Selecting patients for heart transplantation: Comparison of the Heart Failure Survival Score (HFSS) and the Seattle Heart Failure Model (SHFM)
|
|
- Patrick Cummings
- 5 years ago
- Views:
Transcription
1 Selecting patients for heart transplantation: Comparison of the Heart Failure Survival Score (HFSS) and the Seattle Heart Failure Model (SHFM) Ayumi Goda, MD, PhD, a,b Paula Williams, BS, a Donna Mancini, MD, a and Lars H. Lund, MD, PhD c From the a Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York, USA; b Cardiology Department, Kyorin University, Tokyo, Japan; and c Department of Cardiology, Section for Heart Failure, Karolinska University Hospital, Stockholm, Sweden. KEYWORDS: chronic heart failure; heart transplantation; prognostic model; Heart Failure Survival Score; Seattle Heart Failure Model BACKGROUND: The Heart Failure Survival Score (HFSS) risk-stratifies patients with chronic heart failure (CHF) referred for heart transplantation using 7 parameters, including peak VO 2. The Seattle Heart Failure Model (SHFM) is a 2-variable model that combines clinical, laboratory and therapeutic data. Although both models have excellent accuracy, only the HFSS was derived and validated in patients referred for transplantation, and the HFSS and SHFM have not been directly compared. METHODS: We tested the accuracy of the SHFM and compared the HFSS and SHFM in 715 patients referred for heart transplantation. RESULTS: Over a follow-up of days, 354 patients died or received an urgent heart transplantation or a ventricular assist device. One-year event-free survival was 89%, 72% and 6%, respectively, for the low-, medium- and high-risk HFSS strata, and 93%, 76%, and 58%, respectively, for the low-, medium- and high-risk SHFM strata. The HFSS and SHFM were modestly correlated (R.48, p.1). In receiver operating characteristic curve analysis, areas under the curves (AUCs) for the HFSS and SHFM were comparable (1 year:.72 vs.73; 2-year:.7 vs.74, respectively) and incremental to New York Heart Association class. The 1- and 2-year combined HFSS SHFM AUCs were.77 and.76, respectively, significantly better than the HFSS or SHFM alone. CONCLUSIONS: The HFSS and SHFM provide accurate and comparable risk stratification in CHF patients referred for transplantation. Combining the HFSS and SHFM improves predictive ability. J Heart Lung Transplant 211;3: International Society for Heart and Lung Transplantation. All rights reserved. Reprint requests: Lars H. Lund, MD, PhD, Department of Cardiology, Section for Heart Failure, Karolinska University Hospital, N35, Stockholm , Sweden. Telephone: Fax: address: lars.lund@alumni.duke.edu /$ -see front matter 211 International Society for Heart and Lung Transplantation. All rights reserved. doi:1.116/j.healun Chronic heart failure (CHF) is associated with high mortality, but risk may be difficult to assess, ranging from 5% to 75% mortality per year. 1 Therefore, assessing mortality risk becomes a critical component in the evaluation of a candidate for heart transplantation, 2 especially under the current circumstances of severe donor organ shortage. New York Heart Association (NYHA) class correlates with prognosis, but it is subjective. Peak oxygen consumption (VO 2 ) is used in transplant selection but has limitations when used alone. 3 Therefore, we developed the Heart Failure Survival Score (HFSS), which effectively risk-stratifies patients under evaluation for heart transplantation using 7 parameters, including peak VO 2. 4 The HFSS has been validated and found to be more accurate than peak VO 2 alone in numerous settings. 5 1 The Seattle Heart Failure Model (SHFM) was derived from the PRAISE I clinical trial database 1 and has been validated in numerous settings However, 98% of events in the SHFM derivation and validation databases were death, rather than transplantation or left ventricular assist device (LVAD) implantation. 11,15 The SHFM provides risk strata, an estimation of 1-, 2- and 5-year survival rates, a mean life expectancy and an estimated survival curve, using 2 commonly obtained clinical, pharmacologic, device and laboratory parameters, but
2 Goda et al. Comparison of HFSS and SHFM 1237 with NYHA class rather than peak VO 2 as a measure of functional capacity. 1 Although both models have been broadly validated and have excellent accuracy, they were derived and validated in very different populations. The aim of this study, specifically in patients referred for heart transplantation, was to: (1) assess the prognostic accuracy of the SHFM; and (2) compare the HFSS and SHFM. Outcomes Outcome events were defined as death, urgent transplantation (United Network of Organ Sharing [UNOS] Status 1) or LVAD implantation. Patients who were transplanted as non-urgent (UNOS Status 2) were censored alive on the date of the transplant. Vital status of patients lost to clinical follow-up was assessed using the Social Security Death Index. Statistics Methods Study patients and data collection Seven hundred fifteen consecutive patients with systolic heart failure referred to the Columbia University Medical Center for heart transplant evaluation underwent cardiopulmonary exercise testing and collection of variables in the HFSS and SHFM. Clinical characteristics are listed in Table 1. Review of the data was approved by the local human investigations committee. The HFSS includes 7 parameters: resting heart rate (HR); mean blood pressure (mbp); left ventricular ejection fraction (LVEF); serum sodium; presence or absence of ischemic heart disease; presence or absence of intraventricular conduction defect (IVCD); and peak VO 2. Peak VO 2 was determined during maximal treadmill exercise using a modified Naughton protocol and a metabolic cart (Medical Graphics, Minneapolis, MN). LVEF was determined using echocardiography or contrast/radionuclide ventriculography. The presence of IVCD was defined as QRS interval of 12 milliseconds due to left or right bundle branch block, non-specific intraventricular conduction delay or ventricular-paced rhythm. Dichotomous variables were coded as: 1 present and absent. The HFSS was derived in each patient from the 7 clinical parameters. Each variable for the continuous and dichotomous variables was multiplied by a model coefficient, derived from a proportional hazard model. The 7 products were summed and the absolute value determined according to the following equation: HFSS [(.216 * resting HR) (.255 * mbp) (.464 * LVEF) (.47 * serum sodium) (.546 * peak VO 2 ) (.68 * presence or absence of IVCD) (.6931 * presence or absence of ischemic heart disease)]. 4 For the HFSS, risk strata were defined as a low risk ( 8.1), medium risk (7.2 to 8.9) or high risk ( 7.19), using previously described cut-offs. 4 The SHFM score was derived in each patient from 2 variables, including clinical characteristics (age, gender, NYHA class, weight, LVEF, systolic blood pressure [sbp], ischemic etiology), medications (angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, -blocker, statin, aldosterone blocker, loop diuretic equivalent dose, allopurinol), device therapy (implantable cardioverter-defibrillator, cardiac resynchronization therapy) and laboratory data (lymphocyte percentage and serum sodium, hemoglobin, uric acid, total cholesterol), as previously described. 