Abstract:
BACKGROUND:In patients with heart failure and preserved ejection fraction (HF-PEF) randomized in the Americas as part of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, treatment with spironolactone enhanced the risk of hyperkalemia but reduced the risk of hypokalemia. We examined the clinical correlates and prognostic implications of incident hypo- and hyperkalemia during study follow-up. METHODS:We defined the region-specific incidence of hypokalemia (potassium [K+] <3.5 mmol/l) and hyperkalemia (K+ ≥5.5 mmol/l) among both placebo- and spironolactone-assigned patients in TOPCAT. Factors associated with incident hypokalemia and hyperkalemia and the relationship between incident K+ abnormalities and the risk of subsequent mortality were analyzed in multivariable regression models restricted to the Americas. RESULTS:In the Americas, assignment to spironolactone increased risk for hyperkalemia (hazard ratio 3.21, 95% confidence interval 2.46-4.20, P < .001) and reduced risk of hypokalemia (hazard ratio 0.43, 95% confidence interval 0.34-0.55, P < .001). Assignment to spironolactone, lower estimated glomerular filtration rate, higher baseline K+, diabetes, and lower hemoglobin were associated with incident hyperkalemia, whereas assignment to placebo, lower K+, younger age, lower estimated glomerular filtration rate, and use of diuretics at baseline were associated with hypokalemia. The combination of spironolactone and an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker was associated with incremental risk for hyperkalemia and protection from hypokalemia. Independent of region, both hypokalemia and hyperkalemia, were associated with higher risk for cardiovascular and all-cause mortality in multivariable-adjusted Cox regression models. CONCLUSIONS:Both hyperkalemia and hypokalemia are associated with heightened risk for mortality in HF-PEF. Use of spironolactone in this population requires careful laboratory surveillance of K+ and creatinine, particularly in high-risk groups.
journal_name
J Card Failjournal_title
Journal of cardiac failureauthors
Desai AS,Liu J,Pfeffer MA,Claggett B,Fleg J,Lewis EF,McKinlay S,O'Meara E,Shah SJ,Sweitzer NK,Solomon S,Pitt Bdoi
10.1016/j.cardfail.2018.03.002subject
Has Abstractpub_date
2018-05-01 00:00:00pages
313-320issue
5eissn
1071-9164issn
1532-8414pii
S1071-9164(18)30099-Xjournal_volume
24pub_type
杂志文章,多中心研究,随机对照试验abstract:BACKGROUND:Device indications have changed for placement of continuous-flow left ventricular assist devices (CF-LVADs). We performed a multicenter analysis evaluating temporal variations in outcomes after CF-LVAD implantation. METHODS & RESULTS:We retrospectively defined 3 time intervals to reflect changes in CF-LVAD ...
journal_title:Journal of cardiac failure
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doi:10.1016/j.cardfail.2017.07.403
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Retrospective single-center studies have shown that measures of mechanical dyssynchrony before cardiac resynchronization therapy (CRT), or acute changes after CRT, predict response better than QRS duration. The Prospective Minnesota Study of Echocardiographic/TDI in Cardiac Resynchronization Therapy (PROMISE...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.cardfail.2008.12.009
更新日期:2009-06-01 00:00:00
abstract:BACKGROUND:Patients with chronic heart failure (CHF) complain of breathlessness and fatigue on exertion, have reduced peak oxygen consumption (pV(O(2))), and an increased ventilatory response to exercise (V(E)/V(CO(2)) slope). These limitations correlate with abnormalities of spirometry (forced expiratory volume in 1 s...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1054/jcaf.2002.126916
更新日期:2002-08-01 00:00:00
abstract:BACKGROUND:Anemia is associated with higher morbidity and mortality in patients with heart failure (HF), but its implications for heath care costs are not well described. METHODS AND RESULTS:We analyzed data on 1056 patients with symptomatic HF seen at Duke University between 2002 and 2006. Health care costs were obta...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2009.06.435
更新日期:2009-12-01 00:00:00
abstract:BACKGROUND:Theoretically, salt supplementation should promote diuresis through increasing the glomerular filtration rate (GFR) during treatment of acute decompensated heart failure (ADHF) even with low-dose furosemide; however, there is little evidence to support this idea. METHODS AND RESULTS:This was a prospective, ...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.cardfail.2014.01.012
更新日期:2014-05-01 00:00:00
abstract:BACKGROUND:Studies have shown that neither ejection fraction nor hemodynamic abnormalities during exercise in chronic heart failure (HF) correlate with symptoms of fatigue and exhaustion. The concept that exercise limitation in patients with chronic HF is due to abnormal hemodynamics during exercise has been revised to...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,评审
doi:10.1016/j.cardfail.2005.03.002
