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Margaret M. Redfield - One of the best experts on this subject based on the ideXlab platform.

  • Heart Failure with Preserved Ejection Fraction.
    Annual review of medicine, 2018
    Co-Authors: James D. Gladden, Antoine H. Chaanine, Margaret M. Redfield
    Abstract:

    Heart failure (HF) is a clinical syndrome of diverse etiologies and can be associated with preserved, reduced, or mid-range Ejection Fraction (EF). In the community, heart failure with preserved Ejection Fraction (HFpEF) is emerging as the most common form of HF. There remains considerable uncertainty regarding its pathogenesis, diagnosis, and optimal therapeutic approach. Hypotheses have been advanced to explain the underlying pathophysiology responsible for HFpEF, but to date, no specific therapy based on these hypotheses has been proven to improve outcomes in HFpEF. We provide a clinically focused review of the epidemiology, clinical presentation, diagnostic approach, pathophysiology, and treatment of HFpEF.

  • right ventricular function in heart failure with preserved Ejection Fraction
    Circulation, 2014
    Co-Authors: Selma F Mohammed, Veronique L Roger, Imad Hussain, Omar F Abouezzeddine, Hiroyuki Takahama, Susan H Kwon, Paul R Forfia, Margaret M. Redfield
    Abstract:

    Background—The prevalence and clinical significance of right ventricular (RV) systolic dysfunction (RVD) in patients with heart failure and preserved Ejection Fraction (HFpEF) are not well characterized. Methods and Results—Consecutive, prospectively identified HFpEF (Framingham HF criteria, Ejection Fraction ≥50%) patients (n=562) from Olmsted County, Minnesota, underwent echocardiography at HF diagnosis and follow-up for cause-specific mortality and HF hospitalization. RV function was categorized by tertiles of tricuspid annular plane systolic excursion and by semiquantitative (normal, mild RVD, or moderate to severe RVD) 2-dimensional assessment. Whether RVD was defined by semiquantitative assessment or tricuspid annular plane systolic excursion ≤15 mm, HFpEF patients with RVD were more likely to have atrial fibrillation, pacemakers, and chronic diuretic therapy. At echocardiography, patients with RVD had slightly lower left ventricular Ejection Fraction, worse diastolic dysfunction, lower blood pressu...

  • Heart failure with preserved Ejection Fraction
    Pflugers Archiv : European journal of physiology, 2014
    Co-Authors: James D. Gladden, Wolfgang A. Linke, Margaret M. Redfield
    Abstract:

    As part of this series devoted to heart failure (HF), we review the epidemiology, diagnosis, pathophysiology, and treatment of HF with preserved Ejection Fraction (HFpEF). Gaps in knowledge and needed future research are discussed.

  • Response to Letter Regarding Article, “Longitudinal Changes in Ejection Fraction in Heart Failure Patients With Preserved and Reduced Ejection Fraction”
    Circulation. Heart failure, 2013
    Co-Authors: Shannon M. Dunlay, Veronique L Roger, Susan A. Weston, Ruoxiang Jiang, Margaret M. Redfield
    Abstract:

    We appreciate the insightful comments from Nunez et al1 on our recently published article “Longitudinal changes in Ejection Fraction in heart failure patients with preserved and reduced Ejection Fraction.”2 To address their concerns on the effect of nonrandom or informative dropout on our findings, we repeated our analyses using a joint modeling approach as they recommended,3 using R Version 2.15.0. Overall, our findings were similar compared …

  • trends in prevalence and outcome of heart failure with preserved Ejection Fraction
    The New England Journal of Medicine, 2006
    Co-Authors: Theophilus Owan, David O Hodge, Regina M Herges, Steven J Jacobsen, Veronique L Roger, Margaret M. Redfield
    Abstract:

