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Introduction
Skills and Expertise
Publications
Publications (1,266)
Aims
To characterise the phenotype, clinical outcomes and rate of disease progression in patients with early‐stage non‐ischaemic cardiomyopathy (early‐NICM).
Methods and results
We conducted a prospective observational cohort study of patients with early‐NICM assessed by late‐gadolinium‐enhancement cardiovascular magnetic resonance. Cases were cla...
Background:
Patients with heart failure usually have several other medical conditions that might alter the effects of interventions. We investigated whether the burden of comorbidity modified the clinical response to cardiac resynchronization therapy (CRT).
Methods and results:
Original patient-level data from eight randomized trials exploring t...
Background:
Previous reports suggest that risk factors, management, and outcomes of acute heart failure (AHF) may differ by sex, but they rarely extended analysis to low- and middle-income countries.
Objectives:
In this study, the authors sought to analyze sex differences in treatment and outcomes in patients hospitalized for AHF in 44 countries...
Aims:
Hospital admission during nighttime and off hours may affect the outcome of patients with various cardiovascular conditions due to suboptimal resources and personnel availability, but data for acute heart failure remain controversial. Therefore, we studied outcomes of acute heart failure patients according to their time of admission from the...
Background
A high body mass index (BMI) confers a paradoxical survival benefit in patients with heart failure (HF) or diabetes mellitus (DM). There is, however, controversy whether an obesity paradox is also present in patients with HF and concomitant DM. In addition, the influence of glycaemic control and diabetes treatment on the presence or abse...
Objectives
COMMANDER-HF was a randomised trial comparing rivaroxaban 2.5 mg two times a day to placebo, in addition to antiplatelet therapy, in patients hospitalised for worsening heart failure with coronary artery disease and sinus rhythm. Patients with diabetes are at increased risk of cardiovascular events and therefore have more to gain.
Metho...
Aim:
To explore the frequency, causes, and pattern of hospitalisation for patients with chronic HF in the 12 months preceding death. We also investigated cause of death.
Methods:
Patients referred to a secondary care HF clinic were routinely consented for follow-up between 2001 and 2020 and classified into three phenotypes: i) HF with reduced ej...
Aim: To explore the frequency, causes, and pattern of hospitalisation for patients with chronic HF in the 12 months preceding death. We also investigated cause of death.
Methods: Patients referred to a secondary care HF clinic were routinely consented for follow-up between 2001 and 2020 and classified into three phenotypes: i) HF with reduced ejec...
Recurrent myocardial ischemia can lead to left ventricular (LV) dysfunction in patients with coronary artery disease (CAD). In this observational cohort study, we assessed for chronic metabolomic and transcriptomic adaptations within LV myocardium of patients undergoing coronary artery bypass grafting. During surgery, paired transmural LV biopsies...
Aims:
To investigate the association of cardiac resynchronization therapy (CRT) on outcomes among participants with and without a history of atrial fibrillation (AF).
Methods:
Individual-patient-data from four randomized trials investigating CRT-Defibrillators (COMPANION, MADIT-CRT, REVERSE) or CRT-Pacemakers (COMPANION, MIRACLE) were analyzed....
Data on the benefits of cardiac resynchronization therapy (CRT) in patients with severe heart failure (HF) symptoms are limited. We investigated the relative effects of CRT in patients with ambulatory NYHA IV vs III functional class at the time of device implantation. In this meta-analysis, we pooled patient-level data from the MIRACLE, MIRACLE-ICD...
Aims:
Transferrin saturation (TSAT), a marker of iron deficiency, reflects both serum concentrations of iron (SIC) and transferrin (STC). TSAT is susceptible to changes in each of these biomarkers. Little is known about determinants of STC and its influence on TSAT and mortality in patients with heart failure. Accordingly, we studied the relations...
Background
Addressing racial differences in care delivery is one of the current challenges in the diagnosis and treatment of patients with Heart Failure (HF). Compared to Caucasians, patients from minority racial groups with HF and reduced Ejection Fraction (HFrEF) are less likely to receive evidence-based, medical, device or advanced therapies. Ho...
