Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure

Wong, Maylene; Staszewsky, Lidia; Latini, Roberto; Barlera, Simona; Glazer, Robert; Aknay, Nora; Hester, Allen; Anand, Inder; Cohn, Jay N.

doi:10.1016/j.jacc.2003.12.053

Cited by 201 publications

(131 citation statements)

References 22 publications

(18 reference statements)

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“…[15][16][17][18][19][20] Guideline-directed medical therapy with β-blockade and renin-angiotensin-aldosterone system antagonism during the early period after diagnosis of nonischemic cardiomyopathy may result in improved ventricular function and decreased future risk of SCD; 50% of patients with newly diagnosed nonischemic cardiomyopathy will demonstrate a 10% improvement in LVEF with the initiation of medical therapy. 21,22 Although the rationale and reasons for postponing ICD implantation are sensible, the current evidence base is incomplete. For example, the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) excluded patients with a diagnosis of cardiomyopathy of <3 months and those who had not received guideline-directed medical therapy.…”

Section: Table 1 Applying Classification Of Recommendations and Levementioning

confidence: 99%

Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death

Piccini¹,

Allen²,

Kudenchuk³

et al. 2016

Circulation

117

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Section: Table 1 Applying Classification Of Recommendations and Levementioning

confidence: 99%

Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death

Piccini¹,

Allen²,

Kudenchuk³

et al. 2016

Circulation

117

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“…Nevertheless, in line with the obesity paradox, no repercussions were found in terms of left ventricle systolic function i.e. ejection fraction, which is considered as wellestablished predictor of long-term cardiovascular outcome and mortality (22,23). Echocardiographic characteristics clearly showed influence of obesity on left ventricle morphology, and the extent of changes was in correlation with BMI i.e.…”

Section: Discussionmentioning

confidence: 81%

Obesity dilemma in the global burden of cardiovascular diseases

et al. 2013

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Aim: Obesity is a well-known risk factor in the cardiovascular disease continuum. However, its clinical effects are multimodal, perplexed and non-unanimously understood. Our aim was to assess the prevalence and effects of obesity on the cardiometabolic risk factors and systolic function of left ventricle ejection fraction (LVEF) in patients scheduled for cardiovascular rehabilitation. Methods: A cohort of 302 consecutive patients recently treated for ischaemic or valvular heart disease was matched according to the existence of obesity, defined with body mass index (BMI ≥ 30 kg/m 2 ; n = 90 vs. 212), and the advanced grade of obesity (BMI ≥ 35 kg/m 2 ; n = 19 vs. 283). Nutritional risk screening was performed using the standardised NRS-2002 tool. Results: The mean age of patients was 62.4 AE 11.2 (range 23-86) years; there were more men than women 244 (80.8%) : 58 (19.2%). Group of obese conveyed higher prevalence of ischaemic heart disease than non-obese (OR = 2.69; 95% CI: 1.01-7.20; p = 0.048); while the difference was insignificant for the advanced grade of obesity (n = 17; 89.5%) vs. controls (n = 233; 82.3%; p > 0.05). There was no significant difference in prevalence of other comorbidities (diabetes, glucose intolerance, hypercholesterolaemia, chronic renal and chronic obstructive pulmonary disease) between studied groups (p > 0.05). Utilisation of lipid-lowering drugs was of similar range between the studied groups (p > 0.05), respectively. LVEF (%) was 50.5 AE 8.2 vs. 50.7 AE 7.7 (p > 0.05) and 50.6 AE 7.8 vs. 49.6 AE 10.9 (p > 0.05; Rho = 0.001; p > 0.05), respectively. Conclusion: In studied set of patients, BMI positively correlated with left ventricle dimension and thickness. No significant connection of obesity was found with the prevalence of chronic comorbidities, increased nutritional risk, laboratory diagnostics or systolic function of left ventricle. Existence of obesity paradox in clinical practice was in part reaffirmed with our study. What's known• Obesity is a well-established risk factor and an important chronic comorbidity in cardiovascular diseases continuum.• However, obese individuals time and again have more fortunate prognosis than normal weighted individuals, known as the obesity paradox.• Obesity paradox is repeatedly found in reports from observational trials.• Modifications in lifestyle, healthy diet and treatment of obesity represent beneficial evidence-based medical interventions.

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“…They lower blood pressure, preserve serum K+ levels that may be dangerously reduced by diuretic therapy, and produce favorable effects on vascular and cardiac structure. Suppression of ventricular growth and remodeling [33] may be a critical factor in their beneficial effect on hypertension and heart failure [34].…”

Section: Clinical Applicationmentioning

confidence: 99%

Role of the Renin-Angiotensin System in Cardiovascular Disease

Cohn

2010

Cardiovasc Drugs Ther

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Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure

Abstract: Stratification by baseline severity of remodeling showed that patients with worse LVIDd and EF are at highest risk for an event, yet appear to gain the most anti-remodeling effect and clinical benefit with valsartan treatment.

Cited by 201 publications

References 22 publications

Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death

Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death

Obesity dilemma in the global burden of cardiovascular diseases

Role of the Renin-Angiotensin System in Cardiovascular Disease

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