    Background The prevalence of heart failure with preserved Ejection Fraction may be changing as a result of changes in population demographics and in the prevalence and treatment of risk factors for heart failure. Changes in the prevalence of heart failure with preserved Ejection Fraction may contribute to changes in the natural history of heart failure. We performed a study to define secular trends in the prevalence of heart failure with preserved Ejection Fraction among patients at a single institution over a 15-year period. Methods We studied all consecutive patients hospitalized with decompensated heart failure at Mayo Clinic Hospitals in Olmsted County, Minnesota, from 1987 through 2001. We classified patients as having either preserved or reduced Ejection Fraction. The patients were also classified as community patients (Olmsted County residents) or referral patients. Secular trends in the type of heart failure, associated cardiovascular disease, and survival were defined. Results A total of 6076 patients with heart failure were discharged over the 15-year period; data on Ejection Fraction were available for 4596 of these patients (76 percent). Of these, 53 percent had a reduced Ejection Fraction and 47 percent had a preserved Ejection Fraction. The proportion of patients with the diagnosis of heart failure with preserved Ejection Fraction increased over time and was significantly higher among community patients than among referral patients (55 percent vs. 45 percent). The prevalence rates of hypertension, atrial fibrillation, and diabetes among patients with heart failure increased significantly over time. Survival was slightly better among patients with preserved Ejection Fraction (adjusted hazard ratio for death, 0.96; P=0.01). Survival improved over time for those with reduced Ejection Fraction but not for those with preserved Ejection Fraction. Conclusions The prevalence of heart failure with preserved Ejection Fraction increased over a 15-year period, while the rate of death from this disorder remained unchanged. These trends underscore the importance of this growing public health problem.

Jerome L. Fleg - One of the best experts on this subject based on the ideXlab platform.

  • influence of Ejection Fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved Ejection Fraction
    European Heart Journal, 2016
    Co-Authors: Scott D. Solomon, Brian Claggett, Eldrin F. Lewis, Akshay S. Desai, Inder S. Anand, Nancy K. Sweitzer, Sanjiv J. Shah, Sonja M. Mckinlay, Eileen Omeara, Jerome L. Fleg
    Abstract:

    Aims While mineralocorticoid receptor antagonists (MRAs) have been shown to benefit patients with reduced left ventricular Ejection Fraction (LVEF), spironolactone did not reduce the primary endpoint of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest in patients with heart failure with preserved Ejection Fraction (HFpEF) in the TOPCAT trial, which enrolled patients with LVEF of 45% or greater. We utilized data from TOPCAT to assess the relationship between LVEF as well as outcomes and efficacy of spironolactone. Methods and results We assessed differences in baseline characteristics and outcomes across LVEF categories in 3444 patients with HFpEF, and determined whether LVEF modified the treatment effect of spironolactone. Ejection Fraction ranged from 44 to 85%. Patients with higher Ejection Fraction were older, more likely to be female, less likely to have a history of myocardial infarction, and more likely to have a history of hypertension and diabetes. The incidence of the primary endpoint and cardiovascular death was highest in patients at the lower end of the Ejection Fraction spectrum. Ejection Fraction modified the spironolactone treatment effect, particularly in the patients enrolled in the Americas, for the primary outcome ( P = 0.046) and for heart failure hospitalization ( P = 0.039), with stronger estimated benefits of spironolactone at the lower end of the Ejection Fraction spectrum with respect to the primary endpoint (LVEF <50%: HR 0.72, 95% CI 0.50, 1.05; LVEF ≥60%: HR 0.97, 95% CI 0.76, 1.23) and heart failure hospitalization (LVEF <50%: HR 0.76, 95% CI 0.46, 1.27; LVEF ≥60%: HR 0.98, 95% CI 0.74, 1.30). Conclusion In patients with HFpEF enrolled in TOPCAT, patient characteristics and outcomes varied substantially by LVEF. The potential efficacy of spironolactone was greatest at the lower end of the LVEF spectrum. ClinicalTrials.gov number NCT00094302.