1 We used the electronic medical record to collect data on all variables required to calculate the SHFM score. Missing continuous variables were imputed as the mean for all patients in the data set. The SHFM score was rounded to the nearest integer between and 4 (patients with scores were considered to have a score of ). Risk strata were defined as low risk (score ), medium risk (score 1) or high risk (score 2). Baseline characteristics for patients with and without events were compared by chi-square tests (categorical variables) and unpaired t-tests (continuous variables) (Table 1). Pearson s correlations were calculated between the HFSS and SHFM (Figure 1A) and also between the peak VO 2 alone and the SHFM (Figure 1B) (but not between the peak VO 2 and the HFSS, because the peak VO 2 is a heavily weighted component of the HFSS). Event-free survival rates for the different HFSS and SHFM risk strata were determined using the Kaplan Meier method and compared by log-rank test (Figure 2). Components of the HFSS and SHFM were entered into Cox regressions as single variables (univariate) (Table 2) or in combination (multivariate) (Table 3). The 1- and 2-year AUC receiver operator characteristic curve (AUC of ROC) was calculated for the HFSS and SHFM separately and in combination (Figure 3), and also for NYHA in isolation. Statistical significance between AUC values was tested by the method of Hanley and McNeil. 16 To evaluate the predictive ability of a combined HFSS SHFM, a new score was created. Both variables were entered into a Cox regression model (as continuous variables). Both variables were multiplied by its associated -coefficient and the products were summed to determine a patient s risk score. All analyses, except for the comparison between AUCs, were performed using SPSS, version 11. (SPSS, Inc., Chicago, IL). Statistical comparisons were considered significant at p.5. Results Baseline characteristics and outcomes The clinical characteristics and outcomes are listed in Table 1. The mean HFSS was and the mean SHFM score was The HFSS and SHFM were modestly correlated (R.48, p.1; Figure 1A), but more so than the peak VO 2 alone vs SHFM (R.36, p.1; Figure 1B). During a mean follow-up of days, 354 outcome events (49.5%) occurred; 17 patients underwent urgent heart transplantation, 148 patients died, 36 received LVAD implantation, 35 patients underwent elective transplant, and the remaining 326 patients were alive without transplant at last follow-up. Table 1 shows a comparison of the clinical characteristics between patients with and without events. The Kaplan Meier event-free survival curves stratified by low-, medium- and high-risk HFSS and SHFM strata are
3 1238 The Journal of Heart and Lung Transplantation, Vol 3, No 11, November 211 Table 1 Baseline Clinical Characteristics Characteristic All patients (n 715) Patients without events (n 361) Patients with events (n 354) p SHFM components Clinical Age (years) Males/females (n) 464/ / / NYHA class BMI a Resting sbp (mm Hg) Medications ACE inhibitors 564 (78.9%) 276 (76.5%) 288 (81.4%).337 -blockers 54 (7.5%) 281 (77.2%) 223 (63.5%).1 Aldosterone blockers 231 (32.3%) 111 (3.7%) 12 (33.9%).521 Statin 218 (3.5%) 134 (37.1%) 84 (23.7%).1 Allopurinol 43 (6.%) 2 (5.5%) 23 (6.5%).753 Angiotensin receptor blockers 14 (2.%) 14 (3.9%) (%).1 Loop diuretic equivalent (mg) Laboratory data b Hemoglobin (g/dl), n Lymphocytes percentage, n Total cholesterol (mg/dl), n Uric acid (mg/dl), n Devices.34 ICD 244 (34.1%) 11 (3.5%) 134 (37.8%) CRT 3 (4.2%) 12 (3.3%) 18 (5.1%) CRT-D 18 (15.1%) 65 (18.%) 43 (12.1%) HFSS components Rest HR (bpm) Rest mbp (mm Hg) Peak VO 2 (ml/min/kg) Presence of IVCD 41 (56.1%) 182 (5.4%) 219 (61.9%).3 Common to SHFM and HFSS LVEF (%) Ischemic/non-ischemic etiology (n) 284/ /227 15/ Sodium (meq/liter) Scores HFSS SHFM Outcomes Follow-up, days Death 148 (2.7%) LVAD 36 (4.5%) UNOS Status 1 transplant 17 (23.9%) UNOS Status 2 transplant 35 (4.9%) Alive 326 (46.%) Data presented as mean SD for continuous variables or n and (%) for categorical variables. ACE, angiotensin-converting enzyme; BMI, body mass index; HFSS, Heart Failure Survival Score; HR, heart rate; IVCD, intraventricular conduction defect; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; mbp, mean blood pressure; NYHA, New York Heart Association; sbp, systolic blood pressure; SHFM, Seattle Heart Failure Model; VO 2, oxygen uptake. a The SHFM utilizes weight but BMI is presented here. b Missing continuous data for the SHFM data were imputed as the mean for all patients. One or more continuous variable was missing in 272 patients. shown in Figure 2A and B. Event-free survival differed markedly by all strata (all overall and pairwise p.1). One-year event-free survival was 89%, 72% and 6%, respectively, for the low-risk ( 8.1), medium-risk (8.9 to 7.2) and high-risk ( 7.19) HFSS strata, and 93%, 76% and 58%, respectively, for the low-risk (), medium-risk (1) and high-risk ( 2) SHFM strata. Predictors of events Table 2 presents univariate predictors of events. The SHFM (hazards ratio [HR] 1.89, 95% confidence interval [CI] 1.7 to 2.12, p.1) and the HFSS (HR.52, 95% CI.46 to.59, p.1) were highly predictive, as were numerous individual components, including NYHA class.
4 Goda et al. Comparison of HFSS and SHFM 1239 A SHFM HFSS survival rates of low high risk (HFSS 8.1 and SHFM ) and high low risk (HFSS 8.1 and SHFM ) were comparable (81% and 85%, p.556). One-year event-free survival of high high risk (HFSS 8.1 and SHFM ) was 63%, considerably worse than all other groups (all: p.5). In the multivariate analysis that included HFSS and SHFM (Table 3, Part A), both were significantly and independently predictive. The new risk score, combining HFSS SHFM, was determined according to the following equation: combined HFSS SHFM [(.427 * HFSS) (.461 * SHFM)]. The AUCs of combined HFSS SHFM at 1 and 2 years were.77 and.76, respectively (Figure 3), and improved significantly compared with HFSS or SHFM alone (all: p.5). B 4 3 Discussion SHFM Table 3 presents multivariate analysis data. Both the HFSS and SHFM were strong and significant predictors of events independent of one another (p.1). Among components of the SHFM and HFSS, NYHA class, resting sbp, loop diuretic dose equivalent, lymphocytes percentage, presence of IVCD and hemoglobin remained significant independent predictors of events. In ROC curve analysis, AUC results for 1- and 2-year event-free survival for HFSS and SHFM are shown in Figure 3. AUCs for the HFSS and SHFM at 1-year (.72 vs.73, p.26) and 2-year (.7 vs.74, p.54) follow-up were comparable. AUCs for NYHA were.68 and.69, respectively, at 1 and 2 years. Combined HFSS and SHFM 2 Peak VO 2 Table 4 shows the number of the patients in the low- vs medium high-risk HFSS and SHFM strata. Kaplan Meier event-free survival curves stratified by this 4-group combined HFSS and SHFM are shown in Figure 4. One-year event-free survival of low low risk (HFSS 8.1 and SHFM ) was 96%, which was considerably higher than any other groups (all: p.1). One-year event-free 3 4 (ml/min/kg) Figure 1 Pearson s correlations between: (A) HFSS and SHFM (R.48, p.1); and (B) peak VO 2 and SHFM (R.36, p.1). We have presented two novel findings in a CHF population referred for heart transplantation: (1) the SHFM and HFSS are similarly strong; and (2) combining the SHFM and A Event-free Survival B Event-free Survival Over all: p<.1 Low vs Medium: p<.1 Medium vs High: p=.6 High vs Low: p<.1 HFSS stratification 1-year event-free survival 89% 72% 6% Time (Day) SHFM stratification 1-year event-free survival 93% 76% 58% Over all: p<.1 Low vs Medium: p<.1 Medium vs High: p<.1 High vs Low: p<.1 Low (N=313) Medium (N=259) High (N=125) SHFM (N=265) SHFM 1 (N=276) SHFM 2 (N=164) Time (Day) Figure 2 Kaplan Meier curves of survival free from urgent transplant or LVAD implantation, stratified by previously defined low-, medium- and high-risk strata of (A) the HFSS and (B) the SHFM.
