, H, additional, Sakagami, S, additional, Oishi, S, additional, Yasaka, Y, additional, Tsuboi, H, additional, Fujino, Y, additional, Matsuoka, S, additional, Watanabe, Y, additional, Himi, T, additional, Ide, T, additional, Ichikawa, M, additional, Kijima, Y, additional, Koga, T, additional, Yuda, S, additional, Fukui, K, additional, Kubota, T, additional, Manita, M, additional, Fujinaga, H, additional, Matsumura, T, additional, Fukumoto, Y, additional, Kato, R, additional, Kawai, Y, additional, Hiasa, G, additional, Kazatani, Y, additional, Mori, M, additional, Ogimoto, A, additional, Inoko, M, additional, Oguri, M, additional, Kinoshita, M, additional, Okuhara, K, additional, Watanabe, N, additional, Ono, Y, additional, Otomo, K, additional, Sato, Y, additional, Matsunaga, T, additional, Takaishi, A, additional, Miyagi, N, additional, Uehara, H, additional, Takaishi, H, additional, Urata, H, additional, Kataoka, T, additional, Matsubara, H, additional, Matsumoto, T, additional, Suzuki, T, additional, Takahashi, N, additional, Imamaki, M, additional, Yoshitama, T, additional, Saito, T, additional, Sekino, H, additional, Furutani, Y, additional, Koda, M, additional, Shinozaki, T, additional, Hirabayashi, K, additional, Tsunoda, R, additional, Yonezawa, K, additional, Hori, H, additional, Yagi, M, additional, Arikawa, M, additional, Hashizume, T, additional, Ishiki, R, additional, Koizumi, T, additional, Nakayama, K, additional, Taguchi, S, additional, Nanasato, M, additional, Yoshida, Y, additional, Tsujiyama, S, additional, Nakamura, T, additional, Oku, K, additional, Shimizu, M, additional, Suwa, M, additional, Momiyama, Y, additional, Sugiyama, H, additional, Kobayashi, K, additional, Inoue, S, additional, Kadokami, T, additional, Maeno, K, additional, Kawamitsu, K, additional, Maruyama, Y, additional, Nakata, A, additional, Shibata, T, additional, Wada, A, additional, Cho, H-J, additional, Na, JO, additional, Yoo, B-S, additional, Choi, J-O, additional, Hong, SK, additional, Shin, J-H, additional, Cho, M-C, additional, Han, SH, additional, Jeong, J-O, additional, Kim, J-J, additional, Kang, SM, additional, Kim, D-S, additional, Kim, MH, additional, Llamas Esperon, G, additional, Illescas Díaz, J, additional, Fajardo Campos, P, additional, Almeida Alvarado, J, additional, Bazzoni Ruiz, A, additional, Echeverri Rico, J, additional, Lopez Alcocer, I, additional, Valle Molina, L, additional, Hernandez Herrera, C, additional, Calvo Vargas, C, additional, Padilla Padilla, FG, additional, Rodriguez Briones, I, additional, Chuquiure Valenzuela, EJJR, additional, Aguilera Real, ME, additional, Carrillo Calvillo, J, additional, Alpizar Salazar, M, additional, Cervantes Escárcega, JL, additional, Velasco Sanchez, R, additional, Al - Windy, N, additional, van Heerebeek, L, additional, Bellersen, L, additional, Brunner-La Rocca, H-P, additional, Post, J, additional, Linssen, GCM, additional, van de Wetering, M, additional, Peters, R, additional, van Stralen, R, additional, Groutars, R, additional, Smits, P, additional, Yilmaz, A, additional, Kok, WEM, additional, Van der Meer, P, additional, Dijkmans, P, additional, Troquay, R, additional, van Alem, AP, additional, Van de Wal, R, additional, Handoko, L, additional, Westendorp, ICD, additional, van Bergen, PFMM, additional, Rensing, BJWM, additional, Hoogslag, P, additional, Kietselaer, B, additional, Kragten, JA, additional, den