Research Spotlight

Rahimi, G., Tecson, K.M., Elsaid, O. and McCullough, P.A. (2020). “Role of Ischemic Heart Disease in Major Adverse Renal and Cardiac Events Among Individuals with Heart Failure with Preserved Ejection Fraction (From the TOPCAT Trial).” Am J Cardiol Dec 3;S0002-9149(20)31296-0. [Epub ahead of print.].

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Despite improvements in the prognosis of patients with heart failure with reduced ejection fraction (HFrEF), established therapy for heart failure patients with preserved ejection fraction (HFpEF) is lacking. Additionally, ischemic heart disease adversely impacts the clinical course of HFrEF patients; however, its role in HFpEF is not fully understood. We conducted a post hoc analysis of propensity score matched patients from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial to compare HFpEF patients with versus without myocardial ischemia in terms of major adverse renal and/or cardiac events (MARCE). Of 3445 participants, the prevalence of ischemia was 59%. For this analysis, we included 1747 ischemic patients and 1207 propensity matched non-ischemic patients. Ischemia was associated with a 20% increased risk (HR=1.20, 95% CI=1.042-1.382, p-value=0.0112) of MARCE in adjusted analyses. Other important predictors of MARCE were diabetes (HR=1.60, 95% CI=1.38-1.87, p <0.0001), dyslipidemia (HR=1.30, 95% CI=1.10-1.52, p=0.001) and smoking (HR=1.33, 95% CI=1.04-1.69, p= 0.0197). Revascularization was not significantly associated with MARCE in the subgroup of ischemic HFpEF patients. Future work is warranted to develop tailored interventions for patients with both HFpEF and ischemic heart disease to mitigate the risk of MARCE .

Palazzuoli, A., Mancone, M., De Ferrari, G.M., Forleo, G., Secco, G.G., Ruocco, G.M., D’Ascenzo, F., Monticone, S., Paggi, A., Vicenzi, M., Palazzo, A.G., Landolina, M., Taravelli, E., Tavazzi, G., Blasi, F., Infusino, F., Fedele, F., De Rosa, F.G., Emmett, M., Schussler, J.M., Tecson, K.M. and McCullough, P.A. (2020). “Antecedent Administration of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Antagonists and Survival After Hospitalization for COVID-19 Syndrome.” J Am Heart Assoc 9(22): e017364.

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Antecedent Administration of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Antagonists and Survival After Hospitalization for COVID-19 Syndrome.

Elsaid, O., McCullough, P.A., Tecson, K.M., Williams, R.S. and Yoon, A. (2020). “Ventricular Fibrillation Storm in Coronavirus 2019.” Am J Cardiol 135: 177-180.

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Cardiac arrhythmia is a known manifestation of novel coronavirus 2019 (COVID-19) infection. Herein, we describe the clinical course of an otherwise healthy patient who experienced persistent ventricular tachycardia and fibrillation which is believed to be directly related to inflammation, as opposed to acute myocardial injury or medications that can prolong the QT interval.

McCullough, P.A. (2020). “Favipiravir and the Need for Early Ambulatory Treatment of SARS-CoV-2 Infection (COVID-19).” Antimicrob Agents Chemother 64(12).

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It is becoming increasingly clear that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), like most human viral infections, will require multiple drugs in combination to treat COVID-19 illness. In this issue of the Journal, Doi and colleagues describe successful treatment of patients with early COVID-19 with favipiravir, an oral polymerase inhibitor, to rapidly and substantially clear SARS-CoV-2 from nasal secretions irrespective if it was started relatively early or later within the first week of infection. These data support the concept that favipiravir could be paired with at least one more off-target antiviral agent (doxycycline, azithromycin, or ivermectin) followed by corticosteroids and antithrombotics to prevent COVID-19 hospitalization and death in those over age 50 and/or those with one or more comorbidities. Clinical trials and advanced practice should immediately pivot to combination/sequential drug therapy for ambulatory COVID-19 illness.

Barker, C.M., Cork, D.P., McCullough, P.A., Mehta, H.S., Houten, J.V., Gunnarsson, C., Mollenkopf, S. and Verta, P. (2020). “Healthcare utilization in clinically significant tricuspid regurgitation patients with and without heart failure.” J Comp Eff Res Nov 11. [Epub ahead of print.].

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Aim: This study evaluated how the presence of right-sided heart disease (RSHD), other valve disease (OVD) and heart failure (HF) impacts healthcare utilization in patients with tricuspid valve disease (tricuspid regurgitation [TR]). Materials & methods: Of the 33,686 patients with TR: 6618 (19.6%) had TR-only; 8952 (26.6%) had TR with HF; 12,367 (36.7%) had TR with OVD but no HF; and 5749 (17.1%) had TR with RSHD only. Results: The presence of RSHD, OVD or HF in patients with TR was independently associated with increased annualized hospitalizations, hospital days and costs relative to patients with TR alone. Conclusion: All three co-morbidities were associated with increased healthcare utilization, with HF showing the greatest impact across all measures.