5 124 The Journal of Heart and Lung Transplantation, Vol 3, No 11, November 211 Table 2 Univariate Predictors of Events The HFSS Variables HFSS improves predictive power. We have also shown that the SHFM is valid for transplant selection, which was previously not established. 11,17 Heart transplant selection Hazard ratio 95% CI Chi-square p SHFM a HFSS a NYHA a Rest sbp a Loop diuretic dose a equivalent (mg) Peak VO a Sodium a LVEF a Lymphocytes a percentage Presence of IVCD a Uric acid a Hemoglobin a Total cholesterol a Statin a Rest HR a Spironolactone a BMI a -blockers a Age Male gender Ischemic heart disease ACE inhibitors Angiotensin receptor blockers Allopurinol CI, confidence interval. See Table 1 for abbreviations and units of measure. Variables presented in descending order of significance. a Statistically significant. Heart transplantation is an effective treatment option for patients with advanced CHF. An increasing number of ambulatory patients are placed on transplant waiting lists while the supply of donor organs remains limited and is increasingly allotted to urgent transplantation. Therefore, accurate identification of patients most likely to benefit from transplantation is imperative, and risk stratification becomes a critical component of the transplant candidate selection process. 2 Peak VO 2 is a powerful prognostic predictor of survival in CHF patients. 3 However, peak VO 2 may be influenced by several confounding factors such as age, gender, motivation, anemia, body weight and muscle deconditioning, and should not be used as a sole criterion for listing. 2 Therefore, multi-marker scores for risk stratification have been derived and validated. The HFSS provides both better discrimination (large and significant differences in event-free survival between different risk strata) and calibration (appropriate cut-offs for transplant listing) than the peak VO 2 alone, in patients receiving -blockers, 5 for serial risk stratification, 6 in different genders, 7 ages, 9 ethnic origins, 8 and in the modern era of resynchronization and defibrillator therapy. 1 However, the HFSS is limited in that it requires cardiopulmonary exercise testing with measurement of peak VO 2. Some patients cannot perform the exercise test because it is cumbersome and requires specialized equipment. Interpretation of the test is clouded by confounders such as effort and pulmonary dysfunction, and thus requires careful interpretation, including assessment of the respiratory exchange ratio and ensuring that the anaerobic threshold and maximum effort have indeed been achieved. The SHFM The SHFM includes 2 readily available clinical variables and uses NYHA class as a surrogate for peak VO 2 and functional capacity. Because it was developed and validated in outpatient participants with CHF from four clinical trials and two observational registries, 1,13 the utility of the SHFM specifically in a population referred for heart transplantation Table 3 Multivariate Predictors of Events: (A) SHFM and HFSS and (B) Components of SHFM and HFSS Hazard ratio 95% CI Chi-square p (A) Variables SHFM a HFSS a (B) Variables NYHA a Rest sbp a Loop diuretic a dose equivalent (mg) Peak VO Sodium LVEF Lymphocytes percentage a Presence of IVCD a Uric acid Hemoglobin a Total cholesterol Statin Rest HR Spironolactone BMI blockers CI, confidence interval. See Table 1 for abbreviations and units of measure. a Statistically significant.
6 Goda et al. Comparison of HFSS and SHFM 1241 is less well established. Kalogeropoulos et al 11 and Gorodeski et al 17 tested the SHFM in patients with advanced heart failure referred for transplantation, but found that it underestimated risk. In a recent study, the SHFM was useful for evaluation of patients with advanced CHF who were being considered for LVAD implantation. 12 Table 4 Strata Number of Patients in SHFM HFSS Combined Risk SHFM : low risk SHFM 1 to 2: medium to high risk Total HFSS 8.1: low risk HFSS and : medium to high risk Total The SHFM was rounded to nearest integer (as indicated by ). Medium- to high-risk strata were combined for purposes of creating combined strata (here and in Figure 4). Total does not add to 715. The HFSS was not calculated in 18 patients because of missing data. The SHFM was not calculated in 1 patients because of missing categorical data. Missing continuous variables for the SHFM (laboratory data) were imputed as the mean for all patients. In contrast to Kalogeropoulos et al and Gorodeski et al, our findings suggest that the SHFM also appropriately assesses risk in patients referred for heart transplantation, and performs well in both discriminating different risk strata and in calibration of risks, facilitating selection for transplantation. Comparing HFSS and SHFM Our findings also demonstrate that the accuracy of both 1- and 2-year risk prediction was comparable between the HFSS and SHFM. In previous reports, the HFSS had a 1-year ROC for death/lvad/transplantation of.73 to.8 vs.68 to.81 for the SHFM. 1,13,18,19 The AUCs determined from our population are similar to those found previously. Because the HFSS does not require more rare parameters, such as lymphocytes percentage, it may be more available in patients specifically evaluated for transplantation; however, because the SHFM does not require peak VO 2, often available only in specialized referral cen- HFSS+SHFM stratification Figure 3 AUC of the ROC for the HFSS, SHFM, combined HFSS SHFM and clinical control (NYHA class) for: (A) 1-year event-free survival (HFSS vs SHFM: p.26; HFSS vs HFSS SHFM: p.3; SHFM vs HFSS SHFM: p.1; HFSS vs NYHA: p.71; SHFM vs NYHA, p.2; HFSS SHFM vs NYHA: p.1); and (B) 2-year event-free survival (HFSS vs SHFM: p.54; HFSS vs HFSS SHFM: p.3; SHFM vs HFSS SHFM: p.1; HFSS vs NYHA: p.263; SHFM vs NYHA: p.2; HFSS SHFM vs NYHA: p.1). Event-free Survival 1-year event-free survival 96% HFSS:Low-SHFM:Low, n=171 85% 81% 63% Over all: p<.1 Low-Low vs Others: all p<.1 Low-High vs High-Low: p=.556 High-High vs Others: all p<.5 36 HFSS:High-SHFM:Low, n=87 HFSS:Low-SHFM:High, n=142 HFSS:High-SHFM:High, n= Time (Day) 18 Figure 4 Kaplan Meier event-free survival curves stratified by combined HFSS SHFM groups.
