Publications by authors named "Kenneth Dickstein"
Aims: Patients experiencing ischaemic heart failure with reduced ejection fraction (HFrEF) represent a diverse group. We hypothesize that machine learning clustering can help separate distinctive patient phenotypes, paving the way for personalized management.
Methods And Results: A total of 8591 ischaemic HFrEF patients pooled from the EPHESUS and CAPRICORN trials (64 ± 12 years; 28% women) were included in this analysis.
Aims: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in selected patients with heart failure (HF) and electrical dyssynchrony. This treatment receives class IA recommendations in European Society of Cardiology (ESC) guidelines. However, despite these strong recommendations, CRT implantation practice varies greatly in Europe.
View Article and Find Full Text PDFBackground: Outcomes of hospitalized patients with heart failure (HF) and characteristics of advanced HF stage may vary across left ventricular ejection fraction (LVEF) and world regions.
Objectives: This study sought to analyze characteristics of hospitalized advanced HF patients across LVEF spectrum, world regions, and country income.
Methods: Among 18,553 hospitalized patients with acute HF (7,902 new-onset HF and 10,651 decompensated chronic HF) enrolled in the global registry REPORT-HF (International Registry to Assess Medical Practice With Longitudinal Observation for Treatment of Heart Failure), we analyzed characteristics and outcomes of patients with advanced HF, defined as previously diagnosed HF; severe symptoms before current admission (NYHA functional class III/IV); and ≥1 HF-related hospitalization in the preceding 12 months, excluding the current.
Machine learning-based prediction of 1-year all-cause mortality in patients undergoing CRT implantation: validation of the SEMMELWEIS-CRT score in the European CRT Survey I dataset.
Eur Heart J Digit Health
September 2024
Aims: We aimed to externally validate the SEMMELWEIS-CRT score for predicting 1-year all-cause mortality in the European Cardiac Resynchronization Therapy (CRT) Survey I dataset-a large multi-centre cohort of patients undergoing CRT implantation.
Methods And Results: The SEMMELWEIS-CRT score is a machine learning-based tool trained for predicting all-cause mortality in patients undergoing CRT implantation. This tool demonstrated impressive performance during internal validation but has not yet been validated externally.
Article Synopsis
- The study examined heart failure patients with initially low ejection fractions who later showed improvement, identifying about 20% of these individuals achieving a significant increase in heart function after 9 months.* -
- Patients with improved ejection fraction experienced lower rates of rehospitalization and mortality compared to those with persistently low function, with consistent results found in two separate patient registries.* -
- Five key predictors for improvement were identified: female sex, absence of ischemic heart disease, higher initial ejection fraction, and smaller heart sizes, allowing the development of a predictive model to better assess who may improve.*
Article Synopsis
- Implantable devices help patients with heart failure by working alongside medicines to treat the condition and improve their health.
- While some devices are supported by strong evidence and show positive effects, others need more research before they can be widely used.
- The Heart Failure Association and European Heart Rhythm Association suggest a better way to use these devices in care programs to help patients more effectively.
Background: Mitral regurgitation (MR) frequently coexists with heart failure (HF).
Objectives: To better understand potential pathophysiological differences between patients with HF with or without moderate-severe MR, we compared differentially expressed circulating biomarkers between these two groups.
Methods: The Olink Proteomics® Multiplex Cardiovascular (CVD) -II, CVD-III, Immune Response and Oncology-II panels of 363 unique proteins from different pathophysiological domains were used to investigate the biomarker profiles of HF patients from index and validation cohorts of the BIOSTAT-CHF study stratified according to the presence of moderate-to-severe MR or no-mild MR.
Background: Multimorbidity (two or more comorbidities) is common among patients with acute heart failure, but comprehensive global information on its prevalence and clinical consequences across different world regions and income levels is scarce. This study aimed to investigate the prevalence of multimorbidity and its effect on pharmacotherapy and prognosis in participants of the REPORT-HF study.
Methods: REPORT-HF was a prospective, multicentre, global cohort study that enrolled adults (aged ≥18 years) admitted to hospital with a primary diagnosis of acute heart failure from 358 hospitals in 44 countries on six continents.
Article Synopsis
- Major advances in heart failure treatment haven't significantly reduced mortality, indicating that current therapies might be missing key biological pathways.
- A study integrated genetic and molecular data from over 2,500 heart failure patients to identify critical pathways linked to mortality, validating the results with a separate group of nearly 1,800 patients.
- Four major pathways associated with higher death rates were found: PI3K/Akt, MAPK, Ras signaling, and resistance to epidermal growth factor inhibitor, which are linked to reduced activation of the protective ERBB2 receptor influenced by neuregulin.
Aims: Heart failure (HF) is associated with cytokine activation and inflammation. Experimental evidence suggests that plasma interleukin-17 (IL-17) is associated with myocardial fibrosis and cardiac dysfunction in HF. IL-17D, a subtype of IL-17 originates from particular tissues such as the heart.
View Article and Find Full Text PDFArticle Synopsis
- Women hospitalized for acute heart failure (AHF) are generally older and have more health complications but receive less diagnostic testing and treatment compared to men.