Hartog, FR, additional, Alings, A, additional, Danilowicz-Szymanowicz, L, additional, Raczak, G, additional, Piesiewicz, W, additional, Zmuda, W, additional, Kus, W, additional, Podolec, P, additional, Musial, W, additional, Drelich, G, additional, Kania, G, additional, Miekus, P, additional, Mazur, S, additional, Janik, A, additional, Spyra, J, additional, Peruga, J, additional, Balsam, P, additional, Krakowiak, B, additional, Szachniewicz, J, additional, Ginel, M, additional, Grzybowski, J, additional, Chrustowski, W, additional, Wojewoda, P, additional, Kalinka, A, additional, Zurakowski, A, additional, Koc, R, additional, Debinski, M, additional, Fil, W, additional, Kujawiak, M, additional, Forys, J, additional, Kasprzak, M, additional, Krol, M, additional, Michalski, P, additional, Mirek-Bryniarska, E, additional, Radwan, K, additional, Skonieczny, G, additional, Stania, K, additional, Skoczylas, G, additional, Madej, A, additional, Jurowiecki, J, additional, Firek, B, additional, Wozakowska-Kaplon, B, additional, Cymerman, K, additional, Neutel, J, additional, Adams, K, additional, Balfour, P, additional, Deswal, A, 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additional, Khouzam, R, additional, Jaffrani, N, additional, Jarmukli, N, additional, Kazemi, N, additional, Koren, M, additional, Friedman, K, additional, Herzog, W, additional, Silva Enciso, J, additional, Cheung, D, additional, Grover-McKay, M, additional, Hauptman, P, additional, Mikhalkova, D, additional, Hegde, V, additional, Hodsden, J, additional, Khouri, S, additional, McGrew, F, additional, Littlefield, R, additional, Bradley, P, additional, McLaurin, B, additional, Lupovitch, S, additional, Labin, I, additional, Rao, V, additional, Leithe, M, additional, Lesko, M, additional, Lewis, N, additional, Lombardo, D, additional, Mahal, S, additional, Malhotra, V, additional, Dauber, I, additional, Banerjee, A, additional, Needell, J, additional, Miller, G, additional, Paladino, L, additional, Munuswamy, K, additional, Nanna, M, additional, McMillan, E, additional, Mumma, M, additional, Napoli, M, additional, Nelson, W, additional, O'Brien, T, additional, Adlakha, A, additional, Onwuanyi, A, additional, Serota, H, additional, Schmedtje, J, additional, Paraschos, A, additional, Potu, R, additional, Sai-Sudhakar, C, additional, Saltzberg, M, additional, Sauer, A, additional, Shah, P, additional, Skopicki, H, additional, Bui, H, additional, Carr, K, additional, Stevens, G, additional, Tahirkheli, N, additional, Tallaj, J, additional, Yousuf, K, additional, Trichon, B, additional, Welker, J, additional, Tolerico, P, additional, Vest, A, additional, Vivo, R, additional, Wang, X, additional, Abadier, R, additional, Dunlap, S, additional, Weintraub, N, additional, Malik, A, additional, Kotha, P, additional, Zaha, V, additional, Kim, G, additional, Uriel, N, additional, Greene, T, additional, Salacata, A, additional, Arora, R, additional, Gazmuri, R, additional, Kobayashi, J, additional, Iteld, B, additional, Vijayakrishnan, R, additional, Dab, R, additional, Mirza, Z, additional, Marques, V, additional, Nallasivan, M, additional, Bensimhon, D, additional, Peart, B, 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Published
2022
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7. An Enhancing Diabetic Retinopathy Classification and Segmentation based on TaNet

