Prognosis for patients with heart failure and reduced ejection fraction with and without diabetes: A 7 year nationwide veteran administration analysis.

Objective: Evidence suggests diabetes mellitus is an independent risk factor for adverse cardiovascular events in patients with heart failure. As a result, we sought to compare mortality in patients with heart failure with reduced ejection fraction (HFrEF) with and without diabetes.

Research Design And Methods: The Veteran Affairs Hospitals' databases were queried to identify all veterans diagnosed with HFrEF from 2007 to 2015.

One-year mortality after implantable cardioverter-defibrillator placement within the Veterans Affairs Health System.

Aims: Implantable cardioverter-defibrillator (ICD) therapy reduces mortality in patients with heart failure and current guidelines advise implantation of ICDs in patients with a life expectancy of >1 year. We examined trends in all-cause mortality in patients who underwent primary or secondary prevention ICD placement in the Veterans Affairs (VA) Health System.

Methods And Results: US veterans receiving a new ICD placement for primary or secondary prevention of sudden cardiac death between January 2007 and January 2015, who had heart failure with reduced ejection fraction (HFrEF) were included in the analysis.

Lower Post Myocardial Infarction Mortality Among Women Treated at Veterans Affairs Hospitals Compared to Men.

Background: There is conflicting evidence about whether mortality after myocardial infarction is higher among women than among men. This study aimed to compare sex differences in post myocardial infarction mortality in the Veterans Affairs system, a setting where the predominant subjects are men.

Materials And Methods: The Veterans Affairs Corporate Data Warehouse inpatient and laboratory chemistry databases were used to identify patients diagnosed with acute myocardial infarction from inpatient records from January 1st, 2005 to April 25th, 2015.

Effect on Mortality of Higher Versus Lower β-Blocker (Metoprolol Succinate or Carvedilol) Dose in Patients With Heart Failure.

This study aimed to compare the effect of β-blocker dose and heart rate (HR) on mortality in patients with heart failure with reduced ejection fraction (HFrEF). The Veteran Affairs databases were queried to identify all patients diagnosed with HFrEF based on International Classification of Diseases Ninth Revision codes from 2007 to 2015 and β-blocker (carvedilol or metoprolol succinate) use. 36,168 patients on low dose β blocker were then matched with 36,168 patients on high dose β-blocker using propensity score matching.

Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization.

Background: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are used for coronary revascularization in patients with multivessel and left main coronary artery disease. Stroke is among the most feared complications of revascularization. Due to its infrequency, studies with large numbers of patients are required to detect differences in stroke rates between CABG and PCI.

Post-Traumatic Stress Disorder and Heart Failure in Men Within the Veteran Affairs Health System.

Patients with post-traumatic stress disorder (PTSD) are at risk of multiple co-morbidities and are more likely to develop incident heart failure with reduced ejection fraction (HFrEF). The relation of PTSD with clinical outcomes in HFrEF is not established. US veterans diagnosed with HFrEF from January 2007 to January 2015 and treated nationwide in the Veterans Affairs (VA) Health System were included in the study.

Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data.

Background: Numerous randomised trials have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for patients with coronary artery disease. However, no studies have been powered to detect a difference in mortality between the revascularisation strategies.

Methods: We did a systematic review up to July 19, 2017, to identify randomised clinical trials comparing CABG with PCI using stents.

Post-stroke hypertension control and receipt of health care services among veterans.

Many ischemic stroke patients do not achieve goal blood pressure (BP < 140/90 mm Hg). To identify barriers to post-stroke hypertension management, we examined healthcare utilization and BP control in the year after index ischemic stroke admission. This retrospective cohort study included patients admitted for acute ischemic stroke to a VA hospital in fiscal year 2011 and who were discharged with a BP ≥ 140/90 mm Hg.

Residential distance to major roadways and cardiac structure in African Americans: cross-sectional results from the Jackson Heart Study.

