Differences between patients with a preserved and a depressed left ventricular function: a report from the EuroHeart Failure Survey

Aims Due to a lack of clinical trials, scientific evidence regarding the management of patients with chronic heart failure and preserved left ventricular function (PLVF) is scarce. The EuroHeart Failure Survey provided information on the characteristics, treatment and outcomes of patients with PLVF as compared to patients with a left ventricular systolic dysfunction (LVSD). Methods and results We performed a secondary analysis using data from the EuroHeart Failure Survey, only including patients with a measurement of LV function \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $(n=6806)$ \end{document}. We selected two groups: patients with LVSD (54%) and patients with a PLVF (46%). Patients with a PLVF were, on average, 4 years older and more often women (55% vs. 29%, respectively, p <0.001) as compared to LVSD patients, and were more likely to have hypertension (59% vs. 50%, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $p{<}0.001$ \end{document}) and atrial fibrillation (25% vs. 23%, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $p=0.01$ \end{document}). PLVF patients received less cardiovascular medication compared to PLVF patients, with the exception of calcium antagonists. Multivariate analysis revealed that LVSD was an independent predictor for mortality, while no differences in treatment effect on mortality between the two groups was observed. A sensitivity analysis, using different thresholds to separate patients with and without LVSD revealed comparable findings. Conclusions In the EuroHeart Failure Survey, a high percentage of heart failure patients had PLVF. Although major clinical differences were seen between the groups, morbidity and mortality was high in both group

Additive Beneficial Effects of Beta-Blockers to Angiotensin-Converting Enzyme Inhibitors in the Survival and Ventricular Enlargement (SAVE) Study fn1fn1This study was supported by a University-Industry grant from the Medical Research Council, Ottawa, Ontario, Canada and Bristol Myers Squibb, Montreal, Quebec, Canada.

AbstractObjectives. This study assessed whether treatment with a beta-adrenergic blocking agent in addition to the use of the angiotensin-converting enzyme (ACE) inhibitor captopril decreases cardiovascular mortality and morbidity in patients with asymptomatic left ventricular dysfunction after myocardial infarction (MI) and whether the presence of neurohumoral activation at the time of hospital discharge predicts the effects of beta-blocker treatment in these patients.Background. Both beta-blockers and ACE inhibitors have been shown to have beneficial effects in patients with left ventricular dysfunction but no overt heart failure after MI. These patients often have persistent neurohumoral activation at the time of hospital discharge, and one would expect that patients with activation of the sympathetic nervous system derive the most benefit from treatment with beta-blockers. However, beta-blockers are underutilized in this high risk group of patients, and it is unknown whether their beneficial effects are additive to those of ACE inhibitors.Methods. We performed a retrospective analysis of data from the Survival and Ventricular Enlargement (SAVE) study and its neurohumoral substudy. The relations between beta-blocker use at the time of randomization and neurohumoral activation and the subsequent development of cardiovascular events were analyzed by use of Cox proportional hazards models controlling for covariates.Results. After adjustment for baseline imbalances, beta-blocker use was associated with a significant reduction in risk of cardiovascular death (30%, 95% confidence interval [CI] 12% to 44%) and development of heart failure (21%, 95% CI 3% to 36%), but the reduction in recurrent MI (11%, 95% CI 13% to 31%) was not significant. These reductions were independent of the use of captopril. Beta-blockers were not found to have a greater effect in patients with neurohumoral activation at the time of hospital discharge.Conclusions. The beneficial effects of beta-blocker use at the time of hospital discharge in patients with asymptomatic left ventricular dysfunction after MI appear to be additive to those of captopril and other interventions known to improve prognosis. Neurohumoral activation at the time of hospital discharge fails to identify those patients who will derive the greatest benefit from treatment with beta-blockers.(J Am Coll Cardiol 1997;29:229–36

Importance de l’affectif en marketing : application aux sites internet

Depuis le début des années 80, sous l’impulsion de Zajonc, l’affectif est pris en considération pour comprendre le comportement du consommateur. Un nouveau courant s’appuyant sur la production d’expériences émotionnelles gratifiantes, le marketing expérientiel, se développe notamment sur le web. Les marketeurs conçoivent alors des sites en vue de susciter des réactions affectives positives pouvant favoriser les comportements d’achat et de consommation. Après avoir cerné les éléments de sites les plus susceptibles de favoriser les réactions émotionnelles, nous avons axé notre étude sur la présence ou non d’une vidéo et en manipulant deux facteurs : son type d’ouverture et la présence ou non d’une recommandation d’internautes. L’efficacité émotionnelle d’une vidéo s’est révélée modérée. Par contre, une vidéo à ouverture automatique semble avoir une influence plus conséquente et à double sens à savoir un impact positif sur l’éveil et négatif sur la dominance. Une vidéo avec ce type d’ouverture stimule donc l’activation de l’internaute mais provoque le ressenti d’un manque de contrôle. Enfin, la présence d’une recommandation d’internautes n’a pas révélé d’impact tangible ni sur les R.E suscitées ni sur les R.C.Master [120] en sciences de gestion (Mons), Université catholique de Louvain, 201