http://www.theheart.org/ theheart.org provides information on caring for people with disorders of the heart and circulation, and on preventing such disorders. theheart.org is owned and produced by Medscape. We encourage your comments, feedback, and submissions. You can contact us at info@theheart.org http://blogs.law.harvard.edu/tech/rss Thu, 19 Feb 2009 11:01:33 -0800 Cleveland, OH - A terminal illness was identified in about a third of patients in a recent series of implantable cardioverter defibrillator (ICD) recipients, all of whom elected to have their device's shock function turned off to avoid unwelcome "resuscitation" in the event of a life-threatening arrhythmiahttp://www.theheart.org/article/745563.doThu, 19 Feb 2009 11:01:33 -0800 Addison, TX - Filling a gap it sees in previously available documents designed to guide the management of patients with heart failure, the International Society for Heart and Lung Transplantation (ISHLT) has published formal guidelines for the selection and management of candidates for heart transplantationhttp://www.theheart.org/article/746885.doThu, 19 Feb 2009 11:01:01 -0800 Dallas, TX - Many men with systolic heart failure have deficiencies in certain anabolic hormones that are associated with significantly increased mortality independent of NYHA class and other risk markers, according to an observational studyhttp://www.theheart.org/article/747139.doThu, 19 Feb 2009 11:00:34 -0800 St Louis, MO - When reports in two prominent journals raised red flags on giving nesiritide (Natrecor, Scios/Johnson & Johnson) to patients with acute decompensated heart failure (ADHF) last year, physicians cut back on its use right away, suggests an analysis of hospital records from before and after their publicationhttp://www.theheart.org/article/748515.doThu, 19 Feb 2009 11:00:07 -0800 Groningen, the Netherlands - Beta blockers might be of benefit in patients with advanced heart failure and preserved left ventricular ejection fraction (LVEF), say researchers in the Netherlands [1]. "This prospective observational study is the first to indicate that treatment with beta blockers reduces mortality in patients with advanced HF and preserved LVEF," say Dr Daniela Dobre (Northern Centre for Healthcare Research, University Medical Centre Groningen, the Netherlands) and colleagues in their paper published online October 4, 2006 in the European Journal of Heart Failure.http://www.theheart.org/article/750745.doThu, 19 Feb 2009 10:59:36 -0800 Chicago, IL - Patients with heart failure who start taking statins, compared with those who don't, will live longer and have a lower hospitalization risk regardless of cholesterol levels, presence or absence of coronary disease, and other CV drug therapies, according to one of the largest-yet studies of its kindhttp://www.theheart.org/article/751035.doThu, 19 Feb 2009 10:59:09 -0800 Harefield, UK - A group of British researchers have shown in a prospective study that sustained reversal of severe heart failure is possible in selected patients with the use of a left ventricular assist device (LVAD) and a specific drug regimen [1]. Of the 15 patients they treated in this way, 11 had sufficient myocardial recovery to undergo explantation of the LVAD, and eight of these are still alive, with no heart failure, five years later.http://www.theheart.org/article/751415.doThu, 19 Feb 2009 10:50:30 -0800 Baltimore, MD - A comparison of the cardiovascular responses during exercise in patients with nonsystolic heart failure vs control subjects without heart failure but who shared multiple comorbidities, including hypertensive cardiac hypertrophy, has helped shed light on the symptoms of dyspnea, fatigue, and exercise intolerance commonly associated with heart-failure patients who still have preserved ejection fractions (EF)http://www.theheart.org/article/752227.doThu, 19 Feb 2009 10:50:01 -0800 Dallas, TX - Diabetes by itself doesn't shorten postcardiac transplantation survival and so shouldn't necessarily disqualify a patient from being on a wait list. But diabetes-related complications such as renal insufficiency or stroke raise the postoperative risk of death and—given the short supply of donor hearts—could make a patient a less-appropriate transplant candidate. So concluded Dr Mark J Russo (Columbia University College of Physicians and Surgeons, New York, NY) and colleagues from data compiled by the United Network for Organ Sharing (UNOS), which showed an inverse relationship between the severity of any preoperative diabetes-related end-organ damage and posttransplantation survival [1]. Their analysis is published online in Circulation November 6, 2006 and is scheduled for the journal's November 21 issue. http://www.theheart.org/article/752439.doThu, 19 Feb 2009 10:49:19 -0800 161 mm Hg.]]>http://www.theheart.org/article/752119.doThu, 19 Feb 2009 10:48:48 -0800 Chicago, IL - At one time, almost any heart failure in a patient with a normal LV ejection fraction was thought to be caused by impaired diastolic function, and the term "diastolic" HF became a popular way to distinguish the condition from reduced-ejection-fraction "systolic" HF. But the landscape of heart failure is more complex than that. A study of HF patients in the community, published in the November 8, 2006 Journal of the American Medical Association, illustrates just what a frontier it is http://www.theheart.org/article/752613.doThu, 19 Feb 2009 10:48:22 -0800 Chicago, IL - Should all implantable devices in left ventricular dysfunction patients have defibrillation capability? That was the question put forth during a debate today here at the American Heart Association (AHA) 2006 Scientific Sessions, with experts arguing for and against the necessity of defibrillation capabilities in these already-expensive devices. According to Dr William Abraham (Ohio State University, Columbus), the decision is a no-brainer, as the evidence from clinical trials, including the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) and the Multicenter Automatic Defibrillator Implantation Trial (MADIT-2), have "absolutely, definitively, and unequivocally" shown that the prophylactic use of a defibrillator saves lives of heart-failure patients.http://www.theheart.org/article/753071.doThu, 19 Feb 2009 10:47:53 -0800 Chicago IL - The use of thiazolidinedione (TZD) agents is common in selected diabetics with heart failure and, contrary to concerns in the absence of definitive clinical trials, neither increases nor decreases the risk of mortality or HF-related hospitalization, suggests a retrospective cohort studyhttp://www.theheart.org/article/753105.doThu, 19 Feb 2009 10:47:16 -0800 Chicago, IL - Results of two trials of tolvaptan (Otsuka America Pharmaceutical), a novel oral vasopressin V2-receptor antagonist, show that treatment effectively increased serum sodium concentrations vs placebo in patients with euvolemic or hypervolemic hyponatremia associated with heart failure and other conditions [1]. The trials, called the Study of Ascending Levels of Tolvaptan in Hyponatremia 1 and 2 (SALT 1 and 2), are published online in advance of the November 16, 2006 issue in the New England Journal of Medicine, to coincide with their presentation here at the American Heart Association (AHA) 2006 Scientific Sessions. http://www.theheart.org/article/754549.doThu, 19 Feb 2009 10:46:44 -0800 Chicago, IL - Most patients with an implantable cardiac defibrillator (ICD) still ultimately die uncomfortable, slow deaths from heart failure, new data from a French registry show [1]. Regrettably, heart-failure patients themselves greatly overestimate the ability of ICDs to save lives, and most say they would be reluctant to turn off the defibrillator even if they were terminally ill, according to a recent surveyhttp://www.theheart.org/article/754801.doThu, 19 Feb 2009 10:46:03 -0800 Chicago, IL - Results from a small pilot study have shown that pulmonary vein isolation with ablation was significantly better than biventricular pacing in the treatment of atrial fibrillation in a cohort of congestive heart failure patients. Investigators showed that curative ablation eliminated the arrhythmia and improved ejection fraction, quality of life, and six-minute-walk distances and suggest the findings support the use of ablation in the treatment of arrhythmia in these sicker patients.http://www.theheart.org/article/755441.doThu, 19 Feb 2009 10:45:37 -0800 Chicago IL - Two common measures of insulin resistance are associated with poor outcomes in a "dose-response" fashion in nondiabetic patients with heart failure, suggested two studies presented at last week's American Heart Association 2006 Scientific Sessions [1,2]. In one of them, an analysis based on the combined interim results from two prospective randomized trials, rates of HF hospitalization over more than two years rose in tandem with baseline fasting plasma glucose levels in a "high-risk" population of >30 000 diabetic and nondiabetic patients with vascular disease. The association was significant even after adjustment for medical therapies, diabetic status, and other components of the metabolic syndrome, reported Dr Claes Held (Karolinska University Hospital, Stockholm, Sweden). http://www.theheart.org/article/756681.doThu, 19 Feb 2009 10:45:10 -0800 Chicago IL - To borrow from Winston Churchill, it's a "cholesterol paradox" wrapped in a mystery inside an enigma, counterintuitive at several levels but consistent with a good deal of epidemiologic and mechanistic evidence. A large observational study of patients with acute heart failure has suggested that short-term mortality goes up as admission serum total cholesterol (TC) levels go down, yet such patients appear to live longer if they are on statins [1]. Chronic heart failure has previously been associated with a so-called "reverse epidemiology," in which, for example, body-mass index, blood pressure, and serum cholesterol are inversely correlated with mortality [2,3], but it is unclear whether they are mediators or simply markers of risk. The current analysis, based on a European multicenter registry of patients hospitalized with HF, suggests the inverse TC-mortality relationship is independent and points to effects other than lipid modification as central to any clinical benefit HF patients may gain from the drugs, according to the investigators.http://www.theheart.org/article/757891.doThu, 19 Feb 2009 10:44:40 -0800 Chicago IL - If there were ever a cardiovascular drug to inspire both dreamers and cynics, it might be BiDil (NitroMed, Lexington, MA), the isosorbide dinitrate-hydralazine (ISDN-H) combo medication approved by the FDA last year expressly for self-described African Americans with heart failure.http://www.theheart.org/article/759547.doThu, 19 Feb 2009 10:42:12 -0800 Gaithersburg, MD - A special advisory panel has voted to uphold a prior FDA decision not to approve the CorCap ventricular support device (Acorn Cardiovascular, St Paul, MN), a polyester netlike sack designed for placement around the heart in selected patients with drug-refractory chronic heart failure.http://www.theheart.org/article/761199.doThu, 19 Feb 2009 10:41:44 -0800 Washington, DC - A wide QRS interval as an electrocardiographic marker for ventricular dyssynchrony is typically a prerequisite for cardiac resynchronization therapy (CRT) in patients with heart failure, but many with narrow QRS complexes have dyssynchronous ventricles and a lot of wide-QRS patients do not. Two small studies appearing separately in the December 5, 2006 issue of the Journal of the American College of Cardiology support the emerging view that echocardiographic tissue-Doppler imaging (TDI), a more direct way of assessing ventricular synchrony, is more reliable than the QRS criterion as a basis for selecting patients for CRThttp://www.theheart.org/article/762485.doThu, 19 Feb 2009 10:41:14 -0800 Los Angeles, CA - Current heart-failure performance measures, with