Abstract:
BACKGROUND:The addition of an angiotensin receptor blocker (ARB) to an angiotensin-converting enzyme inhibitor (ACEI) in patients with heart failure remains controversial. A recent meta-analysis showed that the combination therapy reduces hospitalization without improved survival. Whether excess risk is associated with this strategy has not been fully explored. We sought to quantify the risk of adverse events of combination therapy (ACEI+ARB) versus ACEI alone. METHODS:MEDLINE, EMBASE, BIOSIS, and Cochrane databases were searched. Eligible studies were randomized, placebo-controlled trials of ACEI versus the combination of ACEI+ARB in patients with heart failure or left ventricular dysfunction. Included studies were reviewed to determine the frequency of adverse effects leading to discontinuation of therapy. RESULTS:Nine trials that enrolled 18,160 patients met the inclusion criteria. A total of 9199 patients received combination therapy, and 8961 patients received an ACEI only. Patients receiving combination therapy had an increased risk of developing any adverse effect by 2.3% (relative risk [RR] = 1.27, 95% confidence interval [CI] = 1.15-1.40, P < .00001, I(2) = 15.9%, number needed to harm [NNH] = 42), hypotension by 1.1% (RR = 1.91, 95% CI = 1.37-2.66, P = .0002, I(2) = 26.6%, NNH = 89), worsening renal function by 1% (RR = 2.12, 95% CI = 1.30-3.46, P = .003, I(2) = 67.3%, NNH = 100), and hyperkalemia by 0.6% (RR = 4.17, 95% CI = 2.31-7.53, P < .00001, I(2) = 0%, NNH = 149). There was no difference in angioedema (RR = 0.88, 95% CI = 0.43-1.80, P = .72, I(2) = 0%) or cough (RR = 0.84, 95% CI = 0.65-1.09, P = .19, I(2) = 0%). CONCLUSION:The current cumulative evidence suggests that patients with left ventricular dysfunction have an increased risk of adverse events leading to discontinuation on ACEI+ARB combination therapy compared with ACEI alone. This excess risk, coupled with a lack of consistent mortality benefit, suggests that ARBs should not routinely be added to ACEI therapy for left ventricular dysfunction. If chosen, the combination strategy may warrant closer patient monitoring to detect adverse effects.
journal_name
J Card Failjournal_title
Journal of cardiac failureauthors
Lakhdar R,Al-Mallah MH,Lanfear DEdoi
10.1016/j.cardfail.2007.11.008subject
Has Abstractpub_date
2008-04-01 00:00:00pages
181-8issue
3eissn
1071-9164issn
1532-8414pii
S1071-9164(07)01159-1journal_volume
14pub_type
杂志文章,meta分析,评审abstract:BACKGROUND:The prognostic value of LA functional measures in heart failure patients with reduced ejection fraction (HFrEF) is unclear. Therefore, this study investigated the prognostic value of left atrial (LA) functional measures such as the left atrial emptying fraction (LAEF) and the minimal LA volume compared with ...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2018.11.016
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Members of the nuclear receptor family proteins function as transcription factors upon ligand binding and thereby regulate gene expression in host cells. Aldosterone, the high-affinity endogenous ligand for the mineralocorticoid receptor, induces cardiac hypertrophy and fibrosis in a variety of animal models...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1054/jcaf.2002.125369
更新日期:2002-06-01 00:00:00
abstract:BACKGROUND:Wolff-Parkinson-White (WPW) has been associated with left ventricular noncompaction (LVNC) in children. Little is known about the prevalence of this association, clinical outcomes, and treatment options. METHODS:Retrospective review of subjects with LVNC. LVNC was defined by established criteria; those with...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2019.09.014
更新日期:2019-12-01 00:00:00
abstract:BACKGROUND:We sought to systematically combine the evidence on efficacy of disease management programs (DMPs) in the treatment of congestive heart failure (CHF), to identify and explain heterogeneity of results from prior studies of DMPs, and to assess potential publication bias from these studies. METHODS AND RESULTS...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.cardfail.2006.03.003
更新日期:2006-09-01 00:00:00
abstract:BACKGROUND:Heart failure (HF) guidelines recommend treatment with multiple medications to improve survival, functioning, and quality of life. Yet, HF treatments can be costly, resulting in significant economic burden for some patients. To date, there are few data on the impact of patients' perceived difficulties in aff...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2006.03.004
更新日期:2006-06-01 00:00:00
abstract:BACKGROUND:Some of the most frequent manifestations of heart involvement in human immunodeficiency virus (HIV) infection include right and left ventricular dysfunction. The pathogenesis remains obscure. METHODS AND RESULTS:This prospective clinical and echocardiographic study involved 181 patients at all stages of HIV...
