V. Le - Academia.edu (original) (raw)

Papers by V. Le

$Research paper thumbnail of Predictors of primary prevention implantable cardioverter‐defibrillator use in heart failure with reduced ejection fraction: impact of the predicted risk of sudden cardiac death and all‐cause mortality$

European Journal of Heart Failure

American Heart Journal, Apr 1, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Heart Rhythm, Aug 1, 2021

European Heart Journal, Nov 21, 2019

Aims While data from randomized trials suggest a declining incidence of sudden cardiac death (SCD... more Aims While data from randomized trials suggest a declining incidence of sudden cardiac death (SCD) among heart failure patients, the extent to which such a trend is present among patients with cardiac resynchronization therapy (CRT) has not been evaluated. We therefore assessed changes in SCD incidence, and associated factors, in CRT recipients over the last 20 years.

Heart Failure Reviews, Feb 7, 2022

Introduction: Even though advanced chronic kidney disease (CKD) frequently aggravates heart failu... more Introduction: Even though advanced chronic kidney disease (CKD) frequently aggravates heart failure (HF), these patients have traditionally been excluded from the majority of HF trials. We aim to provide updated estimates of the representation of patients with advanced CKD and the provision of indices of baseline renal function in HF randomized trials in general and landmark HF trials in particular. Methods: Updated systematic review of MEDLINE (via PubMED) from inception to 31 st December 2019 looking for randomized controlled trials on chronic HF published in the top three medical and cardiology journals and providing data on all-cause or cardiovascular mortality. Analyses conducted to assess the representativeness of advanced CKD patients from HF trials over time and the reporting of baseline renal function. Results: 184 randomized trials with 320,906 participants included in this analysis. A total of 103 trials (60%) had exclusion criteria related with baseline renal function, which persisted over time-seen in 55.1% (27 of 49) of trials published from inception to 2000, 53.4% (39 of 73) in those published from 2001 to 2010 and 61.3% (38 of 62) of trials from 2011 (p=0.64). However, criteria for exclusion based on renal function have gradually become less restrictive. The more recent trials were more likely to provide indices of baseline renal function (28.6% from inception to 2000 versus 53.4% from 2001 to 2010 and 82.3% from 2011, p<0.001). Similar findings were observed when restricting these analyses to landmark HF randomized trials. Conclusions: Patients with severe renal impairment remain underrepresented from HF trials even in modern days, although criteria have become less restrictive over time and the quality of renal function monitoring has gradually improved. Studies specifically designed

Journal of the American Heart Association, Mar 3, 2020

Journal of the American College of Cardiology, Apr 1, 2017

C ardiac resynchronization therapy (CRT) in patients with heart failure (HF) with reduced ejectio... more C ardiac resynchronization therapy (CRT) in patients with heart failure (HF) with reduced ejection fraction (HFREF) with prolonged QRS intervals has resulted in marked durable benefit (1,2). Improvements in ejection fraction (EF) are associated with a reduction in mortality and appropriate shocks, and occur more often with CRT (3). The debate has been whether patients who meet criteria for CRT also need an implantable cardioverterdefibrillator (ICD) or if a CRT pacemaker (CRT-P) is adequate therapy. This debate has been heightened by the DANISH (Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality) trial in nonischemic cardiomyopathy (NICM), in which a CRT defibrillator (CRT-D) was not superior to CRT-P (hazard ratio [HR]: 0.91; p ¼ 0.59) (4). In this issue of the Journal, Barra et al. (5) compared CRT-Ds versus CRT-Ps in a large registry of 5,307 patients in Sweden, the United Kingdom, and France to try to ascertain if the benefit varied in patients with ischemic cardiomyopathy (ICM) and NICM (5). They found no additional benefit with the addition of an ICD in NICM patients, whereas ischemic patients did have benefit.

JACC: Clinical Electrophysiology, Aug 1, 2022

Journal of Heart and Lung Transplantation, Apr 1, 2020

Circulation, Nov 14, 2017

Introduction: Gender differences in outcomes after cardiac resynchronization therapy defibrillato... more Introduction: Gender differences in outcomes after cardiac resynchronization therapy defibrillators (CRT-Ds) have been described in clinical trials, but the influence of gender on CRT-D outcomes in...