Background:
There are few contemporary data on outcomes, costs, and treatment following a hospitalization for heart failure (hHF) in epidemiologically representative cohorts.
Objectives:
The study sought to describe rehospitalizations, hospitalization costs, use of guideline-directed medical therapy (GDMT) (renin-angiotensin system inhibitors, s...
Background:
We sought to identify protein biomarkers of new-onset heart failure (HF) in 3 independent cohorts (HOMAGE cohort [Heart Omics and Ageing], ARIC study [Atherosclerosis Risk in Communities], and FHS [Framingham Heart Study]) and assess if and to what extent they improve HF risk prediction compared to clinical risk factors alone.
Methods...
Episodes of worsening symptoms and signs characterize the clinical course of patients with chronic heart failure (HF). These events are associated with poorer quality of life, increased risks of hospitalization and death and are a major burden on healthcare resources. They usually require diuretic therapy, either administered intravenously or by es...
ackground
An echocardiographic algorithm derived by machine learning (e′VM) characterizes preclinical individuals with different cardiac structure and function, biomarkers, and long-term risk of heart failure (HF). Our aim was the external validation of the e′VM algorithm and to explore whether it may identify subgroups who benefit from spironolact...
BACKGROUND: Mineralocorticoid receptor (MR) activation induces fibrosis. Urinary proteomic profiling (UPP) detects thousands of sequenced peptides, mainly derived from collagen. No previous study applied UPP to generate insights in the antifibrotic actions of MR antagonism.
METHODS: Based on urine sample availability, subsets of the open HOMAGE tri...
Background
Oxidative stress may be a key pathophysiological mediator in the development and progression of heart failure (HF). The role of serum-free thiol concentrations, as a marker of systemic oxidative stress, in HF remains largely unknown.
Objective
The purpose of this study was to investigate associations between serum-free thiol concentrati...
Aims
A high, Doppler-derived, tricuspid regurgitation velocity (TRV) indicates pulmonary hypertension, which may contribute to right ventricular dysfunction and worsening tricuspid regurgitation leading to systemic venous congestion, reflected by an increase in inferior vena cava (IVC) diameter. We hypothesized that venous congestion rather than pu...
Aims:
The importance of autoantibodies (AABs) against adrenergic/muscarinic receptors in heart failure (HF) is not well-understood. We investigated the prevalence and clinical/prognostic associations of four AABs recognizing the M2-muscarinic receptor or the β1-, β2-, or β3-adrenergic receptor in a large and well-characterized cohort of patients w...
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Strategies for Correction of Iron Deficiency in Patients with Cardiovascular Disease
Background:
It is not known whether the optimal Atrioventricular delay (AVopt ) varies between left ventricular (LV) pacing site during endocardial biventricular pacing (BiVP) and may therefore needs consideration.
Methods:
We assessed the haemodynamic AVopt in patients with chronic heart failure undergoing endocardial LV lead implantation. AVop...
Background:
Spironolactone might improve the prognosis of patients with heart failure with preserved left ventricular ejection fraction (HFpEF), but the mechanisms by which it acts are uncertain. Serum concentrations of procollagen type I carboxy-terminal propeptide (PICP) reflect the synthesis of type I collagen and correlate well with histologic...
Background:
For patients with heart failure (HF) and iron deficiency (ID), randomised trials suggest that intravenous (IV) iron reduces heart failure hospitalisations, but uncertainty exists about the effects in subgroups and the impact on mortality. We conducted a meta-analysis of randomised trials investigating the effect of IV iron on clinical...
Conflicts of Interest
Professor Colin Berry is employed by The University of Glasgow, which holds research and consultancy agreements with Abbot Vascular, AstraZeneca, Coroventis, GSK, HeartFlow, Menarini, Neovasc, Novartis, Siemens Healthcare and ValoHealth. These companies had no involvement in this manuscript. The other authors do not have any p...
