Publications by authors named "McMurray J"
Aims: A cardiovascular magnetic resonance (CMR) approach to non-invasively estimate left ventricular (LV) filling pressure was recently developed and shown to correlate with invasively measured pulmonary capillary wedge pressure (PCWP). We examined the association between CMR-estimated PCWP (CMR-PCWP) and other imaging and biomarker measures of congestion, and the effect of empagliflozin on these, in the SUGAR-DM-HF trial (NCT03485092).
Methods And Results: SUGAR-DM-HF enrolled 105 patients with heart failure with reduced ejection fraction (HFrEF) and pre-diabetes or type 2 diabetes who were randomly assigned to empagliflozin 10 mg or placebo once daily for 36 weeks.
Objective: Machine learning (ML) may allow for improved discernment of hemodynamics and oxygen delivery compared to standard invasive monitoring. We hypothesized that an ML algorithm could predict impaired delivery of oxygen (IDO) with comparable discrimination to invasive mixed venous oxygen saturation (SvO) measurement.
Methods: A total of 230 patients not on mechanical circulatory support (MCS) managed with a pulmonary artery catheter (PAC) were identified from 1012 patients admitted to a single cardiovascular intensive care unit (CVICU) between April 2021 and January 2022.
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: This study aims to characterize right ventricular dysfunction (RVD) in heart failure (HF) with preserved ejection fraction and understand the cumulative prognostic value of abnormal RV echocardiographic parameters in HF with preserved ejection fraction.
Methods And Results: Data from 809 patients in the PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Receptor Blocker Global Outcomes in HF With Preserved Ejection Fraction) echocardiographic substudy (55% women, mean age 74±8 years) were analyzed. Correlates of RVD (defined as tricuspid annular plane systolic excursion <1.
Background: The importance of nutritional status is underappreciated in patients with heart failure (HF). This study aimed to describe the range of the prognostic nutrition index (PNI), and the clinical characteristics and outcomes according to PNI, in patients with HF with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). The primary outcome was the composite of HF hospitalization or cardiovascular death.
View Article and Find Full Text PDFAims: The temporal changes in clinical profiles and outcomes of high-risk myocardial infarction survivors enrolled in clinical trials are poorly described. This study compares mortality rates, baseline characteristics, and the prognostic impact of therapies among participants of the VALIANT and PARADISE-MI trials.
Methods And Results: Exclusively VALIANT participants who matched the inclusion criteria of the PARADISE-MI trial were included in the analysis.
Aims: The relationship between body mass index (BMI) and clinical outcomes in patients with cardiovascular disease, including acute heart failure (AHF) and acute myocardial infarction (AMI), remains debated. This study investigates the association between BMI and clinical outcomes within the PARADISE-MI cohort, while also evaluating the impact of angiotensin receptor-neprilysin inhibitor (ARNI) versus angiotensin-converting enzyme inhibitor (ACE-I) treatment on this relationship.
Methods And Results: The analysis included 5589 patients from the PARADISE-MI study with available baseline BMI data.
Aims: To evaluate clinical outcomes, echocardiographic features, and the efficacy and safety of sacubitril/valsartan compared to valsartan across age groups in the PARAGON-HF trial.
Methods And Results: A total of 4796 participants ≥50 years of age with chronic heart failure (HF) and left ventricular ejection fraction (LVEF) ≥45% were divided into three age groups: <65 years (n = 825), 65-74 years (n = 1772), and ≥75 years (n = 2199). Echocardiograms of 1097 patients were analysed in a standardized fashion at a core imaging laboratory.
Aims: The aim of this study was to describe the prognostic importance of left ventricular ejection fraction (LVEF) versus right ventricular (RV) dilatation and dysfunction in patients with heart failure (HF) from countries of different income levels.
Methods And Results: We enrolled 17 321 participants with HF from 40 countries. Participants were followed for a median (25th-75th percentile) of 2.
Aims: Patients with a reduced left ventricular ejection fraction (LVEF) following an acute myocardial infarction (MI) are considered to be at risk of progressive adverse cardiac remodelling which can lead to the development of heart failure and death. The early addition of a sodium-glucose cotransporter 2 (SGLT2) inhibitor to standard treatment may delay or prevent progressive adverse remodelling in these patients.
Methods And Results: We performed a randomized, double-blind, placebo-controlled, multicentre trial using cardiovascular magnetic resonance imaging (MRI), in patients with left ventricular systolic dysfunction following MI.
Background: Obesity is associated with excessive adipocyte-derived aldosterone secretion, independent of the classical renin-angiotensin-aldosterone cascade, and mineralocorticoid receptor antagonists may be more effective in patients with heart failure (HF) and obesity.
Objectives: This study sought to examine the effects of the nonsteroidal mineralocorticoid receptor antagonist finerenone compared with placebo, according to body mass index (BMI) in FINEARTS-HF (FINerenone trial to investigate Efficacy and sAfety superioR to placebo in paTientS with Heart Failure).
Methods: A total of 6,001 patients with HF with NYHA functional class II, III, and IV, a left ventricular ejection fraction of ≥40%, evidence of structural heart disease, and elevated natriuretic peptide levels were randomized to finerenone or placebo.
Background: GLP-1 receptor agonists reduce the risk of major adverse cardiovascular events (MACE) and can also have kidney benefits. However, whether GLP-1 receptor agonists improve clinically important kidney outcomes remains uncertain. We aimed to comprehensively assess the effects of GLP-1 receptor agonists on kidney and cardiovascular disease outcomes by performing a meta-analysis of randomised controlled trials.
View Article and Find Full Text PDFArticle Synopsis
- Wearable accelerometers provide a way to continuously monitor physical activity in patients with heart failure, which could be useful for assessing treatment effects.
