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Articles by Bertram Pitt
Undiagnosed Chronic Kidney Disease, Outcomes, and Finerenone in Heart Failure : The FINEARTS-HF Randomized Clinical Trial
Undiagnosed Chronic Kidney Disease, Outcomes, and Finerenone in Heart Failure: The FINEARTS-HF Randomized Clinical Trial Supplement 1. Supplement 2. eMethods. FINEARTS-HF Participant Flow Diagram Supplement 3. Figure 1.
Short-term effects of combinations of heart failure therapies on blood pressure, kidney function and serum potassium
Abstract Among the most commonly cited reasons for failure to initiate comprehensive medical therapy in patients with heart failure are concerns relating to hypotension, kidney dysfunction and hyperkalemia.
Finerenone and Blood Pressure in Heart Failure With Mildly Reduced or Preserved Ejection Fraction : The FINEARTS-HF Randomized Clinical Trial
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Finerenone and Blood Pressure in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: The FINEARTS-HF Randomized Clinical Trial Hypertension is observed in approximately 90% of people with heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF),1-3 and optimal blood pressure (BP) management is a guideline-directed priority of HF management.4,5 All guideline-recommended pharmacotherapies for HFpEF treatment have been shown to lower BP, and their...
By John W. Ostrominski, Brian Claggett, Ian J. Kulac, Akshay Desai, Pardeep S. Jhund, Alasdair Henderson, Carolyn S.P. Lam, Michele Senni, Sanjiv Shah, Adriaan A. Voors, Faiez Zannad, Bertram Pitt, Meike Brinker, Patrick Schloemer, John McMurray, Scott Solomon Verified, Muthiah Vaduganathan, Lucas Hofmeister
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JAMA Cardiology
Finerenone Across Cardiovascular-Kidney-Metabolic Syndrome Stages : Post Hoc Analysis of the FIDELITY Randomized Clinical Trials
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Finerenone Across Cardiovascular-Kidney-Metabolic Syndrome Stages: Post Hoc Analysis of the FIDELITY Randomized Clinical Trials Key Points Question Does cardiovascular-kidney-metabolic (CKM) stage modify the effects of the nonsteroidal mineralocorticoid receptor antagonist finerenone? Findings In this post hoc analysis of 2 phase 3 clinical trials that included 12 990 participants, 3864 (30%) were classified as CKM stage 2, 3275 stage 3 (25%), and 5851 stage 4 (45%).
By Kevin Lo, John W. Ostrominski, Yasuhiro Hamatani, Brian Claggett, Rajiv Agarwal, Stefan Anker, Gerasimos Filippatos, Peter Rossing, Luis M. Ruilope, Bertram Pitt, Alexandros Briasoulis, Kimon Stamatelopoulos, Meike Brinker, Patrick Schloemer, Andrea Glasauer, Scott Solomon Verified, Muthiah Vaduganathan
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JAMA Cardiology
Insights Into Newer Therapies for Heart Failure and Chronic Kidney Disease
In patients with chronic kidney disease (CKD) and heart failure with preserved ejection fraction (HFpEF), newer therapies including SGLT2 inhibitors and a nonsteroidal mineralocorticoid receptor antagonist (nsMRA) are proving beneficial, reports Dr Bertram Pitt of the University of Michigan. Dr Pitt explains that in patients with CKD and HF, there is a significant increase in the risk related to increased aldosterone levels and increased MR expression.
"Effect of Sotagliflozin on Early Mortality and Heart Failure-Related E" by Bertram Pitt, Deepak L Bhatt et al.
Background: Approximately 25% of patients admitted to hospitals for worsening heart failure (WHF) are readmitted within 30 days. Objectives: The authors conducted a post hoc analysis of the SOLOIST-WHF (Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post-WHF) trial to evaluate the efficacy of sotagliflozin versus placebo to decrease mortality and HF-related events among patients who began study treatment on or before discharge from their index hospitalization.
Towards a better prevention in cardio-kidney metabolic syndrome: Role of aldosterone and albuminuria
Ayuda Buscar en la ayuda Buscar en la ayuda Towards a better prevention in cardio-kidney metabolic syndrome: Role of aldosterone and albuminuria Luis M.
Mineralocorticoid Receptor Antagonists in Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Trials
Get full access to this article View all available purchase options and get full access to this article. Supplementary Material Supplemental Tables 1-6 and Supplemental Figures 1-12 (mmc1.docx) References 1. Byrne R.A., Rossello X., Coughlan J.J., et al. 2023 ESC guidelines for the management of acute coronary syndromes: developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2023;44:3720-3826. 2.
Aldosterone and Aldosterone Modulation in Cardio-Kidney Diseases:
Get full access to this article View all available purchase options and get full access to this article. Supplementary Material Supplemental Table 1 (mmc1.docx) References 1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105:S117-S314. 2. McDonagh T.A., Metra M., Adamo M., et al.
