Effect of aliskiren on post-discharge outcomes among diabetic and non-diabetic patients hospitalized for heart failure: insights from the ASTRONAUT trial

Aims The objective of the Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT) was to determine whether aliskiren, a direct renin inhibitor, would improve post-discharge outcomes in patients with hospitalization for heart failure (HHF) with reduced ejection fraction. Pre-specified subgroup analyses suggested potential heterogeneity in post-discharge outcomes with aliskiren in patients with and without baseline diabetes mellitus (DM). Methods and results ASTRONAUT included 953 patients without DM (aliskiren 489; placebo 464) and 662 patients with DM (aliskiren 319; placebo 343) (as reported by study investigators). Study endpoints included the first occurrence of cardiovascular death or HHF within 6 and 12 months, all-cause death within 6 and 12 months, and change from baseline in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 1, 6, and 12 months. Data regarding risk of hyperkalaemia, renal impairment, and hypotension, and changes in additional serum biomarkers were collected. The effect of aliskiren on cardiovascular death or HHF within 6 months (primary endpoint) did not significantly differ by baseline DM status (P = 0.08 for interaction), but reached statistical significance at 12 months (non-DM: HR: 0.80, 95% CI: 0.64-0.99; DM: HR: 1.16, 95% CI: 0.91-1.47; P = 0.03 for interaction). Risk of 12-month all-cause death with aliskiren significantly differed by the presence of baseline DM (non-DM: HR: 0.69, 95% CI: 0.50-0.94; DM: HR: 1.64, 95% CI: 1.15-2.33; P < 0.01 for interaction). Among non-diabetics, aliskiren significantly reduced NT-proBNP through 6 months and plasma troponin I and aldosterone through 12 months, as compared to placebo. Among diabetic patients, aliskiren reduced plasma troponin I and aldosterone relative to placebo through 1 month only. There was a trend towards differing risk of post-baseline potassium ≥6 mmol/L with aliskiren by underlying DM status (non-DM: HR: 1.17, 95% CI: 0.71-1.93; DM: HR: 2.39, 95% CI: 1.30-4.42; P = 0.07 for interaction). Conclusion This pre-specified subgroup analysis from the ASTRONAUT trial generates the hypothesis that the addition of aliskiren to standard HHF therapy in non-diabetic patients is generally well-tolerated and improves post-discharge outcomes and biomarker profiles. In contrast, diabetic patients receiving aliskiren appear to have worse post-discharge outcomes. Future prospective investigations are needed to confirm potential benefits of renin inhibition in a large cohort of HHF patients without D

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Analysis and design of constant-frequency peak-current-controlled high-power-factor boost rectifier with slope compensation

This paper presents the analysis and the design of a peak-current-controlled high-power-factor boost rectifier, with slope compensation, operating at constant frequency. The input current shaping is achieved, with continuous inductor current mode, with no multiplier to generate a current reference. The resulting overall circuitry is very simple, in comparison with the average-current-controlled boost rectifier. Experimental results are presented, taken from a laboratory prototype rated at 370 W and operating at 67 kHz. The measured power factor was 0.99, with a input current THD equal to 5.6%, for an input voltage THD equal to 2.26%

A novel single-phase ZCS-PWM high power factor boost rectifier

This paper presents a novel single-phase high power factor PWM boost rectifier, featuring soft commutation of the active switches at zero-current (ZCS). It incorporates the most desirable properties of the conventional PWM and the soft-switching resonant techniques. The input current shaping is achieved with average current mode control, and continuous inductor current mode. This new PWM converter provides ZCS turn-on and turn-off of the active switches, and it is suitable for high power applications employing IGBTs. Principle of operation, theoretical analysis, a design example, and experimental results from a laboratory prototype rated at 1600 W with 400 Vdc output voltage are presented. The measured efficiency and power factor were 96.2% and 0.99 respectively, with an input current THD equal to 3.94%, for an input voltage THD equal to 3.8%, at rated load