the exception of the prescription of an ACE inhibitor or angiotensin receptor blocker (ARB) at discharge, have little relationship to patient mortality or combined mortality/rehospitalization in the first 60 to 90 days after discharge, according to the results of a new study [1]. The prescription of beta blockers at discharge, however, while not one of the measures of performance, was associated with the most significant improvement in heart-failure outcomes.http://www.theheart.org/article/763199.doThu, 19 Feb 2009 10:40:44 -0800 Würzburg, Germany - Data from a small genetic study has helped shed light on the variable response to beta-blocker therapy in heart-failure patients, with investigators showing that a polymorphism of the 1-adrenergic receptor resulted in a specific and marked inverse agonist effect when treated with the beta blocker carvedilolhttp://www.theheart.org/article/763597.doThu, 19 Feb 2009 10:40:06 -0800 Washington, DC - Beta blockers, once considered out of the question for patients with heart failure, today are a cornerstone of therapy. Vasodilators that are effectively used in hypertension might also seem risky for a syndrome in which low blood pressure (BP) is a predictor of poor outcome, so they are often avoided in patients with HF whose pressures are already down. But once again, what would seem clear about a drug therapy's risks has turned out quite differently in randomized trials.http://www.theheart.org/article/764699.doThu, 19 Feb 2009 10:39:31 -0800 Dallas, TX - The largest-yet analysis of its kind supports the use of cardiac resynchronization therapy (CRT), either with or without defibrillator backup, in patients with NYHA class 4 heart failure, at least in many who are ambulatory and don't require prolonged IV inotropic therapy [1]. The device therapy can help them live and stay out of the hospital longer, and, contrary to some concerns, the implantation procedure doesn't seem to put them at special risk, conclude Dr JoAnn Lindenfeld (University of Colorado Health Science Center, Denver) and associates in a report from the January 16, 2007 issue of Circulation.http://www.theheart.org/article/766875.doThu, 19 Feb 2009 10:38:51 -0800 Ottawa, ON - Continuous positive airway pressure (CPAP) therapy can not only put an end to obstructive sleep apnea (OSA) in patients with systolic heart failure, growing evidence suggests it can also improve their cardiac function. Now a small study appears to show that CPAP boosts LVEF even as it preserves cardiac "efficiency"—that is, gains in LVEF don't seem to be accompanied by increased myocardial oxygen demandhttp://www.theheart.org/article/767697.doThu, 19 Feb 2009 10:38:19 -0800 Dallas, TX - Patients in the Treating to New Targets (TNT) study who had been randomized to receive atorvastatin (Lipitor, Pfizer) at 80 mg/day were significantly less likely to be hospitalized for heart failure compared with those who got the drug at 10 mg/day, according to a new analysis [1]. The dose-related effect was especially pronounced among the study's small minority of patients with a prior diagnosis of HF, report Dr Kiran K Khush (University of California, San Francisco [UCSF]) and associates in the February 6, 2007 issue of Circulation. http://www.theheart.org/article/768917.doThu, 19 Feb 2009 10:37:50 -0800 Washington, DC - The technique is used today on the strength of smaller studies, but peripheral ultrafiltration's capable showing in a 200-patient controlled trial, now published after its previous release at a scientific meeting, lends more authority to its role as at least an alternative to IV diuretics in patients with acute decompensated HF (ADHF) [1]. Compared with standard management, peripheral ultrafiltration (UF) was seen to remove more fluid and reduce subsequent risk of HF hospitalizations.http://www.theheart.org/article/769069.doThu, 19 Feb 2009 10:36:40 -0800 Washington, DC - Perioperative infusion of nesiritide (Natrecor, Scios/Johnson & Johnson) apparently blunted the adverse renal effects of pump-supported coronary bypass surgery in patients with systolic heart failure, including those who went into the procedure with impaired kidney function, in a small randomized study published in the Journal of the American College of Cardiologyhttp://www.theheart.org/article/769429.doThu, 19 Feb 2009 10:36:10 -0800 Washington, DC - Anemia may be common and a bad prognostic sign in patients with heart failure, but whether correcting it with erythropoiesis-stimulating agents improves their outcomes has been an open question. That hasn't quite changed with the publication of a tiny placebo-controlled trial in which the intervention improved patient quality-of-life scores but made no significant impact on NYHA functional class or objective measures of exercise capacity [1]. But its findings, including favorable trends in some potentially important functional end points, helps keep the door open for more substantive benefits in larger trials, according to the authors.http://www.theheart.org/article/770977.doThu, 19 Feb 2009 10:35:42 -0800 New York, NY - In a series of experiments in mice, suppression of an enzyme involved in the development of cardiac hypertrophy apparently protected the heart muscle from stresses that would normally cause it to thicken, pointing to a potential new therapeutic approach to treating heart failure, according to a report published online February 18, 2007 in Nature Medicinehttp://www.theheart.org/article/772097.doThu, 19 Feb 2009 10:35:11 -0800 Rockville, MD - Roche Laboratories has warned physicians of a high incidence of acute rejection among heart-transplant recipients in a small randomized study who, after being maintained on either tacrolimus or cyclosporine along with the company's immunosuppressant mycophenolate mofetil (MMF, CellCept), had been switched to a regimen of sirolimus (Rapamune, Wyeth Pharmaceuticals) plus MMFhttp://www.theheart.org/article/772497.doThu, 19 Feb 2009 10:33:30 -0800 Rhoon, the Netherlands - A new analysis of the COMET study shows that carvedilol reduces vascular events to a greater extent than metoprolol, an effect that the authors suggest likely contributes to the superior therapeutic profile of carvedilol in the treatment of heart failure. The current analysis, published in the March 6, 2007 issue of the Journal of the American College of Cardiology, was conducted by a group led by Dr Willem J Remme (Sticares Cardiovascular Research Institute, Rhoon, the Netherlands).http://www.theheart.org/article/772607.doThu, 19 Feb 2009 10:33:01 -0800 Philadelphia, PA - What if a heart-failure drug could lessen the adrenal glands' deluge of catecholamines to a more normal ebb and flow, complementing the dam that beta blockers erect at the receptor level? A potential target for such a therapy might be the increased adrenal levels of a particular enzyme that helps mediate sympathetic activity, according to a laboratory study [1]. Inhibition of the enzyme in mouse and rat models of HF appeared to at least partially restore the normal metabolic feedback mechanisms controlling epinephrine and norepinephrine secretion that go out of control in patients with the syndrome.http://www.theheart.org/article/772807.doThu, 19 Feb 2009 10:32:20 -0800 Chicago, IL - Clinical depression significantly raises the risk of death or CV hospitalization in patients with heart failure independently of the syndrome's severity, suggests a prospective study appearing in the February 26, 2007 Archives of Internal Medicinehttp://www.theheart.org/article/773047.doThu, 19 Feb 2009 10:31:50 -0800 Gaithersburg, MD - The FDA's Circulatory System Devices Panel yesterday voted against the approval of Medtronic's implantable hemodynamic monitor, the pacemaker-sized Chronicle, a trailblazing, purely diagnostic device that found itself confronting some of the same regulatory hurdles traditionally faced by investigational therapies.http://www.theheart.org/article/773755.doThu, 19 Feb 2009 10:31:21 -0800 London, UK - A biochemical mediator of angiogenesis in heart muscle regulates the transition of cardiac hypertrophy—an initially useful adaptive response to increased workload—into a cardiomyopathy that causes LV dysfunction and symptoms, suggests a laboratory study that, its authors write, points to a potential treatment target for some forms of heart failurehttp://www.theheart.org/article/773639.doThu, 19 Feb 2009 10:30:50 -0800 Chicago, IL - How well patients hospitalized with acute heart failure fare after discharge depends a lot on their age, their syndrome's severity at presentation, and how sick they might be in other ways, according to a community-based study published in the March 12, 2007 issue of the Archives of Internal Medicinehttp://www.theheart.org/article/776483.doThu, 19 Feb 2009 10:30:23 -0800 Zwolle, the Netherlands - Under the right circumstances, cardiac resynchronization therapy (CRT) can benefit patients with heart failure who are in atrial fibrillation (AF) as much as those in sinus rhythm, according to one of the largest prospective studies to explore the device therapy's efficacy in a population that had been largely excluded from its major randomized trialshttp://www.theheart.org/article/777205.doThu, 19 Feb 2009 10:29:53 -0800 St Paul, MN - The US Food and Drug Administration has market-cleared a cardiac-resynchronization-therapy-defibrillator (CRT-D) device from St Jude Medical that includes an atrial-overdrive pacing function that can partially suppress atrial fibrillation (AF), the company announced todayhttp://www.theheart.org/article/777485.doThu, 19 Feb 2009 10:29:24 -0800 New Orleans, LA - Adding the oral vasopressin antagonist tolvaptan (Otsuka Inc) to standard IV therapy in patients hospitalized with acute decompensated heart failure (ADHF), followed by daily therapy after discharge, led to small but significant improvements in some symptoms and clinical signs without causing any apparent toxicities—but also without having an impact either way on long-term mortality or HF-related hospitalizations—in a study reported here today at the American College of Cardiology (ACC) 2007 Scientific Sessionshttp://www.theheart.org/article/779039.doThu, 19 Feb 2009 10:28:50 -0800 New Orleans, LA - Weekly or twice-weekly outpatient infusions of nesiritide (Natrecor, Scios/Johnson & Johnson) do not prolong survival or prevent future hospitalizations in patients with advanced chronic heart failure and a history of acute decompensation, according to the first large, randomized, controlled study to test the regimen's effectiveness [1]. On the other hand, the drug—given as it was in the trial and to patients similar to those in the trial—appears not to be harmful overall or to renal function in particular, according to its investigators.http://www.theheart.org/article/780273.doThu, 19 Feb 2009 10:28:19 -0800 New Orleans, LA - In a rare long-term placebo-controlled study of a herbal remedy's effect on clinical end points, a commercial extract of Crataegus, also called hawthorn, failed to show any incremental benefit when given with standard drug therapy to patients with chronic systolic heart failure. The trial did suggest, however, that it's safe to use the preparation, WS-1442 (Schwabe Pharmaceuticals, Karlsruhe, Germany), in combination with ACE inhibitors, beta blockers, and other standard HF medications. http://www.theheart.org/article/781747.doThu, 19 Feb 2009 10:27:45 -0800 New Orleans, LA - Until a large, randomized controlled trial that's still in the works sheds a brighter light on the question, concerns that nesiritide may be renotoxic or life-threatening when used in patients with acute decompensated heart failure (ADHF) are based on hindsight observations from separate, often very different studies [1,2]. With prospectively gained insights in short supply, a small randomized, placebo-controlled trial suggested that the drug neither worsens nor improves kidney function in an especially