Author

Koneru Suvarna Vani, Puppala Praneeth, Vivek Kommareddy, Parasa Rishi Kumar, Madala Sarath, Shaik Hussain, and Potluri Ravikiran

Subjects
diabetic retinopathy (dr), transfer learning, trilateral attention network (tanet), wavelet scattering transformation, bilateral segmentation network (bisenet), Biology (General), QH301-705.5, Medicine
Abstract

Human vision depends heavily on retinal tissue. The loss of eyesight may result from infections of the retinal tissues that are treated slowly or do not work at all. Additionally, the diagnosis is susceptible to inaccuracies when a large dataset is involved. Therefore, a fully automated transfer learning approach for diagnosing diabetic retinopathy (DR) is suggested to minimize human intervention while maintaining high classification accuracy. To address this issue, we proposed a transfer learning-based trilateral attention network (TaNet) for the classification. To boost the visual quality of the DR pictures, a contrast constrained adaptive histogram equalization approach is applied. The pre-processed pictures are then segmented using a bilateral segmentation network (BiSeNet). The BiSeNet segmented the optic disc and blood vessels individually. After the completion of segmentation, the features are extracted. Feature extraction is based on the wavelet scattering transformation approach. The results of many trials were evaluated against the Messidor-2, EYEPACS, and APTOS 2019 datasets. The proposed model was created using a refined pre-trained technique and transfer learning methodology. Finally, the suggested framework was tested using efficiency assessment methods, and the classification rate was recorded as having above 98% sensitivity, specificity, precision, and accuracy. The proposed approach yields greater performance and shows enhancement towards the existing approach.

Published
2024
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15. High prevalence of low bone mass in thalassaemia major

Author

Susan M. Tuck, Beatrix Wonke, Emma Prescott, A. Yardumian, Jensen Ce, Richard W Morris, Agnew Je, Koneru S, and A. V. Hoffbrand

Subjects
Bone mineral, medicine.medical_specialty, Bone density, Bone disease, business.industry, Thalassemia, Osteoporosis, Physiology, Beta thalassemia, Hematology, medicine.disease, Osteopenia, Endocrinology, Internal medicine, Diabetes mellitus, medicine, business
Abstract

Cooley's original description of beta-thalassaemia major included marked bone deformities as a characteristic feature. These were thought to be due to expansion of haemopoiesis attempting to compensate for the congenital anaemia. Regular blood transfusions from infancy prevents these skeletal problems. Nevertheless, symptoms due to bone disease frequently occur in adult patients. Osteoporosis has not previously been reported as a cause of severe morbidity in thalassaemia major. The present study shows a high prevalence of low bone mass among thalassaemia major patients and analyses the predisposing causes. Bone density scans were performed in 82 patients with transfusion-dependent beta thalassaemia. Factors known to be associated with low bone mass such as gender, endocrine disorders and lifestyle activities, together with factors specific to the thalassaemia and its management, were included in a series of univariate analyses to ascertain any significant associations. 42 (51%) of the patients had severely low bone mass and a further 37 (45%) had low bone mass. The three factors showing a statistically significant association with severely low bone mass were male sex, 24/38 (63%) males had severely low bone mass, compared with 18/44 (41%) females, the lack of spontaneous puberty, 22/32 (69%) who required therapeutic induction of pubertal development had severely low bone mass, compared with 19/47 (40%) with spontaneous puberty and diabetes, 8/10 (80%) diabetic patients had severely low bone mass, compared with 23/56 (41%) with normal glucose tolerance. There was no association between the bone mineral density measurements and the haematological characteristics or treatment details of these patients. Severely low and low bone mass are common findings in patients with beta-thalassaemia major despite optimal transfusion and iron chelation. The associated features suggest that the severely low bone mass is due to endocrine abnormalities, in contrast to the haematological causes of bone disease characteristically seen in untreated thalassaemics.

Published
1998
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20. Laparoscopic orchidopexy: one-stage alternative for non-palpable testes

Author

Al-Shareef, Z. H., Al-Shlash, S., Koneru, S. R., Towu, E., Al-Dhohayan, A., and Al-Brekett, K.

Subjects
Male, Palpation, Letter, Child, Preschool, Cryptorchidism, Humans, Infant, Laparoscopy, Prospective Studies, Child, Magnetic Resonance Imaging, Research Article, Ultrasonography
Abstract

Laparoscopy was utilised in the evaluation of 24 non-palpable undescended testes in 19 children. The procedure was accurate in all patients while ultrasound (US) and magnetic resonance imaging (MRI) failed to localise the testes in most cases. At the same time laparoscopic orchidopexy was performed on 15 testes (62.5%). The remaining testes were either absent or atrophic, in which case they were excised. There were no complications from these procedures and the hospital stay was short. Paediatric laparoscopy is safe and effective in the definitive management of non-palpable undescended testes.