- In the DETERMINE trials, a subgroup of patients wore accelerometers at different points while also completing questionnaires and walking tests to evaluate their functional status.
- Results showed that lower activity levels were associated with worse health scores and measures, but overall, the relationships between accelerometer data and health assessments were generally weak, suggesting accelerometers could offer additional insights beyond traditional methods.
Article Synopsis
- - Atrial fibrillation (AF) is more common in patients with type 2 diabetes and is linked to worse health outcomes; a trial called Harmony Outcomes was conducted to study the effects of albiglutide, a GLP-1 receptor agonist, on cardiovascular events in these patients.
- - The trial included nearly 9,500 participants over 1.6 years and found that those with a history of AF had a higher rate of major adverse cardiac events, but albiglutide treatment reduced these events regardless of AF history.
- - Although both groups on albiglutide experienced fewer AF events than those receiving a placebo, the reduction wasn't statistically significant, indicating that albiglutide can lower cardiovascular risks without
Article Synopsis
- Lower eGFR might lead to reluctance in starting heart failure therapies, and the study examines how kidney function influences the effectiveness of sacubitril/valsartan compared to valsartan.
- The PARAGON-HF trial included 4,796 chronic heart failure patients and found that those with lower baseline eGFR (<45 mL/min/1.73 m²) experienced a greater reduction in cardiovascular events when treated with sacubitril/valsartan.
- The results suggest that sacubitril/valsartan is particularly beneficial for heart failure patients with preserved ejection fraction and lower eGFR, indicating the need for careful consideration when prescribing treatments in this population.
Background And Aims: Individuals with heart failure (HF), other forms of cardiovascular disease, or kidney disease are at increased risk for the development and adverse health effects of diabetes. As such, prevention or delay of diabetes is an important treatment priority in these groups. The aim of this meta-analysis was to determine the effect of sodium-glucose co-transporter 2 inhibitors (SGLT2i) on incident diabetes in HF across the spectrum of left ventricular ejection fraction (LVEF) and across the broader spectrum of cardiovascular or kidney disease.
View Article and Find Full Text PDFAims: Beta-blockers may inhibit neprilysin activity and conversely, neprilysin inhibition may have a sympatho-inhibitory action. Consequently, sacubitril/valsartan may have a greater effect in patients not receiving a beta-blocker compared to those treated with a beta-blocker.
Methods And Results: We examined the effect of sacubitril/valsartan compared to enalapril on outcomes according to background beta-blocker treatment in the 8399 patients with heart failure with reduced ejection fraction enrolled in PARADIGM-HF.
Article Synopsis
- The study investigates the safety and efficacy of finerenone in treating heart failure, focusing on differences between men and women.
- Conducted as part of the FINEARTS-HF trial, it included over 6000 participants aged 40 and older across multiple countries.
- Results show that finerenone significantly reduces the risk of combined cardiovascular death and heart failure events in both sexes, with women experiencing slightly better outcomes on average.
Article Synopsis
- Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, improved outcomes for heart failure patients in the FINEARTS-HF trial but led to elevated serum potassium levels.
- The study aimed to analyze the frequency of abnormal serum potassium levels (<3.5 mmol/L and >5.5 mmol/L) and the impact of finerenone treatment compared to placebo on patient outcomes.
- Results showed that participants taking finerenone experienced significantly higher potassium levels over time, with increased risk of levels >5.5 mmol/L and reduced risk of levels <3.5 mmol/L, indicating a notable effect of the drug on potassium regulation.
Article Synopsis
- Medical record review by physician committees is the current standard for identifying cardiovascular outcomes in clinical trials, but it's time-consuming and inconsistent.
- A new AI model called "HF-NLP" was developed to automatically assess heart failure outcomes, tested on data from international trials, including the DELIVER trial.
- The AI achieved 83% agreement with expert committee decisions, and when supplemented with human reviews for uncertain cases, it could reach 91% agreement while significantly reducing workload.
Background: Many studies have explored whether individual plasma protein biomarkers improve cardiovascular disease risk prediction. We sought to investigate the use of a plasma proteomics-based approach in predicting different cardiovascular outcomes.
Methods: Among 51 859 UK Biobank participants (mean age, 56.
Subcutaneous furosemide in heart failure: a systematic review.
Eur Heart J Cardiovasc Pharmacother
November 2024
Background And Aim: Intravenous loop diuretics are the primary treatment for congestion in patients with decompensated heart failure (HF). Furosemide is the most commonly used loop diuretic and is licensed for administration either orally, intramuscularly or intravenously but not subcutaneously. Recently developed, pH-neutral, concentrated, 'skin-friendly' preparations of furosemide have been developed which allow subcutaneous administration.
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- * The FINEARTS-HF trial compared the effectiveness of finerenone, a nonsteroidal mineralocorticoid receptor antagonist, against a placebo, measuring primary outcomes like cardiovascular death and HF worsening events.
- * Results showed that lower KCCQ Total Symptom Scores (TSS) indicated a higher risk of adverse events, but finerenone significantly reduced event risks across all KCCQ TSS tertiles, suggesting it may improve outcomes for patients with varying levels of symptom severity.
Article Synopsis
- Heart failure events in cardiovascular trials are often evaluated through centralized review, but its impact on treatment effect accuracy (in terms of hazard ratios) is uncertain.
- In a study of seven trials, positive adjudication rates for heart failure events were generally lower than for cardiovascular deaths, affecting subsequent mortality risk.
- Overall, while central adjudication showed some correlation between event types, it didn’t significantly change the results, suggesting that the need for centralized review should be tailored to each trial's objectives.