Background: Heart failure (HF) is a significant source of morbidity and mortality among African Americans. Ambient air pollution, including from traffic, is associated with HF, but the mechanisms remain unknown. The objectives of this study were to estimate the cross-sectional associations between residential distance to major roadways with markers of cardiac structure: left ventricular (LV) mass index, LV end-diastolic diameter, LV end-systolic diameter, and LV hypertrophy among African Americans.

Residential Proximity to Major Roadways Is Not Associated with Cardiac Function in African Americans: Results from the Jackson Heart Study.

Cardiovascular disease (CVD), including heart failure, is a major cause of morbidity and mortality, particularly among African Americans. Exposure to ambient air pollution, such as that produced by vehicular traffic, is believed to be associated with heart failure, possibly by impairing cardiac function. We evaluated the cross-sectional association between residential proximity to major roads, a marker of long-term exposure to traffic-related pollution, and echocardiographic indicators of left and pulmonary vascular function in African Americans enrolled in the Jackson Heart Study (JHS): left ventricular ejection fraction, E-wave velocity, isovolumic relaxation time, left atrial diameter index, and pulmonary artery systolic pressure.

Percutaneous coronary intervention versus coronary bypass surgery in United States veterans with diabetes.

Objectives: This study sought to determine the optimal coronary revascularization strategy in patients with diabetes with severe coronary disease.

Background: Although subgroup analyses from large trials, databases, and meta-analyses have found better survival for patients with diabetes with complex coronary artery disease when treated with surgery, a randomized trial comparing interventions exclusively with drug-eluting stents and surgery in patients with diabetes with high-risk coronary artery disease has not yet been reported.

Methods: In a prospective, multicenter study, 198 eligible patients with diabetes with severe coronary artery disease were randomly assigned to either coronary artery bypass grafting (CABG) (n = 97) or percutaneous coronary intervention (PCI) with drug-eluting stents (n = 101) and followed for at least 2 years.

Waist circumference and metabolic syndrome: the risk for silent coronary artery disease in males.

Background: Waist circumference (WC) is a component used to define metabolic syndrome. However, its role as an independent predictor of silent coronary artery disease (CAD), above its contribution to metabolic syndrome, remains unknown.

Methods: Male veterans without known CAD, undergoing cardiac stress testing for indications other than typical angina or its equivalent, were evaluated for the presence of silent CAD.

Incremental prognostic value of echocardiography in patients with prior mitral valve surgery.

Background And Aim Of The Study: Patients with prior mitral valve surgery are at increased risk for events late after surgery. The study aim was to investigate the value of assessing clinical variables, and left and right heart anatomy and function, to predict outcome in these patients.

Methods: Two-dimensional echocardiography, Doppler echocardiography and tissue Doppler imaging (TDI) were performed in 84 patients at a mean of 7.

Effect of improvement in left ventricular ejection fraction on long-term survival in revascularized patients with ischaemic left ventricular systolic dysfunction.

Aims: The importance of improvement in the ejection fraction to the prognosis of revascularized patients with ischaemic left ventricular (LV) dysfunction is uncertain.

Methods And Results: Eighty-seven patients with ischaemic LV dysfunction (mean ejection fraction 29 ± 8% by biplane Simpson's) had dobutamine echocardiography before revascularization (coronary bypass graft surgery-81, percutaneous intervention-6). Follow-up echocardiograms were performed a mean of 4.

A modified fluorimetric neutral filter elution method for analyzing radiation-induced double strand break and repair.

Neutral filter elution assay is one of the methods used for detection of DNA double strand breaks (DSBs). However, it is laborious, expensive, and hazardous (radiolabeled precursors for DSB detection and scintillation counter for quantification), making it a less preferred method for DSB detection. In the present study, an attempt was made to improve the existing neutral filter elution assay by making use of fluorescent dye (PicoGreen) and microfiltration assembly for eluting the fragmented DNA, thereby reducing the cost and time required for the assay.

Metabolic syndrome does not predict an increased risk of coronary disease in patients with traditional risk factors referred for stress imaging study.

Background: The impact of metabolic syndrome on the prediction of coronary artery disease (CAD) in subjects with multiple traditional risk factors is unknown.

