Abstract:
BACKGROUND:The prevalence, prognostic import, and impact of renal insufficiency on the benefits of ACE inhibitors and beta-blockers in community-dwelling patients with heart failure are uncertain. METHODS AND RESULTS:We analyzed data from a prospective cohort of 754 patients with heart failure who had ejection fraction, serum creatinine, and weight measured at baseline. Median age was 69 years, and 43% had an ejection fraction > or =35%. By the Cockcroft-Gault equation, 118 patients (16%) had creatinine clearances < or =30 mL/min and 301 (40%) had creatinine clearances between 30 and 59 mL/min. During follow-up (median 926 days), 385 patients (37%) died. Even after adjustment for all other prognostic factors, survival was significantly associated with renal function (P=0.002) in patients with either systolic or diastolic dysfunction; patients exhibited a 1% increase in mortality for each 1-mL/min decrease in creatinine clearance. The associations with 1-year mortality reductions were similar for ACE inhibitors (OR 0.46 [95% CI 0.26 to 0.82] versus OR 0.28 [95% CI 0.11 to 0.70]) and beta-blockers (OR 0.40 [95% CI 0.23 to 0.70] versus OR 0.41 [95% CI 0.19 to 0.85]) in patients with creatinine clearances <60 mL/min versus > or =60 mL/min, although these drugs were used less frequently in patients with renal insufficiency. CONCLUSIONS:Renal insufficiency is more prevalent in patients with heart failure than previously reported and is an independent prognostic factor in diastolic and systolic dysfunction. ACE inhibitors and beta-blockers were associated with similar reductions in mortality in patients with and without renal insufficiency.
journal_name
Circulationjournal_title
Circulationauthors
McAlister FA,Ezekowitz J,Tonelli M,Armstrong PWdoi
10.1161/01.CIR.0000116764.53225.A9subject
Has Abstractpub_date
2004-03-02 00:00:00pages
1004-9issue
8eissn
0009-7322issn
1524-4539pii
01.CIR.0000116764.53225.A9journal_volume
109pub_type
杂志文章相关文献
CIRCULATION文献大全abstract::Total anomalous pulmonary venous connection (TAPVC) is a rare cardiac congenital abnormality which usually results in death in infancy or early childhood. We describe a 52-year-old man with TAPVC and severe calcific pulmonic stenosis. Both diagnoses were suspected clinically and from the chest X-ray. Cardiac catheteri...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.55.1.206
更新日期:1977-01-01 00:00:00
abstract:BACKGROUND:There are no reported studies on the safety and efficacy of low-dose aspirin with low-intensity oral anticoagulation in patients with heart valve replacement. In this study, we compared the use of 100 mg/d aspirin with 650 mg/d aspirin in the prevention of systemic embolism and vascular death in patients wit...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.94.9.2113
更新日期:1996-11-01 00:00:00
abstract::Regional myocardial function and blood flow were determined for 48 hours after permanent occlusion of the left circumflex coronary artery in conscious swine. Systolic wall thickening and end-diastolic wall thickness (EDWTh) were correlated with regional myocardial flow (RMBF) at 15 minutes, 24 and 48 hours after occlu...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.64.4.699
更新日期:1981-10-01 00:00:00
abstract::Expansion (regional dilatation and thinning) of acutely infarcted myocardium in man has been shown to correlate with overall cardiac dilatation and rupture. We studied gross and histopathologic features and the time course of expansion in rats. Infarcts were produced in 84 rats by ligation of the left coronary artery ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.65.7.1446
更新日期:1982-06-01 00:00:00
abstract::Conventional ultrafiltration (UF) fails to reverse satisfactorily hemodilution and the rise in total body water (TBW) seen after cardiopulmonary bypass (CPB). We have modified the technique, timing, and placement of UF in the CPB circuit and in pilot studies observed controlled elevation of hematocrit and a significan...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1991-11-01 00:00:00
abstract:BACKGROUND:The T2G1s monoclonal antifibrin antibody binds specifically to fibrin but not to fibrinogen. METHODS AND RESULTS:In a canine model of acute arterial thrombosis, we determined the feasibility of imaging thrombi using a 99mTc-labeled Fab' fragment. In 14 dogs, 10 carotid and 13 femoral artery thrombi were pro...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.85.1.298
更新日期:1992-01-01 00:00:00
abstract:BACKGROUND:Fibrinogen has been identified as an independent risk factor for cardiovascular disease and associated with traditional cardiovascular risk factors. Also, the role of elevated fibrinogen in thrombosis suggests that it may be on the causal pathway for certain risk factors to exert their effect. These associat...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.102.14.1634
更新日期:2000-10-03 00:00:00
abstract:BACKGROUND:The purpose of this study was to describe the long-term event-free survival patterns of patients with significant coronary artery disease treated medically versus patterns of those treated surgically and to evaluate the factors associated with improved event-free survival. METHODS AND RESULTS:We studied the...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1992-11-01 00:00:00
abstract:BACKGROUND:Increased activity of the sympathetic nervous system contributes significantly to the pathophysiology of heart failure. However, cardiac efferent sympathetic function has not been well characterized in this disorder. In this study, we evaluated cardiac sympathetic innervation using [123I]metaiodobenzylguanid...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.89.6.2843
更新日期:1994-06-01 00:00:00
abstract:BACKGROUND:Approximately half of all patients with chronic heart failure (HF) have a decreased ejection fraction (EF) (systolic HF [SHF]); the other half have HF with a normal EF (diastolic HF [DHF]). However, the underlying pathophysiological differences between DHF and SHF patients are incompletely defined. The purpo...