Circulation, Nov 11, 2016

Introduction: Guidelines for care in Stage D advanced heart failure (HF) include discussions of p... more Introduction: Guidelines for care in Stage D advanced heart failure (HF) include discussions of prognosis, advance care planning, and deactivation of the implantable defibrillator, along with sympt...

Circulation, Nov 10, 2015

Introduction: Heart failure (HF) management guided by implantable hemodynamic monitoring systems ... more Introduction: Heart failure (HF) management guided by implantable hemodynamic monitoring systems reduces overall hospitalizations in NYHA Class III patients with a previous HF hospitalization. Hypothesis: Hemodynamic monitoring may reduce hospitalizations with accompanying low output status, as well as those resulting primarily from congestion. Methods: The CHAMPION Trial enrolled 550 NYHA Class III patients and randomly assigned them to a treatment group who were managed by hemodynamic monitoring using a permanently implanted pulmonary artery (PA) MEMS-based sensor or to a control group who were managed by standard clinical assessments (MEMS-sensors were implanted, but the uploaded pressures were not available to investigators). The primary endpoints were the comparison of HF hospitalization rates between the treatment and control groups assessed after 6 and 17 months of randomized follow-up. The blinded Clinical Events Committee prospectively adjudicated each HF hospitalization based on documented clinical hemodynamic characteristics: (1) well perfused/congested, (2) poorly perfused/congested or (3) poorly perfused without congestion. Group 3 events were rare and not different between groups. Results: Patients in the treatment group had fewer hospitalizations overall (182 hospitalizations, rate 0.46/patient/year treatment vs. 279 hospitalizations, rate 0.68/patient/year control; (HR 0.67 CI (0.55-0.80), p&lt;0.001). The majority of hospitalizations fit the perfused/congested profile, and were decreased in the treatment group compared with control (138 vs. 224 hospitalizations, HR 0.62, CI 0.50-0.77, p&lt;0.001). Poorly perfused/congested events were similarly reduced in the treatment group compared with control (29 vs. 44 hospitalizations, HR 0.63, CI 0.39-1.01, p=0.05). Conclusions: Compared to standard clinical assessments, HF managed with implantable hemodynamic monitoring results in significant reductions in heart failure hospitalization regardless of perfusion status.

*Writing committee members are required to recuse themselves from voting on sections to which the... more *Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.†ACCF/AHA representative.‡ACCF/AHA Task Force on Practice Guidelines liaison.§American College of Physicians representative.‖American College of Chest Physicians representative.¶International Society for Heart and Lung Transplantation representative.#ACCF/AHA Task Force on Performance Measures liaison.**American Academy of Family Physicians representative.††Heart Rhythm Society representative.‡‡Former Task Force member during this writing effort.Full-text guideline available at: http://circ.ahajournals.org/lookup/doi/10.1161/CIR.0b013e31829e8776.This document was approved by the American College of Cardiology Foundation Board of Trustees and the American Heart Association Science Advisory and Coordinating Committee in May 2013.

Circulation, Nov 23, 2010

Background: Resting heart rate (RHR) declines with exercise training. Possible mechanisms include... more Background: Resting heart rate (RHR) declines with exercise training. Possible mechanisms include: 1) increased parasympathetic tone, 2) decreased responsiveness to beta-adrenergic stimulation, 3) decreased intrinsic heart rate, which is the heart rate independent of any nervous or hormonal influences, and 4) a combination of these factors. Objectives: To determine whether an increase in resting parasympathetic tone or a decrease in response to beta-adrenergic stimulation contribute to the decrease in RHR with exercise training. Methods: 51 rigorously screened sedentary healthy subjects aged 18–32 (n= 20, mean age 26, 11 female) or 65–80 (n= 31, mean age 69, 16 female) were tested before and after 6 months of supervised endurance exercise training. Heart rate response to parasympathetic withdrawal was assessed using atropine (0.02mg/kg up to 2mg). During continued parasympathetic blockade, beta-adrenergic responsiveness was assessed using isoproterenol (14ng/kg/min x 14min). Results: Training increased VO2 max by 17% (28.7 to 33.6 ml/kg/min, p Conclusions: In healthy subjects, this study did not find evidence that an increase in parasympathetic tone or a decrease in responsiveness to beta-adrenergic stimulation accounts for the reduction in resting heart rate with exercise training, and suggests that a decline in heart rate with training is most likely due to a decrease in the intrinsic heart rate.

