Natriuretic Peptide–Based Screening and Collaborative Care for Heart Failure

Ledwidge, Mark; Gallagher, Joe; Conlon, C.; Tallon, Elaine; O’Connell, Eoin; Dawkins, Ian; Watson, Chris; O’Hanlon, Rory; Bermingham, Margaret; Patle, A.; Badabhagni, Mallikarjuna; Murtagh, Gillian; Voon, Victor; Tilson, Leslie; Barry, Michael; McDonald, Laura; Maurer, B.; McDonald, Kenneth

doi:10.1001/jama.2013.7588

Cited by 494 publications

(405 citation statements)

References 26 publications

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“…Malignant LVH defines a subgroup of LVH patients, representing 7% of MESA participants, by definition free of known CVD, and independent of the presence of hypertension, who may potentially benefit from increased surveillance. Surveillance with biomarkers has some precedence, previously being efficacious among primary care patients in a randomized, controlled trial of BNP monitoring 18. We show that combining LVH with biomarker elevation identifies participants at a 2.5‐ to 4‐fold greater risk than just biomarker elevation alone.…”

Section: Discussionmentioning

confidence: 83%

“Malignant” Left Ventricular Hypertrophy Identifies Subjects at High Risk for Progression to Asymptomatic Left Ventricular Dysfunction, Heart Failure, and Death: MESA (Multi‐Ethnic Study of Atherosclerosis)

Peters

Seliger

Christenson

et al. 2018

JAHA

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BackgroundAs heart failure (HF)‐associated morbidity and mortality continue to escalate, enhanced focus on prevention is increasingly important. “Malignant” left ventricular (LV) hypertrophy (LVH): LVH combined with an elevated cardiac biomarker reflecting either injury (high‐sensitivity cardiac troponin T), or strain (amino‐terminal pro‐B‐type natriuretic peptide) has predicted accelerated progression to HF. We sought to determine whether malignant LVH identified community‐dwelling adults initially free of cardiovascular disease at high risk of asymptomatic decline in LV ejection fraction or a clinical cardiovascular event.Methods and ResultsA total of 4985 of 6814 individuals without prevalent cardiovascular disease underwent baseline cardiac magnetic resonance for LVH in combination with measurement of plasma high‐sensitivity cardiac troponin T and amino‐terminal pro‐B‐type natriuretic peptide as part of MESA (Multi‐Ethnic Study of Atherosclerosis) and were subsequently divided into 4 groups: (1) No LVH, no elevated biomarkers (n=2206; 44.3%); (2) No LVH, ≥1 elevated biomarkers (n=2275; 45.7%); (3) LVH, no elevated biomarkers (n=153; 3.0%); and (4) LVH, ≥1 elevated biomarkers (malignant LVH; n=351; 7.0%). Cardiac magnetic resonance was repeated 10 years later (n=2831) for assessment of LV ejection fraction <50%. Median follow‐up was 12.2 years. Malignant LVH was associated with 7.0‐, 3.5‐, and 2.6‐fold adjusted increases in incidence of HF, cardiovascular death, and asymptomatic LV dysfunction, respectively, versus group 1. New‐onset HF was predominately HF with reduced ejection fraction (9.5‐fold increase).ConclusionsMalignant LVH is predictive of progression to asymptomatic LV dysfunction, HF (particularly HF with reduced ejection fraction), and cardiovascular death. Consequently, malignant LVH represents a high‐risk phenotype among individuals without known cardiovascular disease, which should be targeted for increased surveillance and more‐aggressive therapies.

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Section: Discussionmentioning

confidence: 83%

“Malignant” Left Ventricular Hypertrophy Identifies Subjects at High Risk for Progression to Asymptomatic Left Ventricular Dysfunction, Heart Failure, and Death: MESA (Multi‐Ethnic Study of Atherosclerosis)

Peters

Seliger

Christenson

et al. 2018

JAHA

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“…The database consists of >12 000 patients with a large spectrum of cardiovascular clinical phenotypes 8. It integrates community‐based population cohorts (Stanislas9 and Health ABC10), cardiovascular risk cohorts (REVE‐1 and REVE‐2,11 ADELAHYDE,12 R2C2, HVC, REMI,13 and STOP‐HF14), and heart failure (HF) cohorts (Leitzaran, MEDIA‐DHF, and TIME‐CHF15). Cohort details are summarized in Table 1 and the Supporting Information, Tables S1 , S2 , and S3 .…”

