By William J. McKenna, William T. Abraham, David Feldman
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All patients enrolled were required to have a heart failure hospitalization (<6 months) attributable to DHF based on the presence of clinical and echocardiographic Doppler criteria. 3 cm. Importantly, fewer than 25% of patients met study diastolic criteria for DHF. 4%) reached the primary endpoint of allcause mortality or first heart failure hospitalization. 9%. 3% placebo vs. 055), results which were driven by a reduction in heart failure hospitalization (n ¼ 53 placebo vs. 033). Furthermore, clinical improvements in NYHA classification, lower hospitalization length of stay, greater 6 min walk distance and reductions of plasma N-terminal pro b-type natriuretic peptide (NT-proBNP) were observed among patients treated with perindopril .
The populations studied in the I-Preserve and AHeFT trials are clearly different on the basis of systolic function. However, I-Preserve enrolled older patients, predominantly NYHA class III patients, and 40% with prior heart failure hospitalization who were less frequently on standard heart failure therapy; arguably a higher-risk demographic . Enrolment based on depressed ejection fraction allowed disease-specific event reductions favoring BiDil treatment in AHeFT; perhaps, in addition to standard clinical criteria, the selection of cohorts with more severe grades of diastolic dysfunction would similarly assign disease-specific risk.
Circulation 2006; 113:1966–1973. 15 Nishikawa N, Yamamoto K, Sakata Y, et al. Differential activation of matrix metalloproteinases in heart failure with and without ventricular dilatation. Cardiovasc Res 2003; 57:766–774. 16 Martos R, Baugh J, Ledwidge M, et al. Diastolic heart failure: evidence of increased myocardial collagen turnover linked to diastolic dysfunction. Circulation 2007; 115:888–895. Serologic analysis of various components of the collagen turnover pathways were assessed in hypertensive patients and correlated with Doppler echocardiographic and clinical markers of DHF.
Current Opinion in Cardiology MAY 2009 by William J. McKenna, William T. Abraham, David Feldman