BACKGROUND
Benefit from cardiac resynchronization therapy (CRT) varies by QRS characteristics; individual randomized trials are underpowered to assess benefit for relatively small subgroups.
METHODS
The authors analyzed patient-level data from pivotal CRT trials (MIRACLE [Multicenter InSync Randomized Clinical Evaluation], MIRACLE-ICD [Multicenter...
The QRS duration can be easily obtained from a 12-lead electrocardiogram. Increased QRS duration reflects greater ventricular activation times and often ventricular dyssynchrony. Dyssynchrony causes an impairment of the global cardiac function and adversely affects the prognosis of patients with heart failure (HF). Little is known about the impact...
Aims
Alternative models of cardiac rehabilitation (CR) are required to improve CR access and uptake. Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) is a comprehensive home-based rehabilitation and self-management programme, facilitated by trained health professionals, for people with heart failure (HF) and their caregivers. REACH-HF...
Background:
N-terminal pro-B-type natriuretic peptide (NT-proBNP) is predictive of both outcomes and response to treatment in patients with heart failure with reduced ejection fraction (HFrEF).
Objective:
To examine the effect of the cardiac myosin activator omecamtiv mecarbil according to baseline NT-proBNP level in the Global Approach to Lower...
Aims:
We investigated the prevalence and clinical value of assessing multi-organ congestion by ultrasound in heart failure (HF) outpatients.
Methods and results:
Ultrasound congestion was defined as inferior vena cava of ≥21 mm, highest tertile of lung B-lines, or discontinuous renal venous flow. Associations with clinical characteristics and pr...
Background
Despite robust evidence and national guidance recommending cardiac rehabilitation (CR) for heart failure (HF), access remains poor, a situation magnified by COVID-19. The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) randomised controlled trial demonstrated the clinical and cost-effectiveness of a novel home-based CR self...
Background
For patients with heart failure, prescription of loop diuretics (LD) and of higher doses are associated with an adverse prognosis. We investigated LD dose trajectories and their associations with outcomes in patients with dilated cardiomyopathy (DCM).
Methods
Associations between outcomes and both furosemide-equivalent dose (FED) at enr...
Introduction: Rapid atrial fibrillation (AF) leads to heart failure (HF), but can also result from cardiac remodelling during HF. Atrioventricular junctional ablation (AVJA) cures rapid AF at the cost of permanent pacemaker dependency. We compared mortality in AF patients treated with AVJA to pharmacological therapy.
Methods: We performed data sear...
Introduction: Diabetes mellitus (DM) is common amongst patients with heart failure (HF) and associated with adverse outcomes. Historically this has been attributed to the association with atherosclerotic disease. We assessed the effect of DM on phenotype and outcomes in patients with non-ischaemic dilated cardiomyopathy (DCM).
Methods: Prospective...
Background:
Renin-angiotensin system (RAS) inhibitors - including angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) - slow the progression of mild or moderate chronic kidney disease. However, the results of some studies have suggested that the discontinuation of RAS inhibitors in patients with advanced chronic...
Background
For patients with heart failure, reduced left ventricular ejection fraction and iron deficiency, intravenous ferric carboxymaltose administration improves quality of life and exercise capacity in the short-term and reduces hospital admissions for heart failure up to 1 year. We aimed to evaluate the longer-term effects of intravenous ferr...
Background
Spironolactone is currently used in a large proportion of patients with heart failure and preserved ejection fraction (HFpEF), yet its effects on cardiac structure and function in a large population has not been well established.
Aims
To study the impact of spironolactone on key echocardiographic parameters in HFpEF.
Methods
Individual...
In summary, among patients at risk of developing heart failure enrolled in HOMAGE, spironolactone induced an early and mild eGFR decrease due to hemodynamic changes in the kidney, without evidence of tubular injury. After 1 month, changes in eGFR were similar between spironolactone and usual care.
