Download PDF by William J. McKenna, William T. Abraham, David Feldman: Current Opinion in Cardiology MAY 2009

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 [46].

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 [45]. 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.

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Current Opinion in Cardiology MAY 2009 by William J. McKenna, William T. Abraham, David Feldman


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