Section: Study Populationmentioning

confidence: 99%

Rationale of the FIBROTARGETS study designed to identify novel biomarkers of myocardial fibrosis

et al. 2017

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AimsMyocardial fibrosis alters the cardiac architecture favouring the development of cardiac dysfunction, including arrhythmias and heart failure. Reducing myocardial fibrosis may improve outcomes through the targeted diagnosis and treatment of emerging fibrotic pathways. The European‐Commission‐funded ‘FIBROTARGETS’ is a multinational academic and industrial consortium with the main aims of (i) characterizing novel key mechanistic pathways involved in the metabolism of fibrillary collagen that may serve as biotargets, (ii) evaluating the potential anti‐fibrotic properties of novel or repurposed molecules interfering with the newly identified biotargets, and (iii) characterizing bioprofiles based on distinct mechanistic phenotypes involving the aforementioned biotargets. These pathways will be explored by performing a systematic and collaborative search for mechanisms and targets of myocardial fibrosis. These mechanisms will then be translated into individualized diagnostic tools and specific therapeutic pharmacological options for heart failure.Methods and resultsThe FIBROTARGETS consortium has merged data from 12 patient cohorts in a common database available to individual consortium partners. The database consists of >12 000 patients with a large spectrum of cardiovascular clinical phenotypes. It integrates community‐based population cohorts, cardiovascular risk cohorts, and heart failure cohorts.ConclusionsThe FIBROTARGETS biomarker programme is aimed at exploring fibrotic pathways allowing the bioprofiling of patients into specific ‘fibrotic’ phenotypes and identifying new therapeutic targets that will potentially enable the development of novel and tailored anti‐fibrotic therapies for heart failure.

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“…6 Some studies revealed a potential beneficial role of cardiomarkers (troponins and natriuretic peptides) in the detection of early manifestation of cardiotoxicity. 7,8 Serial evaluation of symptoms, ECG and echocardiography focused on left ventricle function were seen to be sufficient to cover all cardiotoxicity problems; however, further observations revealed a much wider spectrum of CV complications of cancer therapy. 6 They are divided into nine categories according to their pathophysiology and clinical manifestation: myocardial dysfunction and heart failure; coronary artery disease; valvular disease; arrhythmias, especially those induced by QT-prolonging drugs; arterial hypertension; thromboembolic disease; peripheral vascular disease and stroke; pulmonary hypertension; and pericardial complications.…”

Section: Wide Spectrum Of Cardiovascular Complications Of Cancer Treamentioning

confidence: 99%

The Future Role of Cardio-oncologists

Pudil

2017

Cardiac Failure Review

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Access at: www.CFRjournal.com Cardiovascular (CV) disease and cancer remain the two most common causes of mortality in developed countries. According to recent data from the American Cancer Society, the lifetime probability of being diagnosed with an invasive cancer is higher for men (43 %) than for women (38 %). 1Within the last few decades the progress in the treatment of malignant diseases significantly improved survival of oncological patients. The decreased mortality is driven by both improved diagnostic and therapeutic modalities; however, the improved survival of oncological patients can be limited by adverse effects associated with intensive antitumorous treatment. In particular, cardiotoxicity may compromise the effectiveness of the anticancer therapy, independently of the oncological prognosis, and can negatively affect survival and quality of life of oncological patients.This includes the development of newly diagnosed CV problems, or the exacerbation of previously identified CV disease. Rates of CV problems from cancer-related therapeutics have been reported to be in excess of 30 %, and cardiotoxicity is the second most common cause of morbidity and mortality in cancer survivors.2,3 The number of patients at risk of problems are high. According to the latest data, on 1 January 2016 more than 15.5 million Americans with a history of cancer were alive, and this number is projected to reach more than 20 million by 1 January 2026.Furthermore, 56 % of survivors were diagnosed within the past 10 years, and almost half (47 %) were aged 70 years or older. 4 Similarly, there is an increasing number of patients with malignancy who have a history of CV disease or an increased CV risk. Therefore, the CV problems in oncological patients are not only medical but also social and economic problems, and new strategies to solve this topic are needed. 5 This brief review focuses on some issues that need to be addressed in the near future. Wide Spectrum of Cardiovascular Complications of Cancer TreatmentThe first clinical manifestation of adverse effects from anticancer drugs on the CV system was depression of the left ventricle function leading to heart failure in patients treated with anthracyclines. Therefore, the term there is a need for collaboration from a broad spectrum of specialists covering not only oncology, but all fields of cardiology. Basic Concept for the Management of Patients Treated with Potentially Cardiotoxic DrugsIt has been shown that early detection and adequate treatment of CV complications can improve survival and the quality of life of oncological Abstract Cardiovascular (CV) disease and cancer remain the two most common causes of mortality in developed countries; however, progress in the treatment of malignant diseases significantly improved survival of oncological patients. Similarly, there is an increased number of the patients with malignancy who have a history of CV disease or an increased CV risk. Rates of CV problems from cancer-related therapeutics are high, and cardiotoxicity is the se...

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Natriuretic Peptide–Based Screening and Collaborative Care for Heart Failure

Abstract: clinicaltrials.gov Identifier: NCT00921960.

Cited by 494 publications

References 26 publications

“Malignant” Left Ventricular Hypertrophy Identifies Subjects at High Risk for Progression to Asymptomatic Left Ventricular Dysfunction, Heart Failure, and Death: MESA (Multi‐Ethnic Study of Atherosclerosis)

“Malignant” Left Ventricular Hypertrophy Identifies Subjects at High Risk for Progression to Asymptomatic Left Ventricular Dysfunction, Heart Failure, and Death: MESA (Multi‐Ethnic Study of Atherosclerosis)

Rationale of the FIBROTARGETS study designed to identify novel biomarkers of myocardial fibrosis

The Future Role of Cardio-oncologists

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