Clinical trials update from the American College of Cardiology 2007: ALPHA, EVEREST, FUSION II, VALIDD, PARR‐2, REMODEL, SPICE, COURAGE, COACH, REMADHE, pro‐BNP for the evaluation of dyspnoea and THIS‐diet

Abstract

This article provides information and a commentary on trials relevant to the pathophysiology, prevention and treatment of heart failure, presented at the American College of Cardiology meeting in March 2007. Unpublished reports should be considered as preliminary data, as analyses may change in the final publication.The ALPHA study suggested that patients with heart failure (HF) due to idiopathic dilated cardiomyopathy who have a negative T-wave alternans test have a good prognosis and are unlikely to benefit from ICD therapy. EVEREST provides some evidence of short-term symptom benefit of tolvaptan in patients with acute decompensated HF but no clinically important long-term benefit. FUSION II failed to show a benefit of nesiritide in patients with chronic decompensated HF. Reducing blood pressure in hypertensive patients improved diastolic dysfunction in VALIDD. Eplerenone did not improve left ventricular remodelling in mild to moderate chronic HF. Selecting HF patients for revascularisation using FDG-PET imaging did not significantly improve outcome. Crataegus extract added to standard HF therapy did not reduce morbidity or mortality in SPICE. The COURAGE study, conducted in patients without HF or major cardiac dysfunction, showed that PCI did not reduce cardiac morbidity or mortality and can be safely deferred in patients with stable coronary disease on optimal medical therapy. The COACH study failed to show that HF nurse-intervention could reduce hospitalisations but did show trends to lower mortality, especially amongst patients with reduced ejection fraction; however, the smaller REMADHE study suggested striking benefits on morbidity and mortality. A large study of BNP provided additional information on its ability to distinguish cardiac and pulmonary breathlessness. The importance of dietary intervention in post-MI patients was highlighted by the findings of THIS-diet study.

Tele‐guidance of chronic heart failure patients enhances knowledge about the disease. A multi‐centre, randomised controlled study

“…The latter finding is in line with almost all previous studies of the effects of intensive followup by structured telephone support or telemonitoring which did not show reductions in all-cause admissions [13,22,23]. With the proven effects of intensive follow-up on survival and quality of life however, the absence of more hospitalisations or higher mortality in patients who are guided by teletechnology is an encouraging finding.…”

Clinico-Angiographic Profile and Prevalence of Restenosis in Patients Undergoing Percutaneous Transluminal Coronary Angioplasty to Left Main Coronary Artery: An Observational Cohort Study

“…A total of 17 patients were enrolled in the study according to the inclusion and exclusion criteria. According to the INTERHEART study [8], the median age for the presentation of CAD in the South Asian population is 53 years which was consistent with our study but earlier than the western population as feature in COURAGE trial (62 years) [9]. In contrary to the Beig et al study [10], CAD was presented earlier in female (mean age 50.25 ± 11.44) compared to men (mean age 55.00 ± 9.46) in our study.…”

Natriuretic Peptides: Their Structures, Receptors, Physiologic Functions and Therapeutic Applications

“…The second study involving about 900 patients, called FUSION II, was conducted to determine the safety and efficacy of outpatient administration of nesiritide to patients with heart failure. Preliminary analysis indicates that nesiritide did not induce renal complications or increase patient mortality (Cleland et al 2007). Finally, there is the ASCEND HF trial (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure).…”