Published
1996

22. Laparoscopic ligation of varicoceles: an anatomically superior operation

Author

al-Shareef, Z. H., Koneru, S. R., al-Tayeb, A., Shehata, Z. M., Aly, T. F., and Basyouni, A.

Subjects
Adult, Male, Letter, Treatment Outcome, Adolescent, Sperm Count, Varicocele, Humans, Laparoscopy, Oligospermia, Ligation, Research Article
Abstract

Since December 1991, 25 consecutive symptomatic male patients with 26 varicoceles were treated by laparoscopic ligation of internal spermatic veins under general anaesthesia. Twenty-one patients had either scrotal discomfort or painful swelling and four patients presented with infertility. The mean follow-up period is 5 months (range 3 weeks to 9 months). The procedure has provided a satisfactory outcome in 19 out of 21 patients (90.5%) with scrotal symptoms. Of the four patients presenting with infertility due to oligospermia, three had significantly elevated sperm counts at 3 months which resulted in one pregnancy. So far there has been no recurrence of the varicocele. The main potential advantage of the laparoscopic approach is better visualisation of the anatomy, especially the testicular artery and the collateral venous circulation at the level of the internal inguinal ring. In addition to being less invasive with implied benefits, the endoscopic procedure has enabled identification of multiple veins in 22 out of 26 (84.6%) varicoceles in our series.

Published
1994

33. Extrapolated accelerated gauss-seidel methods

Author

Koneru, S. R. and Vatti, V.B. Kumar

Abstract

First and second degree Extrapolated Accelerated Gauss-Seidel (EAGS) methods for solving a system of linear algebraic equations are studied and it is shown that the second degree EAGS method is superior to the Accelerated Overtaxation (AOR) under the assumption that the matrix coefficient of the system is consistently ordered and positive definite and zero is not an eigenvalue of the corresponding Jacobi matrix.

Published
1987
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35. CONTROLLED DELIVERY OF KRYPTON-81M BOLI IN NORMAL SUBJECTS - RESULTS AND IMPLICATIONS

Author

Sylvia Verbanck, Koneru, S., Martin Cohen, Clarke, S. W., Agnew, J. E., and Internal Medicine Specializations

Subjects
TECHNEGAS, PULMONARY-EMBOLISM, diagnosis, aerosol, GAS, ABNORMALITIES, scintigraphy, REGIONAL VENTILA, deposition, lung
Abstract

Interregional sequential filling potentially affects lung ventilation imaging, depending on the distribution of the tracer within the inspired volume. We investigated its importance quantitatively under near tidal breathing conditions in the upright lung using a short-lived radioactive tracer. Ten normal volunteers performed two runs of 900-ml breaths (from functional residual capacity) in which 100 ml of Kr-81m boli were delivered ''early'' or ''late'' in inspiration, i.e., 50 ml or 450 ml volumetric depth. Apex-to-base gradients in the vertical profile were - 106 +/- 22 (s.e.) counts/cm (early) and - 187 +/- 24 (s.e.) counts/cm (late). Ratios of upper-to-lower regional ventilation (U/L) were 0.88 +/- 0.01 (s.e.) (early) and 0.81 +/- 0.01 (s.e.) (late). Simulations with a compartment model show that a simple pattern of sequential filling can by itself account for the experimental results observed. Control over Kr-81m delivery can be important to physiologically accurate assessment of ventilation-perfusion matching. Controlled delivery techniques could also modify effectiveness and targeting of other inhaled agents including therapeutic aerosols.

