M A Konstam

..Additional placebo-controlled data, from patients at both high and low risk for cardiovascular events, are warranted to clarify the cardiovascular effects of this class of agents...

..Clinical trials have provided significant treatment advances; ongoing and future trials will demonstrate the degree to which we can improve on what we have achieved to date with pharmacologic treatments...

..A combined analysis of individual patient data was undertaken to determine whether there was an excess of CV thrombotic events in patients treated with rofecoxib compared with those treated with placebo or nonselective NSAIDs...

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..Further work is necessary to explore the potential mechanisms underlying these gender-based differences...

..Inhibiting the action of vasopressin may be beneficial in patients with heart failure...

..These results serve as an important basis for planned investigations to evaluate the anti-remodelling effects of these agents on mice in which genetic manipulations are used to disrupt components of the Ang II signalling system...

..It is also demonstrated that drug therapies that slow or reverse the remodeling process appear to have favorable natural history effects in the short term as well as during long-term therapy...

..We did the ELITE II Losartan Heart Failure Survival Study to confirm whether losartan is superior to captopril in improving survival and is better tolerated...

..Heart failure causes more than 1 million US hospitalizations yearly, mostly related to congestion. Tolvaptan, an oral, nonpeptide, selective vasopressin V2-receptor antagonist, shows promise in this condition...

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..CONCLUSIONS: Decreased kidney function and anemia are risk factors for all-cause mortality in patients with LV dysfunction, especially when both are present. These relationships need to be confirmed in additional studies...

..Vasopressin mediates fluid retention in heart failure. Tolvaptan, a vasopressin V2 receptor blocker, shows promise for management of heart failure...

..This study sought to examine the effects of vasopressin V2 receptor antagonism with tolvaptan on the changes in left ventricular (LV) volumes over time...

..Beta-blocker therapy postmyocardial infarction is generally recommended because it reduces mortality. However, beta-blockers may increase anaphylaxis mortality in the growing population of patients with peanut-induced anaphylaxis...

..We compared effects of losartan to captopril on mortality, morbidity, and functional status for patients in the ELITE II study...

..The results of EVEREST will determine whether these effects translate into improved clinical outcomes...

..Longer-term benefit likely requires more active chronic intervention, even among patients who appear clinically stable...

..CONCLUSIONS: Each of these techniques carries specific advantages and disadvantages for assessment of remodeling in individual patients and in the context of large-scale clinical trials...

..As the importance of neurohormonal activation in the progression of heart failure becomes increasingly apparent, new therapeutic strategies targeting these neurohormonal systems are being investigated...

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..This study was designed to determine the economic effect of a tertiary heart failure (HF) program at an academic medical center...

..If the diagnosis of fatty infiltration is suspected at time of donor harvest, the relative risks and benefits of proceeding with transplantation should be carefully assessed...

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..This study sought to assess the acute hemodynamic effect of vasopressin V(2) receptor antagonism...

..Prospective studies of the assessment and treatment of CAD in patients with AHFS are urgently needed...

..This study sought to determine the relationship between pre-transplant ventricular assist device (VAD) support and mortality after heart transplantation...

..We explore the relationship between change in BW after hospitalization for worsening HF and risk for repeat hospitalization and mortality in the EVEREST trial...

..Few data are available on effects of aldosterone antagonism in patients with mild-to-moderate HF...

..The purpose of this study was to quantitatively assess the relationship between therapy-induced changes in left ventricular (LV) remodeling and longer-term outcomes in patients with left ventricular dysfunction (LVD)...

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..4 per 1000 patient-years in the placebo group (RR, 0.64; 95% CI, 0.48-0.85; P =.002). CONCLUSION: Enalapril is associated with a decreased incidence of hospitalization with atrial tachyarrhythmias in patients with LV dysfunction...

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..This article describes each of these challenges in turn...

..We compared the effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure...

..We examined the effect of mechanical unloading with ventricular assist device (VAD) therapy on myocardial inducible nitric oxide synthase (iNOS) expression and cardiomyocyte apoptosis in patients with end-stage heart failure (HF)...

..The AHM system measured and transmitted body weight, blood pressure, and heart rate data as well as subjective patient self-assessments via a standard telephone line to a central server...

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..These devices are at various stages of development and clinical investigation. One or more of these newer devices is likely to emerge as an important development in the treatment of patients with advanced heart failure...

..Determine the effect on hospitalization cost of a heart failure disease management (HFDM) program delivered within a diverse provider network as demonstrated in the SPAN-CHF randomized controlled trial...

..These findings raise further concern about the use of amiodarone treatment in patients with heart failure before undergoing HT...

..It also defines the current understanding of strategies for risk stratification in the setting of decompensated heart failure...

..5 L/min) with an extracorporeal, magnetic, centrifugal pump, improves hemodynamics and renal function with benefits persisting 24 hours after discontinuation...

..Combined inhibition of the angiotensin-converting enzyme (ACE) and neutral endopeptidase (NEP) may produce greater benefits in heart failure than ACE inhibition alone...

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..Thus, endothelin(A) blockade is unlikely to be useful as an add-on treatment in such patients...

..The meeting integrates the best of basic advances with clinical trials and outcomes observations in a single seamless forum. The meeting in Toronto, Canada, attracted close to 3,000 attendees...

..It is therefore appropriate to consider ventricular remodeling in conjunction with outcome events in the construct of clinical trials in HF...

..Additional research is need on optimally weighting components of composite outcomes and to better using the entire event history of patients in heart failure trials. Further analyses of completed trials could be useful in this respect...

..No differences in adverse events were observed between the groups. In conclusion, tolvaptan appears to be more effective than fluid restriction at correcting hyponatremia in hospitalized subjects, without an increase in adverse events...

..This finding suggests that peripheral vascular disease is a relative-not an absolute-contraindication for CAFA, but requires close monitoring of flow during CAFA therapy...

..This study was designed to evaluate the cost-effectiveness of screening patients with a B-type natriuretic peptide (BNP) blood test to identify those with depressed left ventricular systolic function...

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..Hospitalization for heart failure is associated with high postdischarge mortality and morbidity. The predictive value of the QRS duration during admission for heart failure has not been well studied...

..Because patient availability to evaluate these devices is limited and randomized trials have been slow in enrolling patients, a workshop was convened to consider designs for MCSD development including alternatives to randomized trials...

..These new generation devices offer the promise of improved LV function and an enhanced neurohormonal profile for the failing ventricle, thus improving the quality of life in the ever-burgeoning heart failure population...

..In the coming years, expanded clinical investigation is likely to explore the potential for devices to normalize underlying cardiac function and thereby improve long-term clinical outcomes...