high-risk population that presented with ADHF and moderate to severe renal insufficiencyhttp://www.theheart.org/article/782391.doThu, 19 Feb 2009 10:27:16 -0800 New Orleans, LA - The greater volume removal and better 90-day clinical outcomes possible with peripheral ultrafiltration therapy compared with diuretics in patients with acute decompensated heart failure (ADHF) may have less to do with each other than meets the eye, suggests a post hoc analysis [1] of a randomized trial whose primary results were published earlier this yearhttp://www.theheart.org/article/783091.doThu, 19 Feb 2009 10:26:47 -0800 Toronto, ON - The presence of obstructive sleep apnea (OSA) in patients with heart failure significantly raises their risk of death, independent of ventricular function and HF severity, suggests a prospective single-center observational study that emphasizes the importance of looking for—and maybe treating—the breathing disorder when it accompanies heart failure [1]. Of 164 patients with systolic HF but no prior diagnosis of sleep apnea, those with OSA discovered by polysomnography but who declined continuous positive airway pressure (CPAP) therapy had more than twice the adjusted risk of death over an average of three years than those found to be without OSA, write Dr Hanqiao Wang and associates (University of Toronto, ON). None of the OSA patients who agreed to receive CPAP therapy died, but the apparent treatment-related risk reduction failed to reach significance, according to their report, published online March 30, 2007 in the Journal of the American College of Cardiology.http://www.theheart.org/article/784103.doThu, 19 Feb 2009 10:26:22 -0800 Dallas, TX - Repeated self-administration of a 23-item health-status questionnaire [1] by patients with post-MI heart failure can help identify changes in their risk status that could potentially guide management decisions and the efficient use of provider resources, proposes a report published online April 9, 2007 in Circulationhttp://www.theheart.org/article/784569.doThu, 19 Feb 2009 10:25:52 -0800 Dallas, TX - Not all cardiac resynchronization therapy (CRT) is the same, and the modes that involve biventricular (BiV) pacing may be the best, at least when it comes to ventricular structural improvements. A randomized comparison in patients with heart failure and ECG-defined ventricular dyssynchrony found that simultaneous and sequential BiV pacing both improved LV dimensions better than LV-only pacinghttp://www.theheart.org/article/785465.doThu, 19 Feb 2009 10:25:24 -0800 Glasgow, Scotland - The use of rosiglitazone (Avandia, GlaxoSmithKline) in type 2 diabetic patients with NYHA class 1-2 heart failure does not adversely alter echocardiographic structure or function, according to the results of a recent study [1]. While there were more fluid-related events with the thiazolidinedione (TZD), these changes did not lead to study withdrawal and were not associated with a worsening of heart failure, report investigators.http://www.theheart.org/article/785679.doThu, 19 Feb 2009 10:24:57 -0800 Washington, DC - With hopes of making the medical therapy of chronic heart failure less of an art and more of a science, the natriuretic peptides are under scrutiny as possible targets for medical therapy in the outpatient setting. A randomized trial, one of several exploring the issue and among the first to make it into print, suggested that the biomarker-guided approach as a complement to traditional clinically driven management led to greater use of evidence-based medications and fewer clinical eventshttp://www.theheart.org/article/785927.doThu, 19 Feb 2009 10:24:31 -0800 San Francisco, CA - Increased levels of two commonly measured biomarkers, taken together, are significantly predictive of both all-cause mortality and cardiac allograft vasculopathy (CAV) in patients with transplanted hearts and could help distinguish those who might need further, perhaps more invasive, testing from those who probably don't, say researchers here at the International Society for Heart and Lung Transplantation (ISHLT) 2007 Annual Meetinghttp://www.theheart.org/article/787581.doThu, 19 Feb 2009 10:24:02 -0800 Chicago, IL - On paper, levosimendan (Simdax, Orion Pharma) seemed like it might make an effective and safer substitute for inotropic agents in the setting of acute decompensated heart failure (ADHF), and early clinical trials suggested it had promise. But in a randomized mortality trial comparing levosimendan with dobutamine, one- and six-month outcomes—which also included various objective and subjective measures of heart-failure severity—were about the same with both drugshttp://www.theheart.org/article/789427.doThu, 19 Feb 2009 10:23:29 -0800 New Brunswick, NJ - New data from the SCD-HeFT trial have helped to better characterize the risk of thromboembolism (TE) in patients with chronic heart failure, revealing for the first time that ejection fraction (EF) is an independent predictor of risk and that amiodarone and ICD therapy appear to halve the incidence of such eventshttp://www.theheart.org/article/789587.doThu, 19 Feb 2009 10:23:03 -0800 Cincinnati, OH - Another study has found that people with heart failure and sleep apnea face higher risks of dying than do heart-failure patients without sleep disordered breathing . Researchers writing in the May 22, 2007 issue of the Journal of the American College of Cardiology say the study results show HF patients without sleep apnea may live twice as long as those who also have significant central sleep apnea.http://www.theheart.org/article/790421.doThu, 19 Feb 2009 10:22:26 -0800 Washington, DC - Using multidetector (multislice) computed tomography (MDCT) to screen for coronary causes of dilated cardiomyopathy is feasible, safe, and offers an attractive substitute for standard coronary angiography to differentiate between ischemic and idiopathic, authors of a new study sayhttp://www.theheart.org/article/790315.doThu, 19 Feb 2009 10:21:51 -0800 Birmingham, AL - Older women with heart failure who also have diabetes fare much worse than men or younger women, new research shows [1]. Dr Ali Ahmed (University of Alabama at Birmingham) and colleagues report their study online May 8, 2007 in Heart. Women with heart failure and diabetes were almost 70% more likely to die and 50% more likely to be hospitalized than women with heart failure and no diabetes, with these adverse effects seen primarily in those aged over 65. The effect of diabetes in men with heart failure was much weaker, however.http://www.theheart.org/article/791197.doThu, 19 Feb 2009 10:21:12 -0800 Washington, DC - A year of treatment with the vasopressin-receptor antagonist tolvaptan (Otsuka America Pharmaceuticals) had no apparent effect on LV end-diastolic volume (LVEDV) in patients with chronic systolic heart failure who were already on evidence-based medical therapy in a small but randomized and placebo-controlled studyhttp://www.theheart.org/article/793479.doThu, 19 Feb 2009 10:20:44 -0800 Sophia-Antipolis, France - Hypokalemia is associated with an increased mortality risk independently of NYHA functional class, drugs used in therapy, and use of potassium supplements, according to a post hoc analysis [1] of data from a randomized trial conducted in the 1990s [2]. "Low serum potassium in HF may be caused by diuretic therapy or may be a marker of increased neurohormonal activity and disease progression," according to the authors, who say their study has implications for contemporary HF management. Its findings argue against the use of diuretics in euvolemic patients with milder HF and for an emphasis on potassium-sparing diuretics in those with more symptomatic disease and volume overload, write Dr Ali Ahmed (University of Alabama, Birmingham) and associates. http://www.theheart.org/article/795755.doThu, 19 Feb 2009 10:20:17 -0800 Dallas, TX - The addition of natriuretic peptide testing to the traditional clinical evaluation of patients with dyspnea of suspected cardiac origin cut the duration of emergency-department visits by one-fifth and reduced the 60-day risk of rehospitalization by about a third, all while lowering costs, in a Canadian multicenter studyhttp://www.theheart.org/article/798315.doThu, 19 Feb 2009 10:19:48 -0800 Dallas, TX - A prediction model invented to stratify patients with heart failure according to all-cause mortality risk also seems to predict their mode of death, whether from sudden cardiac death (SCD) or from progressive pump failure, suggests an analysis [1]. The Seattle Heart Failure Model (SHFM) [2], which showed signs of being more discriminating for HF mortality outcomes than the traditional New York Heart Association functional class, could potentially be used to guide treatment decisions, according to the authors.http://www.theheart.org/article/801907.doThu, 19 Feb 2009 10:19:23 -0800 Chicago, IL - Hospitals that participated in a comprehensive quality-improvement initiative for heart-failure care increased their adherence to guideline-recommended management over two years, and their patients were rewarded with shorter hospitalization times, report investigators in the July 23, 2007 issue of the Archives of Internal Medicine. There were also trends suggesting improved survival 60 and 90 days after discharge.http://www.theheart.org/article/803325.doThu, 19 Feb 2009 10:18:47 -0800 Washington, DC - Patients hospitalized with heart failure and preserved LV systolic function fare better during hospitalization than those with a low LVEF, but that advantage may go away a few months after discharge, suggest data from a large registry [1]. The report is published in the August 21, 2007 issue of the Journal of the American College of Cardiology. http://www.theheart.org/article/806057.doThu, 19 Feb 2009 10:18:14 -0800 Washington, DC - Transplant-ineligible patients with end-stage heart failure in a prospective study had a significantly better survival when implanted with an LV-assist device (LVAD) compared with maintenance on inotropic drug therapy [1]. That's the unsurprising good news. The caveat is that even with an LVAD, nearly three-fourths of patients had died within a year.http://www.theheart.org/article/806827.doThu, 19 Feb 2009 10:17:30 -0800 Boston, MA - With a design that can be traced back about 2200 years to Archimedes and his screw-based pump, a left-ventricular assist device (LVAD) that propels blood in a continuous stream successfully bridged patients to heart transplantation or sustained them at least six months while they were waiting for a donor heart in three out of four transplant candidates who received the devices, according to an observational study reported this weekhttp://www.theheart.org/article/807979.doThu, 19 Feb 2009 10:14:08 -0800 Seattle, WA - Researchers in Washington say they have overcome two key hurdles that have barred the successful differentiation of human embryonic stem (HES) cells into cardiomyocytes and their subsequent survival after transplantation. The group, having successfully created a highly purified cardiomyocyte culture and ensured high survival of the cells, went on to demonstrate not only that the cells then developed into heart muscle in rats but that, compared with rats that did not receive this cell line, rats that received the purified cells experienced some degree of recovery in infarcted muscle and did not develop heart failure.http://www.theheart.org/article/808177.doThu, 19 Feb 2009 08:48:09 -0800 Vienna, Austria - New real-world data from a prospective study designed to assess the incidence of implantable cardioverter defibrillator (ICD) interventions in patients treated with the device following MI has shown the incidence of appropriate and inappropriate shocks to be nearly identical to the incidence observed in a clinical trial where benefit was first observedhttp://www.theheart.org/article/808585.doThu, 19 Feb 2009 08:47:42 -0800 Vienna, Austria - The addition of aliskiren (Tekturna, Novartis) to the standard pharmacologic assault on the renin-angiotensin system (RAS) in chronic heart failure earned a vote of confidence from a controlled trial suggesting that it can lower natriuretic peptide levels without compromising safetyhttp://www.theheart.org/article/808913.doThu, 19 Feb 2009 08:47:17 -0800 Vienna, Austria - Aficionados of cardiac resynchronization therapy (CRT) for heart failure have been looking to echocardiography and its various function-assessing offshoots to improve on QRS-interval prolongation, considered at best a crude indicator of ventricular dyssynchrony, as a precondition for treatment candidates. But an international prospective study has suggested, according to its investigators, that it may be a while before clinical practice is ready to use pulsed-Doppler, tissue-Doppler, or other quantitative echo techniques for selecting patients for CRThttp://www.theheart.org/article/810947.doThu, 19 Feb 2009 08:46:52 -0800 Vienna, Austria - Increasingly, the clinical benefits of statin therapy in patients with heart failure don't seem to be much about cholesterol. The results of a randomized pilot trial support what some observational studies and retrospective data from large trials have hinted, that the drugs protect against sudden cardiac death (SCD) in the setting of chronic heart failure [1]. In the single-center 110-patient study reported here at the European Society of Cardiology Congress 2007, atorvastatin at the unconventionally low dosage of 10 mg/day was associated with a significant drop in all-cause mortality over one year, a benefit mostly attributable to a reduction in the SCD rate that was independent of lipid levels, LVEF, and HF etiology. In multivariate analysis, predictors of sudden death included randomization to the control group and, consistent with prior research, a high degree of QT-interval variability. http://www.theheart.org/article/811301.doThu, 19 Feb 2009 08:46:29 -0800 Chicago, IL - Treatment with carvedilol (Coreg, GlaxoSmithKline) did nothing to improve the clinical status of children and adolescents with heart failure in a randomized trial that, it is said, has lessons for future pediatric cardiovascular drug research [1]. There was a signal of possible benefit from the beta blocker, however, in a subgroup of the trial's patients, the majority whose left ventricle supports the systemic circulation, as compared with those with a nonsystemic left ventricle, according to the authors, led by Dr Robert E Shaddy (Children's Hospital of Philadelphia, PA). http://www.theheart.org/article/812241.doThu, 19 Feb 2009 08:45:36 -0800 Washington, DC - The application of evidence-based guidelines for managing chronic heart failure varied widely at cardiology practices participating in a national performance-improvement initiative, with shortfalls showing up in some surprisingly fundamental areas, according to reports presented here at the Heart Failure Society of America 2007 Scientific Meeting. It's not just that many eligible patients were missing out on some recommended drug therapies and that others who qualified for cardiac resynchronization therapy (CRT) or implantable cardioverter-defibrillators (ICDs) weren't receiving them, as suggested by baseline data from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE-HF). http://www.theheart.org/article/813463.doThu, 19 Feb 2009 08:45:08 -0800 Washington, DC - One way heart-failure disease management programs streamline care is to have a lot of it take place over the phone, potentially avoiding extra clinic visits and perhaps even some hospitalizations. And the extra telephone time that takes doesn't cost anything—at least, that's the misconception built into Medicare reimbursement schedules, according to investigators who are arguing for changeshttp://www.theheart.org/article/813915.doThu, 19 Feb 2009 08:44:44 -0800 Washington, DC - One frustration heart-failure specialists are quick to discuss when they get together at scientific meetings centers on the short list of drug therapies available to relieve symptoms in patients with acute decompensated heart failure (ADHF) that don't come with nagging safety concerns. So it's with some interest that they are following the slow but steady progress of tolvaptan (Otsuka America Pharmaceuticals), a vasopressin receptor antagonist, in its march toward possible market approval.http://www.theheart.org/article/814409.doThu, 19 Feb 2009 08:44:18 -0800 Washington, DC - Low-LVEF patients with implantable cardioverter-defibrillators (ICDs) who don't need pacing for bradycardia have about the same quality-of-life outcomes with their devices set to provide atrial-based pacing, activated at a heart rate of 70 bpm (AAI-70), as with devices programmed for only single-chamber backup pacing (VVI-40), according to a randomized trialhttp://www.theheart.org/article/815057.doThu, 19 Feb 2009 08:43:50 -0800 Washington, DC - Automated telemonitoring systems, used by heart-failure care providers with some success to stay on top of their patients' changing management needs, may hit a wall in their ability to improve outcomes under some circumstances—for example, in some special patient populations or when medical therapy is already tightly managed, according to investigators from a randomized trialhttp://www.theheart.org/article/815305.doThu, 19 Feb 2009 08:43:27 -0800 Washington, DC - Measurement of brain-type natriuretic peptide (BNP) levels in cancer patients receiving anthracyclines can predict the treatment's risk of cardiotoxicity more reliably than troponin levels or echocardiographic assessment of LV function, according to a small prospective studyhttp://www.theheart.org/article/815783.doThu, 19 Feb 2009 08:42:45 -0800 Copenhagen, Denmark - A natriuretic peptide blood test can help determine whether dyspnea is of cardiac or pulmonary origin in patients presenting to primary-care physicians, who tend not to have ready access to echocardiography, according to a study of a strategy that's already largely appreciated but not necessarily all that commonhttp://www.theheart.org/article/818763.doThu, 19 Feb 2009 08:42:20 -0800 Stanford, CA - Infusions of nesiritide (Natrecor, Scios/Johnson & Johnson) on top of standard therapy were not associated with worsening renal function in a small, randomized placebo-controlled trial of patients with acute decompensated heart failure (ADHF) whose kidneys were already compromised [1]. The findings add to other limited data suggesting that, contrary to some concerns, nesiritide doesn't hurt the kidneys in patients with ADHF. But they fall far short of proving it and do not address allegations that the drug may increase mortality in the same setting.http://www.theheart.org/article/821879.doThu, 19 Feb 2009 08:41:22 -0800 Buenos Aires, Argentina - A small placebo-controlled study, adding to the scant published data on the use of IV-iron therapy without concomitant erythropoiesis-stimulating agents in patients with heart failure and chronic kidney disease, suggests that the strategy can improve biomarker and functional measures of HF status over at least several monthshttp://www.theheart.org/article/822539.doThu, 19 Feb 2009 08:40:48 -0800 Orlando, FL - In the first of several large, randomized explorations of a statin given explicitly for heart failure to reach the reporting stage, treatment with rosuvastatin (Crestor, AstraZeneca) had no significant effect on cardiovascular outcomes, as measured by the primary-end-point composite of CV death, nonfatal MI, or strokehttp://www.theheart.org/article/823819.doThu, 19 Feb 2009 08:40:07 -0800 Chicago, IL - Intravenous treatment with tezosentan (Veletri, Actelion), an endothelin receptor antagonist, alleviated hemodynamics but failed to improve dyspnea or survival or to have any other noteworthy in-hospital or longer-term clinical effects, in an identical-twin pair of randomized trials of patients with acute decompensated heart failure (ADHF) [1]. The findings are consistent with a frustratingly common disconnect between hemodynamic and clinical responses observed for a number of drugs tested, usually with unsatisfying results, in this clinical setting.http://www.theheart.org/article/822995.doThu, 19 Feb 2009 08:39:34 -0800 Orlando, FL - Patients with systolic heart failure and echocardiographic LV dyssynchrony do not objectively benefit from cardiac resynchronization therapy (CRT) when their QRS duration is less than 130 ms, according to a randomized trial that argues against using CRT in so-called narrow-QRS patientshttp://www.theheart.org/article/825539.doThu, 19 Feb 2009 08:39:08 -0800 Rockville, MD - The FDA has issued a letter to Scios requesting that the company withdraw several promotional items for nesiritide (Natrecor) because they "are not appropriate reminder labeling." The items, which include a mouse pad and a pen, present an image of a distressed older male patient in a hospital bed. The patient is submerged up to his shoulders in water and is connected to a heart monitor and a nasal cannula, which the FDA says makes a representation or suggestion about Natrecor. The agency notes that reminder labeling is labeling that calls attention to the name of the drug product but does not include its indication or dosage recommendations or other representations or suggestions relating to the drug product. http://www.theheart.org/article/826861.doThu, 19 Feb 2009 08:38:45 -0800 Pleasanton, CA - The Thoratec Corp announced yesterday that last month it initiated a recall of some of its implantable ventricular assist devices (IVADs) manufactured since 2004 [1]. The devices had been distributed directly to 87 hospitals throughout the world, which were sent recall notification letters on October 19, according to the company statement. The affected devices have a catalog number of 10012-2555-001 and serial numbers of 488 or higher; the identifier is on both the device packaging and the Y connector at the end of its percutaneous driveline, Thoratec said. http://www.theheart.org/article/827055.doThu, 19 Feb 2009 08:38:20 -0800 Orlando, FL - Pacing functions that suppress atrial fibrillation (AF) don't have to be routinely activated during cardiac resynchronization therapy (CRT); rather, they could be turned on as needed if the arrhythmia develops, according to investigators from one of the first prospective, randomized explorations of how AF may influence CRT effectivenesshttp://www.theheart.org/article/827369.doThu, 19 Feb 2009 08:37:47 -0800 Chicago, IL - Receiving an implantable cardioverter defibrillator (ICD) per se didn't seem to cause any long-term changes in health-related quality of life (HRQL) among patients with nonischemic cardiomyopathy in a major randomized trial, but HRQL measures of mental and emotional health started to slide once patients received a shockhttp://www.theheart.org/article/828077.doThu, 19 Feb 2009 08:37:19 -0800 Dallas, TX - Two tiny randomized trials add to burgeoning observational and mechanistic evidence in favor of adding sildenafil, and perhaps other type-5 phosphodiesterase (PDE-5) inhibitors, to standard drug therapy in patients with heart failurehttp://www.theheart.org/article/830485.doThu, 19 Feb 2009 08:36:54 -0800 Washington, DC - The FDA is facing mounting pressure to rethink the black-box warning and contraindications it recently imposed on two ultrasound contrast agents. The product labels for perflutren liquid microspheres (Definity, Bristol-Myers Squibb) and perflutren protein-type A microspheres for injection (Optison, General Electric) now warn users about serious cardiopulmonary reactions occurring within 30 minutes of product administration and note that the products are contraindicated in patients with unstable cardiopulmonary status, including those with unstable angina, acute MI, respiratory failure, and recent worsening of congestive heart failure.http://www.theheart.org/article/830665.doThu, 19 Feb 2009 08:36:30 -0800 