journal_title:Circulation
pub_type: 杂志文章,随机对照试验
doi:10.1161/CIRCULATIONAHA.108.783910
更新日期:2008-09-30 00:00:00
abstract:BACKGROUND:Our aim was to compare the electron-beam CT (EBCT) features of coronary arteries in heart transplant recipients with those of biplane coronary angiography and intracoronary ultrasound (ICUS). METHODS AND RESULTS:We examined 112 heart transplant recipients (25 female; age, 17 to 69 years; median, 52 years) 1...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.101.17.2078
更新日期:2000-05-02 00:00:00
abstract:BACKGROUND:There is increasing evidence of a link between conduit vessel stiffness and cardiovascular events, although the association has never been tested in a large post-myocardial infarction patient population. METHODS AND RESULTS:We evaluated the relationship between baseline pulse pressure, measured by sphygmoma...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.96.12.4254
更新日期:1997-12-16 00:00:00
abstract::The purpose of this study was to develop a clinically applicable system for quantifying premortem myocardial area at risk. Coronary artery occlusion was performed in 18 closed-chest dogs (11 left anterior descending and seven circumflex). 99mTc (15 mCi)-labeled macroaggregated albumin was then injected through an angi...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.73.3.551
更新日期:1986-03-01 00:00:00
abstract:BACKGROUND:Many clinical trials use composite end points to reduce sample size, but the relative importance of each individual end point within the composite may differ between patients and researchers. METHODS AND RESULTS:We asked 785 cardiovascular patients and 164 clinical trial authors to assign 25 "spending weigh...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.113.006588
更新日期:2014-10-07 00:00:00
abstract::Coronary artery bypass surgery with or without aneurysmectomy has been used to treat patients with angiographically defined left ventricular aneurysm. To evaluate whether surgery benefits such patients, we analyzed the data from 1131 patients who were enrolled in the registry of the Coronary Artery Surgery Study. Four...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.74.1.110
更新日期:1986-07-01 00:00:00
abstract:BACKGROUND:Continuous-flow rotary pumps with axial design are increasingly used for left ventricular assist support. The efficacy of this design compared with pulsatile, volume displacement pumps, with respect to characteristics of left ventricular unloading, and exercise performance remains largely unstudied. METHODS...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.106.677898
更新日期:2007-09-11 00:00:00
abstract:BACKGROUND:Previous studies suggest that the antifibrillatory action of class I and III drugs is due to prolongation of the atrial wavelength. The aim of the present study was to directly evaluate the electrophysiological action of antifibrillatory drugs in a goat model of chronic atrial fibrillation (AF). METHODS AND...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.102.2.260
更新日期:2000-07-11 00:00:00
abstract:BACKGROUND:Cystic kidneys and vascular aneurysms are clinical manifestations seen in patients with polycystic kidney disease, a cilia-associated pathology (ciliopathy). Survivin overexpression is associated with cancer, but the clinical pathology associated with survivin downregulation or knockout has never been studie...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.113.005746
更新日期:2014-02-11 00:00:00
abstract::In rats, atrial natriuretic factor (ANF) reduces sympathetic nerve activity (SNA) reflexively by sensitizing cardiac mechanoreceptors with inhibitory vagal afferents. We performed three series of experiments in 26 normal young men to document whether ANF inhibits SNA in humans and if so, to determine potential mechani...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.81.6.1860
更新日期:1990-06-01 00:00:00
abstract::The clinical and pathologic features of 18 consecutive patients with peripartum cardiomyopathy at The Johns Hopkins Hospital were examined in an attempt to define the incidence of myocarditis and to determine its response to immunosuppressive agents. In addition to routine studies, patients were evaluated with echocar...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.81.3.922
更新日期:1990-03-01 00:00:00
abstract:BACKGROUND:Ischemia reperfusion injury (IRI) predisposes to the formation of donor-specific antibodies, a factor contributing to chronic rejection and late allograft loss. METHODS:We describe a mechanism underlying the correlative association between IRI and donor-specific antibodies by using humanized models and pati...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.119.042501
更新日期:2020-02-11 00:00:00
abstract:BACKGROUND:Doxycycline has been shown to effectively inhibit aneurysm formation in animal models of abdominal aortic aneurysm. Although this effect is ascribed to matrix metalloproteinase-9 inhibition, such an effect is unclear in human studies. We reevaluated the effect of doxycycline on aortic wall protease content i...