Methods: We enrolled 2,626 consecutive subjects who underwent clinically indicated stress imaging studies using echocardiography or single-photon emission computed tomography (SPECT) myocardial perfusion. Patients with known CAD were excluded leaving 1256 subjects.

Retracted: Relation of atherosclerotic cardiovascular events to progression of aortic stenosis in older men.

Background: RETRACTION: Publication of the following article is being retracted by the publisher due to erroneous publication. The authors were unable to obtain internal review board permission to publish the work and requested withdrawal after acceptance of: "Relation of Atherosclerotic Cardiovascular Events to Progression of Aortic Stenosis in Older Men" by Masoor Kamalesh, Charlotte Ng, and George Eckert. This article published on EarlyView on December 14, 2009 (DOI: 10.

Diabetes and peripheral arterial disease in men: trends in prevalence, mortality, and effect of concomitant coronary disease.

Background: Recent data on trends in diabetes mellitus (DM) prevalence and long-term effect on mortality in peripheral arterial disease (PAD) subjects is lacking.

Methods: All subjects discharged from any VA medical center between October 1990 to September 1997 with an International Classification of Diseases (ICD)-9 code for PAD and DM in the discharge summary were retrospectively identified. Demographic data were extracted from the database.

Do cardioselective beta-adrenoceptor antagonists reduce mortality in diabetic patients with congestive heart failure?

Background: The relative benefits of cardioselective beta-adrenoceptor antagonists (CSB) among patients with congestive heart failure (CHF) and diabetes mellitus are not firmly established.

Objective: To determine whether diabetic patients with CHF accrue the same mortality benefit from CSB therapy as non-diabetic patients.

Method: Between October 1999 and November 2000 consecutive patients with CHF at the Veteran's Affairs Medical Center in Indianapolis, IN, USA, were enrolled in a randomized controlled trial and prospectively followed for 5 years.

Wall motion abnormalities with low-dose dobutamine predict a high risk of cardiac death in medically treated patients with ischemic cardiomyopathy.

Background: Severe and extensive coronary artery disease is the underlying cause of stress-induced wall motion abnormalities (SWMA) with low-dose (10 microg/kg/min) dobutamine suggesting that these abnormalities may identify those with poor outcome.

Hypothesis: We assessed the prognostic value of low-dose SWMA in medically treated patients with ischemic cardiomyopathy.

Methods: Low- and peak-dose dobutamine echocardiography was performed in 235 patients with ischemic cardiomyopathy (ejection fraction 31% +/- 8%) who were treated with medical therapy.

Medication changes based on echocardiography in dialysis patients.

Kidney/Disease Outcome Quality Initiative (K/DOQI) guidelines recommend baseline echocardiography at the initiation of dialysis and every 3 years thereafter in patients for early detection of cardiac disease to optimize medical therapy. Because dialysis patients are at increased cardiovascular risk and thus most are already on cardioprotective medications, we hypothesize that serial screening echocardiography will not alter cardioprotective medications in dialysis patients. Retrospective analysis of medication administration of 231 dialysis patients was conducted.

Does diabetes accelerate progression of calcific aortic stenosis?

Aims: Calcific aortic valve stenosis (CAS) is an active disease like atherosclerosis. Effect of diabetes (D) on severity of CAS is not well documented.

Methods And Results: We retrospectively analysed 166 consecutive patients with CAS and multiple echocardiograms from January 1997 to March 2005.

Heart failure due to systolic dysfunction and mortality in diabetes: pooled analysis of 39,505 subjects.

Background: Despite recent successes in improving mortality from congestive heart failure (CHF) with drugs and devices, several reports suggest increased mortality among CHF subjects with diabetes. Our objective was to conduct a meta-analysis to determine aggregate risk of mortality and hospitalization in CHF from systolic dysfunction and diabetes.

Methods And Results: Observational and randomized trials reporting on CHF and mortality in diabetes since 2001 were identified through MEDLINE and Cochrane database searches and hand searching of cross-references.