  • Influence of Ejection Fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved Ejection Fraction
    European heart journal, 2015
    Co-Authors: Scott D. Solomon, Brian Claggett, Eldrin F. Lewis, Akshay S. Desai, Inder S. Anand, Nancy K. Sweitzer, Eileen O'meara, Sanjiv J. Shah, Sonja M. Mckinlay, Jerome L. Fleg
    Abstract:

    Aims While mineralocorticoid receptor antagonists (MRAs) have been shown to benefit patients with reduced left ventricular Ejection Fraction (LVEF), spironolactone did not reduce the primary endpoint of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest in patients with heart failure with preserved Ejection Fraction (HFpEF) in the TOPCAT trial, which enrolled patients with LVEF of 45% or greater. We utilized data from TOPCAT to assess the relationship between LVEF as well as outcomes and efficacy of spironolactone. Methods and results We assessed differences in baseline characteristics and outcomes across LVEF categories in 3444 patients with HFpEF, and determined whether LVEF modified the treatment effect of spironolactone. Ejection Fraction ranged from 44 to 85%. Patients with higher Ejection Fraction were older, more likely to be female, less likely to have a history of myocardial infarction, and more likely to have a history of hypertension and diabetes. The incidence of the primary endpoint and cardiovascular death was highest in patients at the lower end of the Ejection Fraction spectrum. Ejection Fraction modified the spironolactone treatment effect, particularly in the patients enrolled in the Americas, for the primary outcome ( P = 0.046) and for heart failure hospitalization ( P = 0.039), with stronger estimated benefits of spironolactone at the lower end of the Ejection Fraction spectrum with respect to the primary endpoint (LVEF

  • spironolactone for heart failure with preserved Ejection Fraction
    The New England Journal of Medicine, 2014
    Co-Authors: Bertram Pitt, Brian Claggett, Akshay S. Desai, Inder S. Anand, Marc A Pfeffer, Susan F Assmann, Robin Boineau, Nadine Clausell, Rafael Diaz, Jerome L. Fleg
    Abstract:

    Background Mineralocorticoid-receptor antagonists improve the prognosis for patients with heart failure and a reduced left ventricular Ejection Fraction. We evaluated the effects of spironolactone in patients with heart failure and a preserved left ventricular Ejection Fraction. Methods In this randomized, double-blind trial, we assigned 3445 patients with symptomatic heart failure and a left ventricular Ejection Fraction of 45% or more to receive either spironolactone (15 to 45 mg daily) or placebo. The primary outcome was a composite of death from cardiovascular causes, aborted cardiac arrest, or hospitalization for the management of heart failure. Results With a mean follow-up of 3.3 years, the primary outcome occurred in 320 of 1722 patients in the spironolactone group (18.6%) and 351 of 1723 patients in the placebo group (20.4%) (hazard ratio, 0.89; 95% confidence interval [CI], 0.77 to 1.04; P = 0.14). Of the components of the primary outcome, only hospitalization for heart failure had a significantly lower incidence in the spironolactone group than in the placebo group (206 patients [12.0%] vs. 245 patients [14.2%]; hazard ratio, 0.83; 95% CI, 0.69 to 0.99, P = 0.04). Neither total deaths nor hospitalizations for any reason were significantly reduced by spironolactone. Treatment with spiron olactone was associated with increased serum creatinine levels and a doubling of the rate of hyperkalemia (18.7%, vs. 9.1% in the placebo group) but reduced hypokalemia. With frequent monitoring, there were no significant differences in the incidence of serious adverse events, a serum creatinine level of 3.0 mg per deciliter (265 μmol per liter) or higher, or dialysis. Conclusions In patients with heart failure and a preserved Ejection Fraction, treatment with spironolactone did not significantly reduce the incidence of the primary composite outcome of death from cardiovascular causes, aborted cardiac arrest, or hospitalization for the management of heart failure. (Funded by the National Heart, Lung, and Blood Institute; TOPCAT ClinicalTrials.gov number, NCT00094302.)

Amil M. Shah - One of the best experts on this subject based on the ideXlab platform.

  • heart failure with preserved Ejection Fraction in perspective
    Circulation Research, 2019
    Co-Authors: Marc A Pfeffer, Amil M. Shah, Barry A Borlaug
    Abstract:

    Approximately half of the patients with signs and symptoms of heart failure have a left ventricular Ejection Fraction that is not markedly abnormal. Despite the historically initial surprise, heightened risks for heart failure specific major adverse events occur across the broad range of Ejection Fraction, including normal. The recognition of the magnitude of the problem of heart failure with preserved Ejection Fraction in the past 20 years has spurred an explosion of clinical investigation and growing intensity of informative outcome trials. This article addresses the historic development of this component of the heart failure syndrome, including the epidemiology, pathophysiology, and existing and planned therapeutic studies. Looking forward, more specific phenotyping and even genotyping of subpopulations should lead to improvements in outcomes from future trials.

