Publications by authors named "Stephen Gottlieb"
Background: Clinical genetic evaluation of dilated cardiomyopathy (DCM) is implemented variably or not at all. Identifying needs and barriers to genetic evaluations will enable strategies to enhance precision medicine care.
Methods: An online survey was conducted in June 2024 among cardiologist investigators of the DCM Consortium from US advanced heart failure/transplant (HF/TX) programs to collect demographics, training, program characteristics, genetic evaluation practices for DCM, and implementation needs.
Background: Fatigue is a prominent symptom of heart failure (HF). However, underlying mechanisms remain poorly understood. Fluid volume status has been suggested as a physiologic mechanism of HF-related fatigue.
View Article and Find Full Text PDFAtrial fibrillation (AF) and heart failure (HF) are common cardiovascular conditions that frequently coexist. Among patients with HF, more than one-half also have AF. Both are associated with significant morbidity and mortality.
View Article and Find Full Text PDFBackground Correct hospital medication reconciliation is important for continuity of care, but optimal home antihypertensive medication ordering has not been adequately studied. Since excessive hospital blood pressure control is associated with adverse renal and cardiovascular outcomes, we assessed the association of inpatient doses of amlodipine (10mg vs. 5mg) with length of stay and renal failure and fluid and electrolyte disorders (RF/FED).
View Article and Find Full Text PDFArticle Synopsis
- The study investigates the genetic factors associated with advanced dilated cardiomyopathy (DCM), particularly focusing on rare genetic variants related to patients requiring devices like left ventricular assist devices (LVAD) or heart transplants (HT).
- Researchers analyzed data from a diverse group of 1,198 patients enrolled in a precision medicine study, classifying the severity of DCM based on treatment type and assessing genetic variants in 36 related genes.
- Findings revealed that 26.2% of patients with advanced DCM (LVAD/HT) had pathogenic genetic variants, significantly more than those with only an implantable cardioverter defibrillator (15.9%) or neither treatment (15.0%), indicating a strong genetic link to
Article Synopsis
- - The study investigates the genetic differences in dilated cardiomyopathy (DCM) among Black, Hispanic, and White patients, noting that Black patients face higher familial risk and worse health outcomes compared to White patients, despite most existing genetic data coming from the latter group.
- - Researchers conducted a cross-sectional study involving over 1,000 patients across various US heart failure centers, focusing on genetic variants in 36 DCM-related genes, classified based on their significance and clinical impact.
- - Findings revealed that Black patients displayed a lower percentage of clinically actionable genetic variants compared to White patients (8.2% vs 25.5%), particularly in the TTN gene, highlighting potential disparities in genetic influences on DCM severity among different ances
Article Synopsis
- Cardiovascular screening for first-degree relatives (FDRs) of patients with dilated cardiomyopathy (DCM) was studied to determine its effectiveness among those without known familial DCM and across different demographics.
- The study involved 1,365 adult FDRs who underwent echocardiograms and ECGs, revealing that 14.1% were newly diagnosed with DCM, left ventricular systolic dysfunction (LVSD), or left ventricular enlargement (LVE).
- The results showed higher diagnosis rates in older FDRs and those with hypertension or obesity, indicating that screening is beneficial for all FDRs, regardless of race or ethnicity.
Article Synopsis
- The DCM Precision Medicine Study aimed to improve the communication of genetic disease risk among first-degree relatives of individuals diagnosed with dilated cardiomyopathy (DCM), focusing on enhancing participation in clinical screenings.
- A booklet was created to assist probands in conveying the importance of cardiovascular screening to their at-risk family members, and its effectiveness was evaluated in a large controlled trial.
- Results showed that first-degree relatives of probands who received the booklet had a higher screening completion rate (19.5%) compared to those who did not receive it (16.0%), indicating the booklet's success in motivating screenings.
Article Synopsis
- - The summary discusses a long-term study that builds on earlier research (ATTR-ACT) focusing on transthyretin amyloid cardiomyopathy (ATTR-CM), a heart disease that can lead to heart failure and death.
- - Participants either received the drug tafamidis or a placebo in the initial study, and the extension study allowed continued use of tafamidis or switching from placebo to tafamidis for another 2½ years.
- - Early and continuous treatment with tafamidis is associated with a lower risk of death compared to those who switched from placebo, emphasizing the need for early detection and treatment of ATTR-CM for better long-term survival.
Heart failure (HF) is a complex syndrome that affects mortality/morbidity and acts at different levels in the patient's life, resulting in a drastic impairment in multiple aspects of daily activities (e.g. physical, mental/emotional, and social) and leading to a reduction in quality of life.
View Article and Find Full Text PDFArticle Synopsis
- Cardiovascular disease significantly impacts mortality rates among underrepresented racial and ethnic groups, highlighting a need to understand trust in medical research and genome sequencing knowledge to improve research participation.
- The study aimed to evaluate differences in trust and genomic knowledge among patients with idiopathic dilated cardiomyopathy across diverse racial and ethnic backgrounds.
- Findings showed Hispanic and Black participants had lower genome-sequencing knowledge compared to White participants, and trust in medical researchers was lowest among Black participants, suggesting barriers that need addressing.
Whither digitalis? What we can still learn from cardiotonic steroids about heart failure and hypertension.