Gaithersburg, MD - After a day of debate over safety concerns and vexing limitations of the data submitted in support of the device, the FDA Circulatory System Devices Panel unanimously recommended that the HeartMate 2 axial-flow left ventricular assist device (LVAD) (Thoratec, Pleasanton, CA) be given the commercial green light as a bridge to transplantation in end-stage heart failure. The 12-to-zero decision was subject to a series of conditions, forged during hours of sometimes passionate discussion on the device's safety issues and promise for special patient groups, that involved the label's wording and data gaps to be filled in postmarket studies.http://www.theheart.org/article/831075.doThu, 19 Feb 2009 08:35:58 -0800 Durham, NC - After five years of sluggish enrollment, the Surgical Treatment for Ischemic Heart Failure (STICH) has finally finished enrolling patients in its two-pronged study. Results from hypothesis one of the trial will be released in late 2008 or early 2009; results from hypothesis two will likely take until 2011, researchers now say.http://www.theheart.org/article/833709.doThu, 19 Feb 2009 08:35:33 -0800 Dallas, TX - An implantable sensor that continuously monitors left-atrial (LA) pressures in patients with heart failure, potentially warning of impending decompensation, showed that it can be safely implanted and produce reliable ambulatory LA-pressure readings in a 12-week feasibility study conducted in eight patients, the first ever to receive the devicehttp://www.theheart.org/article/834201.doThu, 19 Feb 2009 08:35:07 -0800 Ft Lauderdale, FL - The CorCap (Acorn Cardiovascular), a polyester jacket for the heart that can resist or reverse the remodeling process in patients with dilated cardiomyopathy and heart failure, has demonstrated that the improvements it makes in cardiac size and shape are sustained for at least several years [1]. Compared with similar patients who didn't get the device, those who did showed persisting gains in cardiac structural parameters, such as sphericity index and LV end-diastolic volume (LVEDV), in a 36-month follow-up analysis from the shorter-term randomized trial previously but unsuccessfully submitted to the FDA for market approval http://www.theheart.org/article/834557.doThu, 19 Feb 2009 08:34:43 -0800 Washington, DC - From a clinical trial largely responsible for the current wave of primary-prevention ICD use comes a simple clinical-risk scoring system that could potentially screen out patients unlikely ever to need the deviceshttp://www.theheart.org/article/837523.doThu, 19 Feb 2009 08:34:08 -0800 Lexington, MA - Nitromed has announced wholesale cuts to its personnel and a halt to marketing of its fixed-dose combination of isosorbide dinitrate and hydralazine (BiDil), a three-times-a-day pill approved for African Americans with heart failure, while it continues development on a once-daily extended-release formulation it hopes will sell better. But the currently approved version of the drug will still be on pharmacy shelves.http://www.theheart.org/article/837931.doThu, 19 Feb 2009 08:33:45 -0800 Minneapolis, MN - In a new study, published online January 13, 2008 in Nature Medicine, scientists showed that the dream of growing new human hearts to replace damaged ones is not simply in the realm of a too-distant future, as the group reported they were successful in creating a beating rat heart in a laboratoryhttp://www.theheart.org/article/838017.doThu, 19 Feb 2009 08:33:21 -0800 London, UK - A novel treatment that triggers a nonspecific immune response believed to attenuate inflammatory processes associated with heart failure failed to improve survival or reduce heart-failure hospitalizations in a randomized placebo-controlled trial reported in the January 19, 2008 issue of the Lancethttp://www.theheart.org/article/839331.doThu, 19 Feb 2009 08:32:54 -0800 Exeter and Plymouth, UK - Hawthorn extract, a herbal medicinal taken widely for heart health, can improve exercise performance in chronic heart failure without an important risk of side effects, concludes a review of a limited number of randomized, placebo-controlled trials [1]. "The best evidence that is available suggests that hawthorn has significant benefits, compared with placebo, as an adjunctive treatment for patients with chronic heart failure," according to the authors, led by Dr Max H Pittler (Peninsula Medical School, Universities of Exeter and Plymouth, UK). "Reported adverse events were infrequent, mild, and transient," they write in the first 2008 issue of the Cochrane Database of Systematic Reviews, published online January 23.http://www.theheart.org/article/840033.doThu, 19 Feb 2009 08:32:28 -0800 Cleveland, OH - Anemia associated with heart failure often resolves spontaneously and, in such cases, doesn't seem to increase the risk of death, but it's a significant mortality risk factor when it persists, suggests a retrospective single-center study [1]. But the analysis, which appears in the February 5, 2008 issue of the Journal of the American College of Cardiology, offers few insights as to whether such information could be used to guide therapy. http://www.theheart.org/article/840801.doThu, 19 Feb 2009 08:32:03 -0800 Fort Lauderdale, FL - Adding surgical ventricular restoration (SVR) to CABG in selected patients with ischemic dilated cardiomyopathy, compared with CABG alone, can improve LVEF and HF functional class and prevent hospitalization for heart failure, concluded researchers here earlier this week at the Society of Thoracic Surgeons 2008 Annual Meeting [1]. Their retrospective single-center study addresses a longstanding question about SVR, which many believe improves patient outcomes on its own but whose effects have been difficult to tease out from those of the CABG generally accompanying it.http://www.theheart.org/article/841315.doThu, 19 Feb 2009 08:31:38 -0800 Chicago, IL - A rare large, multicenter randomized trial comparing disease-management strategies with conventional follow-up for survivors of a heart-failure hospitalization failed to show that the intervention reduces mortality or HF rehospitalizationshttp://www.theheart.org/article/842927.doThu, 19 Feb 2009 08:31:12 -0800 New York, NY - A new regimen of "dose-dense" chemotherapy plus the HER-2 antibody trastuzumab (Herceptin, Genentech/Amgen) has shown low levels of cardiotoxicity in the adjuvant setting in the treatment of breast cancerhttp://www.theheart.org/article/847941.doThu, 19 Feb 2009 08:30:48 -0800 Rockville, MD - The FDA has granted market clearance to the automated VIDAS N-terminal fragment of B-type natriuretic peptide (NT-proBNP) assay for measuring serum or plasma levels of NT-proBNP, the test's manufacturer, bioMérieux, has announcedhttp://www.theheart.org/article/848951.doThu, 19 Feb 2009 08:30:14 -0800 Durham, NC - Patients undergoing major noncardiac surgery have significantly increased risks of operative death or short-term readmission if their clinical picture also includes CAD or heart failure, compared with having neither condition, suggests an analysis of a huge Medicare cohort that controlled for type of surgery [1]. It also found that the associated risks were much greater for heart failure than for CAD.http://www.theheart.org/article/848983.doThu, 19 Feb 2009 08:29:50 -0800 Chicago, IL - A moderately large, randomized controlled trial has bolstered years of observational evidence suggesting that cardiac resynchronization therapy (CRT) may benefit patients with ventricular dyssynchrony and the mildest forms of heart failure—that is, those who are asymptomatic as a result of therapy or are only mildly symptomatichttp://www.theheart.org/article/854151.doThu, 19 Feb 2009 08:29:23 -0800 Chicago, IL - Given the short list of effective and bone fide safe intravenous drugs available for acute decompensated heart failure (ADHF), it's welcome news that the inotrope istaroxime appears to be staying on track in early dose-ranging studies. An investigational agent with some quirks compared with available IV inotropic agents, it may have lusitropic effects that could make the drug an enhancer of diastolic as well as systolic function.http://www.theheart.org/article/855883.doThu, 19 Feb 2009 08:28:59 -0800 Boston, MA - The new wave of left-ventricular assist devices (LVADs), none yet approved for sale in the US but some available in Europe, go for small size and greater durability to make them more patient-friendly and, potentially, cut the need for replacement due to wear and tear, compared with the pulsatile-pump first-generation devices.http://www.theheart.org/article/858177.doThu, 19 Feb 2009 08:28:37 -0800 Baltimore, MD - Around 40% of blacks carry a genetic variant that appears to act like a natural beta blocker and seems to protect them after heart failure, prolonging their lives, new research has shown [1]. The findings may help explain why beta blockers don't appear to benefit some African Americans, say Dr Stephen B Liggett (University of Maryland, Baltimore) and colleagues in a study published online April 20, 2008 in Nature Medicine. http://www.theheart.org/article/859047.doThu, 19 Feb 2009 08:28:14 -0800 Rockville, MD - The FDA has granted marketing clearance for a new, more compact left ventricular assist device (LVAD)—one that is small enough to be used in women and in men with smaller trunk sizes. The axial-flow HeartMate II left ventricular assist system, made by Thoratec, has been slimmed down through the use of a continuous-flow pump instead of the standard pulsatile pump used in larger models. According to the company and researchers who have used the device, the more compact device will considerably broaden the pool of people who could benefit from a ventricular assist device. In addition to being compact, the next-generation device is also quieter as compared with the mechanical clicks and thuds produced by the valves and pulsatile pumps of LVADs already on the market.http://www.theheart.org/article/859075.doThu, 19 Feb 2009 08:27:46 -0800 Washington DC - Diabetics with retinopathy but no clinical cardiac disease had more than twice the risk of developing heart failure over a follow-up of about nine years, compared with those without retinopathy and independent of glycemic control and a long list of other risk factors, in an analysis from the Atherosclerosis Risk in Communities (ARIC) studyhttp://www.theheart.org/article/859817.doThu, 19 Feb 2009 08:27:21 -0800 Los Angeles, CA - Deterioration of clinical status leading to heart-failure hospitalizations is frequently accompanied by identifiable factors that contribute to decompensations beyond the underlying heart-failure disease state, a new study has foundhttp://www.theheart.org/article/860007.doThu, 19 Feb 2009 08:26:55 -0800 Baltimore, MD- In an interim analysis of a pilot study, ambulatory patients with heart failure believed their disease was better controlled and may have avoided hospitalizations by using a remote monitoring device to regularly stay in touch with providers, who could observe their vital signs and symptom status and recommend treatment adjustments as neededhttp://www.theheart.org/article/860871.doThu, 19 Feb 2009 08:26:30 -0800 Baltimore, MD - Patients with heart failure and those with advanced malignancies are similarly burdened by symptoms, depression, and quality-of-life issues that can be addressed by care providers, with the need significantly greater among the most debilitated patients with heart failure, according to a small observational studyhttp://www.theheart.org/article/861235.doThu, 19 Feb 2009 08:26:07 -0800 Baltimore, MD - The use of home-based exercise and cognitive behavioral therapy (CBT) together has led to an improvement in symptoms in a pilot study in depressed patients with heart failure. This is the first-ever research to look at a combination of such treatments, lead investigator Dr Rebecca Gary (Emory University, Atlanta, GA) told