  • Heart Failure and Midrange Ejection Fraction: Implications of Recovered Ejection Fraction for Exercise Tolerance and Outcomes.
    Circulation. Heart failure, 2016
    Co-Authors: Wilson Nadruz, Erin West, Mário Santos, Hicham Skali, John D. Groarke, Daniel E. Forman, Amil M. Shah
    Abstract:

    Background—Evidence-based therapies for heart failure (HF) differ significantly according to left ventricular Ejection Fraction (LVEF). However, few data are available on the phenotype and prognosis of patients with HF with midrange LVEF of 40% to 55%, and the impact of recovered systolic function on the clinical features, functional capacity, and outcomes of this population is not known. Methods and Results—We studied 944 patients with HF who underwent clinically indicated cardiopulmonary exercise testing. The study population was categorized according to LVEF as follows: HF with reduced LVEF (HFrEF; LVEF 55%; n=47). HF with midrange Ejection Fraction and no recovered Ejection Fraction and HF with recovered midrange Ejection Fraction had similar...

  • The many faces of heart failure with preserved Ejection Fraction.
    Nature reviews. Cardiology, 2012
    Co-Authors: Amil M. Shah, Marc A Pfeffer
    Abstract:

    By definition, patients with heart failure and preserved Ejection Fraction are characterized by a normal or near-normal left ventricular Ejection Fraction, but marked heterogeneity in the extent of other cardiac structural and functional abnormalities exists. Improved appreciation of this diversity might provide insights into prognosis and therapeutic interventions.

Akshay S. Desai - One of the best experts on this subject based on the ideXlab platform.

  • Extraction of Ejection Fraction From Echocardiography Notes for Constructing a Cohort of Patients Having Heart Failure With Reduced Ejection Fraction (HFrEF)
    Journal of medical systems, 2018
    Co-Authors: Kavishwar B. Wagholikar, Akshay S. Desai, Christina M. Fischer, Alyssa P. Goodson, Christopher Herrick, Martin Rees, Eloy Toscano, Calum A. Macrae, Benjamin M. Scirica, Shawn N. Murphy
    Abstract:

    Left ventricular Ejection Fraction (LVEF) is an important prognostic indicator of cardiovascular outcomes. It is used clinically to determine the indication for several therapeutic interventions. LVEF is most commonly derived using in-line tools and some manual assessment by cardiologists from standardized echocardiographic views. LVEF is typically documented in free-text reports, and variation in LVEF documentation pose a challenge for the extraction and utilization of LVEF in computer-based clinical workflows. To address this problem, we developed a computerized algorithm to extract LVEF from echocardiography reports for the identification of patients having heart failure with reduced Ejection Fraction (HFrEF) for therapeutic intervention at a large healthcare system. We processed echocardiogram reports for 57,158 patients with coded diagnosis of Heart Failure that visited the healthcare system over a two-year period. Our algorithm identified a total of 3910 patients with reduced Ejection Fraction. Of the 46,634 echocardiography reports processed, 97% included a mention of LVEF. Of these reports, 85% contained numerical Ejection Fraction values, 9% contained ranges, and the remaining 6% contained qualitative descriptions. Overall, 18% of extracted numerical LVEFs were ≤ 40%. Furthermore, manual validation for a sample of 339 reports yielded an accuracy of 1.0. Our study demonstrates that a regular expression-based approach can accurately extract LVEF from echocardiograms, and is useful for delineating heart-failure patients with reduced Ejection Fraction.