38. Dust collection fans and wear plates.

Author

Koneru S., Maintenance engineering 2000 and beyond Technical programme of the 10th CIM maintenance/engineering conference, held in Saskatoon, Saskatchewan 13-Sep-9816-Sep-98, Koneru S., and Maintenance engineering 2000 and beyond Technical programme of the 10th CIM maintenance/engineering conference, held in Saskatoon, Saskatchewan 13-Sep-9816-Sep-98

Abstract

Dust collection fans are important parts of dust collection systems, and wear plates play an important role in prolonging the life of fan wheels in abrasive dust-handling environments. Brief discussion is presented of dust collection fans, types of wheels, properties of commonly-used wear plates and wear points and locations. The proper selection of wear plates and proper installation procedures are important, with improper installation causing premature failure in wear plates., Dust collection fans are important parts of dust collection systems, and wear plates play an important role in prolonging the life of fan wheels in abrasive dust-handling environments. Brief discussion is presented of dust collection fans, types of wheels, properties of commonly-used wear plates and wear points and locations. The proper selection of wear plates and proper installation procedures are important, with improper installation causing premature failure in wear plates.

50. Empagliflozin in the treatment of heart failure with reduced ejection fraction in addition to background therapies and therapeutic combinations (EMPEROR-Reduced): a post-hoc analysis of a randomised, double-blind trial