7 1242 The Journal of Heart and Lung Transplantation, Vol 3, No 11, November 211 ters, the SHFM may be more easily obtained and useful as an initial screening for selecting patients who should be referred for complete transplant evaluation. The SHFM may also be useful if peak VO 2 cannot be obtained, due to the inability to exercise, or if peak VO 2 is unreliable, due to low respiratory exchange ratio. NYHA class is a component of the SHFM, but even in isolation it was an independent predictor of prognosis. The HFSS and SHFM were incremental to NYHA class, which nevertheless continues to maintain a robust value in clinical discrimination. This suggests that the multiple factors that go into a clinician s assigning an NYHA class are also important. There are some reports that addition of other variables, such as natriuretic peptides and renal function, may improve the predictive ability of peak VO 2, HFSS and SHFM, 13,18,2 23 but the utility of these risk markers for transplant selection remains to be determined. Combining HFSS and SHFM The HFSS and SHFM were strong predictors independent of one another. Not surprisingly, they were complementary. The AUC for a combination of both was higher than either alone. One-year event-free survival in patients with low-risk HFSS ( 8.1) and low-risk SHFM ( ) was 96% in our cohort, higher than that in low-risk HFSS (89%) and lowrisk SHFM (93%) separately. Therefore, low-risk scores on both provide additional reassurance that deferring transplantation is safe. Furthermore, the addition of one score to the other may be especially useful in medium-risk patients, for whom transplant listing decisions are the most difficult. Limitations Our study has limitations. It was a retrospective analysis of clinical and cardiopulmonary exercise data collected at a single center. Patients unable to exercise because of respiratory disorders, arrhythmias, angina, musculoskeletal disease, neurologic disorders or frailty were excluded. The HFSS and the SHFM are derived in stable patients, but most transplants are now urgent. However, most patients who deteriorate and are transplanted urgently or receive an LVAD have at some point been evaluated and listed for transplantation, and we propose that these models are useful in this selection process. Furthermore, non-urgent (UNOS II) transplantation is still common outside the USA. Predictors of outcome after transplantation would also be of interest, but we analyzed only the prognosis in heart failure per se, as a tool for determining which patients were most in need of transplantation. Finally, determining heart transplantation and LVAD candidacy requires consideration of numerous factors in addition to these scores. In conclusion, among patients referred for heart transplant evaluation, the prognostic accuracy of the HFSS and SHFM is strong and comparable. In addition, combining the HFSS and SHFM improves predictive ability. We propose that both should be integral parts of the transplant evaluation process. Disclosure statement This work was supported by grants from the Stockholms Läns Landsting and the Swedish Heart Lung Foundation, Stockholm, Sweden (to L.H.L.); the Division of Research Resources, General Clinical Research Centers Program, National Institutes of Health (5 MO1 RR645), Bethesda, MD; the Foundation for Cardiac Therapies (FACT Fund), New York, NY; and the Altman Fund, New York, NY (to D.M.). None of the authors have any conflicts of interest to disclose. References 1. Levy WC, Mozaffarian D, Linker DT, et al. The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation 26;113: Mehra MR, Kobashigawa J, Starling R, et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates 26. J Heart Lung Transplant 26;25: Mancini DM, Eisen H, Kussmaul W, et al. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 1991;83: Aaronson KD, Schwartz JS, Chen TM, et al. Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation 1997; 95: Lund LH, Aaronson KD, Mancini DM. Predicting survival in ambulatory patients with severe heart failure on beta-blocker therapy. Am J Cardiol 23;92: Lund LH, Aaronson KD, Mancini DM. Validation of peak exercise oxygen consumption and the Heart Failure Survival Score for serial risk stratification in advanced heart failure. Am J Cardiol 25;95: Green P, Lund LH, Mancini D. Comparison of peak exercise oxygen consumption and the Heart Failure Survival Score for predicting prognosis in women versus men. Am J Cardiol 27;99: Goda A, Lund LH, Mancini DM. Comparison across races of peak oxygen consumption and heart failure survival score for selection for cardiac transplantation. Am J Cardiol 21;15: Parikh MN, Lund LH, Goda A, et al. Usefulness of peak exercise oxygen consumption and the heart failure survival score to predict survival in patients 65 years of age with heart failure. Am J Cardiol 29;13: Goda A, Lund LH, Mancini D. The Heart Failure Survival Score outperforms the peak oxygen consumption for heart transplantation selection in the era of device therapy. J Heart Lung Transplant 211; 3: Kalogeropoulos AP, Georgiopoulou VV, Giamouzis G, et al. Utility of the Seattle Heart Failure Model in patients with advanced heart failure. J Am Coll Cardiol 29;53: Levy WC, Mozaffarian D, Linker DT, et al. Can the Seattle Heart Failure Model be used to risk-stratify heart failure patients for potential left ventricular assist device therapy? J Heart Lung Transplant 29; 28: May HT, Horne BD, Levy WC, et al. Validation of the Seattle Heart Failure Model in a community-based heart failure population and enhancement by adding B-type natriuretic peptide. Am J Cardiol 27;1: Mozaffarian D, Anker SD, Anand I, et al. Prediction of mode of death in heart failure: the Seattle Heart Failure Model. Circulation 27;116:392-8.
8 Goda et al. Comparison of HFSS and SHFM Allen LA, Yager JE, Funk MJ, et al. Discordance between patientpredicted and model-predicted life expectancy among ambulatory patients with heart failure. JAMA 28;299: Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148: Gorodeski EZ, Chu EC, Chow CH, et al. Application of the Seattle Heart Failure Model in ambulatory patients presented to an advanced heart failure therapeutics committee. Circ Heart Fail 21;3: Zugck C, Kruger C, Kell R, et al. Risk stratification in middle-aged patients with congestive heart failure: prospective comparison of the Heart Failure Survival Score (HFSS) and a simplified two-variable model. Eur J Heart Fail 21;3: Koelling TM, Joseph S, Aaronson KD. Heart failure survival score continues to predict clinical outcomes in patients with heart failure receiving beta-blockers. J Heart Lung Transplant 24;23: Pfister R, Diedrichs H, Schiedermair A, et al. Prognostic impact of NT-proBNP and renal function in comparison to contemporary multimarker risk scores in heart failure patients. Eur J Heart Fail 28;1: Giamouzis G, Kalogeropoulos AP, Georgiopoulou VV, et al. Incremental value of renal function in risk prediction with the Seattle Heart Failure Model. Am Heart J 29;157: Kallistratos MS, Dritsas A, Laoutaris ID, et al. Incremental value of N-terminal pro-brain natriuretic peptide over left ventricle ejection fraction and aerobic capacity for estimating prognosis in heart failure patients. J Heart Lung Transplant 28;27: Rothenburger M, Wichter T, Schmid C, et al. Aminoterminal pro type B natriuretic peptide as a predictive and prognostic marker in patients with chronic heart failure. J Heart Lung Transplant 24; 23:
Surgery and device intervention for the elderly with heart failure: assessing the need. Devices and Technology for heart failure in 2011
Surgery and device intervention for the elderly with heart failure: assessing the need Devices and Technology for heart failure in 2011 Assessing cardiovascular function / prognosis (in the elderly): composite
More informationClinical Investigations
Clinical Investigations Comparison of the Seattle Heart Failure Model and Cardiopulmonary Exercise Capacity for Prediction of Death in Patients With Chronic Ischemic Heart Failure and Intracoronary Progenitor
More informationRita Calé, Miguel Mendes, António Ferreira, João Brito, Pedro Sousa, Pedro Carmo, Francisco Costa, Pedro Adragão, João Calqueiro, José Aniceto Silva.