heartwire. http://www.theheart.org/article/861289.doThu, 19 Feb 2009 08:25:39 -0800 Boston, MA - Raised troponin levels point to an increased risk of dying during hospitalization among patients with a confirmed diagnosis of acute decompensated heart failure (ADHF), suggests a registry analysis in which the survival curves of those with vs without the biomarker elevations diverged starting on day onehttp://www.theheart.org/article/865447.doThu, 19 Feb 2009 08:25:14 -0800 Los Angeles, CA - The day of the week on which a patient is admitted to the hospital for heart failure or discharged has no bearing on their clinical outcome, new registry data show [1]. Dr Gregg C Fonarow (University of California, Los Angeles) and colleagues report their findings in the inaugural, May 1, 2008 issue of Circulation: Heart Failurehttp://www.theheart.org/article/868423.doThu, 19 Feb 2009 08:24:42 -0800 Minneapolis, MN - A new analysis has confirmed that low baseline systolic blood-pressure levels and changes in systolic blood pressure over time are risk factors for adverse events in heart-failure patients [1]. The study also showed, however, that the beneficial effects of the angiotensin-receptor blocker valsartan (Diovan, Novartis Pharmaceuticals) did not vary significantly by baseline blood pressure and that reductions in blood pressure did not counteract the beneficial effects of the drug on heart-failure morbidity.http://www.theheart.org/article/868923.doThu, 19 Feb 2009 08:24:08 -0800 Buenos Aires, Argentina - There is a guidelines "evidence gap" regarding use of aldosterone antagonists in patients with heart failure, in that the only two relevant major randomized trials to explore the issue, ultimately supporting their post-MI use and in NYHA class 3-4 disease, respectively, essentially excluded patients in NYHA class 2. That much was agreed by Dr Willem J Remme (Sticares Cardiovascular Research Foundation, Rhoon, the Netherlands) and Dr José Luis López-Sendón (Hospital Universitario La Paz, Madrid, Spain) at a debate held during the World Congress of Cardiology 2008 scientific meeting. Their point of contention: does it matter?http://www.theheart.org/article/869655.doThu, 19 Feb 2009 08:23:42 -0800 Dallas, TX - The Follow-Up Serial Infusions of Nesiritide in Advanced Heart Failure (FUSION II) study, showing no major benefits of nesiritide (human B-type natriuretic peptide [BNP]) (Natrecor, Scios) in the outpatient treatment of advanced chronic heart failure, has now been published in the inaugural, May 1, 2008 issue of the new journal Circulation: Heart Failurehttp://www.theheart.org/article/869793.doThu, 19 Feb 2009 08:23:15 -0800 Rhoon, the Netherlands - A new Europe-wide survey has found wide differences among physician specialties and countries in terms of their management of heart failure [1]. Primary-care physicians and internists/geriatricians display less-than-optimal use of echocardiography for diagnosis of HF, and they often do not prescribe pivotal therapies such as ACE inhibitors and beta blockers, say Dr Willem J Remme (Sticares Research Foundation, AB Rhoon, the Netherlands) and colleagues in a report published online May 27, 2008 in the European Heart Journal. http://www.theheart.org/article/871169.doThu, 19 Feb 2009 08:22:48 -0800 Washington, DC - Intravenous therapy with istaroxime, an investigational inotrope with some potentially helpful properties not generally found in other such agents, improved various hemodynamic measures, apparently without serious side effects or changes in renal function, in a small phase 2 study of patients hospitalized with systolic heart failurehttp://www.theheart.org/article/871911.doThu, 19 Feb 2009 08:21:18 -0800 Rockville, MD - The FDA has granted marketing clearance to Abiomed's Impella 2.5 cardiac-assist device [1]. The device, which can be implanted percutaneously via the femoral artery into the left ventricle, is used for partial circulatory support for up to six hours.http://www.theheart.org/article/872123.doThu, 19 Feb 2009 08:20:54 -0800 Durham, NC - A new study has shown that patients with heart failure substantially overestimate their own life expectancy compared with HF-model-based predictions for survival [1]. Dr Larry A Allen (Duke Clinical Research Institute, Durham, NC) and colleagues report their findings in the June 4, 2008 issue of the Journal of the American Medical Association.http://www.theheart.org/article/872013.doThu, 19 Feb 2009 08:20:30 -0800 San Francisco, CA - Cardiac resynchronization therapy (CRT) in patients with early-stage heart failure doesn't reduce their risk of ventricular arrhythmias during the first year [1], according to a randomized trial that had previously disclosed no advantage to device therapy in that population with respect to a primary composite end point that included mortality, HF hospitalization, and worsening heart failure. http://www.theheart.org/article/872331.doThu, 19 Feb 2009 08:20:03 -0800 Chicago, IL - Prolongation of the QRS interval, an electrocardiographic marker for ventricular dyssynchrony, is present in more than a third of low-LVEF patients hospitalized for acute heart failure and independently predicts all-cause mortality and cardiovascular morbidity after discharge, suggests a post hoc analysis of almost 3000 patients in a major international clinical trialhttp://www.theheart.org/article/874191.doThu, 19 Feb 2009 08:19:39 -0800 Ann Arbor, MI - Adding extract of hawthorn to standard heart-failure medications might worsen the early progression of the disease, according to a retrospective analysis of a randomized trial that primarily found no adverse effects overall, nor any clinical benefits, associated with the supplement over six monthshttp://www.theheart.org/article/875105.doThu, 19 Feb 2009 08:19:08 -0800 Chicago, IL - African Americans treated in the hospital for acute decompensated heart failure (ADHF), compared with whites, are more likely to have several important cardiovascular risk indicators and in other ways appear to have heart failure that follows a different natural history; yet they are at least as likely as whites to receive evidence-based therapies and more likely to survive to discharge [1]. These findings, from a registry analysis encompassing >135 000 ADHF admissions, were independent of age and IV vasodilator use but, on closer analysis, were more pronounced in patients with nonischemic heart failure and didn't apply to those with ischemic disease.http://www.theheart.org/article/875963.doThu, 19 Feb 2009 08:18:44 -0800 Silver Spring, MD - By an eight-to-three vote, an FDA advisory panel yesterday recommended approval of tolvaptan (Otsuka America Pharmaceuticals), a selective vasopressin-receptor antagonist that can be taken orally, for the indication of hypervolemic or euvolemic hyponatremia. Most members of the panel, regardless of their vote, had reservations about some of the drug's remaining unknowns and pressed for studies that follow broader populations of patients for longer than the tolvaptan trials performed so far.http://www.theheart.org/article/878727.doThu, 19 Feb 2009 08:18:15 -0800 Washington, DC - Patients who are hospitalized for acute decompensated heart failure (ADHF) with a reduced LVEF should stay on beta blockers if they are already on them and, if they aren't, should start taking the drugs if they are eligible, according to a large, prospectively defined registry analysis [1]. Its authors say it provides some of the first "real-world" data consistent with recommendations that, until now, had only tenuous support in the literature based on select, atypical ADHF populations—patients who were young or had few comorbidities, for example.http://www.theheart.org/article/881045.doThu, 19 Feb 2009 08:17:48 -0800 Memphis, TN - Treatment with spironolactone in chronic heart failure may have the added benefit of preventing bone fractures, at least in men, suggests a retrospective analysis of patients from a single center [1]. Those who took the aldosterone inhibitor and diuretic in the case-control study showed a >40% drop in adjusted risk of incident fractures, especially if they were on the drug for at least six months. http://www.theheart.org/article/881349.doThu, 19 Feb 2009 08:17:16 -0800 Vienna, Austria - Plasma levels of copeptin, the C-terminal peptide fragment of a precursor to the antidiuretic and vasoconstricting hormone vasopressin, can predict long-term mortality in patients with almost any degree of chronic heart failure, and as a prognostic biomarker it appears to be in the same league as the natriuretic peptides, according to an observational studyhttp://www.theheart.org/article/882383.doThu, 19 Feb 2009 08:16:49 -0800 Rochester, MN - Increased serum levels of tumor necrosis factor alpha (TNF-), a proinflammatory cytokine known to play a role in progressive cardiomyopathy, were common and emerged as a significant mortality predictor, independent of LVEF and other heart-failure risk measures, in a prospectively studied community-based heart-failure populationhttp://www.theheart.org/article/884235.doThu, 19 Feb 2009 08:16:18 -0800 Toronto, ON - Many patients with heart failure would prefer to be on chronic medical therapy, which is likely to prolong survival at the cost of some quality of life, while others would rather be on a treatment that makes them feel better but perhaps die sooner, such as oral inotropic agents—that much is well known. But the path a patient would choose appears unrelated to LV ejection fraction, NYHA functional class, quality-of-life scores, or other measures of symptom status and overall health, according to a small study of adults with heart failure published online July 28, 2008 in the Journal of Heart & Lung Transplantation [1], with Jane MacIverhttp://www.theheart.org/article/886071.doThu, 19 Feb 2009 08:15:52 -0800 Washington, DC - Abnormal heart-rate turbulence (HRT) as measured on Holter monitoring predicts mortality, including sudden-death mortality, in patients with heart failure, independently of ventricular systolic function, according to a large, prospective cohort-based studyhttp://www.theheart.org/article/886351.doThu, 19 Feb 2009 08:15:26 -0800 Durham, NC - There is a large variation in the use of cardiac resynchronization therapy (CRT) throughout the US, and this technology is not always used according to the guidelines, a new registry study showshttp://www.theheart.org/article/886533.doThu, 19 Feb 2009 08:15:03 -0800 Rockville, MD - The US FDA has approved a diagnostic blood test, AlloMap (XDx, Brisbane, CA), to help identify heart-transplant recipients who might be at risk of organ rejection [1]. AlloMap measures the activity of genes related to allograft rejection, allowing patients to potentially avoid invasive endomyocardial biopsies and improving clinicians' ability to make management decisions.http://www.theheart.org/article/898541.doThu, 19 Feb 2009 08:14:39 -0800 Munich, Germany - Omega-3 fatty-acid supplementation improves morbidity and mortality in symptomatic heart-failure patients, while statins failed to have any beneficial effect in the same group of patients, two new studies have shown [1,2]. The long-term administration of omega-3 fatty acids reduced all-cause mortality and admission to the hospital for cardiovascular reasons, while there was no effect on these end points with 10-mg rosuvastatinhttp://www.theheart.org/article/898959.doThu, 19 Feb 2009 08:14:14 -0800 Munich, Germany - The use of natriuretic-peptide levels rather than symptoms alone to guide the medical management of heart failure, a strategy that's been tested in several trials with mixed results, failed to influence the primary end point of hospitalization-free survival over 18 months in a randomized heart-failure trial reported here today at the European Society of Cardiology Congress 2008http://www.theheart.org/article/899263.doThu, 19 Feb 2009 08:13:50 -0800 Munich, Germany - A small study in patients with virus-negative inflammatory