Browsing by Author "Fiuzat, Mona"

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    Heart Failure With Preserved Ejection Fraction Expert Panel Report: Current Controversies and Implications for Clinical Trials
    (JACC: Heart Failure, 2018-08-01) Parikh, Kishan S; Sharma, Kavita; Fiuzat, Mona; Surks, Howard K; George, Jyothis T; Honarpour, Narimon; Depre, Christopher; Desvigne-Nickens, Patrice; Nkulikiyinka, Richard; Lewis, Gregory D; Gomberg-Maitland, Mardi; O'Connor, Christopher M; Stockbridge, Norman; Califf, Robert M; Konstam, Marvin A; Januzzi, James L; Solomon, Scott D; Borlaug, Barry A; Shah, Sanjiv J; Redfield, Margaret M; Felker, G Michael
    © 2018 American College of Cardiology Foundation The number of persons with heart failure has continued to rise over the last several years. Approximately one-half of those living with heart failure have heart failure with preserved ejection fraction, but critical unsolved questions remain across the spectrum of basic, translational, clinical, and population research in heart failure with preserved ejection fraction. In this study, the authors summarize existing knowledge, persistent controversies, and gaps in evidence with regard to the understanding of heart failure with preserved ejection fraction. Our analysis is based on an expert panel discussion “Think Tank” meeting that included representatives from academia, the National Institutes of Health, the U.S. Food and Drug Administration, the Centers for Medicare & Medicaid Services, and industry.
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    Ischaemia change with revascularisation versus medical therapy in reduced ejection fraction.
    (Open Heart, 2015) Mentz, Robert J; Fiuzat, Mona; Shaw, Linda K; Farzaneh-Far, Afshin; M O'Connor, Christopher; Borges-Neto, Salvador
    OBJECTIVE: Nuclear imaging data demonstrate that revascularisation leads to favourable effects on ischaemia burden and improved outcomes compared with medical therapy (MT). In patients with heart failure (HF), the effects of MT versus revascularisation on ischaemia change and its independent prognostic significance requires investigation. METHODS: From the Duke Databank, we performed a retrospective analysis of 278 consecutive patients with coronary artery disease (CAD) and ejection fraction (EF) ≤40%, who underwent 2 serial myocardial perfusion scans between 1993 and 2009. Ischaemia change was calculated for patients undergoing MT alone, or revascularisation. Cox proportional hazards regression modelling was used to identify factors associated with death/myocardial infarction (MI). RESULTS: The magnitude of ischeamia reduction was greater with revascularisation than with MT alone (median change of -6% vs 0%, p<0.001). With revascularisation, more patients experienced ≥5% ischaemia reduction compared with MT (52% vs 25%, p<0.01) and a similar percentage experienced ≥5% ischaemia worsening (13% vs 18%, p=0.37). After risk adjustment, ≥5% ischaemia worsening was associated with decreased death/MI (HR=0.58; 95% CI 0.36 to 0.96). CONCLUSIONS: In patients with HF with CAD, revascularisation improves long-term ischaemia burden compared with MT. Ischaemia worsening on nuclear imaging was associated with reduced risk of death/MI, potentially related to development of ischaemic viable myocardium as opposed to scar tissue.
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    Torsemide versus furosemide in heart failure patients: insights from Duke University Hospital.
    (J Cardiovasc Pharmacol, 2015-05) Mentz, Robert J; Buggey, Jonathan; Fiuzat, Mona; Ersbøll, Mads K; Schulte, Phillip J; DeVore, Adam D; Eisenstein, Eric L; Anstrom, Kevin J; OʼConnor, Christopher M; Velazquez, Eric J
    Furosemide has historically been the primary loop diuretic in heart failure patients despite data suggesting potential advantages with torsemide. We used the Duke Echocardiography Lab Database to investigate patients admitted with heart failure to Duke Hospital from 2000 to 2010 who were discharged on either torsemide or furosemide. We described baseline characteristics based on discharge diuretic and assessed the relationship with all-cause mortality through 5 years. Of 4580 patients, 86% (n = 3955) received furosemide and 14% (n = 625) received torsemide. Patients receiving torsemide were more likely to be female and had more comorbidities compared with furosemide-treated patients. Survival was worse in torsemide-treated patients [5-year Kaplan-Meier estimated survival of 41.4% (95% CI: 36.7-46.0) vs. 51.5% (95% CI: 49.8-53.1)]. After risk adjustment, torsemide use was no longer associated with increased mortality (hazard ratio 1.16; 95% CI: 0.98-1.38; P = 0.0864). Prospective trials are needed to investigate the effect of torsemide versus furosemide because of the potential for residual confounding.