Peak Circulatory Power : a new parameter of cardiopulmonary exercise testing to predict arrhythmic events in patients with implantable cardioverter defibrillator for primary prevention Rita Calé, Miguel
More informationRED CELL DISTRIBUTION WIDTH
RED CELL DISTRIBUTION WIDTH A NEW MARKER OF EXERCISE INTOLERANCE IN PATIENTS WITH CHRONIC HEART FAILURE Emeline Van Craenenbroeck, Paul Beckers, Nadine Possemiers, Christiaan Vrints, Viviane Conraads Cardiology
More informationCongestive Heart Failure: Outpatient Management
The Chattanooga Heart Institute Cardiovascular Symposium Congestive Heart Failure: Outpatient Management E. Philip Lehman MD, MPP Disclosure No financial disclosures. Objectives Evidence-based therapy
More informationIt has been shown from meta-analysis of randomized clinical trials that patients with a pre-crt QRS duration (QRSD) >150 ms benefit
Cardiac Resynchronization Therapy may be detrimental in patients with a Very Wide QRSD > 180 ms (VWQRSD) and Right Bundle Branch Block Morphology: Analysis From the Medicare ICD Registry Varun Sundaram
More informationArbolishvili GN, Mareev VY Institute of Clinical Cardiology, Moscow, Russia
THE VALUE OF 24 H HEART RATE VARIABILITY IN PREDICTING THE MODE OF DEATH IN PATIENTS WITH HEART FAILURE AND SYSTOLIC DYSFUNCTION IN BETA-BLOCKING BLOCKING ERA Arbolishvili GN, Mareev VY Institute of Clinical
More informationST2 in Heart Failure. ST2 as a Cardiovascular Biomarker. Competitive Model of ST2/IL-33 Signaling. ST2 and IL-33: Cardioprotective
ST2 as a Cardiovascular Biomarker Lori B. Daniels, MD, MAS, FACC Professor of Medicine Director, Coronary Care Unit University of California, San Diego ST2 and IL-33: Cardioprotective ST2: member of the
More informationThe Who, How and When of Advanced Heart Failure Therapies. Disclosures. What is Advanced Heart Failure?
The Who, How and When of Advanced Heart Failure Therapies 9 th Annual Dartmouth Conference on Advances in Heart Failure Therapies Dartmouth-Hitchcock Medical Center Lebanon, NH May 20, 2013 Joseph G. Rogers,
More informationHeart Failure. Guillaume Jondeau Hôpital Bichat, Paris, France
Heart Failure Guillaume Jondeau Hôpital Bichat, Paris, France Epidemiology Importance of PEF Europe I-PREFER study. Abstract: 2835 Prevalence of HF Preserved LV systolic Function older (65 vs 62 y, p
More informationDialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy
Dialysis-Dependent Cardiomyopathy Patients Demonstrate Poor Survival Despite Reverse Remodeling With Cardiac Resynchronization Therapy Evan Adelstein, MD, FHRS John Gorcsan III, MD Samir Saba, MD, FHRS
More informationThe ACC Heart Failure Guidelines
The ACC Heart Failure Guidelines Fakhr Alayoubi, Msc,R Ph President of SCCP Cardiology Clinical Pharmacist Assistant Professor At King Saud University King Khalid University Hospital Riyadh-KSA 2017 ACC/AHA/HFSA
More information3/2/2017. Identifying the Patient for Advanced Therapies. Why is Identifying the Adv HF patient important? CHF Stages and Steps of Treatment
Identifying the Patient for Advanced Therapies Cindy Bither Chief NP- Adv HF Program Medstar Heart and Vascular Institute Stage A High risk with no symptoms Stage B Structural heart disease, no symptoms
More informationHeart Failure Medical and Surgical Treatment
Heart Failure Medical and Surgical Treatment Daniel S. Yip, M.D. Medical Director, Heart Failure and Transplantation Mayo Clinic Second Annual Lakeland Regional Health Cardiovascular Symposium February
More informationEvaluation of Sum Absolute QRST Integral as a Clinical Marker for Ventricular Arrhythmias. Markus Kowalsky Group 11
Evaluation of Sum Absolute QRST Integral as a Clinical Marker for Ventricular Arrhythmias Markus Kowalsky Group 11 Selected Paper Ventricular arrhythmia is predicted by sum absolute QRST integral but not
More informationPerformance and Quality Measures 1. NQF Measure Number. Coronary Artery Disease Measure Set
Unless indicated, the PINNACLE Registry measures are endorsed by the American College of Cardiology Foundation and the American Heart Association and may be used for purposes of health care insurance payer
More informationEffects of Gender on Peak Oxygen Consumption and the Timing of Cardiac Transplantation
Journal of the American College of Cardiology Vol. 47, No. 11, 2006 2006 by the American College of Cardiology Foundation ISSN 0735-1097/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.11.089
More informationHeart transplantation (HTx) is the only curative treatment. Original Articles
Original Articles Value of Peak Exercise Oxygen Consumption Combined With B-type Natriuretic Peptide Levels for Optimal Timing of Cardiac Transplantation Tomoko S. Kato, MD, PhD; Elias Collado, MD; Tuba
More informationJohn G Lainchbury, A Mark Richards
538 * Heart failure EXERCISE TESTING IN THE ASSESSMENT OF CHRONIC CONGESTIVE HEART FAILURE John G Lainchbury, A Mark Richards Heart 22;88:538 543 See end of article for authors affiliations c PRACTICAL
More informationA Validated Practical Risk Score to Predict the Need for RVAD after Continuous-flow LVAD
A Validated Practical Risk Score to Predict the Need for RVAD after Continuous-flow LVAD SK Singh MD MSc, DK Pujara MBBS, J Anand MD, WE Cohn MD, OH Frazier MD, HR Mallidi MD Division of Transplant & Assist
More informationClinical Risk Prediction Tools in Patients Hospitalized With Heart Failure
ManageMent Update Clinical Risk Prediction Tools in Patients Hospitalized With Heart Failure Gregg C. Fonarow, MD, FACC, FAHA Ahmanson UCLA Cardiomyopathy Center, University of California Los Angeles,
More informationThe Failing Heart in Primary Care
The Failing Heart in Primary Care Hamid Ikram How fares the Heart Failure Epidemic? 4357 patients, 57% women, mean age 74 years HFSA 2010 Practice Guideline (3.1) Heart Failure Prevention A careful and
More informationMulticenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 (MOMENTUM 3) Long Term Outcomes
Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with (MOMENTUM 3) Long Term Outcomes Mandeep R. Mehra, MD, Daniel J. Goldstein, MD, Nir Uriel, MD, Joseph
More informationDisclosures. Advances in Chronic Heart Failure Management 6/12/2017. Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017
Advances in Chronic Heart Failure Management Van N Selby, MD UCSF Advanced Heart Failure Program June 19, 2017 I have nothing to disclose Disclosures 1 Goal statement To review recently-approved therapies
More informationOnline Appendix (JACC )
Beta blockers in Heart Failure Collaborative Group Online Appendix (JACC013117-0413) Heart rate, heart rhythm and prognostic effect of beta-blockers in heart failure: individual-patient data meta-analysis
More informationBeta-blockers in Patients with Mid-range Left Ventricular Ejection Fraction after AMI Improved Clinical Outcomes
Beta-blockers in Patients with Mid-range Left Ventricular Ejection Fraction after AMI Improved Clinical Outcomes Seung-Jae Joo and other KAMIR-NIH investigators Department of Cardiology, Jeju National
More informationImplantable Cardioverter Defibrillator Therapy in MADIT II Patients with Signs and Symptoms of Heart Failure
Implantable Cardioverter Defibrillator Therapy in MADIT II Patients with Signs and Symptoms of Heart Failure Wojciech Zareba Postinfarction patients with left ventricular dysfunction are at increased risk
More informationPrognostic Value of Cardiopulmonary Exercise Testing in Patients with Atrial Fibrillation
Prognostic Value of Cardiopulmonary Exercise Testing in Patients with Atrial Fibrillation Hidekazu Tsuneoka 1)2), Akira Koike 2), Osamu Nagayama 2), Koji Sakurada 2), Hitoshi Sawada 2), Kazutaka Aonuma
More informationDisclosures. Overview. Goal statement. Advances in Chronic Heart Failure Management 5/22/17
Disclosures Advances in Chronic Heart Failure Management I have nothing to disclose Van N Selby, MD UCSF Advanced Heart Failure Program May 22, 2017 Goal statement To review recently-approved therapies
More informationProgram Metrics. New Unique ID. Old Unique ID. Metric Set Metric Name Description. Old Metric Name
Program Metrics The list below includes the metrics that will be calculated by the PINNACLE Registry for the outpatient office setting. These include metrics for, Atrial Fibrillation, Hypertension and.