cardiomyopathy indicates that six months of immunosuppressive therapy can improve left ventricular function and results in a disappearance of inflammatory infiltrates. According to Dr Andrea Frustaci (La Sapienza University, Rome, Italy), who presented the results during the final hotline session of the European Society of Cardiology Congress 2008, the findings justify a strategy of first testing patients for persistent viral load and, if negative, proceeding with immunosuppressive therapy.http://www.theheart.org/article/901601.doThu, 19 Feb 2009 08:13:23 -0800 Boston, MA- Implantable cardioverter defibrillators (ICDs) can deliver shocks to prevent sudden death in patients with heart failure, but, statistically, such patients' all-cause mortality risk climbs whenever those shocks are delivered, according to a secondary, prospectively defined analysis from the SCD-HeFT trial [1]. ICD discharges, the study further found, seemed to raise the risk of death whether or not they were triggered by the kind of arrhythmias that cause sudden death.http://www.theheart.org/article/902043.doThu, 19 Feb 2009 08:12:58 -0800 Munich, Germany - An additional six months of data from the European cohort of the Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction (REVERSE) trial supports secondary conclusions from its previously reported main analysis, that cardiac resynchronization therapy (CRT) added to optimal medical therapy in patients with initially mild heart failure can turn the tide of the heart's remodeling changes known to contribute to HF progression [1]. The analysis at 18 months also suggested a favorable effect of CRT on clinical outcomes in this populationhttp://www.theheart.org/article/902375.doThu, 19 Feb 2009 08:12:35 -0800 Munich, Germany - Another biomarker in the natriuretic peptide family may be in the offing for helping with the emergency-department diagnosis of acute heart failure. A prospective study has concluded that, in that setting, an assay for the mid-regional fragment of atrial natriuretic peptide (ANP) prohormone (MR-proANP) is noninferior to the well-established test for B-type natriuretic peptide (BNP)http://www.theheart.org/article/903059.doThu, 19 Feb 2009 08:12:07 -0800 Toronto, ON - Continuous aortic flow therapy is possibly best utilized in patients refractory to drug therapy and with severe hemodynamic disturbances but who do not have features of late-stage heart failure, a new post hoc analysis has shown. Chronic heart-failure patients with nonischemic etiology and without kidney dysfunction or severe N-terminal pro-brain-natriuretic peptide (NT-proBNP) expression benefited from the device, report investigators.http://www.theheart.org/article/906621.doThu, 19 Feb 2009 08:11:34 -0800 Lausanne, Switzerland - A new study has found that older adults with severe subclinical hypothyroidism had almost double the risk of developing heart failure (HF) compared with those with normal thyroid function over a 12-year follow-up period [1]. Dr Nicolas Rodondi (University of Lausanne, Switzerland) and colleagues report their findings in the September 30, 2008 issue of the Journal of the American College of Cardiology.http://www.theheart.org/article/905975.doThu, 19 Feb 2009 08:11:02 -0800 Toronto, ON - Patients with both heart failure and clinical depression who received the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft/Lustral, Pfizer) for three months and those who received placebo showed about the same improvements in their depression and similar clinical outcomes, in a randomized trial that explored the long-intriguing question of whether treating the psychiatric condition would also improve the clinical disorderhttp://www.theheart.org/article/906715.doThu, 19 Feb 2009 08:10:25 -0800 Toronto, ON - Investigators testing 3,5-diiodothyropropionic acid (DITPA), a thyroid hormone analog, in patients with heart failure should be given an A+ for creativity, said one expert, even though their investigation was stopped early because the drug tended to worsen heart-failure symptoms. Despite the high discontinuation rate, the drug had positive secondary end points, which included reducing vascular resistance, weight, and cholesterol levels.http://www.theheart.org/article/906919.doThu, 19 Feb 2009 08:10:02 -0800 Toronto, ON - Changes in intrathoracic impedance related to fluid buildup in the chest, monitored by technology included in an implantable electronic device, predict subsequent heart-failure-related adverse events, a new study has shown. Fluid indices crossing a predefined threshold significantly increased the risk of subsequent decompensation, shortness of breath, peripheral edema, and fatigue, suggesting impedance data can help stratify patients at risk for worsening heart failure, report investigators. http://www.theheart.org/article/907389.doThu, 19 Feb 2009 08:09:36 -0800 Toronto, ON - A long-acting preparation of carvedilol (Coreg-CR, GlaxoSmithKline) designed for once-daily administration is "noninferior" to the off-patent twice-a-day version of the beta blocker with respect to LV hemodynamics in patients with systolic heart failure, according to COMPARE, a randomized study presented here at the Heart Failure Society of America 2008 Scientific Meeting [1]. Its researchers say the controlled-release (CR) carvedilol, compared with the immediate-release (IR) version, is a step forward for the drug in heart-failure patients, many of whom are less likely to stick with a pill prescription that calls for more than once-daily administration, since poor drug compliance tracks with poorer outcomeshttp://www.theheart.org/article/907439.doThu, 19 Feb 2009 08:09:09 -0800 Toronto, ON - An investigational adenosine A1-receptor antagonist modestly improved hemodynamics and renal function in stable heart-failure patients, a small dose-response study has shown. The agent reduced pulmonary capillary wedge pressures at the highest doses, although not significantly, had a weak diuretic effect, and improved renal-function measures, including cystatin C, urine volume, and sodium and potassium excretion. http://www.theheart.org/article/907617.doThu, 19 Feb 2009 08:08:43 -0800 Toronto, ON - Would that which is called an inotrope, by any other name, be safer in heart failure? A small dose-ranging study in patients with stable heart failure supports animal research suggesting that an obscure drug, a selective activator of cardiac myosin, can amplify contractile function without increasing myocardial oxygen demand [1]. Investigators hope that CK-1827452 (Cytokinetics), as it's called for now, will offer the benefits of conventional inotropic agents without the effects that can ultimately harm patients taking them.http://www.theheart.org/article/907767.doThu, 19 Feb 2009 08:08:19 -0800 St Paul, MN - The American Board of Medical Specialties (ABMS) has approved a proposal to establish a subspecialty certification in "advanced heart failure and transplant cardiology," the Heart Failure Society of America (HFSA) has announced [1]. The HFSA was a prime mover in the effort to establish the certification, which it hopes will promote quality and guarantee a degree of consistency in the training and expertise of physicians specializing in heart failure.http://www.theheart.org/article/908411.doThu, 19 Feb 2009 08:07:53 -0800 Toronto, ON - Patients with heart failure who are admitted to the hospital on Saturday or Sunday are about as likely to receive evidence-based therapies, have a similar length of stay, and have comparable in-hospital mortality as those admitted on a weekday, according to data from hospitals participating in a quality-improvement programhttp://www.theheart.org/article/909117.doThu, 19 Feb 2009 08:07:24 -0800 Edmonton, AB - Patients who are newly diagnosed with heart failure in the emergency department are at least four times as likely to suffer serious bone fractures over the next year compared with patients presenting to the emergency department with other CV disorders, suggests a study based on hospital data from >16 000 patientshttp://www.theheart.org/article/912781.doThu, 19 Feb 2009 08:06:43 -0800 Toronto, ON - With three beta blockers currently recommended for heart failure and entrenched in clinical practice, the FDA has agreed to consider approval of yet another. But this time there's a novel, potentially revolutionary twist: the contender, bucindolol (ARCA Biopharma, Broomfield, CO), would be marketed with a "companion genetic test" that may identify heart-failure patients who are predisposed to an especially good treatment response.http://www.theheart.org/article/910489.doThu, 19 Feb 2009 08:06:20 -0800 Lexington, MA - NitroMed will sell its only product, a proprietary combination of hydralazine and isosorbide dinitrate (BiDil), to the privately owned JHP Pharmaceuticals for a cool $26 million cash if its shareholders warm to the deal, the company announced yesterday [1]. The company says it will continue marketing BiDil until it passes to the new owner, which was founded only last year but currently manufactures and sells a range of pharmaceutical products acquired from other companies.http://www.theheart.org/article/913983.doThu, 19 Feb 2009 08:05:54 -0800 Pleasanton, CA - Heart-pump manufacturer Thoratec is warning that wear and tear on the percutaneous lead that connects its HeartMate II left ventricular assist device (LVAD) to the device controller may result in damage that can interrupt pump function over time [1]. Out of almost 2000 devices implanted over the past five years, the company has confirmed 27 reports of "fatigue" to the percutaneous lead, requiring pump replacement. Five people who could not undergo pump replacement have died as a result of the damaged leads; however, all patients who were able to undergo replacement of the LVAD pump survived the procedure and were alive at least 30 days postoperatively, the company states.http://www.theheart.org/article/914379.doThu, 19 Feb 2009 08:05:22 -0800 Philadelphia, PA - A heart-failure disease-management program that had cut the risk of hospitalization in a predominantly Hispanic and black population [1] is also cost-effective in that the benefit came at an expected societal cost under $25 000 per quality-adjusted life-year (QALY) gained, suggests a new analysishttp://www.theheart.org/article/914965.doThu, 19 Feb 2009 08:04:59 -0800 Chicago, IL- Some associations between race and heart failure may have been predictable, while at least one came as a surprise, in a new analysis from a venerable longitudinal cohort study reported in the October 27, 2008 issue of the Archives of Internal Medicine [1]. African Americans were more likely to develop new heart failure over four years compared with the three other racial/ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA), which had entered >6800 people from six communities across the US who were free of clinically manifest cardiovascular disease.http://www.theheart.org/article/915335.doThu, 19 Feb 2009 08:04:23 -0800 Boston, MA - A new analysis of the Framingham Heart Study has shown that a decline in deaths from MI in recent decades appears to have been accompanied by an increase in the incidence of heart failure [1]. Dr Raghava S Velagaleti (Framingham Heart Study, Boston, MA) and colleagues report their findings online October 27, 2008 in Circulation. http://www.theheart.org/article/916103.doThu, 19 Feb 2009 08:03:51 -0800 New Orleans, LA - Heart-failure patients participating in a highly structured exercise program in the HF-ACTION trial, reported here at the American Heart Association (AHA) 2008 Scientific Sessions, saw no significant reductions in all-cause mortality or all-cause hospitalization as compared with patients getting "usual care," including recommendations for daily exercise. http://www.theheart.org/article/919703.doThu, 19 Feb 2009 08:03:28 -0800 New Orleans, LA - A phase 2 trial has shown that interferon beta-1b (IFNB-1b) (Betaferon/Betaseron, Bayer Healthcare)—a drug currently used to treat multiple sclerosis (MS)—may be effective in chronic viral cardiomyopathy (CVC). Dr Heinz Peter Schultheiss (Charité-Univ Medizin, Berlin, Germany) presented the results at a late-breaking trial session here today at the American Heart Association 2008 Scientific Sessions. http://www.theheart.org/article/919797.doThu, 19 Feb 2009 08:03:00 -0800 New Orleans, LA - A novel biomarker of vascular status is a better predictor of mortality at three months than brain natriuretic peptide (BNP) in acute heart-failure patients presenting at the emergency department with shortness of breath. The use of mid-region pro-adrenomedullin (MR-proADM) was also a better predictor of mortality than N-terminal pro-BNP (NT-proBNP), and these data suggest that MR-proADM can help triage very high-risk heart-failure patients who should be treated intensively. http://www.theheart.org/article/919885.doThu, 19 Feb 2009 08:02:36 -0800 New Orleans, LA - About four years of treatment with the angiotensin-receptor blocker (ARB) irbesartan (Avapro, Bristol-Myers Squibb/Sanofi-Synthelabo) failed to make a difference in mortality or cardiovascular events in patients with heart failure and preserved LVEF in a randomized trial presented here at the American Heart Association 2008 Scientific Sessionshttp://www.theheart.org/article/920311.doThu, 19 Feb 2009 08:02:08 -0800 New Orleans, LA - Heart-failure patients participating in an exercise training program improved their quality of life, with the improvement occurring early and sustained for three years, new research shows. In addition to being safe, investigators say the results are consistent with prior clinical findings and support the use of exercise training in this population. http://www.theheart.org/article/920619.doThu, 19 Feb 2009 08:01:41 -0800 Durham, NC - Contrary to recent research suggesting antidepressants increase mortality in heart-disease patients, a new study suggests that, at least when it comes to selective serotonin-reuptake inhibitors (SSRIs), this is not the case [1]. A large prospective cohort study in HF patients shows that depression, but not antidepressant use, was associated with a 33% increased mortality risk. http://www.theheart.org/article/921645.doThu, 19 Feb 2009 08:01:14 -0800 New Orleans, LA - Negative thinking may play a major role in the development of depression in patients with heart failure, new research suggests [1]. Researchers at the University of Kentucky, in Lexington, found negative thinking accounts for more than a third of depressive symptoms in patients with heart failure, independent of sociodemographic factors, antidepressant therapy, and severity of heart failure. http://www.theheart.org/article/921713.doThu, 19 Feb 2009 08:00:47 -0800 New Orleans - In the largest study to date looking at the issue, researchers report that survival in heart-transplant recipients is significantly reduced if recipients receive a heart from a donor of the opposite sex. According to Dr Eric Weiss (Johns Hopkins Medical Institutions, Baltimore, MD), who presented the analysis during the American Heart Association 2008 Scientific Sessions, the findings should help transplant programs choose the best recipient for a heart transplant when a donor organ becomes available.http://www.theheart.org/article/922633.doThu, 19 Feb 2009 07:59:51 -0800 Johannesburg, South Africa - One of the largest and most comprehensive studies of heart failure to date in Africa has shown that the disease is a big problem and that although the traditional causes of HF—which differ from those seen in Western nations—still predominate, there are signs that the range of etiologies is broadening [1]. This has important implications for primary- and secondary-prevention strategies, say Dr Simon Stewart (Diabetes Research Institute, Melbourne, Australia) and colleagues from South Africa in a report published online November 24, 2008 in Circulation. http://www.theheart.org/article/923975.doThu, 19 Feb 2009 07:59:24 -0800 Boston, MA - Older diabetic patients treated with rosiglitazone (Avandia, GlaxoSmithKline) are at higher risk of dying or developing heart failure than patients treated with pioglitazone (Actos, Takeda Pharmaceuticals), a new analysis of Medicare beneficiaries suggests [1]. The observational study—the largest of its kind to date—appears in the November 24, 2008 issue of the Archives of Internal Medicine and is likely to fan the ongoing controversy over the adverse-effect profile of rosiglitazone as compared with other drugs in the thiazolidinedione (TZD) class.http://www.theheart.org/article/924093.doThu, 19 Feb 2009 07:58:57 -0800 Durham, NC - Mortality associated with ventricular-assist-device (VAD) use in Medicare patients with end-stage heart failure is considerably higher than that seen in registries and other research settings, according to an analysis of device implantations over a recent six-year period that identified several issues worthy of further explorationhttp://www.theheart.org/article/924377.doThu, 19 Feb 2009 07:58:27 -0800 Washington, DC - Inhibition of a single type of microRNA, the molecular intermediary between DNA and messenger RNA in the gene-expression machinery of cells, stemmed the development of cardiac fibrosis and hypertrophy and slowed the progression of cardiac dysfunction in an animal model of heart failurehttp://www.theheart.org/article/926245.doThu, 19 Feb 2009 07:57:50 -0800 Boston, MA - "It was the first week after being appointed head of the cath lab, and I was a puppy. This was in 1958," Dr Eugene Braunwald (Brigham and Women's Hospital, Boston, MA) said about a memorable early episode in his long and distinguished career. The key event, a decade before the advent of echocardiography: the first known diagnosis based solely on clinical signs of what is now called hypertrophic cardiomyopathy (HCM).http://www.theheart.org/article/927303.doThu, 19 Feb 2009 07:57:12 -0800 Washington, DC - Increased left ventricular mass in people initially without heart disease emerged as a strong and independently significant risk factor for subsequent heart failure in an analysis from a prominent longitudinal study, one that also saw a relationship between LV mass/volume ratio and risk of later coronary-disease events and strokehttp://www.theheart.org/article/929195.doThu, 19 Feb 2009 07:56:44 -0800 Cleveland, OH - An echocardiographic technique for estimating left ventricular filling pressures that has gained popularity in recent years apparently isn't very reliable in some types of patients, including a few for whom a dependable noninvasive test would be especially useful, say investigators on the basis of their prospective observational studyhttp://www.theheart.org/article/930471.doThu, 19 Feb 2009 07:56:21 -0800 Boston, MA - The risk of new heart failure went up by about 11% for every one-point increase in body-mass index (BMI) over a follow-up of about 20 years in an analyses from the venerable Physician's Health Study (PHS) that also looked at HF risk according to the baseline BMI category in the trial's male participantshttp://www.theheart.org/article/930883.doThu, 19 Feb 2009 07:55:50 -0800 Durham, NC and Los Angeles, CA - Elderly patients hospitalized with heart failure who go on beta blockers for the first time and continue them after discharge can expect prolonged survival and fewer rehospitalizations, unless they are one of the many with preserved systolic function, suggests an analysis based on a large prospective registry [1]. The findings, which appear in the January 13, 2009 issue of the Journal of the American College of Cardiology, are consistent with the few other studies of beta blockade in comparable patients and highlight how poorly understood preserved-ejection-fraction heart failure is compared with systolic heart failure.http://www.theheart.org/article/933143.doThu, 19 Feb 2009 07:55:21 -0800 Worcester and Boston, MA - Transplant-listed patients supported on a ventricular assist device (VAD) while awaiting a donor heart are more likely to die within the first six months after the surgery than transplanted patients who hadn't been bridged with a VAD, according to an analysis based on United Network for Organ Sharing (UNOS) data that date from several years to more than a decade ago [1]. The mortality increase in bridged patients dissipated after the six-month posttransplant period but appeared again five years later.http://www.theheart.org/article/933815.doThu, 19 Feb 2009 07:54:49 -0800 Washington, DC - Heart failure treated with cardiac resynchronization therapy (CRT) is most likely to improve clinically and least likely to cause hospitalization or death when the biventricular pacing is active all or nearly all the time, according to a retrospective analysis of more than 1800 patients pooled from two CRT trials and published in the January 27, 2009 Journal of the American College of Cardiology http://www.theheart.org/article/934865.doThu, 19 Feb 2009 07:54:18 -0800 Hyderabad, India - A heritable 25-base-pair (bp) deletion from the gene coding for cardiac myosin-binding protein C (MYBPC3) is associated with cardiomyopathy and risk for heart failure in South Asian populations, according to a new study published online January 18, 2009 in Nature Genetics [1]. Defective cardiac-myosin binding protein C, a component of filaments in cardiac muscle cells, results in distorted sarcomeres—the smallest functional units of muscle.http://www.theheart.org/article/936165.doThu, 19 Feb 2009 07:53:49 -0800 Homburg/Saar, Germany - A new German study has shown that female doctors appear to provide the best care to heart-failure patients, by being more likely to prescribe guideline-recommended treatment [1]. The results also show that female HF patients are less likely to receive optimum care, particularly when male physicians treat them.http://www.theheart.org/article/936839.doThu, 19 Feb 2009 07:53:15 -0800 Further evidence that even commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) are harmful to heart-failure patients has come from a new study The study, published in the January 26, 2009 issue of the Archives of Internal Medicine, shows dose-related increases in risk of death and rehospitalization for heart failure or MI with all COX-2 inhibitors or other NSAIDs. http://www.theheart.org/article/938249.doThu, 19 Feb 2009 07:48:33 -0800 Ventricular remodeling responses and clinical outcomes with cardiac resynchronization therapy (CRT) in heart failure may be frustratingly variable from patient to patient, but if short-term reverse remodeling is pronounced after six months, at least there is a good chance that long-term survival will be excellent, a new cohort study suggests [1]. Similarly, it found, long-term survival may be disappointing if the short-term reverse-remodeling response is poor.http://www.theheart.org/article/939439.doThu, 19 Feb 2009 07:46:52 -0800 Study researchers, led by Dr Mary Jane Sauvé (University of California Davis Medical Center, Sacramento), matched 50 HF patients with 50 community controls on the basis of age, sex, and estimated intelligence quotient. Neuropsychologic tests assessed cognitive function in six areas: orientation, attention, memory, executive function, motor speed, and reaction times. Most of the tests were brief assessments that have been shown in previous studies to have a high sensitivity for measuring specific cognitive functions, she explained.http://www.theheart.org/article/942145.doThu, 19 Feb 2009 07:46:52 -0800 In the Trial of Intensified versus Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF), drug therapy guided by N-terminal brain-type natriuretic-peptide (NT-proBNP) levels, as compared with conventional symptom-guided management, made no significant difference to the primary end point of hospitalization-free survival at 18 months.http://www.theheart.org/article/937793.doThu, 19 Feb 2009 07:46:52 -0800