- In low-income countries with less income disparity, women have better one-year survival rates than men, but this advantage diminishes in areas with greater income inequality.
- The study highlights a critical need for equitable heart failure care across genders, as disparities in treatment and outcomes persist globally, particularly in lower-income regions.
Aims: Hospital admission during nighttime and off hours may affect the outcome of patients with various cardiovascular conditions due to suboptimal resources and personnel availability, but data for acute heart failure remain controversial. Therefore, we studied outcomes of acute heart failure patients according to their time of admission from the global International Registry to assess medical practice with lOngitudinal obseRvation for Treatment of Heart Failure.
Methods And Results: Overall, 18 553 acute heart failure patients were divided according to time of admission into 'morning' (7:00-14:59), 'evening' (15:00-22:59), and 'night' (23:00-06:59) shift groups.
Article Synopsis
- Cardiac resynchronization therapy (CRT) is effective for heart failure with reduced ejection fraction (HFrEF) but is not being used enough in eligible patients.
- In a study involving over 16,000 patients from multiple registries, it was found that a significant percentage of those with an indication for CRT did not receive the treatment, with notable factors influencing this, such as age, prior hospitalizations, and hospital enrollment types.
- CRT was utilized more in the ESC-HF-Long Term Registry compared to the Swedish Heart Failure Registry, highlighting discrepancies in treatment access and usage based on clinical and demographic factors.
Aims: Multimorbidity, the coexistence of two or more chronic conditions, is synonymous with heart failure (HF). How risk related to comorbidities compares at individual and population levels is unknown. The aim of this study is to examine the risk related to comorbidities, alone and in combination, both at individual and population levels.
View Article and Find Full Text PDFBackground: Oxidative stress may be a key pathophysiological mediator in the development and progression of heart failure (HF). The role of serum-free thiol concentrations, as a marker of systemic oxidative stress, in HF remains largely unknown.
Objective: The purpose of this study was to investigate associations between serum-free thiol concentrations and disease severity and clinical outcome in patients with new-onset or worsening HF.
Aim: Evidence on healthcare resource utilization (HCRU) for hospitalized patients with heart failure (HF) and reduced (HFrEF), mildly reduced (HFmrEF) and preserved (HFpEF) ejection fraction is limited.
Methods And Results: We analysed HCRU in relation to left ventricular ejection fraction (LVEF) phenotypes, clinical features and in-hospital and 12-month outcomes in 16 943 patients hospitalized for HF in a worldwide registry. HFrEF was more prevalent (53%) than HFmrEF (17%) or HFpEF (30%).
Aims: The importance of autoantibodies (AABs) against adrenergic/muscarinic receptors in heart failure (HF) is not well-understood. We investigated the prevalence and clinical/prognostic associations of four AABs recognizing the M2-muscarinic receptor or the β1-, β2-, or β3-adrenergic receptor in a large and well-characterized cohort of patients with HF.
Methods And Results: Serum samples from 2256 patients with HF from the BIOSTAT-CHF cohort and 299 healthy controls were analysed using newly established chemiluminescence immunoassays.
Background: Recent data suggest different causes of renal dysfunction between heart failure with reduced (HFrEF) versus preserved ejection fraction (HFpEF). We therefore studied a wide range of urinary markers reflecting different nephron segments in heart failure patients.
Methods: In 2070, in chronic heart failure patients, we measured several established and upcoming urinary markers reflecting different nephron segments.
Background: Serum selenium levels have been associated with the incidence of heart failure (HF) and signs of the metabolic syndrome. In addition, notable differences have been reported between males and females in food intake and micronutrient metabolism, possibly explaining different health outcomes.
Objective: Our objective was to elucidate sex-specific, cross-sectional phenotypic differences in the association of serum selenium concentrations with parameters of metabolic syndrome and HF.
Aim: The comorbidities that collectively define metabolic syndrome are common in patients with heart failure. However, the role of metabolic syndrome in the pathophysiology of heart failure is not well understood. We therefore investigated the clinical and biomarker correlates of metabolic syndrome in patients with heart failure.
View Article and Find Full Text PDFAim: Acute heart failure can be a life-threatening medical condition. Delaying administration of intravenous furosemide (time-to-diuretics) has been postulated to increase mortality, but prior reports have been inconclusive. We aimed to evaluate the association between time-to-diuretics and mortality in the international REPORT-HF registry.
View Article and Find Full Text PDFAims: Albuminuria is common in patients with heart failure and associated with worse outcomes. The underlying pathophysiological mechanism of albuminuria in heart failure is still incompletely understood. The association of clinical characteristics and biomarker profile with albuminuria in patients with heart failure with both reduced and preserved ejection fractions were evaluated.
View Article and Find Full Text PDFAims: Insulin like growth factor binding protein 7 (IGFBP7) is a marker of senescence secretome and a novel biomarker in patients with heart failure (HF). We evaluated the prognostic value of IGFBP7 in patients with heart failure and examined associations to uncover potential new pathophysiological pathways related to increased plasma IGFBP7 concentrations.
Methods And Results: We have measured plasma IGFBP7 concentrations in 2250 subjects with new-onset or worsening heart failure (BIOSTAT-CHF cohort).