Author
Marc Klapholz
Other affiliations: University of Medicine and Dentistry of New Jersey, Yeshiva University, University Hospital, Newark ...read more
Bio: Marc Klapholz is an academic researcher from Rutgers University. The author has contributed to research in topics: Heart failure & Ejection fraction. The author has an hindex of 25, co-authored 95 publications receiving 4666 citations. Previous affiliations of Marc Klapholz include University of Medicine and Dentistry of New Jersey & Yeshiva University.
Papers published on a yearly basis
Papers
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TL;DR: Heart failure is a syndrome characterized by high mortality, frequent hospitalization, reduced quality of life, and a complex therapeutic regimen that makes HF an ideal candidate for practice guidelines.
1,226 citations
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TL;DR: Evaluating the short- and intermediate-term effects of tolvaptan in patients hospitalized with heart failure finds the vasopressin antagonist may increase net volume loss in heart failure without adversely affecting electrolytes and renal function.
Abstract: Context Nearly 1 million hospitalizations for chronic heart failure occur yearly in the United States, with most related to worsening systemic congestion. Diuretic use, the mainstay therapy for congestion, is associated with electrolyte abnormalities and worsening renal function. In contrast to diuretics, the vasopressin antagonist tolvaptan may increase net volume loss in heart failure without adversely affecting electrolytes and renal function. Objective To evaluate the short- and intermediate-term effects of tolvaptan in patients hospitalized with heart failure. Design, Setting, and Participants Randomized, double-blind, placebocontrolled, parallel-group, dose-ranging, phase 2 trial conducted at 45 centers in the United States and Argentina and enrolling 319 patients with left ventricular ejection fraction of less than 40% and hospitalized for heart failure with persistent signs and symptoms of systemic congestion despite standard therapy.
614 citations
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Columbia University1, Boston University2, University of Rochester3, Memorial Hospital of South Bend4, Stony Brook University5, Icahn School of Medicine at Mount Sinai6, Henry Ford Health System7, Tufts University8, University of Maryland, Baltimore9, Georgetown University10, Ohio State University11, Yeshiva University12, GlaxoSmithKline13
TL;DR: In a multicenter trial as mentioned in this paper, patients with moderate to severe heart failure (6-minute walk distance, 150 to 450 m) and a left ventricular ejection fraction ≤ 0.35 at 31 centers were randomly assigned to either placebo or carvedilol for 6 months, while background therapy with digoxin, diuretics and an ACE inhibitor remained constant.
Abstract: Background Carvedilol has improved the symptomatic status of patients with moderate to severe heart failure in single-center studies, but its clinical effects have not been evaluated in large, multicenter trials. Methods and Results We enrolled 278 patients with moderate to severe heart failure (6-minute walk distance, 150 to 450 m) and a left ventricular ejection fraction ≤0.35 at 31 centers. After an open-label, run-in period, each patient was randomly assigned (double-blind) to either placebo (n=145) or carvedilol (n=133; target dose, 25 to 50 mg BID) for 6 months, while background therapy with digoxin, diuretics, and an ACE inhibitor remained constant. Compared with placebo, patients in the carvedilol group had a greater frequency of symptomatic improvement and lower risk of clinical deterioration, as evaluated by changes in the NYHA functional class (P=.014) or by a global assessment of progress judged either by the patient (P=.002) or by the physician (P<.001). In addition, treatment with carvedilol...
603 citations
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Shunichi Homma1, John L.P. Thompson1, Patrick M. Pullicino2, Bruce Levin1 +533 more•Institutions (12)
TL;DR: There was no significant overall difference in the primary outcome between treatment with warfarin and treatment with aspirin among patients with reduced LVEF who were in sinus rhythm, and a reduced risk of ischemic stroke withwarfarin was offset by an increased risk of major hemorrhage.