More informationBenefits of Combined Aerobic/Resistance/Inspiratory Muscle Training in Patients with Chronic Heart Failure. The Ideal Exercise Program for CHF?
Benefits of Combined Aerobic/Resistance/Inspiratory Muscle Training in Patients with Chronic Heart Failure. The Ideal Exercise Program for CHF? I D. Laoutaris, S Adamopoulos, A Manginas, D B. Panagiotakos,
More informationAdult heart transplant: indications and outcomes
Review Article Adult heart transplant: indications and outcomes M. Chadi Alraies, Peter Eckman Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, USA
More informationLarge RCT s of CRT 2002 to present
Have We Expanded Our Use of CRT for Heart Failure Patients? Sana M. Al-Khatib, MD, MHS Associate Professor of Medicine Electrophysiology Section- Division of Cardiology Duke University Potential Conflicts
More informationCopeptin in heart failure: Associations with clinical characteristics and prognosis
Copeptin in heart failure: Associations with clinical characteristics and prognosis D. Berliner, N. Deubner, W. Fenske, S. Brenner, G. Güder, B. Allolio, R. Jahns, G. Ertl, CE. Angermann, S. Störk for
More informationNew PINNACLE Measures The below measures for PINNACLE will be added as new measures to the outcomes reporting starting with Version 2.0.
New PINNACLE Measures The below measures for PINNACLE will be added as new measures to the outcomes reporting starting with Version 2.0. Measure Steward Measure Name Measure Description Rationale for Adding
More informationWHEN TO REFER FOR ADVANCED HEART FAILURE THERAPIES
WHEN TO REFER FOR ADVANCED HEART FAILURE THERAPIES Mrudula R Munagala, M.D., FACC CO- Director Heart Failure & Circulatory Support Program OklahomaHeart.com Heart Failure Prevalence Heart Failure affects
More informationCongestive Heart Failure
Congestive Heart Failure Benefit of exercise therapy for systolic heart failure in relation to disease severity and etiology findings from the Heart Failure and A Controlled Trial Investigating Outcomes
More informationDISCLOSURES ACHIEVING SUCCESS THROUGH FAILURE: UPDATE ON HEART FAILURE WITH PRESERVED EJECTION FRACTION NONE
ACHIEVING SUCCESS THROUGH FAILURE: UPDATE ON HEART FAILURE WITH PRESERVED EJECTION FRACTION Lori M. Tam, MD Providence Heart Institute DISCLOSURES NONE 1 OUTLINE Systolic vs. Diastolic Heart Failure New
More informationRelationship between body mass index, coronary disease extension and clinical outcomes in patients with acute coronary syndrome
Relationship between body mass index, coronary disease extension and clinical outcomes in patients with acute coronary syndrome Helder Dores, Luís Bronze Carvalho, Ingrid Rosário, Sílvio Leal, Maria João
More informationThe Role of Ventricular Electrical Delay to Predict Left Ventricular Remodeling With Cardiac Resynchronization Therapy
The Role of Ventricular Electrical Delay to Predict Left Ventricular Remodeling With Cardiac Resynchronization Therapy Results from the SMART-AV Trial Michael R. Gold, MD, PhD, Ulrika Birgersdotter-Green,
More informationTrial to Reduce. Aranesp* Therapy. Cardiovascular Events with
Trial to Reduce Cardiovascular Events with Aranesp* Therapy John J.V. McMurray, Hajime Uno, Petr Jarolim, Akshay S. Desai, Dick de Zeeuw, Kai-Uwe Eckardt, Peter Ivanovich, Andrew S. Levey, Eldrin F. Lewis,
More informationResting Heart Rate Does Not Reflect the Degree of Beta-Blockade in Subjects with Heart Failure on Chronic Beta-Blocker Therapy
RESEARCH Resting Heart Rate Does Not Reflect the Degree of Beta-Blockade in Subjects with Heart Failure on Chronic Beta-Blocker Therapy Andrea Mignatti, Daniel B. Sims, Paolo C. Colombo, Luis I. Garcia,
More informationComparison of clinical trials evaluating cardiac resynchronization therapy in mild to moderate heart failure
HOT TOPIC Cardiology Journal 2010, Vol. 17, No. 6, pp. 543 548 Copyright 2010 Via Medica ISSN 1897 5593 Comparison of clinical trials evaluating cardiac resynchronization therapy in mild to moderate heart
More informationRamani GV et al. Mayo Clin Proc 2010;85:180-95
THERAPIES FOR ADVANCED HEART FAILURE: WHEN TO REFER Navin Rajagopalan, MD Assistant Professor of Medicine University of Kentucky Director, Congestive Heart Failure Medical Director of Cardiac Transplantation
More informationWhat s new in heart failure management? Yonsei Cardiovascular Center Yonsei University College of Medicine
What s new in heart failure management? Yonsei Cardiovascular Center Yonsei University College of Medicine Current Guideline of Treatment Asymptomatic Mild/Mod Severe Refractory Correct Cause: Arrhythmias
More informationHeart Failure Management. Waleed AlHabeeb, MD, MHA Assistant Professor of Medicine Consultant Heart Failure Cardiologist
Heart Failure Management Waleed AlHabeeb, MD, MHA Assistant Professor of Medicine Consultant Heart Failure Cardiologist Heart failure prevalence is expected to continue to increase¹ 21 MILLION ADULTS WORLDWIDE
More informationClinical Investigations
Clinical Investigations Predictors of 30-Day Readmission in Patients Hospitalized With Decompensated Heart Failure Address for correspondence: Gian M. Novaro, MD, Department of Cardiology, Cleveland Clinic
More informationSupplementary Online Content
Supplementary Online Content Nikolova AP, Hitzeman TC, Baum R, et al. Association of a novel diagnostic biomarker, the plasma cardiac bridging integrator 1 score, with heart failure with preserved ejection
More informationFrom PARADIGM-HF to Clinical Practice. Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group
From PARADIGM-HF to Clinical Practice Waleed AlHabeeb, MD, MHA Associate Professor of Medicine President of the Saudi Heart Failure Group PARADIGM-HF: Inclusion Criteria Chronic HF NYHA FC II IV with LVEF
More informationShocks burden and increased mortality in implantable cardioverter-defibrillator patients
Shocks burden and increased mortality in implantable cardioverter-defibrillator patients Gail K. Larsen, MD, MPH,* John Evans, MD, William E. Lambert, PhD,* Yiyi Chen, PhD,* Merritt H. Raitt, MD* From
More informationWHAT IS ADVANCED HEART FAILURE? James C. Fang, MD, FACC Professor and Chief Cardiovascular Division University of Utah School of Medicine
WHAT IS ADVANCED HEART FAILURE? James C. Fang, MD, FACC Professor and Chief Cardiovascular Division University of Utah School of Medicine Disclosures Data Safety Monitoring Board SOPRANO (J&J), EVALUATE-HF
More informationCHANGING THE WAY HEART FAILURE IS TREATED. VAD Therapy
CHANGING THE WAY HEART FAILURE IS TREATED VAD Therapy VAD THERAPY IS BECOMING AN ESSENTIAL PART OF HEART FAILURE PROGRAMS AROUND THE WORLD. Patients with advanced heart failure experience an impaired quality
More informationState-of-the-Art Management of Chronic Systolic Heart Failure
State-of-the-Art Management of Chronic Systolic Heart Failure Michael McCulloch, MD 17 th Annual Cardiovascular Update Intermountain Medical Center December 16, 2017 Disclosures: I have no financial disclosures
More informationHeart Failure Guidelines For your Daily Practice
Heart Failure Guidelines For your Daily Practice Juan M. Aranda, Jr., MD, FACC, FHFSA Professor of Medicine Director of Heart Failure and Cardiac Transplantation University of Florida College of Medicine
More informationBiomarkers in the Assessment of Congestive Heart Failure
Biomarkers in the Assessment of Congestive Heart Failure Mid-Regional pro-adrenomedullin (MR-proADM) vs BNP & NT-proBNP as Prognosticator in Heart Failure Patients: Results of the BACH Multinational Trial
More information2017 Summer MAOFP Update
2017 Summer MAOFP Update. Cardiology Update 2017 Landmark Trials Change Practice Guidelines David J. Strobl, DO, FNLA Heart Failure: Epidemiology More than 4 million patients affected 400,000 new cases
More informationBiomarkers and Arrhythmias/Devices Ulrika Birgersdotter-Green, M.D.