Author

Subodh Verma, Nitish K Dhingra, Javed Butler, Stefan D Anker, Joao Pedro Ferreira, Gerasimos Filippatos, James L Januzzi, Carolyn S P Lam, Naveed Sattar, Barbara Peil, Matias Nordaby, Martina Brueckmann, Stuart J Pocock, Faiez Zannad, Milton Packer, M Packer, S Anker, J Butler, G Filippatos, S Pocock, F Zannad, JP Ferreira, M Brueckmann, J George, W Jamal, FK Welty, M Palmer, T Clayton, KG Parhofer, TR Pedersen, B Greenberg, MA Konstam, KR Lees, P Carson, W Doehner, A Miller, M Haas, S Pehrson, M Komajda, I Anand, J Teerlink, A Rabinstein, T Steiner, H Kamel, G Tsivgoulis, J Lewis, J Freston, N Kaplowitz, J Mann, J Petrie, S Perrone, S Nicholls, S Janssens, E Bocchi, N Giannetti, S Verma, J Zhang, J Spinar, M-F Seronde, M Boehm, B Merkely, V Chopra, M Senni, S Taddi, H Tsutsui, D-J Choi, E Chuquiure, HPB La Rocca, P Ponikowski, JRG Juanatey, I Squire, J Januzzi, I Pina, R Bernstein, A Cheung, J Green, S Kaul, C Lam, G Lip, N Marx, P McCullough, C Mehta, J Rosenstock, N Sattar, B Scirica, S Shah, C Wanner, D Aizenberg, L Cartasegna, F Colombo Berra, H Colombo, M Fernandez Moutin, J Glenny, C Alvarez Lorio, D Anauch, R Campos, A Facta, A Fernandez, R Ahuad Guerrero, L Lobo Márquez, RA Leon de la Fuente, M Mansilla, M Hominal, E Hasbani, M Najenson, G Moises Azize, H Luquez, L Guzman, H Sessa, M Amuchástegui, O Salomone, E Perna, D Piskorz, M Sicer, D Perez de Arenaza, C Zaidman, S Nani, C Poy, J Resk, R Villarreal, C Majul, T Smith Casabella, S Sassone, A Liberman, G Carnero, A Caccavo, M Berli, N Budassi, J Bono, A Alvarisqueta, J Amerena, K Kostner, A Hamilton, A Begg, J Beltrame, D Colquhoun, G Gordon, A Sverdlov, G Vaddadi, J Wong, J Coller, D Prior, A Friart, A Leone, G Vervoort, P Timmermans, P Troisfontaines, C Franssen, T Sarens, H Vandekerckhove, P Van De Borne, F Chenot, J De Sutter, E De Vuyst, P Debonnaire, M Dupont, O Pereira Dutra, LH Canani, MdC Vieira Moreira, W de Souza, LM Backes, L Maia, B De Souza Paolino, ER Manenti, W Saporito, F Villaça Guimarães Filho, T Franco Hirakawa, LA Saliba, FC Neuenschwander, CA de Freitas Zerbini, G Gonçalves, Y Gonçalves Mello, J Ascenção de Souza, L Beck da Silva Neto, EA Bocchi, J Da Silveira, JB de Moura Xavier Moraes Junior, JD de Souza Neto, M Hernandes, HC Finimundi, CR Sampaio, E Vasconcellos, FJ Neves Mancuso, MM Noya Rabelo, M Rodrigues Bacci, F Santos, M Vidotti, MV Simões, FL Gomes, C Vieira Nascimento, D Precoma, FA Helfenstein Fonseca, JA Ribas Fortes, PE Leães, D Campos de Albuquerque, JF Kerr Saraiva, S Rassi, FA Alves da Costa, G Reis, S Zieroth, D Dion, D Savard, R Bourgeois, C Constance, K Anderson, M-H Leblanc, D Yung, E Swiggum, L Pliamm, Y Pesant, B Tyrrell, T Huynh, J Spiegelman, J-P Lavoie, M Hartleib, R Bhargava, L Straatman, S Virani, A Costa-Vitali, L Hill, M Heffernan, Y Khaykin, J Ricci, M Senaratne, A Zhai, B Lubelsky, M Toma, L Yao, R McKelvie, L Noronha, M Babapulle, A Pandey, G Curnew, A Lavoie, J Berlingieri, S Kouz, E Lonn, R Chehayeb, Y Zheng, Y Sun, H Cui, Z Fan, X Han, X Jiang, Q Tang, J Zhou, Z Zheng, X Zhang, N Zhang, Y Zhang, A Shen, J Yu, J Ye, Y Yao, J Yan, X Xu, Z Wang, J Ma, Y Li, S Li, S Lu, X Kong, Y Song, G Yang, Z Yao, Y Pan, X Guo, Z Sun, Y Dong, J Zhu, D Peng, Z Yuan, J Lin, Y Yin, O Jerabek, H Burianova, T Fiala, J Hubac, O Ludka, Z Monhart, P Vodnansky, K Zeman, D Foldyna, J Krupicka, I Podpera, L Busak, M Radvan, Z Vomacka, R Prosecky, R Cifkova, V Durdil, J Vesely, J Vaclavik, P Cervinka, A Linhart, T Brabec, R Miklik, H Bourhaial, H-G Olbrich, S Genth-Zotz, E Kemala, B Lemke, M Böhm, S Schellong, W Rieker, T Heitzer, H Ince, M Faghih, A Birkenfeld, A Begemann, A Ghanem, A Ujeyl, S von Haehling, T Dorsel, J Bauersachs, M Prull, F Weidemann, H Darius, G Nickenig, A Wilke, J Sauter, U Rauch-Kroehnert, N Frey, CP Schulze, W König, L Maier, F Menzel, N Proskynitopoulos, H-H Ebert, H-E Sarnighausen, H-D Düngen, M Licka, C Stellbrink, B Winkelmann, N Menck, JL López-Sendón, L de la Fuente Galán, JF Delgado Jiménez, N 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Potu, R, Sai-Sudhakar, C, Saltzberg, M, Sauer, A, Shah, P, Skopicki, H, Bui, H, Carr, K, Stevens, G, Tahirkheli, N, Tallaj, J, Yousuf, K, Trichon, B, Welker, J, Tolerico, P, Vest, A, Vivo, R, Wang, X, Abadier, R, Dunlap, S, Weintraub, N, Malik, A, Kotha, P, Zaha, V, Kim, G, Uriel, N, Greene, T, Salacata, A, Arora, R, Gazmuri, R, Kobayashi, J, Iteld, B, Vijayakrishnan, R, Dab, R, Mirza, Z, Marques, V, Nallasivan, M, Bensimhon, D, Peart, B, Saint-Jacques, H, Barringhaus, K, Contreras, J, Gupta, A, Koneru, S, Nguyen, V, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)