Abstract: BACKGROUND It is unknown whether warfarin or aspirin therapy is superior for patients with heart failure who are in sinus rhythm. METHODS We designed this trial to determine whether warfarin (with a target international normalized ratio of 2.0 to 3.5) or aspirin (at a dose of 325 mg per day) is a better treatment for patients in sinus rhythm who have a reduced left ventricular ejection fraction (LVEF). We followed 2305 patients for up to 6 years (mean [±SD], 3.5±1.8). The primary outcome was the time to the first event in a composite end point of ischemic stroke, intracerebral hemorrhage, or death from any cause. RESULTS The rates of the primary outcome were 7.47 events per 100 patient-years in the warfarin group and 7.93 in the aspirin group (hazard ratio with warfarin, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P = 0.40). Thus, there was no significant overall difference between the two treatments. In a time-varying analysis, the hazard ratio changed over time, slightly favoring warfarin over aspirin by the fourth year of follow-up, but this finding was only marginally significant (P = 0.046). Warfarin, as compared with aspirin, was associated with a significant reduction in the rate of ischemic stroke throughout the follow-up period (0.72 events per 100 patient-years vs. 1.36 per 100 patient-years; hazard ratio, 0.52; 95% CI, 0.33 to 0.82; P = 0.005). The rate of major hemorrhage was 1.78 events per 100 patient-years in the warfarin group as compared with 0.87 in the aspirin group (P<0.001). The rates of intracerebral and intracranial hemorrhage did not differ significantly between the two treatment groups (0.27 events per 100 patient-years with warfarin and 0.22 with aspirin, P = 0.82). CONCLUSIONS Among patients with reduced LVEF who were in sinus rhythm, there was no significant overall difference in the primary outcome between treatment with warfarin and treatment with aspirin. A reduced risk of ischemic stroke with warfarin was offset by an increased risk of major hemorrhage. The choice between warfarin and aspirin should be individualized. (Funded by the National Institute of Neurological Disorders and Stroke; WARCEF ClinicalTrials.gov number, NCT00041938.)
497 citations
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NewYork–Presbyterian Hospital1, New York Hospital Queens2, Jacobi Medical Center3, Beth Israel Medical Center4, Mount Sinai Hospital5, Lincoln Hospital6, Valley Hospital7, Montefiore Medical Center8, Bronx-Lebanon Hospital Center9, Mercy Medical Center (Baltimore, Maryland)10, Albert Einstein College of Medicine11
TL;DR: Patients hospitalized for heart failure with a normal ejection fraction are most often chronically incapacitated elderly women with a history of hypertension and increased LV mass, and reasons for clinical decompensation are identified in only one-half of patients.
382 citations
Cited by
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TL;DR: Authors/Task Force Members: Piotr Ponikowski* (Chairperson) (Poland), Adriaan A. Voors* (Co-Chair person) (The Netherlands), Stefan D. Anker (Germany), Héctor Bueno (Spain), John G. F. Cleland (UK), Andrew J. S. Coats (UK)
13,400 citations
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TL;DR: In this article, Anderson et al. proposed a new FAHA Chair, Jeffrey L. Anderson, MD, FACC, FAHA, Chair-Elect, Alice K. Jacobs et al., this article and Biykem Bozkurt.
11,386 citations
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TL;DR: ACCF/AHAIAI: angiotensin-converting enzyme inhibitor as discussed by the authors, angio-catabolizing enzyme inhibitor inhibitor inhibitor (ACS inhibitor) is a drug that is used to prevent atrial fibrillation.
Abstract: ACC/AHA
: American College of Cardiology/American Heart Association
ACCF/AHA
: American College of Cardiology Foundation/American Heart Association
ACE
: angiotensin-converting enzyme
ACEI
: angiotensin-converting enzyme inhibitor
ACS
: acute coronary syndrome
AF
: atrial fibrillation
7,489 citations
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TL;DR: Authors/Task Force Members: Piotr Ponikowski* (Chairperson) (Poland), Adriaan A. Voors* (Co-Chair person) (The Netherlands), Stefan D. Anker (Germany), Héctor Bueno (Spain), John G. F. Cleland (UK), Andrew J. S. Coats (UK)
Abstract: ACC/AHA
: American College of Cardiology/American Heart Association
ACCF/AHA
: American College of Cardiology Foundation/American Heart Association
ACE
: angiotensin-converting enzyme
ACEI
: angiotensin-converting enzyme inhibitor
ACS
: acute coronary syndrome
AF
: atrial fibrillation
6,757 citations
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TL;DR: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation are published.
Abstract: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)
6,599 citations