Baseline characteristics of patients with heart failure with preserved ejection fraction in the EMPEROR-Preserved trial.

Aims: EMPEROR-Preserved is an ongoing trial evaluating the effect of empagliflozin in patients with heart failure with preserved ejection fraction (HFpEF). This report describes the baseline characteristics of the EMPEROR-Preserved cohort and compares them with patients enrolled in prior HFpEF trials.

Methods And Results: EMPEROR-Preserved is a phase III randomized, international, double-blind, parallel-group, placebo-controlled trial in which 5988 symptomatic HFpEF patients [left ventricular ejection fraction (LVEF) >40%] with and without type 2 diabetes mellitus (T2DM) have been enrolled.

Prognostic Value of Serial ST2 Measurements in Patients With Acute Heart Failure.

Background: Several clinical studies have evaluated the association between ST2 and outcome in patients with heart failure (HF). However, little is known about the predictive value of frequently measured ST2 levels in patients with acute HF.

Objectives: This study sought to describe the prognostic value of baseline and repeated ST2 measurements in patients with acute HF.

The heart-brain connection: a multidisciplinary approach targeting a missing link in the pathophysiology of vascular cognitive impairment.

While both cardiac dysfunction and progressive loss of cognitive functioning are prominent features of an aging population, surprisingly few studies have addressed the link between heart and brain function. This is probably due to the monodisciplinary approach to these problems by cardiologists, neurologists, and geriatricians. Recent data indicate that autoregulation of cerebral flow cannot always protect the brain from hypoperfusion when cardiac output is reduced or atherosclerosis is prominent.

The effect of a nurse-led integrated chronic care approach on quality of life in patients with atrial fibrillation.

Aims: Quality of life (QoL) is often impaired in patients with atrial fibrillation (AF). A novel nurse-led integrated chronic care approach demonstrated superiority compared with usual care in terms of cardiovascular hospitalization and mortality. Consequently, we hypothesized that this approach may also improve QoL and AF-related knowledge, which in turn may positively correlate with QoL.

Stent thrombosis after coronary stent implantation: a protective effect of high-dose statin therapy?

Objectives: To assess independent predictors of stent thrombosis (ST) in an all-comer trial.

Methods: This is an observational case-control study based on a retrospective analysis of the Basel Stent Kosten Effektivitäts Trial (BASKET) (n = 826). Patients with ST were compared to controls with regard to baseline parameters.

NADPH oxidase-dependent oxidative stress in the failing heart: From pathogenic roles to therapeutic approach.

Heart failure (HF) occurs when the adaptation mechanisms of the heart fail to compensate for stress factors, such as pressure overload, myocardial infarction, inflammation, diabetes, and cardiotoxic drugs, with subsequent ventricular hypertrophy, fibrosis, myocardial dysfunction, and chamber dilatation. Oxidative stress, defined as an imbalance between reactive oxygen species (ROS) generation and the capacity of antioxidant defense systems, has been authenticated as a pivotal player in the cardiopathogenesis of the various HF subtypes. The family of NADPH oxidases has been investigated as a key enzymatic source of ROS in the pathogenesis of HF.

Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial.

Objective: To assess the effectiveness of a school based physical activity programme during one school year on physical and psychological health in young schoolchildren.

Design: Cluster randomised controlled trial.

Setting: 28 classes from 15 elementary schools in Switzerland randomly selected and assigned in a 4:3 ratio to an intervention (n=16) or control arm (n=12) after stratification for grade (first and fifth grade), from August 2005 to June 2006.

Drug-eluting stents and glycoprotein IIb/IIIa inhibitors in vessels at low anatomic risk: a retrospective analysis of previously published data from the Basel Stent Kosten Effektivitäts Trial.

Background: Drug-eluting stents (DESs) are associated with late stent thromboses, but the exact mechanism of action is unknown.

Objective: The goal of this article was to assess the clinical interaction of glycoprotein IIb/IIIa inhibitors (GPIs) with different stent and vessel types in unselected patients undergoing percutaneous coronary intervention (PCI).

Methods: This was a predefined retrospective analysis of the randomized controlled Basel Stent Kosten Effektivitats Trial (BASKET), which compared DES with bare-metal stents (BMSs) in patients undergoing PCI.

Early and late increased bleeding rates after angioplasty and stenting due to combined antiplatelet and anticoagulanttherapy.

Aims: To assess major bleeding complications in patients after coronary stenting who are on dual antiplatelet drugs with or without oral anticoagulants.

Methods And Results: Bleeding complications necessitating hospital admission were prospectively recorded during initial hospitalisation and during a complete follow-up of three years in 813 consecutive patients undergoing coronary artery stenting. All patients were assigned to antiplatelet therapy with aspirin and clopidogrel for at least six months and continued aspirin use thereafter.

Detection of intake of nonsteroidal anti-inflammatory drugs in elderly patients with heart failure. How to ask the patient?

Principles: Heart failure hospitalisations may be related to non-steroidal anti-inflammatory drug (NSAID) use. Since NSAIDs are usually prescribed by general practitioners or taken without prescription, their use may be largely underestimated. Therefore, we assessed the impact of a focussed analgesic medication history as compared to a usual medication history on detection of NSAID intake in elderly heart failure patients and the potential effect of medical advice on discontinuation of this therapy in a non-controlled study design.

Dexamethasone but not tadalafil improves exercise capacity in adults prone to high-altitude pulmonary edema.

Rationale: Whether pulmonary hypertension at high altitude limits exercise capacity remains uncertain.

Objectives: To gain further insight into the pathophysiology of hypoxia induced pulmonary hypertension and the resulting reduction in exercise capacity, we investigated if the reduction in hypoxic pulmonary vasoconstrictive response with corticosteroids or phosphodiesterase-5 inhibition improves exercise capacity.

