Publications by authors named "Finnian Mc Causland"
Background: Hypertension is common in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), and current guidelines recommend treating systolic blood pressure (SBP) to a target <130 mm Hg. However, data supporting treatment to this target are limited. Additionally, pulse pressure (PP), a marker of aortic stiffness, has been associated with increased risk of cardiovascular events, but its prognostic impact in HFpEF has not been extensively studied.
View Article and Find Full Text PDFBackground: Lower estimated glomerular filtration rate (eGFR) may be one of the major reasons for hesitation or failure to initiate potentially beneficial therapies in patients with heart failure (HF).
Objectives: This study sought to assess if the effects of sacubitril/valsartan (vs valsartan) on cardiovascular outcomes differ according to baseline kidney function in patients with HF with preserved ejection fraction.
Methods: The PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF with Preserved Ejection Fraction) trial was global clinical trial of 4,796 patients with chronic HF and left ventricular ejection fraction (LVEF) ≥45% randomly assigned to sacubitril/valsartan or valsartan.
Background: Finerenone has kidney protective effects in patients with chronic kidney disease (CKD) with type 2 diabetes, but effects on kidney outcomes in patients with heart failure (HF) with and without diabetes and/or CKD are not known.
Objectives: Examine the effects of finerenone on kidney outcomes in FINEARTS-HF, a randomized trial of finerenone vs. placebo among patients with HF with mildly reduced or preserved ejection fraction.
Article Synopsis
- Sudden death is a significant concern for hemodialysis patients, accounting for about 25% of their deaths, with more incidents occurring on the days they receive treatment.
- A study analyzed data from 66 patients using implantable loop recorders over 12 months to examine how higher levels of dialysate bicarbonate (DBIC) affected the occurrence of serious heart arrhythmias.
- The results showed that while fewer episodes of clinically significant arrhythmia were linked to DBIC levels over 35 mEq/L, this finding lost significance when factoring in potassium levels, highlighting the need for further research with larger sample sizes.
Article Synopsis
- N-terminal pro-B-type natriuretic peptides (NT-proBNPs) are important biomarkers for evaluating heart failure risk, but their levels can be misleading in patients with chronic kidney disease due to the kidney’s impact on eGFR.
- This study aimed to analyze the relationship between NT-proBNP levels and cardiovascular outcomes, specifically hospitalizations and deaths, in heart failure patients with varying kidney function.
- In a large cohort of over 14,000 patients, the results indicated that NT-proBNP levels significantly increased with lower eGFR levels, and every doubling of NT-proBNP was linked to a 37% higher risk of adverse cardiovascular outcomes.
Background: Kidney outcomes have been variably defined using nonstandardized composite end points in key heart failure trials, thus introducing complexity in their interpretation and cross-trial comparability. We examined the effects of steroidal mineralocorticoid receptor antagonists, the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan, and SGLT2 (sodium-glucose cotransporter-2) inhibitors on composite kidney end points using uniform definitions in 6 contemporary heart failure trials.
Methods: Individual participant-level data from trials of steroidal mineralocorticoid receptor antagonists (EMPHASIS-HF [Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure], TOPCAT [Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist] Americas), angiotensin receptor-neprilysin inhibitor (PARADIGM-HF [Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure], PARAGON-HF [Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Receptor Blockers Global Outcomes in HF With Preserved Ejection Fraction]), and SGLT2 inhibitors (DAPA-HF [Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure], DELIVER [Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure]) were included.
Article Synopsis
- Renal dysfunction is common in heart failure patients and linked to poor outcomes, but how cardiac structure and function impact kidney health remains unclear.
- This study analyzed data from the PARAGON-HF trial to explore the relationship between echocardiographic measurements of heart structure/function and changes in kidney function over time.
- Results showed that higher left ventricular mass and certain heart parameters are associated with greater declines in kidney function and an increased risk of serious kidney-related events, suggesting that cardiac health plays a crucial role in renal outcomes for these patients.
Article Synopsis
- The study examined the impact of two medications, sacubitril/valsartan and ramipril, on short-term kidney function changes in patients experiencing acute myocardial infarction (MI), focusing on serum creatinine levels.
- In a trial with 5,661 patients, it was found that those taking sacubitril/valsartan had a slightly higher likelihood of experiencing initial increases in serum creatinine compared to those taking ramipril.
- However, acute changes in creatinine levels from either medication did not correlate with worse long-term cardiovascular outcomes or significant changes in kidney function, suggesting the initial increases might not indicate long-term risks.
Introduction: Calcium channel blockers (CCBs) are common antihypertensive agents among patients receiving hemodialysis (HD). Despite this, the association of CCBs with intradialytic hypotension (IDH), an important adverse outcome that is associated with cardiovascular morbidity and mortality, remains largely unexplored.
Methods: Using kinetic modeling sessions data from the Hemodialysis (HEMO) Study, random effects regression models were fit to assess the association of CCB use versus nonuse with IDH (defined as systolic blood pressure [SBP] < 90 mm Hg if pre-HD SBP < 160 mm Hg or < 100 mm Hg if pre-HD SBP ≥160 mm Hg).
Background: Sacubitril/valsartan is a foundational therapy for patients with heart failure. Although current U.S.
View Article and Find Full Text PDFIntroduction: Diabetes mellitus is a common cause of kidney failure and is often complicated by autonomic neuropathy, which may have implications for blood pressure (BP) homeostasis during hemodialysis (HD).
Methods: In this post hoc analysis of the Frequent Hemodialysis Network (FHN) Daily Trial, we used random effects Poisson and linear regression models to estimate the association of diabetes (vs. not) with intra-dialytic hypotension (IDH) and peri-dialytic BP parameters, respectively.