Background and aims
Congestion is a key driver of morbidity and mortality in heart failure. Implanted haemodynamic monitoring devices might allow early identification and management of congestion. Here, we provide a state-of-the-art review of implanted haemodynamic monitoring devices for patients with heart failure, including a meta-analysis of ran...
Background:
Acute heart failure (AHF) can be a life-threatening medical condition. Delaying administration of intravenous furosemide (time-to-diuretics) has been postulated to increase mortality, but prior reports have been inconclusive.
Objective:
To evaluate the association between time-to-diuretics and mortality in the international REPORT-HF...
In addition to the diaphragm’s role as the primary respiratory muscle, it also plays an under-recognized role in cardiac function. It serves as a pump facilitating venous and lymph return, modulating left ventricular afterload hemodynamics and pericardial pressures, as well as regulating autonomic tone. Heart failure (HF) is associated with diaphra...
Aims:
Albuminuria is common in patients with heart failure and associated with worse outcomes. The underlying pathophysiological mechanism of albuminuria in heart failure is still incompletely understood. The association of clinical characteristics and biomarker profile with albuminuria in patients with heart failure with both reduced and preserve...
Aims
Insulin like growth factor binding protein 7 (IGFBP7) is a marker of senescence secretome and a novel biomarker in patients with heart failure (HF). We evaluated the prognostic value of IGFBP7 in patients with heart failure and examined associations to uncover potential new pathophysiological pathways related to increased plasma IGFBP7 concent...
Aims
In people at risk of heart failure (HF) enrolled in the Heart ‘OMics’ in AGEing (HOMAGE) trial, spironolactone reduced circulating markers of collagen synthesis, natriuretic peptides, and blood pressure and improved cardiac structure and function. In the present report, we explored factors associated with dyskalaemia.
Methods and results
The...
Background
Few data are available regarding changes in mitral regurgitation (MR) severity with guideline-recommended medical therapy (GRMT) in heart failure (HF). Our aim was to evaluate the evolution and impact of MR after GRMT in the Biology study to Tailored treatment in chronic heart failure (BIOSTAT-CHF).
Methods
A retrospective post-hoc anal...
Background: Acute myocarditis is an inflammatory condition that may herald the onset of dilated cardiomyopathy (DCM) or arrhythmogenic cardiomyopathy (ACM). We investigated the frequency and clinical consequences of DCM and ACM genetic variants in a population-based cohort of patients with acute myocarditis.
Methods: This was a population-based coh...
Aims:
Risk changes with the progression of disease and the impact of treatment. We developed a dynamic risk stratification Markov chain model using artificial intelligence in patients with chronic heart failure (CHF).
Methods and results:
We described the pattern of behaviour among 7496 consecutive patients assessed for suspected HF. The followi...
Background
A high proportion of patients undergoing catheter ablation (CA) for atrial fibrillation (AF) experience recurrence of arrhythmia. This meta-analysis aims to identify pre-ablation serum biomarker(s) associated with arrhythmia recurrence to improve patient selection before CA.
Methods
A systematic approach following PRISMA reporting guide...
Background
Dilated cardiomyopathy (DCM) is a final common manifestation of heterogenous etiologies. Adverse outcomes highlight the need for disease stratification beyond ejection fraction.
Objectives
The purpose of this study was to identify novel, reproducible subphenotypes of DCM using multiparametric data for improved patient stratification.
M...
Background
Pivotal randomized trials demonstrating efficacy, safety and good tolerance, of two new potassium binders (patiromer and sodium zirconium cyclosilicate) led to their recent approval. A major hurdle to the implementation of these potassium-binders is understanding how to integrate them safely and effectively into the long-term management...
Introduction
Patients with acutely decompensated heart failure (ADHF) are usually admitted to hospital for management. However, there is growing interest in delivering IV diuretic therapy at home, in the community or in hospital day-care units. The safety and effectiveness of out-patient based management (OPM) for ADHF has not been established. Acc...