  • influence of Ejection Fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved Ejection Fraction
    European Heart Journal, 2016
    Co-Authors: Scott D. Solomon, Brian Claggett, Eldrin F. Lewis, Akshay S. Desai, Inder S. Anand, Nancy K. Sweitzer, Sanjiv J. Shah, Sonja M. Mckinlay, Eileen Omeara, Jerome L. Fleg
    Abstract:

    Aims While mineralocorticoid receptor antagonists (MRAs) have been shown to benefit patients with reduced left ventricular Ejection Fraction (LVEF), spironolactone did not reduce the primary endpoint of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest in patients with heart failure with preserved Ejection Fraction (HFpEF) in the TOPCAT trial, which enrolled patients with LVEF of 45% or greater. We utilized data from TOPCAT to assess the relationship between LVEF as well as outcomes and efficacy of spironolactone. Methods and results We assessed differences in baseline characteristics and outcomes across LVEF categories in 3444 patients with HFpEF, and determined whether LVEF modified the treatment effect of spironolactone. Ejection Fraction ranged from 44 to 85%. Patients with higher Ejection Fraction were older, more likely to be female, less likely to have a history of myocardial infarction, and more likely to have a history of hypertension and diabetes. The incidence of the primary endpoint and cardiovascular death was highest in patients at the lower end of the Ejection Fraction spectrum. Ejection Fraction modified the spironolactone treatment effect, particularly in the patients enrolled in the Americas, for the primary outcome ( P = 0.046) and for heart failure hospitalization ( P = 0.039), with stronger estimated benefits of spironolactone at the lower end of the Ejection Fraction spectrum with respect to the primary endpoint (LVEF <50%: HR 0.72, 95% CI 0.50, 1.05; LVEF ≥60%: HR 0.97, 95% CI 0.76, 1.23) and heart failure hospitalization (LVEF <50%: HR 0.76, 95% CI 0.46, 1.27; LVEF ≥60%: HR 0.98, 95% CI 0.74, 1.30). Conclusion In patients with HFpEF enrolled in TOPCAT, patient characteristics and outcomes varied substantially by LVEF. The potential efficacy of spironolactone was greatest at the lower end of the LVEF spectrum. ClinicalTrials.gov number NCT00094302.

  • Influence of Ejection Fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved Ejection Fraction
    European heart journal, 2015
    Co-Authors: Scott D. Solomon, Brian Claggett, Eldrin F. Lewis, Akshay S. Desai, Inder S. Anand, Nancy K. Sweitzer, Eileen O'meara, Sanjiv J. Shah, Sonja M. Mckinlay, Jerome L. Fleg
    Abstract:

    Aims While mineralocorticoid receptor antagonists (MRAs) have been shown to benefit patients with reduced left ventricular Ejection Fraction (LVEF), spironolactone did not reduce the primary endpoint of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest in patients with heart failure with preserved Ejection Fraction (HFpEF) in the TOPCAT trial, which enrolled patients with LVEF of 45% or greater. We utilized data from TOPCAT to assess the relationship between LVEF as well as outcomes and efficacy of spironolactone. Methods and results We assessed differences in baseline characteristics and outcomes across LVEF categories in 3444 patients with HFpEF, and determined whether LVEF modified the treatment effect of spironolactone. Ejection Fraction ranged from 44 to 85%. Patients with higher Ejection Fraction were older, more likely to be female, less likely to have a history of myocardial infarction, and more likely to have a history of hypertension and diabetes. The incidence of the primary endpoint and cardiovascular death was highest in patients at the lower end of the Ejection Fraction spectrum. Ejection Fraction modified the spironolactone treatment effect, particularly in the patients enrolled in the Americas, for the primary outcome ( P = 0.046) and for heart failure hospitalization ( P = 0.039), with stronger estimated benefits of spironolactone at the lower end of the Ejection Fraction spectrum with respect to the primary endpoint (LVEF

  • spironolactone for heart failure with preserved Ejection Fraction
    The New England Journal of Medicine, 2014
    Co-Authors: Bertram Pitt, Brian Claggett, Akshay S. Desai, Inder S. Anand, Marc A Pfeffer, Susan F Assmann, Robin Boineau, Nadine Clausell, Rafael Diaz, Jerome L. Fleg
    Abstract:

    Background Mineralocorticoid-receptor antagonists improve the prognosis for patients with heart failure and a reduced left ventricular Ejection Fraction. We evaluated the effects of spironolactone in patients with heart failure and a preserved left ventricular Ejection Fraction. Methods In this randomized, double-blind trial, we assigned 3445 patients with symptomatic heart failure and a left ventricular Ejection Fraction of 45% or more to receive either spironolactone (15 to 45 mg daily) or placebo. The primary outcome was a composite of death from cardiovascular causes, aborted cardiac arrest, or hospitalization for the management of heart failure. Results With a mean follow-up of 3.3 years, the primary outcome occurred in 320 of 1722 patients in the spironolactone group (18.6%) and 351 of 1723 patients in the placebo group (20.4%) (hazard ratio, 0.89; 95% confidence interval [CI], 0.77 to 1.04; P = 0.14). Of the components of the primary outcome, only hospitalization for heart failure had a significantly lower incidence in the spironolactone group than in the placebo group (206 patients [12.0%] vs. 245 patients [14.2%]; hazard ratio, 0.83; 95% CI, 0.69 to 0.99, P = 0.04). Neither total deaths nor hospitalizations for any reason were significantly reduced by spironolactone. Treatment with spiron olactone was associated with increased serum creatinine levels and a doubling of the rate of hyperkalemia (18.7%, vs. 9.1% in the placebo group) but reduced hypokalemia. With frequent monitoring, there were no significant differences in the incidence of serious adverse events, a serum creatinine level of 3.0 mg per deciliter (265 μmol per liter) or higher, or dialysis. Conclusions In patients with heart failure and a preserved Ejection Fraction, treatment with spironolactone did not significantly reduce the incidence of the primary composite outcome of death from cardiovascular causes, aborted cardiac arrest, or hospitalization for the management of heart failure. (Funded by the National Heart, Lung, and Blood Institute; TOPCAT ClinicalTrials.gov number, NCT00094302.)

Lisa Mielniczuk - One of the best experts on this subject based on the ideXlab platform.

  • Ejection Fraction improvement and reverse remodeling achieved with sacubitril valsartan in heart failure with reduced Ejection Fraction patients
    American journal of cardiovascular disease, 2017
    Co-Authors: Aws Almufleh, Jeffrey Marbach, Sharon Chih, Ellamae Stadnick, Ross A Davies, Lisa Mielniczuk
    Abstract:

    BACKGROUND: Sacubitril/Valsartan has been shown to improve mortality and reduce hospitalizations in patients with heart failure with reduced Ejection Fraction (HFrEF). The effect of Sacubitril/Valsartan on Ejection Fraction (EF) and reverse remodeling parameters have not been previously described. METHODS: We performed a single-center, retrospective, cohort study of HFrEF patients (n=48) who were treated with Sacubitril/Valsartan for a median duration of 3 months (Interquartile range 2-6 months). Clinical and echocardiographic parameters were reviewed at three time points (pre-baseline which was median of 18 months before starting Sacubitril/Valsartan, baseline before treatment started, and post-Sacubitril/Valsartan). Paired sample t-test and one-way repeated measures ANOVA were used for normally distributed data, while Wilcoxon Signed Rank test for non-normally distributed data. RESULTS: Sacubitril/Valsartan use was associated with an average 5% (±1.2) increase in EF, from a mean baseline of 25.33% to 30.14% (p<0.001) with a median duration of treatment 3 months. There was no significant change in mean LVEF over a median duration of 11 months (IQR 5.5-15.5) between pre-baseline and baseline time points prior to treatment (p=1.0). The mean increase in Ejection Fraction tended to be marginally greater in the medium/high dose cohort as compared to the low dose cohort, with a mean increase of 5.09% (±1.36) and 4.03% (±3.17), respectively (p=0.184). There was a 3.36 mm reduction in left ventricular end-systolic diameter (p=0.04), a 2.64 mm reduction in left ventricular end-diastolic diameter (p=0.02), and a 14.4 g/m2 reduction in left ventricular mass index (p<0.01). CONCLUSION: Sacubitril/Valsartan was found to improve EF and multiple measures of reverse remodeling beyond the effects of concomitant optimal medical therapy. Though these results are encouraging, our small sample, observational study requires confirmation in larger cohorts with longer follow-up periods.