Biomarkers and Arrhythmias/Devices Ulrika Birgersdotter-Green, M.D. Professor of Medicine Division of Cardiology University of California, San Diego Disclosures Honoraria, Research Grants, Medtronic Honoraria,
More informationHeart Failure Therapies State of the Art 2017
Heart Failure Therapies State of the Art 2017 Andrew J. Sauer, MD Assistant Professor Director, Center for Heart Failure Medical Director, Heart Transplantation UNOS Primary Transplant Physician asauer@kumc.edu
More informationSimple prediction formula for peak oxygen consumption in patients with chronic heart failure
Available online at www.sciencedirect.com Journal of Exercise Science & Fitness 10 (2012) 23e27 Original article Simple prediction formula for peak oxygen consumption in patients with chronic heart failure
More informationAbnormal Heart Rate Recovery Immediately After Cardiopulmonary Exercise Testing in Heart Failure Patients
Abnormal Heart Rate Recovery Immediately After Cardiopulmonary Exercise Testing in Heart Failure Patients Tuba BILSEL, 1 MD, Sait TERZI, 1 MD, Tamer AKBULUT, 1 MD, Nurten SAYAR, 1 MD, Gultekin HOBIKOGLU,
More informationDevice Therapy for Heart Failure
Device Therapy for Heart Failure Dr. Shelley Zieroth FRCPC Assistant Professor, Cardiology, University of Manitoba Director of Cardiac Transplant and Heart Failure Clinics St Boniface General Hospital,
More informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Is there a mortality risk associated with aspirin use in heart failure? Results from a large community based cohort Margaret Bermingham, Mary-Kate Shanahan, Saki Miwa,
More informationLong-term outcome of cardiac contractility modulation in patients with severe congestive heart failure
Europace Advance Access published June 28, 2011 Europace doi:10.1093/europace/eur153 CLINICAL RESEARCH Long-term outcome of cardiac contractility modulation in patients with severe congestive heart failure
More informationThe Role of Exercise in Management of Patients with Heart Failure
The Role of Exercise in Management of Patients with Heart Failure Pamela B. Morris, MD, FACC, FAHA, FASPC, FNLA Chair, ACC Prevention of Cardiovascular Disease Leadership Council and Section Director,
More informationJournal of the American College of Cardiology Vol. 35, No. 3, by the American College of Cardiology ISSN /00/$20.
Journal of the American College of Cardiology Vol. 35, No. 3, 2000 2000 by the American College of Cardiology ISSN 0735-1097/00/$20.00 Published by Elsevier Science Inc. PII S0735-1097(99)00608-7 The Prognostic
More informationPrognostic usefulness of the functional aerobic reserve in patients with heart failure
Prognostic usefulness of the functional aerobic reserve in patients with heart failure Paul Chase, MEd, a Ross Arena, PhD, PT, b,c,d Marco Guazzi, MD, PhD, e Jonathan Myers, PhD, f Mary Ann Peberdy, MD,
More informationQuality Payment Program: Cardiology Specialty Measure Set
Quality Payment Program: Cardiology Specialty Set Title Number CMS Reporting Method(s) Heart Failure (HF): Angiotensin- Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for
More informationSummary, conclusions and future perspectives
Summary, conclusions and future perspectives Summary The general introduction (Chapter 1) of this thesis describes aspects of sudden cardiac death (SCD), ventricular arrhythmias, substrates for ventricular
More informationUK Liver Transplant Audit
November 2012 UK Liver Transplant Audit In patients who received a Liver Transplant between 1 st March 1994 and 31 st March 2012 ANNUAL REPORT Advisory Group for National Specialised Services Prepared
More informationSCOMPENSO CARDIACO: IL PUNTO DELLA RICERCA
Journal Club 19 Marzo 2010 SCOMPENSO CARDIACO: IL PUNTO DELLA RICERCA Alessandro Giordano Prevalence of heart failure by sex and age (NHANES:1999-2004) Circulation 2007 Incidence of heart failure by age
More informationSupplementary Online Content
Supplementary Online Content Zusterzeel R, Selzman KA, Sanders WE, et al. Cardiac resynchronization therapy in women: US Food and Drug Administration meta-analysis of patientlevel data. Published online
More informationUpdates in Congestive Heart Failure
Updates in Congestive Heart Failure GREGORY YOST, DO JOHNSTOWN CARDIOVASCULAR ASSOCIATES 1/28/2018 Disclosures Edwards speaker on Sapien3 valves (TAVR) Stages A-D and NYHA Classes I-IV Stage A: High risk
More informationChronic Primary Mitral Regurgitation
Chronic Primary Mitral Regurgitation The Case For Early Surgical Intervention William K. Freeman, MD, FACC, FASE DISCLOSURES Relevant Financial Relationship(s) None Off Label Usage None Watchful Waiting......
More informationGALECTIN-3 PREDICTS LONG TERM CARDIOVASCULAR DEATH IN HIGH-RISK CORONARY ARTERY DISEASE PATIENTS
GALECTIN-3 PREDICTS LONG TERM CARDIOVASCULAR DEATH IN HIGH-RISK CORONARY ARTERY DISEASE PATIENTS Table of Contents List of authors pag 2 Supplemental figure I pag 3 Supplemental figure II pag 4 Supplemental
More informationHeart Failure Clinician Guide JANUARY 2016
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Heart Failure Clinician Guide JANUARY 2016 Introduction This evidence-based guideline summary is based on the 2016 National Heart Failure Guideline.
