Pathophysiology of heart failure and frailty: a common inflammatory origin?

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136680/1/acel12581_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136680/2/acel12581.pd

Use of the Palliative Performance Scale to estimate survival among home hospice patients with heart failure

AimsEstimating survival is challenging in the terminal phase of advanced heart failure. Patients, families, and health‐care organizations would benefit from more reliable prognostic tools. The Palliative Performance Scale Version 2 (PPSv2) is a reliable and validated tool used to measure functional performance; higher scores indicate higher functionality. It has been widely used to estimate survival in patients with cancer but rarely used in patients with heart failure. The aim of this study was to identify prognostic cut‐points of the PPSv2 for predicting survival among patients with heart failure receiving home hospice care.Methods and resultsThis retrospective cohort study included 1114 adult patients with a primary diagnosis of heart failure from a not‐for‐profit hospice agency between January 2013 and May 2017. The primary outcome was survival time. A Cox proportional‐hazards model and sensitivity analyses were used to examine the association between PPSv2 scores and survival time, controlling for demographic and clinical variables. Receiver operating characteristic curves were plotted to quantify the diagnostic performance of PPSv2 scores by survival time. Lower PPSv2 scores on admission to hospice were associated with decreased median (interquartile range, IQR) survival time [PPSv2 10 = 2 IQR: 1–5 days; PPSv2 20 = 3 IQR: 2–8 days] IQR: 55–207. The discrimination of the PPSv2 at baseline for predicting death was highest at 7 days [area under the curve (AUC) = 0.802], followed by an AUC of 0.774 at 14 days, an AUC of 0.736 at 30 days, and an AUC of 0.705 at 90 days.ConclusionsThe PPSv2 tool can be used by health‐care providers for prognostication of hospice‐enrolled patients with heart failure who are at high risk of near‐term death. It has the greatest utility in patients who have the most functional impairment.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148390/1/ehf212398_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148390/2/ehf212398.pd

Treatment of Heart Failure with Preserved Ejection Fraction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90240/1/phco.31.3.312.pd

Tidally-Triggered Star Formation in Close Pairs of Galaxies

We analyze new optical spectra of a sample of 502 galaxies in close pairs and n-tuples, separated by <= 50/h kpc. We extracted the sample objectively from the CfA2 redshift survey, without regard to the surroundings of the tight systems. We probe the relationship between star formation and the dynamics of the systems of galaxies. The equivalent widths of H\alpha (EW(H\alpha) and other emission lines anti-correlate strongly with pair spatial separation (\Delta D) and velocity separation. We use the measured EW(H\alpha) and the starburst models of Leitherer et al. to estimate the time since the most recent burst of star for- mation began for each galaxy. In the absence of a large contribution from an old stellar population to the continuum around H\alpha, the observed \Delta D -- EW(H\alpha) correlation signifies that starbursts with larger separations on the sky are, on average, older. By matching the dynamical timescale to the burst timescale, we show that the data support a simple picture in which a close pass initiates a starburst; EW(H\alpha) decreases with time as the pair separation increases, accounting for the anti-correlation. This picture leads to a method for measuring the duration and the initial mass function of interaction-induced starbursts: our data are compatible with the starburst and orbit models in many respects, as long as the starburst lasts longer than \sim10^8 years and the delay between the close pass and the initiation of the starburst is less than a few \times 10^7 years. If there is no large contribution from an old stellar population to the continuum around H\alpha the Miller-Scalo and cutoff (M <= 30 M_\sun) Salpeter initial mass functions fit the data much better than a standard Salpeter IMF. (Abridged.)Comment: 43 pages, 22 figures, to appear in the ApJ; we correct an error which had minor effects on numerical values in the pape

Transcatheter interatrial shunt device for the treatment of heart failure with preserved ejection fraction (REDUCE LAP-HF I [Reduce Elevated Left Atrial Pressure in Patients With Heart Failure]): A phase 2, randomized, sham-controlled trial