journal_title:Journal of cardiac failure
pub_type: 临床试验,杂志文章
doi:10.1016/s1071-9164(98)90504-8
更新日期:1998-03-01 00:00:00
abstract:BACKGROUND:Heart failure with preserved ejection fraction (HFpEF) has been increasingly recognized as a leading cause of pulmonary hypertension (HFpEF-PH). It remains unknown how HFpEF-PH fares in relation to systolic HF (reduced ejection fraction)-induced PH (HFrEF-PH). Therefore, we sought to determine the long-term ...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,多中心研究
doi:10.1016/j.cardfail.2014.05.003
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Two recent literature-based meta-analyses revealed that restrictive filling pattern (RFP) was associated with a 4-fold increase in the risk of death in patients with heart failure (HF) and postacute myocardial infarction (AMI). This similar but unique analysis evaluated the link between RFP and morbidity. M...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,meta分析
doi:10.1016/j.cardfail.2007.01.010
更新日期:2007-06-01 00:00:00
abstract::Carfilzomib is a novel irreversible proteasome inhibitor (PI) used with increasing frequency to treat patients with relapsed and/or refractory multiple myeloma (RRMM). This agent is an effective treatment for this challenging population, but proteasome inhibition has the potential of significant cardiac toxicity via t...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2014.11.008
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:The left ventricular assist device (LVAD) is a therapy for patients with end-stage heart failure, many of whom have a preexisting implantable cardioverter-defibrillator (ICD). We investigated whether the implantation of a LVAD affects ICD function. METHODS AND RESULTS:Patients implanted with a LVAD between ...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2009.12.003
更新日期:2010-04-01 00:00:00
abstract:BACKGROUND:Atrial fibrillation (AF) is a common arrhythmia which contributes to morbidity and mortality in patients with heart failure (HF). Atrial remodeling is a key substrate for the development of AF in HF. However, experimental models that study AF in the setting of HF have important limitations. We evaluated a ne...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2007.10.021
更新日期:2008-04-01 00:00:00
abstract:METHODS AND RESULTS:Over an 18-month period, the patients on the heart transplantation waiting list at our institution were evaluated to determine if continued listing was appropriate. Ten patients were removed because of significant improvement in clinical status and exercise capacity (n = 9) or because of criteria vi...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/s1071-9164(97)90042-7
更新日期:1997-06-01 00:00:00
abstract:BACKGROUND:Circulating pro-angiogenic cells (PACs) contribute to vascular and myocardial regeneration. A low level of PACs is associated with worse outcome in patients with coronary heart disease. However, little is known about PACs in heart failure (HF). METHODS AND RESULTS:Blood was sampled at baseline in 111 patien...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,多中心研究
doi:10.1016/j.cardfail.2009.05.011
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:Increased serum leptin concentration has been linked to increased ventilation in patients with mild heart failure (HF). However, in animal models the absence of leptin has also been associated with increased ventilation. This study evaluated the relationship of circulating leptin concentration with exercise ...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2013.10.004
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:Aortic insufficiency (AI) is associated with morbidity and mortality in patients with continuous-flow left ventricular assist devices (LVADs), whereas its impact on the HeartMate 3 LVAD cohorts remains uninvestigated. We aimed to investigate the clinical impact of AI on patients with HeartMate 3 LVADs. METH...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2020.05.013
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:We investigated the relationship between nonsustained ventricular tachycardia (NSVT) and left ventricular (LV) dilatation, function, remodeling, and scar tissue extent in patients with previous myocardial infarction (MI). METHODS AND RESULTS:Eighty-two patients (ages 64+/-10 years) with first previous MI we...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2009.09.001
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Improvement of left ventricular (LV) systolic dysfunction can occur in patients with dilated cardiomyopathy (DCM), and it is more frequently observed if patients have no delayed enhancement (DE) in cardiac magnetic resonance imaging (CMR). However, even in the absence of DE, not all patients have functional ...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2015.12.011
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Fixed pulmonary hypertension is common in patients with advanced heart failure and is a contraindication for heart transplantation. Left ventricular assist devices (LVAD) and inotropes have been used to reduce pulmonary vascular resistance (PVR) and allow transplantation. However, little is known about the e...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2016.06.421
