NT-proBNP and predictors of event free survival and left ventricular systolic function recovery in peripartum cardiomyopathy.

Objective: To determine predictors of adverse outcomes in peripartum cardiomyopathy (PPCM).

Methods And Results: We conducted a multi-center cohort study across four centers to identify subjects with PPCM with the following criteria: LVEF <40%, development of heart failure within the last month of pregnancy or within 5 months of delivery and no other identifiable cause of heart failure with reduced ejection fraction. Outcomes included 1) survival free from major adverse events (need for extra-corporeal membrane oxygenation, ventricular assist device, orthotopic heart transplantation or death) and 2) LVEF recovery ≥ 50%.

Interpreting Neurologic Outcomes in a Changing Trial Design Landscape: An Analysis of HeartWare Left Ventricular Assist Device Using a Hybrid Intention to Treat Population.

Randomized controlled trials can provide optimal clinical evidence to assess the benefits of new devices, and it is these data that often shape device usage in real-world practice. However, individual clinical trial results sometimes appear discordant for the same device, and alternative devices are sometimes not employed in similar patient populations. To make sound evidence-based decisions, clinicians routinely rely on cross-trial comparisons from different trials of similar but not identical patient populations to assess competing technology when head-to-head randomized comparisons are unavailable.

The value of psychosocial factors in patient selection and outcomes after heart transplantation.

Heart transplantation remains the gold standard treatment for advanced heart failure, although its use is limited by donor organ availability. To ensure that the rare resource of a donor heart is allocated appropriately, the evaluation of the heart transplant candidates includes extensive medical and psychosocial assessments. These psychosocial factors are critically important to understand pre-heart transplant because it is known that psychosocial evaluation and psychosocial comorbidities have a strong association with post-heart transplant outcomes.

Long-term cardiovascular risks associated with an elevated heart rate: the Framingham Heart Study.

Background: Higher heart rate has been associated with an adverse prognosis, but most prior studies focused on individuals with known cardiovascular disease or examined a limited number of outcomes. We sought to examine the association of baseline heart rate with both fatal and nonfatal outcomes during 2 decades of follow-up.

Methods And Results: Our study included 4058 Framingham Heart Study participants (mean age 55 years, 56% women).

Relation between soluble ST2, growth differentiation factor-15, and high-sensitivity troponin I and incident atrial fibrillation.

Background: We investigated whether circulating concentrations of soluble ST2, growth differentiation factor-15 (GDF-15), and high-sensitivity troponin I (hsTnI) are associated with incident atrial fibrillation (AF) and whether these biomarkers improve current risk prediction models including AF risk factors, B-type natriuretic peptide (BNP), and C-reactive protein (CRP).

Methods: We studied the relation between soluble ST2, GDF-15, and hsTnI and development of AF in Framingham Heart Study participants without prevalent AF. We used Cox proportional hazard regression analysis to examine the relation of incident AF during a 10-year follow-up period with each biomarker.

Distribution and clinical correlates of the interleukin receptor family member soluble ST2 in the Framingham Heart Study.

Background: Soluble ST2 (sST2) is a cardiac biomarker whose concentration rises in response to myocardial strain. Increased sST2 concentrations may predict adverse outcomes in patients with heart failure and myocardial infarction. Because sST2 was largely undetectable with first-generation assays in ambulatory individuals, there are few data regarding its distribution and correlates in community-based populations.

Testosterone supplementation in heart failure: a meta-analysis.

Background: Low testosterone is an independent predictor of reduced exercise capacity and poor clinical outcomes in patients with heart failure (HF). We sought to determine whether testosterone therapy improves exercise capacity in patients with stable chronic HF.

Methods And Results: We searched Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (1980-2010).

Clinical monitoring of stage B heart failure: echocardiography.

Estimates of the prevalence of asymptomatic left ventricular systolic dysfunction (LVSD) vary widely depending on the study sample and definition of LVSD. Subtle reductions in LV systolic or diastolic function are now detectable with newer echocardiographic measures, which can influence estimates of the burden of stage B heart failure (HF). If the definition is broadened to include diastolic filling abnormalities, the estimated prevalence of stage B HF increases dramatically.

Usefulness of the blood hematocrit level to predict development of heart failure in a community.

Current data suggest that increases in hemoglobin may decrease nitric oxide and adversely affect vascular function. In the preclinical setting, these changes could precipitate the development of heart failure (HF). We hypothesized that higher hematocrit (HCT) would be associated with an increased incidence of new-onset HF in the community.