Background -In non-randomized, open-label studies, a transcatheter interatrial shunt device (IASD, Corvia Medical) was associated with lower pulmonary capillary wedge pressure (PCWP), less symptoms, and greater quality of life and exercise capacity in patients with heart failure (HF) and mid-range or preserved ejection fraction (EF ≥ 40%). We conducted the first randomized, sham-controlled trial to evaluate the IASD in HF with EF ≥ 40%. Methods -REDUCE LAP-HF I was a phase 2, randomized, parallel-group, blinded multicenter trial in patients with New York Heart Association (NYHA) class III or ambulatory class IV HF, EF ≥ 40%, exercise PCWP ≥ 25 mmHg, and PCWP-right atrial pressure gradient ≥ 5 mmHg. Participants were randomized (1:1) to the IASD vs. a sham procedure (femoral venous access with intracardiac echocardiography but no IASD placement). The participants and investigators assessing the participants during follow-up were blinded to treatment assignment. The primary effectiveness endpoint was exercise PCWP at 1 month. The primary safety endpoint was major adverse cardiac, cerebrovascular, and renal events (MACCRE) at 1 month. PCWP during exercise was compared between treatment groups using a mixed effects repeated measures model analysis of covariance that included data from all available stages of exercise. Results -A total of 94 patients were enrolled, of which n=44 met inclusion/exclusion criteria and were randomized to the IASD (n=22) and control (n=22) groups. Mean age was 70±9 years and 50% were female. At 1 month, the IASD resulted in a greater reduction in PCWP compared to sham-control (P=0.028 accounting for all stages of exercise). Peak PCWP decreased by 3.5±6.4 mmHg in the treatment group vs. 0.5±5.0 mmHg in the control group (P=0.14). There were no peri-procedural or 1-month MACCRE in the IASD group and 1 event (worsening renal function) in the control group (P=1.0). Conclusions -In patients with HF and EF ≥ 40%, IASD treatment reduces PCWP during exercise. Whether this mechanistic effect will translate into sustained improvements in symptoms and outcomes requires further evaluation. Clinical Trial Registration -URL: http://clinicaltrials.gov. Unique identifier: NCT02600234

Resampling methods for parameter-free and robust feature selection with mutual information

Combining the mutual information criterion with a forward feature selection strategy offers a good trade-off between optimality of the selected feature subset and computation time. However, it requires to set the parameter(s) of the mutual information estimator and to determine when to halt the forward procedure. These two choices are difficult to make because, as the dimensionality of the subset increases, the estimation of the mutual information becomes less and less reliable. This paper proposes to use resampling methods, a K-fold cross-validation and the permutation test, to address both issues. The resampling methods bring information about the variance of the estimator, information which can then be used to automatically set the parameter and to calculate a threshold to stop the forward procedure. The procedure is illustrated on a synthetic dataset as well as on real-world examples

Resolving the Radio Source Background: Deeper Understanding Through Confusion

We used the Karl G. Jansky Very Large Array (VLA) to image one primary beam area at 3 GHz with 8 arcsec FWHM resolution and 1.0 microJy/beam rms noise near the pointing center. The P(D) distribution from the central 10 arcmin of this confusion-limited image constrains the count of discrete sources in the 1 < S(microJy/beam) < 10 range. At this level the brightness-weighted differential count S^2 n(S) is converging rapidly, as predicted by evolutionary models in which the faintest radio sources are star-forming galaxies; and ~96$% of the background originating in galaxies has been resolved into discrete sources. About 63% of the radio background is produced by AGNs, and the remaining 37% comes from star-forming galaxies that obey the far-infrared (FIR) / radio correlation and account for most of the FIR background at lambda = 160 microns. Our new data confirm that radio sources powered by AGNs and star formation evolve at about the same rate, a result consistent with AGN feedback and the rough correlation of black hole and bulge stellar masses. The confusion at centimeter wavelengths is low enough that neither the planned SKA nor its pathfinder ASKAP EMU survey should be confusion limited, and the ultimate source detection limit imposed by "natural" confusion is < 0.01 microJy at 1.4 GHz. If discrete sources dominate the bright extragalactic background reported by ARCADE2 at 3.3 GHz, they cannot be located in or near galaxies and most are < 0.03 microJy at 1.4 GHz.Comment: 28 pages including 16 figures. ApJ accepted for publicatio

Submaximal Oxygen Uptake Kinetics, Functional Mobility, and Physical Activity in Older Adults with Heart Failure and Reduced Ejection Fraction

Background: Submaximal oxygen uptake measures are more feasible and may better predict clinical cardiac outcomes than maximal tests in older adults with heart failure (HF). We examined relationships between maximal oxygen uptake, submaximal oxygen kinetics, functional mobility, and physical activity in older adults with HF and reduced ejection fraction. Methods: Older adults with HF and reduced ejection fraction (n = 25, age 75 ± 7 years) were compared to 25 healthy age- and gender-matched controls. Assessments included a maximal treadmill test for peak oxygen uptake (VO2peak), oxygen uptake kinetics at onset of and on recovery from a submaximal treadmill test, functional mobility testing [Get Up and Go (GUG), Comfortable Gait Speed (CGS), Unipedal Stance (US)], and self-reported physical activity (PA). Results: Compared to controls, HF had worse performance on GUG, CGS, and US, greater delays in submaximal oxygen uptake kinetics, and lower PA. In controls, VO2peak was more strongly associated with functional mobility and PA than submaximal oxygen uptake kinetics. In HF patients, submaximal oxygen uptake kinetics were similarly associated with GUG and CGS as VO2peak, but weakly associated with PA. Conclusions: Based on their mobility performance, older HF patients with reduced ejection fraction are at risk for adverse functional outcomes. In this population, submaximal oxygen uptake measures may be equivalent to VO2 peak in predicting functional mobility, and in addition to being more feasible, may provide better insight into how aerobic function relates to mobility in older adults with HF