Background/Introduction
Early detection of worsening congestion in heart failure (HF) patients can prompt timely interventions and potentially decrease hospital admissions. Accordingly, standard care recommendations include the monitoring of symptoms and daily weighing at home. However, most patients with worsening HF do not appear to weigh themsel...
Introduction
Despite evidence that cardiac rehabilitation (CR) and self-care are essential in managing heart failure, and strong national and international guidelines recommending their provision, referral and uptake remains low. Centre-based provision is a known barrier, and the need for flexible models of CR has become more pronounced in the rece...
Background
In the UK, approximately half of patients with heart failure and a reduced ejection fraction (HeFREF) are discharged from hospital on triple therapy (angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), beta-blockers (BB), and mineralocorticoid receptor antagonists (MRA). It is unknown what proportion o...
Background:
Procollagen type I C-terminal propeptide (PICP) and procollagen type III N-terminal propeptide (PIIINP) are markers reflecting collagen synthesis in cardiac fibrosis. However, they may be influenced by the presence of noncardiac comorbidities (e.g., ageing, obesity, renal impairment). Understanding the associations between markers of c...
Introduction:
Limited data exist regarding the prognostic relevance of changes in left atrial (LA) dimensions in patients with heart failure (HF). We assessed changes in LA dimension and their relation with outcomes after optimization of guideline-directed medical therapy (GDMT) in patients with worsening HF.
Methods and results:
LA diameter was...
Aims:
Synchronized diaphragmatic stimulation (SDS) modulates intrathoracic and intra-abdominal pressures with favourable effects on cardiac function for patients with a reduced left ventricular ejection fraction (LVEF) and heart failure (HFrEF). VisONE-HF is a first-in-patient, observational study assessing the feasibility and 1 year effects of a...
Abstract Patients with heart failure (HF) and coronary artery disease (CAD) have a high risk for cardiovascular (CV) events including HF hospitalization, stroke, myocardial infarction (MI) and sudden cardiac death (SCD). The present study evaluated associations of proteomic biomarkers with CV outcome in patients with CAD and HF with reduced ejectio...
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National Heart, Lung, and Blood Institute
Background
Many patients with heart failure who are considered for cardiac resynchronization therapy (CRT) have a history of (h/o) atrial fibrillation (AF) but there are doubts about the efficacy of CRT in pati...
Importance:
Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The role of TAVI in patients at lower risk is unclear.
Objective:
To determine whether TAVI is noninferior to surgery in patients at moderately increase...
Aims:
Chronic Heart Failure (CHF) is a systemic syndrome with a poor prognosis and a need for novel therapies. We investigated whether whole-blood transcriptomic profiling can provide new mechanistic insights into cardiovascular (CV) mortality in CHF.
Methods and results:
Transcriptome profiles were generated at baseline from 944 CHF patients fr...
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Average daily pressures before and during the COVID lockdown period. In the left-hand panel, only 40% of patients completed 12 months of monitoring prior to the COVID lockdown; many patients will have been censored between months 8 and 12. The right-hand panel shows pressures starting several months after trial inclus...
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are both common causes of breathlessness and often conspire to confound accurate diagnosis and optimal therapy. Risk factors (such as aging, smoking, and obesity) and clinical presentation (eg, cough and breathlessness on exertion) can be very similar, but the treatment and prognos...
Background:
Cardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm.
Objectives:
To identify patient-characteristics that predict the effect, specifically, of CRT-pacemakers (CRT-P) on all-cause mortality or the c...
Aims:
Clinical differences between women and men have been described in heart failure (HF). However, less is known about the underlying pathophysiological mechanisms. In this study, we compared multiple circulating biomarkers to gain better insights into differential HF pathophysiology between women and men.
Methods and results:
In 537 women and...
Remission of heart failure, defined by resolution of symptoms, normalization of left ventricular ejection fraction, and plasma concentrations of natriuretic peptides and by the ability to withdraw diuretic agents without recurrence of congestion is increasingly recognized among patients with dilated cardiomyopathy. Once remission has been achieved,...