Subjects
Male, medicine.medical_specialty, Angiotensin receptor, Glucoside, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Adrenergic beta-Antagonists, Angiotensin-Converting Enzyme Inhibitors, 030204 cardiovascular system & hematology, Placebo, 03 medical and health sciences, Angiotensin Receptor Antagonists, 0302 clinical medicine, Endocrinology, Mineralocorticoid receptor, Glucosides, Double-Blind Method, Internal medicine, Post-hoc analysis, Internal Medicine, medicine, Empagliflozin, Humans, 030212 general & internal medicine, Benzhydryl Compounds, ComputingMilieux_MISCELLANEOUS, Aged, Benzhydryl Compound, Heart Failure, Ejection fraction, business.industry, Angiotensin Receptor Antagonist, Adrenergic beta-Antagonist, Angiotensin-Converting Enzyme Inhibitor, Stroke Volume, medicine.disease, 3. Good health, Heart failure, ACE inhibitor, Female, Hypotension, business, medicine.drug, Human
Abstract

Contains fulltext : 249977.pdf (Publisher’s version ) (Closed access) BACKGROUND: It is important to evaluate whether a new treatment for heart failure with reduced ejection fraction (HFrEF) provides additive benefit to background foundational treatments. As such, we aimed to evaluate the efficacy and safety of empagliflozin in patients with HFrEF in addition to baseline treatment with specific doses and combinations of disease-modifying therapies. METHODS: We performed a post-hoc analysis of the EMPEROR-Reduced randomised, double-blind, parallel-group trial, which took place in 520 centres (hospitals and medical clinics) in 20 countries in Asia, Australia, Europe, North America, and South America. Patients with New York Heart Association (NYHA) classification II-IV with an ejection fraction of 40% or less were randomly assigned (1:1) to receive the addition of either oral empagliflozin 10 mg per day or placebo to background therapy. The primary composite outcome was cardiovascular death and heart failure hospitalisation; the secondary outcome was total heart failure hospital admissions. An extended composite outcome consisted of inpatient and outpatient HFrEF events was also evaluated. Outcomes were analysed according to background use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) or angiotensin receptor neprilysin inhibitors (ARNIs), as well as β blockers and mineralocorticoid receptor antagonists (MRAs) at less than 50% or 50% or more of target doses and in various combinations. This study is registered with ClinicalTrials.gov, NCT03057977. FINDINGS: In this post-hoc analysis of 3730 patients (mean age 66·8 years [SD 11·0], 893 [23·9%] women; 1863 [49·9%] in the empagliflozin group, 1867 [50·1%] in the placebo group) assessed between March 6, 2017, and May 28, 2020, empagliflozin reduced the risk of the primary outcome (361 in 1863 participants in the empagliflozin group and 462 of 1867 in the placebo group; HR 0·75 [95% CI 0·65-0·86]) regardless of background therapy or its target doses for ACE inhibitors or ARBs at doses of less than 50% of the target dose (HR 0·85 [0·69-1·06]) and for doses of 50% or more of the target dose (HR 0·67 [0·52-0·88]; p(interaction)=0·18). A similar result was seen for β blockers at doses of less than 50% of the target dose (HR 0·66 [0·54-0·80]) and for doses of 50% or more of the target dose (HR 0·81 [0·66-1·00]; p(interaction)=0·15). Empagliflozin also reduced the risk of the primary outcome irrespective of background use of triple therapy with an ACE inhibitor, ARB, or ARNI plus β blocker plus MRA (given combination HR 0·73 [0·61-0·88]; not given combination HR 0·76 [0·62-0·94]; p(interaction)=0·77). Similar patterns of benefit were observed for the secondary and extended composite outcomes. Empagliflozin was well tolerated and rates of hypotension, symptomatic hypotension, and hyperkalaemia were similar across all subgroups. INTERPRETATION: Empagliflozin reduced serious heart failure outcomes across doses and combinations of disease-modifying therapies for HFrEF. Clinically, these data suggest that empagliflozin might be considered as a foundational therapy in patients with HFrEF regardless of their existing background therapy. FUNDING: Boehringer Ingelheim and Eli Lilly and Company.

Published
2022
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