More informationChronic heart failure (CHF) is a major cause of morbidity
Systolic Blood Pressure Response to Exercise as a Predictor of Mortality in Patients With Chronic Heart Failure Yasuhiro Nishiyama, 1 MD, Hirohiko Morita, 1 MD, Haruhito Harada, 1 MD, Atsushi Katoh, 1
More informationN-terminal fraction of pro-b-type natriuretic peptide versus clinical risk scores for prognostic stratification in chronic systolic heart failure
Full research paper N-terminal fraction of pro-b-type natriuretic peptide versus clinical risk scores for prognostic stratification in chronic systolic heart failure European Journal of Preventive Cardiology
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationHEART FAILURE IN WOMEN. Marian Limacher, MD Division of Cardiovascular Medicine University of Florida
HEART FAILURE IN WOMEN Marian Limacher, MD Division of Cardiovascular Medicine University of Florida Outline Epidemiology Clinical Overview Why HF is such a challenge State of the Field Heart Failure Adjudication
More informationNatriuretic Peptides The Cardiologists View. Christopher defilippi, MD University of Maryland Baltimore, MD, USA
Natriuretic Peptides The Cardiologists View Christopher defilippi, MD University of Maryland Baltimore, MD, USA Disclosures Research support: Alere, BG Medicine, Critical Diagnostics, Roche Diagnostics,
More informationBehandlungsalgorithmus bei Herzinsuffizienz mit reduzierter Auswurffraktion
Behandlungsalgorithmus bei Herzinsuffizienz mit reduzierter Auswurffraktion Professor Dr. med. Roger Hullin Leiter Programm für Schwere Herzinsuffizienz, VAD & Herztransplantation Suisse Romande Klinik
More informationRisk stratification in middle-aged patients with congestive heart failure: prospective comparison of the Heart Failure
Ž. European Journal of Heart Failure 3 001 577 585 Risk stratification in middle-aged patients with congestive heart failure: prospective comparison of the Heart Failure Survival Score ž HFSS/ and a simplified
More informationRandomized Trial to Optimize the Dose and Efficacy of Beta-Blocker in Systolic Heart Failure: Japanese Chronic Heart Failure (J-CHF) Study
82th AHA Meeting Nov 17, 2009 Orlando, USA Presenter Disclosure Information Randomized Trial to Optimize the Dose and Efficacy of Beta-Blocker in Systolic Heart Failure: Japanese Chronic Heart Failure
More informationIndications for and Prediction of Successful Responses of CRT for Patients with Heart Failure
Indications for and Prediction of Successful Responses of CRT for Patients with Heart Failure Edmund Keung, MD Clinical Chief, Cardiology Section San Francisco VAMC October 25, 2008 Presentation Outline
More informationPreoperative tests (update)
National Institute for Health and Care Excellence. Preoperative tests (update) Routine preoperative tests for elective surgery NICE guideline NG45 Appendix C: April 2016 Developed by the National Guideline
More informationRisk Stratification of Sudden Cardiac Death
Risk Stratification of Sudden Cardiac Death Michael R Gold, MD, PhD Medical University of South Carolina Charleston, SC USA Disclosures: None Sudden Cardiac Death A Major Public Health Problem > 1/2 of
More informationPredictive Power of the Baseline QRS Complex Duration for Clinical Response to Cardiac Resynchronisation Therapy
CARDIAC MARKERS ORIGINAL RESEARCH Predictive Power of the Baseline QRS Complex Duration for Clinical Response to Cardiac Resynchronisation Therapy Ali Kazemisaeid, MD, Ali Bozorgi, MD, Ahmad Yamini Sharif,
More informationRisk prediction in inherited conditions Laminopathies
Risk prediction in inherited conditions Laminopathies Karim Wahbi Cochin hospital, Paris karim.wahbi@aphp.fr Risk prediction in laminopathies Current approach for risk stratification A new score to predict
More informationTreating HF Patients with ARNI s Why, When and How?
Treating HF Patients with ARNI s Why, When and How? 19 th Annual San Diego Heart Failure Symposium for Primary Care Physicians January 11-12, 2019 La Jolla, CA Barry Greenberg M.D. Distinguished Professor
More informationdoi: /CIRCHEARTFAILURE
Risk Prediction Models for Mortality in Ambulatory Patients With Heart Failure: A Systematic Review Ana C. Alba, Thomas Agoritsas, Milosz Jankowski, Delphine Courvoisier, Stephen D. Walter, Gordon H. Guyatt
More informationLong-term prognostic value of N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) changes within one year in patients with coronary heart disease
Long-term prognostic value of N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) changes within one year in patients with coronary heart disease D. Dallmeier 1, D. Rothenbacher 2, W. Koenig 1, H. Brenner
More informationHeart Failure Treatments
Heart Failure Treatments Past & Present www.philippelefevre.com Background Background Chronic heart failure Drugs Mechanical Electrical Background Chronic heart failure Drugs Mechanical Electrical Sudden
More informationPredictive Power of the Baseline QRS Complex Duration for Clinical Response to Cardiac Resynchronisation Therapy
CARDIAC RESYNCHRONISATION THERAPY ORIGINAL ARTICLE Predictive Power of the Baseline QRS Complex Duration for Clinical Response to Cardiac Resynchronisation Therapy Ali Kazemisaeid, MD, Ali Bozorgi, MD,
More informationResponse of Right Ventricular Size to Treatment with Cardiac Resynchronization Therapy and the Risk of Ventricular Tachyarrhythmias in MADIT-CRT
Response of Right Ventricular Size to Treatment with Cardiac Resynchronization Therapy and the Risk of Ventricular Tachyarrhythmias in MADIT-CRT Heart Rhythm Society (May 11, 2012) Colin L. Doyle, BA,*
More informationAll in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, MFMER
ICD for NICM All in the Past? Win K. Shen, MD Mayo Clinic Arizona Controversies and Advances in CV Diseases Cedars-Sinai Heart Institute, 2017 2017 MFMER 3686275-1 DISCLOSURE Relevant Financial Relationship(s)
More informationBrian Olshansky, MD, FHRS,* John D. Day, MD, FHRS, Renee M. Sullivan, MD,* Patrick Yong, MSEE, Elizabeth Galle, MS, Jonathan S. Steinberg, MD, FHRS
Does cardiac resynchronization therapy provide unrecognized benefit in patients with prolonged PR intervals? The impact of restoring atrioventricular synchrony: An analysis from the COMPANION Trial Brian
More informationHeart Failure in Women: Dr Goh Ping Ping Cardiologist Asian Heart & Vascular Centre
Heart Failure in Women: More than EF? Dr Goh Ping Ping Cardiologist Asian Heart & Vascular Centre Overview Review pathophysiology as it relates to diagnosis and management Rational approach to workup:
More informationFocus on Rehabilitation, Exercise and Surgical Coronary Revascularization
Focus on Rehabilitation, Exercise and Surgical Coronary Revascularization Sam Haddad, MD Kenneth O Reilly, MD Disclosure of Commercial or Pharma Support NTD Learning Objectives At the conclusion of this
More informationESC Guidelines. ESC Guidelines Update For internal training purpose. European Heart Journal, doi: /eurheart/ehn309
ESC Guidelines Update 2008 ESC Guidelines Heart failure update 2008 For internal training purpose. 0 Agenda Introduction Classes of recommendations Level of evidence Treatment algorithm Changes to ESC
More informationEffects of heart rate reduction with ivabradine on left ventricular remodeling and function:
Systolic Heart failure treatment with the If inhibitor ivabradine Trial Effects of heart rate reduction with ivabradine on left ventricular remodeling and function: results of the SHIFT echocardiography
More information