[Show abstract][Hide abstract] ABSTRACT: By the early 2000s, several landmark trials had demonstrated clear morbidity and mortality benefit for neurohormonal antagonists and vasodilators in patients with heart failure and reduced ejection fraction (HFrEF), including beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), aldosterone antagonists (AldA), and the combination of hydralazine and isosorbide dinitrate (H-ISDN). These therapies were justifiably assimilated into guidelines for the treatment of patients with HFrEF, but evidence emerged documenting wide variability in compliance with evidence-based therapies and clinical outcomes.(1) At the same time, important studies highlighted that patients started on ACEi and BB while hospitalized for heart failure (HF) were much more likely to remain on these therapies during follow-up than if initiation was deferred to the outpatient setting.(2, 3) Hospital-based interventions to improve compliance with HF therapies suggested clinical benefit with reduced HF readmissions and mortality(4), and support for this inpatient strategy was buttressed by similar efforts aimed at patients with coronary artery disease.(5).
[Show abstract][Hide abstract] ABSTRACT: Cardiologists Mariell Jessup, Keith Fox, and Michel Komajda join study co-chairs John McMurray and Milton Packer to discuss PARADIGM-HF, a trial of angiotensin-neprilysin inhibition versus enalapril in advanced heart failure. View the video of this roundtable discussion and contribute your comments.
New England Journal of Medicine 09/2014; 371(11). DOI:10.1056/NEJMp1410203 · 55.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This editorial refers to '2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management'(dagger), by The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA), on page 2383.
European Heart Journal 08/2014; 35(35). DOI:10.1093/eurheartj/ehu295 · 15.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Granulomatous diseases are a rare cause of hypercalcemia. The pathogenesis is presumed to be from endogenous production of 1,25-dihydroxyvitamin D by activated macrophages in granulomatous lesions, which harbor the 1α-hydroxylase enzyme. Herein the first case of hypercalcemia associated with giant cell myocarditis, an unusual type of granulomatous process, is reported. In this case, a patient with giant cell myocarditis had development of progressive heart failure and cardiorenal syndrome that required biventricular support. One year later, hypercalcemia associated with a relatively high 1,25-vitamin D level and a concomitantly suppressed parathyroid hormone level developed in the presence of stage 4 chronic kidney disease. Her other workup of hypercalcemia was unrevealing for vitamin D intoxication and multiple myeloma. Computed tomography of her chest showed no signs of hilar lymphadenopathy. Her calcium levels returned to normal with low-dose steroid therapy and have remained normal following a successful heart transplant. This case illustrates an unusual cause of hypercalcemia thought to be due to extrarenal calcitriol production associated with giant cell myocarditis.