Win statistics offer a new approach to the analysis of outcomes in clinical trials, allowing the combination of time-to-event and longitudinal measurements and taking into account the clinical importance of the components of composite outcomes, as well as their relative timing. We examined this approach in a post hoc analysis of two trials that compared dapagliflozin to placebo in patients with heart failure and reduced ejection fraction (DAPA-HF) and mildly reduced or preserved ejection fraction (DELIVER). The effect of dapagliflozin on a hierarchical composite kidney outcome was assessed, including the following: (1) all-cause mortality; (2) end-stage kidney disease; (3) a decline in estimated glomerular filtration rate (eGFR) of ≥57%; (4) a decline in eGFR of ≥50%; (5) a decline in eGFR of ≥40%; and (6) participant-level eGFR slope.
View Article and Find Full Text PDFKey Points: Bioimpedance has been proposed as an objective method to assess volume status among patients receiving maintenance hemodialysis. The Frequent Hemodialysis Network Daily Trial measured bioimpedance parameters of volume status (vector length) and cardiac magnetic resonance imaging at baseline and 12 months. We observed that changes in vector length were inversely associated with changes in left ventricular mass and volume over a 12-month period.
View Article and Find Full Text PDFBackground: The Kidney Disease Improving Global Outcomes (KDIGO) classification integrates both estimated glomerular filtration rate and urine-albumin-creatinine ratio to stratify risk more comprehensively in patients with chronic kidney disease. There are limited data assessing whether this classification system is associated with prognosis and treatment response in heart failure populations.
Objectives: The aim of this study was to evaluate the relative treatment effects of sacubitril/valsartan across the KDIGO risk categories in patients with HFrEF.
Article Synopsis
- Heart failure with improved ejection fraction (HFimpEF) is a condition where patients previously had a left ventricular ejection fraction (LVEF) of 40% or lower but have improved to above 40%, and this area is not well-researched.* -
- The study aimed to analyze death causes in HFimpEF patients and how the diabetes drug dapagliflozin affects specific death rates by comparing it to a placebo in a clinical trial with over 5,000 participants.* -
- Out of 1,151 patients with HFimpEF, 16.5% died, with a similar rate of death compared to those with stable LVEF above 40%, and the majority of deaths
Introduction: Chronic kidney disease (CKD) and left ventricular (LV) dysfunction are risk factors for cardiovascular events. We explore whether the association of LV ejection fraction (LVEF) with cardiac arrest, heart failure hospitalization, and all-cause mortality differs across stages of kidney impairment.
Methods: We performed an observational cohort study of 19,032 patients from 2004 to 2014 with estimated glomerular filtration rate (eGFR) ≤90 ml/min per 1.
Background: Intradialytic hypertension, defined as an increase in BP from pre- to post-hemodialysis (HD), affects 5%-15% of patients receiving maintenance HD and is associated with cardiovascular and all-cause mortality. Hypervolemia is believed to be a major etiological factor, yet the association of more objective biomarkers of volume status with intradialytic hypertension is not well described.
Methods: In a post hoc analysis of the Frequent Hemodialysis Network Daily Trial ( n =234), using data from baseline, 1-, 4-, and 12-month visits ( n =800), we used random-effects regression to assess the association of bioimpedance estimates of volume (vector length) with post-HD systolic BP (continuous) and any increase in systolic BP (categorical) from pre- to post-HD.
Importance: An initial decline in estimated glomerular filtration rate (eGFR) is expected after initiating a sodium-glucose cotransporter-2 inhibitor (SGLT2i) and has been observed across patients with diabetes, chronic kidney disease, and heart failure.
Objective: To examine the implications of initial changes in eGFR among patients with heart failure with mildly reduced ejection fraction (HFmrEF) or preserved ejection fraction (HFpEF) enrolled in the Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial.
Design, Setting, And Participants: This was a prespecified analysis of the results of the DELIVER randomized clinical trial, which was an international multicenter study of patients with EF greater than 40% and eGFR greater than or equal to 25.
Sacubitril/valsartan compared to ramipril in high-risk post-myocardial infarction patients stratified according to use of mineralocorticoid receptor antagonists: Insight from the PARADISE MI trial.
Eur J Heart Fail
January 2024
Aim: It is unknown whether safety and clinical endpoints by use of sacubitril/valsartan (an angiotensin receptor-neprilysin inhibitor [ARNI]) are affected by mineralocorticoid receptor antagonists (MRA) in high-risk myocardial infarction (MI) patients. The aim of this study was to examine whether MRA modifies safety and clinical endpoints by use of sacubitril/valsartan in patients with a MI and left ventricular systolic dysfunction (LVSD) and/or pulmonary congestion.
Methods And Results: Patients (n = 5661) included in the PARADISE MI trial (Prospective ARNI vs.
Article Synopsis
- Kidney transplant recipients face significantly higher risks of cardiovascular events and kidney failure compared to age- and sex-matched controls, based on a study using Danish administrative databases from 2005-2018.
- In the first year post-transplant, 2.6% of recipients experienced cardiovascular issues, which increased to 8.3% by year five, while overall mortality rates were 2.2% and 10.3%.
- The findings highlight the need for improved cardiovascular preventive strategies for kidney transplant recipients to enhance their long-term health outcomes.
Introduction: Elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) is a potent predictor of adverse outcomes in hemodialysis initiation. These patients often experience intradialytic hypotension, which may partially reflect cardiac dysfunction, but the association of NT-proBNP with intradialytic hypotension is not clear.
Methods: We performed a post hoc analysis of a randomized trial that tested mannitol versus placebo in 52 patients initiating hemodialysis (NCT01520207).