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:Frailty reflects decreased resilience to physiological stressors; its prevalence and prognosis are not fully defined in heart failure with preserved ejection fraction (HFpEF). METHODS:The Short Physical Performance Battery (SPPB) was prospectively obtained in 114 outpatients with HFpEF. The SPPB tests gait ...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2018.09.002
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND:The present study was designed to study the progression of heart failure in rabbits with catecholamine-induced cardiomyopathy. METHODS AND RESULTS:We investigated the effects of three repetitive applications (at 16-day intervals) of high-dose epinephrine (first infusion, 5 micrograms/kg/min for 60 minutes; ...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/s1071-9164(99)90033-7
更新日期:1999-06-01 00:00:00
abstract::Beta-adrenergic blocking agents are standard treatment for patients with mild-to-moderate heart failure. When patients receiving beta-blockers decompensate they often need treatment with a positive inotropic agent. The beta-agonist dobutamine may not produce much increase in cardiac output during full-dose beta-blocke...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,评审
doi:10.1054/jcaf.2001.26655
更新日期:2001-06-01 00:00:00
abstract:BACKGROUND:The long-term effects of carvedilol on muscle sympathetic nerve activity (MSNA) and muscle blood flow at rest and exercise in patients with chronic heart failure (CHF) remain unknown. METHODS AND RESULTS:Twenty-six patients (New York Heart Association class II-III) were randomized to carvedilol or placebo. ...
journal_title:Journal of cardiac failure
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.cardfail.2004.03.006
更新日期:2004-12-01 00:00:00
abstract:BACKGROUND:Numerous models predicting the risk of incident heart failure (HF) have been developed; however, evidence of their methodological rigor and reporting remains unclear. This study critically appraises the methods underpinning incident HF risk prediction models. METHODS AND RESULTS:EMBASE and PubMed were searc...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,评审
doi:10.1016/j.cardfail.2017.03.005
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation results in significant morbidity and mortality. Preoperative parameters from transthoracic echocardiography (TTE) that predict RVF after LVAD implantation might identify patients in need of temporary or permanent right v...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2012.11.001
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Coronary artery disease is the most common cause of heart failure (HF) in developed countries. The aim of this study was to elucidate the mechanisms of reduction of arrhythmias after sacubitril/valsartan (LCZ696) therapy in a myocardial infarction (MI)-HF rabbit model. METHODS AND RESULTS:Chronic MI in rabb...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2020.03.007
更新日期:2020-06-01 00:00:00
abstract::Studies in patients with moderate heart failure have shown a positive relation between atrial size and plasma atrial natriuretic peptide (ANP)(99-126) concentrations; however, the relation of the hormone level and left atrial size and left ventricular function in patients with severe chronic heart failure has not been...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/1071-9164(95)90012-8
更新日期:1995-03-01 00:00:00
abstract:BACKGROUND:Cardiac resynchronization therapy (CRT) has been shown to improve heart failure (HF) symptoms and survival. We hypothesized that a greater improvement in left-ventricular ejection fraction (LVEF) after CRT is associated with greater survival benefit. METHODS AND RESULTS:In 693 patients across 2 internationa...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,多中心研究
doi:10.1016/j.cardfail.2014.03.001
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:To determine the feasibility of peripheral intravenous volume analysis (PIVA) of venous waveforms for assessing volume overload in patients admitted to the hospital with acute decompensated heart failure (ADHF). METHODS:Venous waveforms were captured from a peripheral intravenous catheter in subjects admitt...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2018.05.003
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Phosphodiesterase-5A inhibitors (PDE5i) are sometimes used in patients with advanced heart failure with reduced ejection fraction before heart transplant or left ventricular assist device implantation to decrease right ventricular (RV) afterload and mitigate the risk of right heart failure. Conflicting evide...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2020.11.007
更新日期:2020-11-21 00:00:00
abstract:BACKGROUND:Gamma-glutamyltransferase (GGT) and total bilirubin (T-Bil) are elevated and of prognostic significance in chronic heart failure (CHF). This study sought to compare these novel cardiovascular risk markers in CHF. METHODS AND RESULTS:We evaluated 1,087 ambulatory patients from our heart failure program. Long...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2011.02.012
更新日期:2011-07-01 00:00:00