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND:Chronic heart failure is a disease syndrome characterized in its advanced stages by a poor quality of life, frequent hospitalizations, and a high risk of mortality. In advanced and ultra-advanced chronic heart failure, many treatment options, such as cardiac transplantation and mechanical devices, are severe...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2005.10.013
更新日期:2005-12-01 00:00:00
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journal_title:Journal of cardiac failure
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.cardfail.2008.02.007
更新日期:2008-08-01 00:00:00
abstract:BACKGROUND:Systolic heart failure (SHF), particularly when requiring hospital admission carries a poor prognosis. There is a paucity of data in Indo-Asians on outcomes of SHF, among whom the burden of cardiovascular disease is consistently rising. The purpose of this study was to determine the frequency and predictors ...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2007.07.005
更新日期:2007-12-01 00:00:00
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journal_title:Journal of cardiac failure
pub_type: 杂志文章,评审
doi:10.1054/jcaf.2002.129274
更新日期:2002-12-01 00:00:00
abstract:BACKGROUND:Some controlled clinical trials showed a beneficial effect of beta-blockers on symptoms, exercise tolerance, and left ventricular function in dilated cardiomyopathy. The purpose of this study was to investigate if there are clinical variables at baseline that could predict a favorable response to long-term m...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/s1071-9164(96)80027-3
更新日期:1996-06-01 00:00:00
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journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2014.06.358
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:Heart failure in blacks has been associated with a poorer prognosis than in whites. In such diseases as hypertension, blacks show pathophysiological differences and respond differently to some therapies than whites. The aim of this study is to evaluate the clinical characteristics and response to therapy of ...
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/s1071-9164(99)90001-5
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND:Familial involvement is common in dilated cardiomyopathy (DCM) and >40 genes have been implicated in causing disease. However, the role of genetic testing in clinical practice is not well defined. We examined the experience of clinical genetic testing in a diverse DCM population to characterize the prevalenc...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2012.01.013
更新日期:2012-04-01 00:00:00
abstract:BACKGROUND:There are no well validated patient-reported disease status instruments for acute heart failure (HF). We assessed the feasibility of using the Kansas City Cardiomyopathy Questionnaire (KCCQ) during acute heart failure hospitalization, and the association of acute changes with 30-day readmission. METHODS AND...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2013.11.010
更新日期:2014-01-01 00:00:00
abstract::Simultaneous dysfunction of the heart and the kidney represents a distinct spectrum of disease states composed of complex clinical scenarios with adverse outcomes. Worsening renal function (WRF) in the setting of acute decompensated heart failure (ADHF) is one such clinical setup for which the underlying mechanisms ar...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,评审
doi:10.1016/j.cardfail.2014.09.005
更新日期:2014-12-01 00:00:00
abstract::Heart failure (HF) is an increasingly common syndrome associated with high mortality and economic burden, and there has been a paucity over the past decade of new pharmacotherapies that improve outcomes. However, recent data from a large randomized controlled trial compared the novel agent LCZ696, a dual-acting angiot...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,评审
doi:10.1016/j.cardfail.2015.07.008
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVE:To elucidate the prevalence and role of β1 adrenergic receptor autoantibodies (β1AR-AAb) belonging to the immunoglobulin (Ig)G3 subclass in patients with heart failure (HF) treated with β-adrenergic blockers. BACKGROUND:Several cardiac AAbs have been reported to be present in sera from patients with dilated ...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2016.03.005
更新日期:2016-06-01 00:00:00
abstract:BACKGROUND:Large-scale clinical trials have demonstrated the benefits of cardiac resynchronization therapy (CRT) in patients with New York Heart Association (NYHA) Class III/IV heart failure, systolic left ventricular dysfunction, and a wide QRS. However, additional patient groups may also benefit from CRT. METHODS AN...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,meta分析
doi:10.1016/j.cardfail.2009.12.018
更新日期:2010-05-01 00:00:00
abstract::Although atrial fibrillation is common in patients with heart failure, patients with atrial fibrillation are often excluded from congestive heart failure trials or are not analyzed separately. Consequently, while the effect of angiotensin-converting enzyme inhibitors in patients with sinus rhythm is well established, ...