journal_title:Circulation
pub_type: 杂志文章,随机对照试验
doi:10.1161/CIRCULATIONAHA.108.806505
更新日期:2009-04-28 00:00:00
abstract:BACKGROUND:Transplant-associated coronary artery disease (TxCAD) is the manifestation of chronic rejection in the cardiac allograft. Both immunological and nonimmunological factors contribute to its development. Stratification by the time of development of TxCAD has not been considered previously for an extensive trans...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1997-11-04 00:00:00
abstract::Experimental studies demonstrate that short-term regional perfusion-contraction matching, in which the energy demands of regional myocardial contraction are reduced to match the diminished myocardial substrate supply, occurs during states of low coronary blood flow under resting conditions and during exercise-induced ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.83.3.1076
更新日期:1991-03-01 00:00:00
abstract:BACKGROUND:The relative anti-aggregatory effects of currently prescribed platelet glycoprotein IIb/IIIa receptor antagonists during and after percutaneous coronary intervention for acute coronary syndromes have not been established. METHODS AND RESULTS:We randomized 70 acute coronary syndrome patients undergoing percu...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.0000029744.01096.1f
更新日期:2002-09-17 00:00:00
abstract::The two new 99m (99mTc) labeled myocardial perfusion agents, 99mTc-Sestamibi and 99mTc-Teboroxime, are now available for routine clinical application. Both agents allow assessment of ejection fraction by the first-pass technique at rest or during exercise, thus providing additional information not available with thall...
journal_title:Circulation
pub_type: 临床试验,杂志文章,多中心研究,评审
doi:
更新日期:1991-09-01 00:00:00
abstract:BACKGROUND:Little is known of the prognostic significance of mitral regurgitation (MR) on transcatheter aortic valve replacement (TAVR), the impact of TAVR on MR severity, and the variables associated with possible post-TAVR improvement in MR. We evaluated these issues in a multicenter registry of patients undergoing C...
journal_title:Circulation
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCULATIONAHA.113.001822
更新日期:2013-11-05 00:00:00
abstract:BACKGROUND:Alfieri edge-to-edge mitral repair has been used clinically with ring annuloplasty to correct ischemic mitral regurgitation (IMR), but its efficacy without concomitant ring annuloplasty has not been described in this setting. METHODS:Seventeen sheep underwent implantation of 9 radiopaque markers on the left...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.0000087943.76135.fd
更新日期:2003-09-09 00:00:00
abstract:BACKGROUND:Patients with prior atherosclerosis in 1 or more vascular territories (coronary, cerebrovascular, or peripheral arterial) who present with acute coronary syndromes have high cardiovascular risk and may benefit significantly from evidence-based therapies, yet whether these are used consistently is unknown. M...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.109.877092
更新日期:2009-08-18 00:00:00
abstract:BACKGROUND:Patients with acute ischemic right ventricular dysfunction often develop hemodynamic compromise, yet most manifest spontaneous early clinical improvement and later recovery of global right ventricular performance. This study was designed to delineate the determinants of right ventricular performance followin...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.88.2.696
更新日期:1993-08-01 00:00:00