The American Journal of Medicine, Oct 1, 2020

Europace, Mar 10, 2020

Heart failure (HF) is associated with an increased risk of sudden cardiac death (SCD). This study... more Heart failure (HF) is associated with an increased risk of sudden cardiac death (SCD). This study sought to demonstrate the incidence of SCD within a multicentre Japanese registry of HF patients hospitalized for acute decompensation, and externally validate the Seattle Proportional Risk Model (SPRM).

Asaio Journal, Oct 11, 2019

Strokes remain a leading cause of morbidity and mortality in patients with ventricular assist dev... more Strokes remain a leading cause of morbidity and mortality in patients with ventricular assist devices (VADs). Varying study populations, event definitions, and reporting methods make direct comparison of neurologic event risk across clinical trials and registries challenging. We aim to highlight important differences among major VAD studies and standardize rates of neurologic events to facilitate a comprehensive and objective comparison. We systematically identified and analyzed key clinical trials and registries evaluating the HeartMate II (HMII), HeartMate 3 (HM3), and HVAD devices. Reported neurologic events were nonexclusively categorized into ischemic stroke, hemorrhagic stroke, disabling stroke, fatal stroke, and other neurologic events per the studies' definitions. Event rates were standardized to events per patient-year (EPPY) and freedom from event formats. Seven key clinical trials and registries were included in our analysis. There is significant variation and overlap in neurologic event rates for the three VAD platforms across clinical trials (all neurologic events [EPPY]: HM3 0.17-0.21; HMII 0.19-0.26; HVAD 0.16-0.28). None performs consistently better for all types of neurologic events. Furthermore, stroke rates among VAD trials correlated with baseline stroke risk factors including ischemic etiology, history of atrial fibrillation, and history of prior stroke.

Journal of the American College of Cardiology, May 1, 2021

European Journal of Heart Failure, Apr 5, 2021

The risk of sudden cardiac death (SCD) has long been known to by dynamic. For example, Solomon an... more The risk of sudden cardiac death (SCD) has long been known to by dynamic. For example, Solomon and colleagues demonstrated that the months after a myocardial infarction represents a transient high-risk period where the absolute rate of SCD is acutely elevated before declining to a basal and lower rate.1 Likewise, in patients with implantable cardioverter-defibrillators (ICDs), the observed distribution of ICD therapies is non-random, with clear clustering of ventricular arrhythmias.2 The reality of this dynamic SCD risk is buttressed against the typically cross-sectional nature in which we deploy risk assessment in the care of patients. Missing, therefore, is a risk assessment approach that flexibly captures dynamic changes in SCD risk over the course of a patient’s lifetime. Such a strategy could have significant implications for prevention of SCD events and, possibly, maximization of ICD benefit. In this issue of the Journal, Rohde and colleagues sought to identify dynamic risk factors for SCD in patients with systolic heart failure (HF).3 The cohort included 8399 patients from the PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial,4 a randomized controlled comparison of sacubitril/valsartan and enalapril in subjects with chronic, systolic HF and left ventricular ejection fraction (LVEF) ≤40%. Leveraging pre-specified serial assessment during the trial, the authors employed a multivariable model of time-updated markers to identify dynamic predictors of SCD risk. To assess the relationship between trajectories of clinical and serological markers with SCD risk, they performed a ‘look-back’ analysis, working retrospectively from the time of death. A third analysis involved a machine learning algorithm [classification and regression tree (CART) analysis] to identify dynamic predictors of risk. Cognizant of the relevance of competing risk, the authors used logistic regression models