Methods: A cardiopulmonary exercise test and echocardiography to estimate systolic pulmonary artery pressure were performed in 23 subjects with previous history of high altitude pulmonary edema, known to be associated with enhanced hypoxic vasoconstriction.

Short and long-term benefits of sirolimus-eluting stent in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials.

Background: Recent concerns have emerged on the potential higher risk of stent thrombosis after DES implantation, that might be even more pronounced among STEMI patients. The aim of the current study was to perform a meta-analysis to evaluate the benefits and safety of Sirolimus-Eluting Stent (SES) as compared to BMS in patients undergoing primary angioplasty for STEMI.

Methods: The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL).

Long-term benefit-risk balance of drug-eluting vs. bare-metal stents in daily practice: does stent diameter matter? Three-year follow-up of BASKET.

Aims: To assess the long-term benefit-risk ratio of drug-eluting (DES) vs. bare-metal stents (BMS) relative to stent size.

Methods And Results: All 826 consecutive BASKET (BAsel Stent Kosten-Effektivitäts Trial) patients randomized 2:1 to DES vs.

Impact of the exercise mode on heart rate recovery after maximal exercise.

Heart rate recovery 1 min after exercise termination (HRR-1) is a prognostic predictor. However, the influence of the exercise mode on HRR-1 is incompletely characterised. Twenty-nine young and healthy subjects and 16 elderly patients with chronic heart failure underwent cardiopulmonary exercise testing using cycle ergometer and treadmill ramp protocols in random order.

Drug-eluting or bare-metal stents for large coronary vessel stenting? The BASKET-PROVE (PROspective Validation Examination) trial: study protocol and design.

Background: Based on a subgroup analysis of 18-month BAsel Stent Kosten Effektivitäts Trial (BASKET) outcome data, we hypothesized that very late (> 12 months) stent thrombosis occurs predominantly after drug-eluting stent implantation in large native coronary vessel stenting.

Methods: To prove or refute this hypothesis, we set up an 11-center 4-country prospective trial of 2260 consecutive patients treated with > or = 3.0-mm stents only, randomized to receive Cypher (Johnson & Johnson, Miami Lakes, FL), Vision (Abbott Vascular, Abbott Laboratories, IL), or Xience stents (Abbott Vascular).

Value and limitations of target-vessel ischemia in predicting late clinical events after drug-eluting stent implantation.

Unlabelled: Drug-eluting stents reduce clinical events related to restenosis but may be complicated by late stent-thrombosis. Whereas assessment of target-vessel ischemia by myocardial perfusion scintigraphy identifies relevant restenosis noninvasively, it is unknown whether this technique may also predict late clinical events related to late stent-thrombosis and to restenosis after drug-eluting stent implantation.

Methods: All 826 patients treated with stenting between May 2003 and May 2004 were included in the Basel Stent Cost Effectiveness Trial (Basel Stent Kosten-Effektivitäts Trial, or BASKET) and randomized (2:1) to drug-eluting stents or bare metal stents.

Use of B-type natriuretic peptide outside of the emergency department.

In contrast to their established role in the evaluation of acute dyspnea in emergency department (ED) patients, applications of B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP) in patients outside of the ED are less well defined. A PubMed-based electronic and hand search for articles dealing with BNP and NT-proBNP in settings other than the ED was performed. We found that currently available evidence is sufficient to support the use of BNP and NT-proBNP in four cardiovascular settings outside of the ED: i) evaluation of patients with suspected heart failure (HF) referred from primary care, ii) risk stratification in patients with HF, iii) risk stratification in stable coronary artery disease, and iv) risk stratification in pulmonary artery hypertension.

Cost-effectiveness of drug-eluting stents in patients at high or low risk of major cardiac events in the Basel Stent KostenEffektivitäts Trial (BASKET): an 18-month analysis.

Background: Our aim was to determine whether drug-eluting stents are good value for money in long-term, everyday practice.

Methods: We did an 18-month cost-effectiveness analysis of the Basel Stent KostenEffektivitäts Trial (BASKET), which randomised 826 patients 2:1 to drug-eluting stents (n=545) or to bare-metal stents (281). We used non-parametric bootstrap techniques to determine incremental cost-effectiveness ratios (ICERs) of drug-eluting versus bare-metal stents, to compare low-risk (> or =3.

Cardiopulmonary exercise testing in mild heart failure: impact of the mode of exercise on established prognostic predictors.

Objectives: In patients with heart failure (HF), peak oxygen consumption (peak VO(2)), the relationship between minute ventilation and carbon dioxide production (VE/VCO(2) slope) and heart rate recovery (HRR) are established prognostic predictors. However, treadmill exercise has been shown to elicit higher peak VO(2) values than bicycle exercise. We sought to assess whether the VE/VCO(2) slope and HRR in HF also depend on the exercise mode.

Sublingual administration of furosemide: new application of an old drug.

Background: In patients with decompensated heart failure, absorption of orally administered furosemide may be delayed, possibly leading to impaired pharmacodynamic effects. Sublingual administration may represent an alternative in such situations.

Methods: In a crossover study including 11 healthy men, 20 mg furosemide was administered intravenously, orally and sublingually on three different days.

Acute changes in pulmonary artery pressures due to exercise and exposure to high altitude do not cause left ventricular diastolic dysfunction.

Background: Altitude-induced pulmonary hypertension has been suggested to cause left ventricular (LV) diastolic dysfunction due to ventricular interaction. In this study, we evaluate the effects of exercise- and altitude-induced increase in pulmonary artery pressures on LV diastolic function in an interventional setting investigating high-altitude pulmonary edema (HAPE) prophylaxis.

Methods: Among 39 subjects, 29 were HAPE susceptible (HAPE-S) and 10 served as control subjects.