journal_title:Journal of cardiac failure
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1995-12-01 00:00:00
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journal_title:Journal of cardiac failure
pub_type: 杂志文章,多中心研究
doi:10.1016/j.cardfail.2003.12.008
更新日期:2004-10-01 00:00:00
abstract:BACKGROUND:Cardiac resynchronization therapy (CRT) is now an established therapy for patients with advanced heart failure with electromechanical delay, although nonresponders have been observed. Because natriuretic peptides are relevant markers to reflect the severity of heart failure and filling pressure of cardiac ch...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2005.04.007
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:Pediatric heart failure (HF) patients have a suboptimal response to traditional HF medications, although phosphodiesterase-3 inhibition (PDE3i) has been used with greater success than in the adult HF population. We hypothesized that molecular alterations specific to children with HF and HF etiology may affec...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2016.07.429
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVE:In chronic heart failure (HF), diuretic doses increase as the disease progresses, often after hospitalization for instability, and have been associated with worsening renal function and increased mortality. METHODS AND RESULTS:A prospective observational analysis of 183 patients in an advanced HF clinic stra...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2008.01.015
更新日期:2008-06-01 00:00:00
abstract:BACKGROUND:The objective of this study was to prospectively evaluate beta-blocker use at hospital discharge as an indicator of quality of care and outcomes in patients with heart failure (HF). METHODS AND RESULTS:Data from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failu...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2007.06.727
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:We investigated the effects of the dipeptidyl peptidase 4 inhibitor teneligliptin on cardiac function and hemodynamics during heart failure in hypertensive model rats. METHODS AND RESULTS:Fifty-five male Dahl salt-sensitive rats were divided into 4 groups: control group (0.3% NaCl chow; n = 13), hypertensio...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2017.09.001
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Despite ample data from randomized clinical trials (RCTs), the management of advanced heart failure (HF) varies greatly. We examined the most common refractory questions arising in routine inpatient management of advanced HF. METHODS:From the inpatient HF service at 1 hospital, we prospectively recorded cli...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2003.10.006
更新日期:2004-06-01 00:00:00
abstract::Stimulation of the V1a receptor for arginine vasopressin produces myocardial and vascular effects similar to those of angiotensin II while stimulation of the V2 receptor causes fluid retention. There are no data with sustained blockade of the V1a receptor while single-dose experiments suggest benefit. Acute and chroni...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,评审
doi:10.1016/j.cardfail.2017.12.011
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Patients having heart failure with midrange ejection fraction (HFmrEF: 40% ≤ EF < 50%) are increasingly being considered a new subset of the population with heart failure. Despite recent advances in heart-failure treatment strategies, the prognosis of these patients has not improved substantially over time. ...
journal_title:Journal of cardiac failure
pub_type: 杂志文章,多中心研究
doi:10.1016/j.cardfail.2019.05.010
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:We investigated a correlation between electromechanical properties of the myocardium and response to CD34+ cell therapy in patients with chronic heart failure. METHODS AND RESULTS:We enrolled 40 patients with ischemic cardiomyopathy (ICM) and 40 with nonischemic dilated cardiomyopathy (DCM). All patients we...
journal_title:Journal of cardiac failure
pub_type: 杂志文章
doi:10.1016/j.cardfail.2016.08.002
更新日期:2017-02-01 00:00:00