Effect of nesiritide in patients with acute decompensated heart failure

Background Nesiritide is approved in the United States for early relief of dyspnea in patients with acute heart failure. Previous meta-analyses have raised questions regarding renal toxicity and the mortality associated with this agent. Methods We randomly assigned 7141 patients who were hospitalized with acute heart failure to receive either nesiritide or placebo for 24 to 168 hours in addition to standard care. Coprimary end points were the change in dyspnea at 6 and 24 hours, as measured on a 7-point Likert scale, and the composite end point of rehospitalization for heart failure or death within 30 days. Results Patients randomly assigned to nesiritide, as compared with those assigned to placebo, more frequently reported markedly or moderately improved dyspnea at 6 hours (44.5% vs. 42.1%, P = 0.03) and 24 hours (68.2% vs. 66.1%, P = 0.007), but the prespecified level for significance (P≤0.005 for both assessments or P≤0.0025 for either) was not met. The rate of rehospitalization for heart failure or death from any cause within 30 days was 9.4% in the nesiritide group versus 10.1% in the placebo group (absolute difference, −0.7 percentage points; 95% confidence interval [CI], −2.1 to 0.7; P = 0.31). There were no significant differences in rates of death from any cause at 30 days (3.6% with nesiritide vs. 4.0% with placebo; absolute difference, −0.4 percentage points; 95% CI, −1.3 to 0.5) or rates of worsening renal function, defined by more than a 25% decrease in the estimated glomerular filtration rate (31.4% vs. 29.5%; odds ratio, 1.09; 95% CI, 0.98 to 1.21; P = 0.11). Conclusions Nesiritide was not associated with an increase or a decrease in the rate of death and rehospitalization and had a small, nonsignificant effect on dyspnea when used in combination with other therapies. It was not associated with a worsening of renal function, but it was associated with an increase in rates of hypotension. On the basis of these results, nesiritide cannot be recommended for routine use in the broad population of patients with acute heart failure. (Funded by Scios; ClinicalTrials.gov number, NCT00475852.

Understanding morphological variation in the extant koala as a framework for identification of species boundaries in extinct koalas (Phascolarctidae; Marsupialia)

We document morphological variation (both geographical and sexual) in the dentition of the extant koala, Phascolarctos cinereus, in order to facilitate discrimination of species boundaries in extinct phascolarctids. Considerable variation is evident in dental structures previously used to diagnose several phascolarctid fossil species. Consistent patterns of morphological variation are not evident between sexes or geographic regions, with variation as great between samples as within them. Metric variation is evident between the sexes in upper molar dimensions with Victorian (southern) males significantly larger than Victorian females, although this is not reflected in lower molar dimensions or in the Queensland (northern) sample. Male koalas from southern populations generally display significantly larger molars than their northern counterparts; however this trend is not evident in female upper molar dimensions. In both males and females, some, but not all, lower molar dimensions are larger in southern populations than northern. In light of these results, a systematic revision of species of Litokoala suggests L. dicktedfordi' is a junior synonym of L. kutjamarpensis, and the poorly known L. thurmerae is regarded to be a nomen dubium. Further, we describe a partial cranium of a new species of koala from Early Miocene sediments in the Riversleigh World Heritage Area, northern Australia. Litokoala dicksmithi sp. nov. is the fifth koala species recorded from the diverse rainforest assemblages of Riversleigh and the third species referred to the Oligo-Miocene genus Litokoala. Aspects of cranial morphology, including a shortened robust rostrum and broad, irregular nasal aperture, confirm placement of Litokoala as sister taxon to the modern genus Phascolarctos. Relatively large orbits and small body size suggest the possibility that L. dicksmithi was nocturnal, had enhanced visual acuity, and was a more agile arboreal species than the relatively sedentary extant koala

The contrasting relationships between betaine and homocysteine in two clinical cohorts are associated with plasma lipids and drug treatments

10.1371/journal.pone.0032460PLoS ONE73e3246

Heart Fatty Acid Binding Protein and cardiac troponin: Development of an optimal rule-out strategy for acute myocardial infarction

10.1186/s12873-016-0089-yBMC Emergency Medicine1613

Betaine and trimethylamine-N-oxide as predictors of cardiovascular outcomes show different patterns in diabetes mellitus: An observational study

10.1371/journal.pone.0114969PLoS ONE912e11496

Genomic Risk Variants at 1p13.3, 1q41, and 3q22.3 Are Associated With Subsequent Cardiovascular Outcomes in Healthy Controls and in Established Coronary Artery Genomic Risk Variants at 1p13.3, 1q41, and 3q22.3 Are Associated With Subsequent Cardiovascular Outcomes in Healthy Controls and in Established Coronary Artery Disease

Coronary artery disease (CAD) has multifactorial origins, and although some families are particularly affected, no precise mode of inheritance has been identified. It is likely that this reflects the contribution of numerous genetic components, each conferring a small risk in cumulative interaction with environmental factors to substantively increase disease susceptibility.1 In recent years, significant advances have been made in elucidating the genetic basis of CAD with the completion of several large genome-wide association studies (GWAS) that have looked at the DNA variation across the entire human genome. In a landmark study in 2007, the Wellcome Trust Case Control Consortium identified a region on chromosome 9 (9p21.3) that was the most strongly associated with the risk of developing CAD,2 a finding that has since been replicated in several independent studies.3–6 The 9p21.3 rs1333049 variant is common and may potentially be added to risk profiling in the future. Already it has been reported that adding the 9p21.3 genotype to the traditional risk score significantly improves CAD risk prediction in the community

The chromosome 9p21.3 coronary heart disease risk allele is associated with altered gene expression in normal heart and vascular tissues

10.1371/journal.pone.0039574PLoS ONE76e3957

Genetic polymorphism rs6922269 in the MTHFD1L gene is associated with survival and baseline active vitamin b12 levels in post-acute coronary syndromes patients

Background and Aims: The methylene-tetrahydrofolate dehydrogenase (NADP+ dependent) 1-like (MTHFD1L) gene is involved in mitochondrial tetrahydrofolate metabolism. Polymorphisms in MTHFD1L, including rs6922269, have been implicated in risk for coronary artery disease (CAD). We investigated the association between rs6922269 and known metabolic risk factors and survival in two independent cohorts of coronary heart disease patients. Methods and Results: DNA and plasma from 1940 patients with acute coronary syndromes were collected a median of 32 days after index hospital admission (Coronary Disease Cohort Study, CDCS). Samples from a validation cohort of 842 patients post-myocardial infarction (PMI) were taken 24–96 hours after hospitalization. DNA samples were genotyped for rs6922269, using a TaqMan assay. Homocysteine and active vitamin B12 were measured by immunoassay in baseline CDCS plasma samples, but not PMI plasma. All cause mortality was documented over follow-up of 4.1 (CDCS) and 8.8 (PMI) years, respectively. rs6922269 genotype frequencies were AA n = 135, 7.0%; GA n = 785, 40.5% and GG n = 1020, 52.5% in the CDCS and similar in the PMI cohort. CDCS patients with AA genotype for rs6922269 had lower levels of co-variate adjusted baseline plasma active vitamin B12 (p = 0.017) and poorer survival than patients with GG or GA genotype (mortality: AA 19.6%, GA 12.0%, GG 11.6%; p = 0.007). In multivariate analysis, rs6922269 genotype predicted survival, independent of established covariate predictors (p = 0.03). However the association between genotype and survival was not validated in the PMI cohort. Conclusion: MTHFD1L rs6922269 genotype is associated with active vitamin B12 levels at baseline and may be a marker of prognostic risk in patients with established coronary heart disease