Java applets para um software educacional distribuído em eletrônica de potência

Este artigo apresenta programas na forma de Java applets para um sistema de auxílio ao ensino multimídia de um curso em Eletrônica de Potência baseado na WWW (world wide web). Os programas foram desenvolvidos com o propósito de analisar os circuitos retificadores não-controlados (a diodos) e controlados (a tiristores), monofásicos e trifásicos, idealizados e em regime permanente, permitindo a simulação visual e interativa dos mesmos. Além disso, este artigo aborda o desenvolvimento e a utilização de Java applets para resolução de algumas equações de projetos orientados para aplicações destes retificadores. O principal objetivo destas Java applets propostas foi o de proporcionar maiores facilidades para os estudantes aumentarem e melhorarem o ritmo de aprendizado no curso de Eletrônica de Potência, enfatizando-se as análises das formas de onda e proporcionando condições para uma efetiva análise comparativa imediata (on-line) entre diferentes experiências desenvolvidas em laboratório, através da conexão TCP/IP padrão da Internet. Portanto, à partir da utilização das Java applets propostas, que estão inseridas em um sistema de auxílio ao ensino do curso de Eletrônica de Potência baseado na WWW, foi observado uma importante melhoria no aprendizado do conteúdo do curso. Conseqüentemente, a estrutura do curso tornou-se mais fluída, permitindo efetivamente um curso on-line através da WWW, motivando os alunos a aprender o conteúdo teórico, aplicando-o em projetos de estruturas retificadoras e nos seus deveres escolares.This paper introduces Java applet programs for a WWW (world wide web)-HTML (hypertext markup language)-based multimedia course in Power Electronics. The applet programs were developed with the purpose of providing an interactive visual simulation and analysis of idealized uncontrolled and controlled single-phase, and three-phase rectifiers. In addition, this paper discusses the development and utilization of Java applet programs to solve some design-oriented equations for rectifier applications. The major goal of these proposed Java applets was to provide more facilities for the students increase their pace in Power Electronics course, emphasizing waveforms analysis, and providing conditions for an on-line comparative analysis among different hands-on laboratory experiences, via a normal Internet TCP/IP connection. Therefore, using the proposed Java applets, which were embedded in a WWW-HTML-based course in Power Electronics, was observed an important improvement of the apprenticeship for the content of this course. Therefore, the course structure becomes fluid, allowing a true on-line course over the WWW, motivating students to learn its content, and apply it in some applications-oriented projects, and their home-works.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Modeling of pre-regulator boost ZCS interleaved operating in critical conduction mode and with high power factor

This paper presents a new pre-regulator boost operating in the boundary area between the continuous and discontinuous conduction modes of the boost inductor current, where the switches and boost diode performing zero-current commutations during its turn-off, eliminating the disadvantages related to the reverse recovery losses and electromagnetic interference problems of the boost diode when operating in the continuous conduction mode. Additionally, the interleaving technique is applied in the power cell, providing a significant input current ripple reduction. It should be noticed that the main objective of this paper is to present a complete modeling for the converter operating in the critical conduction mode, allowing an improved design procedure for interleaved techniques with high input power factor, a complete dynamic analysis of the structure, and the possibility of implementing digital control techniques in closed loop

Simulação em Tempo Real de Sistemas de Distribuição de Energia Elétrica Utilizando-se Estruturas com Descrição de Hardware em Software

Este artigo apresenta a utilização das linguagens de descrição de hardware VHDL (Very High Speed Integrated Circuit Description Language) e VHDL-AMS (VHDL analog and mixed-signal) para o desenvolvimento de uma nova Arquitetura de Simulação em Tempo Real e Controle (ASTR&C) para alimentadores elétricos de distribuição. A ASTR&C utiliza uma plataforma VHDL-AMS como interface gráfica do usuário (GUI) para desenvolver a simulação do sistema elétrico e a linguagem VHDL para o desenvolvimento do Sistema de Gerenciamento e Controle da rede de distribuição (DMS&C), através de um dispositivo FPGA (Field Programmable Gate Array). As linguagens VHDL e VHDL-AMS, juntamente com as informações do sistema elétrico, tornam possível a simulação em tempo real e controle de alimentadores elétricos de distribuição. O DMS&C desenvolvido está focado no gerenciamento do perfil de tensão do alimentador admitido como estudo de caso, realizado através do dispositivo FPGA, o qual dispõe como prioridade o controle do regulador de tensão do sistema de distribuição, com base na comutação de TAP do mesmo. Destaca-se como contribuição principal deste trabalho, a apresentação de uma nova ferramenta voltada à avaliação da qualidade da energia elétrica e ao melhoramento das ações de controle nos alimentadores de distribuição, utilizando-se as linguagens VHDL e VHDL-AMS

Three-phase tri-state buck-boost integrated inverter

This paper presents a three-phase integrated inverter suitable for stand-alone and/or grid-connected applications. The usage of the special features of the tri-state coupled with the special space vector modulation allows the inverter to present an attractive degree of freedom for the controllers' design, i.e. input and output can be controlled independently. Additionally all controllers are based on dq0 transformation, the system are described and interesting simulation results are available to confirm the proposal. Finally, this paper presents experimental evaluations of the inverter feeding a three-phase stand-alone load confirming the remarkable features of the decoupling control. © 2013 IEEE

Simulation Tools of DC-DC Converters for Power Electronics Education

This paper presents interactive simulation tools to support the enhancement of power electronics education considering DC to DC converters. These interactive tools make use of the benefits of Java language to provide a dynamic and interactive visualization of simulations in steady-state for idealized non-isolated DC to DC converters. Additionally, this paper discusses the features and the usage of the interactive educational tools to serve as a first design tool for the laboratory experiments in the power electronics courses. In this way, some results were confronted with a well-known simulator package and with experimental results in order to validate the developed interactive simulation tools