Publications by authors named "Pardeep Jhund"
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.
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: 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 PDFBackground: Remote patient monitoring (RPM) clinical trials have reported mixed results in improving outcomes for patients with chronic heart failure (HF). The impact of clinical workflows that could impact RPM effectiveness is often overlooked. We sought to characterize workflows and response protocols that could impact outcomes in studies of non-invasive RPM in HF.
View Article and Find Full Text PDFAims: 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: 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 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.
Article Synopsis
- * 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.
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.
Aims: Resting heart rate (HR) is a strong risk marker in patients with heart failure (HF), but the clinical implications of visit-to-visit changes in HR (ΔHR) are less well established. We aimed to explore the association between ΔHR and subsequent outcomes in a pooled dataset of two well-characterized cohorts of patients with HF across the full range of left ventricular ejection fraction (LVEF).
Methods And Results: PARADIGM-HF and PARAGON-HF were randomized trials testing sacubitril/valsartan versus enalapril or valsartan, respectively, in patients with HF and LVEF ≤40% (PARADIGM-HF) or LVEF ≥45% (PARAGON-HF).
Background: Cognitive impairment is common in patients with heart failure and preserved ejection fraction but its clinical correlates and prognostic associations are poorly understood.
Methods: We analyzed cognitive function, using the Mini-Mental State Examination (MMSE), in patients with heart failure and preserved ejection fraction enrolled in a prespecified substudy of the PARAGON-HF trial (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in Heart Failure With Preserved Ejection Fraction). Logistic regression analyses were performed to determine the variables associated with lower MMSE scores at baseline and postbaseline decline in MMSE scores at 48 weeks.
Article Synopsis
- - The study investigated how race influences the effects of the heart failure treatment sacubitril/valsartan, comparing its safety and efficacy among White, Asian, and Black patients based on data from two large clinical trials (PARADIGM-HF and PARAGON-HF).
- - Results showed that Black and Asian patients had a higher risk of heart failure hospitalization or cardiovascular death compared to White patients, even though the treatment was effective for all racial groups, with no significant difference in efficacy observed across races.
- - Severe angioedema (swelling) was more common in Black patients receiving sacubitril/valsartan compared to those on alternative treatments, highlighting potential racial disparities in treatment response and safety.
Article Synopsis
- Patients with heart failure (HF) are at an increased risk of hospital readmission and mortality, particularly following a recent worsening heart failure (WHF) event.
- The FINEARTS-HF trial investigated the impact of the drug finerenone on cardiovascular events in HF patients, focusing on their WHF history and timing of treatment initiation.
- Results showed that those treated with finerenone shortly after a WHF event (within 7 days) had a significantly reduced risk of cardiovascular issues compared to the placebo group, indicating timeliness of treatment may influence effectiveness.
Article Synopsis
- Finerenone demonstrates positive outcomes for patients with heart failure and varying degrees of ejection fraction, specifically HFmrHF and HFpEF, in a large clinical trial involving 6,001 participants aged 40-97.
- The analysis revealed that while the incidence of adverse cardiovascular outcomes increased with age, finerenone consistently reduced the risk of these outcomes across all age groups.
- Safety profiles, including the occurrence of hypotension and changes in potassium levels, showed no significant differences among age categories, suggesting that finerenone is safe and effective regardless of age.
Background: The effects of treatments for heart failure (HF) may vary among patients according to left ventricular ejection fraction (LVEF). In FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure), the nonsteroidal mineralocorticoid receptor antagonist finerenone reduced the risk of cardiovascular death and total worsening HF events in patients with HF with mildly reduced or preserved ejection fraction. We examined the effect of finerenone according to LVEF in FINEARTS-HF.
View Article and Find Full Text PDFArticle Synopsis
- Patients with heart failure (HF) experience increased risks of health complications, but medications like SGLT2 inhibitors (SGLT2i) and finerenone can help reduce cardiovascular events.
- A study called FINEARTS-HF examined the effects of finerenone in patients with HF and varying ejection fractions, especially looking at those already using SGLT2i.
- Results showed finerenone effectively lowered the primary health risks in patients regardless of whether they were on SGLT2i, indicating that these treatments can be beneficial together.