Am J Physiol Heart Circ Physiol
December 2022
Cloning of the "Na pump" (Na,K-ATPase or NKA) and identification of a circulating ligand, endogenous ouabain (EO), a cardiotonic steroid (CTS), triggered seminal discoveries regarding EO and its NKA receptor in cardiovascular function and the pathophysiology of heart failure (HF) and hypertension. Cardiotonic digitalis preparations were a preferred treatment for HF for two centuries, but digoxin was only marginally effective in a large clinical trial (1997). This led to diminished digoxin use.
View Article and Find Full Text PDFArticle Synopsis
- Early detection of idiopathic dilated cardiomyopathy (DCM) in at-risk family members can allow for earlier treatment, but most research has focused on White patients, ignoring the higher risks faced by Black patients.* -
- This study aimed to assess how common familial DCM is among patients with the condition and to determine the risk for first-degree relatives across different racial and ethnic groups.* -
- The research involved 1,220 DCM patients and their family members, finding a 11.6% prevalence of familial DCM in those studied, which could rise to 29.7% if all relatives were screened.*
Background: Chronic heart failure is a debilitating condition that accounts for an annual NHS spend of £2.3B. Low levels of endogenous coenzyme Q10 may exacerbate chronic heart failure.
View Article and Find Full Text PDFHeart failure with reduced ejection fraction is managed with increasing numbers of guideline-directed medical therapies (GDMT). Benefits tend to be additive. Burdens can also be additive.
View Article and Find Full Text PDFArticle Synopsis
- Tafamidis is a drug approved for treating transthyretin amyloid cardiomyopathy, and this study analyzes its long-term effectiveness through ongoing trials following a major clinical trial called ATTR-ACT.
- In the study, patients previously on tafamidis or those switching from placebo to tafamidis were monitored for all-cause mortality over a median follow-up of about 58 months.
- Results showed that patients continuously treated with tafamidis had a significantly lower death rate compared to those who switched from placebo, emphasizing the critical role of early treatment in improving survival outcomes in this condition.
Medications with proven benefit in patients with heart failure with reduced ejection fraction are recommended, according to prospective large clinical trials, in the stable patient after careful up-titration in a strict sequential order. Although the relevance of careful clinical up-titration is unproven, there is evidence that after recompensation and shortly after hospital discharge, the rate of cardiovascular death and hospitalization is high. Clinical studies provided evidence that the onset of treatment effects is rapid, occurring within 28 days with most of these drugs used, and in some trials, early treatment after discharge or already started in the hospital has provided benefits.
View Article and Find Full Text PDFBackground: Outpatient calcitrope infusions-that is, the cardiac inotropes milrinone and dobutamine-are often used for bridge to transplantation and palliation in advanced heart failure, but few data exist about the real-world use of these agents.
Methods And Results: We used the Symphony Integrated DataVerse of commercial, managed Medicare, and Medicaid insurance claims of approximately 280 million people (2012-2020) to determine the incidence and characteristics of ambulatory calcitrope use. Demographics were calculated, including geographic densities at the metropolitan statistical area level.
Heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) constitute a high-risk phenotype with significant morbidity and mortality and poor prognosis. Multiple proinflammatory comorbid conditions influence the pathogenesis of HFpEF and CKD. Renal dysfunction in HFpEF is a consequence of the complex interplay between hemodynamic factors, systemic congestion, inflammation, endothelial dysfunction, and neurohormonal mechanisms.
View Article and Find Full Text PDFBackground: Insomnia may be a risk factor for cardiovascular disease in HIV (HIV-CVD); however, mechanisms have yet to be elucidated.
Methods: We examined cross-sectional associations of insomnia symptoms with biological mechanisms of HIV-CVD (immune activation, systemic inflammation, and coagulation) among 1,542 people with HIV from the Veterans Aging Cohort Study (VACS) Biomarker Cohort. Past-month insomnia symptoms were assessed by the item, "Difficulty falling or staying asleep?," with the following response options: "I do not have this symptom" or "I have this symptom and…" "it doesn't bother me," "it bothers me a little," "it bothers me," "it bothers me a lot.
Article Synopsis
- Heart failure (HF) is a serious condition that often leads to fluid buildup and difficulty breathing, for which loop diuretics are commonly prescribed; however, their effect on patient outcomes is not fully understood.
- This study analyzed data from over 25,000 older HF patients to explore the association between the use of loop diuretics and clinical outcomes.
- Results indicated that patients who received loop diuretics had a lower 30-day mortality rate and reduced risk of HF readmission compared to those who did not use them, but no significant differences were observed after 60 days.
Background: Under controlled conditions, mental stress can provoke decrements in ventricular function, yet little is known about the effect of mental stress on diastolic function in patients with heart failure (HF).
Methods And Results: Twenty-four patients with HF with ischemic cardiomyopathy and reduced ejection fraction (n = 23 men; mean left ventricular [LV] ejection fraction 27 ± 9%; n = 13 with baseline elevated E/e') completed daily assessment of perceived stress, anger, and negative emotion for 7 days, followed by a laboratory mental stress protocol. Two-dimensional Doppler echocardiography was performed at rest and during sequential anger recall and mental arithmetic tasks to assess indices of diastolic function (E, e', and E/e').
Introduction: Heart failure is associated with increased neurohormonal activation that results in changes in body composition including volume overload and the loss of skeletal muscle, body fat, and bone density. Bioelectrical impedance measures body composition based on the conduction of electrical current through body fluids.
Areas Covered: The PubMed and Scopus databases were reviewed up to the third week of June 2020.