Efficacy and safety of finerenone in patients with chronic kidney disease and type 2 diabetes by diuretic use: A FIDELITY analysis
Supporting Information Filename Description ejhf3569-sup-0001-Supinfo.docxWord 2007 document , 620.3 KB Appendix S1. Supporting Information. References 1, , . Detecting and treating lung congestion with kidney failure. Clin J Am Soc Nephrol 2022; 17: 757–765. https://doi.org/10.2215/cjn.14591121 2, , , . Volume overload and adverse outcomes in chronic kidney disease: Clinical observational and animal studies. J Am Heart Assoc 2015; 4:e001918. https://doi.org/10.1161/jaha.115.001918 3, .
Finerenone in patients with heart failure with mildly reduced or preserved ejection fraction: Rationale and design of the FINEARTS‐HF trial
Introduction Activation of the mineralocorticoid receptor (MR) by aldosterone has long been recognized as a central driver of heart failure (HF) pathogenesis.1 Mechanistically, ligand binding to the nuclear MR triggers a diverse signalling cascade contributing to excess salt and water retention, systemic hypertension, endothelial dysfunction, and pathological fibrosis, hypertrophy, and inflammation of the end organs, including the heart and kidneys.2 These core mechanisms of disease...
New opportunity for targeting systemic inflammation in patients with heart failure through leucocyte immunomodulation
Introduction Despite current therapy of patients hospitalized with acute (AHF) or worsening (WHF) heart failure, both heart failure with a reduced ejection fraction (HFrEF) and a preserved ejection fraction (HFpEF), there remains a relatively high incidence of cardiovascular (CV) mortality and hospitalizations for HF (HHF) at 30 and 90 days post-admission and/or discharge.1 The administration of sodium–glucose cotransporter inhibitors prior to and or shortly after discharge for AHF or WHF is...
Aldosterone Synthase Inhibitors and Mineralocorticoid Receptor Antagonists: Competitors or Collaborators?
REFERENCES 1. Brown JM, Siddiqui M, Calhoun DA, Carey RM, Hopkins PN, Williams GH, Vaidya A . The unrecognized prevalence of primary aldosteronism: a cross-sectional study.Ann Intern Med. 2020; 173:10–20. doi: 10.7326/M20-0065CrossrefMedlineGoogle Scholar 2. Bauersachs J, Jaisser F, Toto R . Mineralocorticoid receptor activation and mineralocorticoid receptor antagonist treatment in cardiac and renal disease.Hypertension. 2015; 65:257–263. doi: 10.1161/HYPERTENSIONAHA.114.04488LinkGoogle Scholar 3.
Reassessing the management of hypertension: Time to prevent aldosterone‐mediated heart failure
Corresponding Author Javier Diez Center for Applied Medical Research (CIMA), and School of Medicine, University of Navarra, Pamplona, Spain Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain Corresponding author. Edificio CIMA, Av Pío XII 55, 31008 Pamplona, Spain. Email: jadimar@unav.es Search for more papers by this author
The Use Of Mineralocorticoid Receptor Antagonists For Patients With Heart Failure With A Reduced Ejection Fraction: A Time For Reassessment
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/ejhf.3091.
Patients with diabetes, worsening HF benefit from sotagliflozin at or before discharge
Source/Disclosures Disclosures: The study was funded by Sanofi and Lexicon.
Effect of Sotagliflozin on Early Mortality and Heart Failure-Related Events: A Post Hoc Analysis of SOLOIST-WHF
Introduction Heart failure (HF) is the second most common cause of hospitalizations for patients >65 years of age in the United States, posing a significant cost burden on society.1,2 The morbidity and mortality impact on patients is also severe.
Modifiability of Composite Cardiovascular Risk Associated With Chronic Kidney Disease in Type 2 Diabetes With Finerenone
Key Points Question In type 2 diabetes, is chronic kidney disease (CKD)–associated composite cardiovascular risk modifiable with finerenone?
Mineralocorticoid receptor antagonists for chronic heart failure: a meta-analysis focusing on the number needed to treat
1. Introduction One of the most prevalent public health issues of the 21st century is chronic heart failure (CHF) (1). Any structural or functional change, such as ventricular filling or blood ejection, is responsible for the onset and progression of heart failure (HF), a complex, clinically integrated disease (2). The prevalence of heart failure (HF) is increasing every year due to an ageing population and ongoing advancements in medical technology (3).
Resistant hypertension: cardiorenal protection with mineralocorticoid receptor blockade
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Finerenone and Heart Failure Outcomes by Kidney Function/Albuminuria in Chronic Kidney Disease and Diabetes:
JACC Journals › JACC: Heart Failure › Archives › Vol. 10 No. 11 Abstract Background In patients with type 2 diabetes (T2D), risks of cardiovascular mortality and heart failure (HF) increase with decreasing kidney function (estimated glomerular filtration rate [eGFR]) and increasing albuminuria (urine albumin-to-creatinine ratio [UACR]).
Steroidal MRA Across the Spectrum of Renal Function: A Pooled Analysis of RCTs
JACC Journals › JACC: Heart Failure › Archives › Just Accepted Abstract Background Mineralocorticoid receptor antagonists (MRAs) are underused in patients with kidney dysfunction, and their efficacy among patients with chronic kidney disease (CKD) is uncertain. Objectives The goal of this study was to analyze the efficacy and safety of steroidal MRAs across the spectrum of estimated glomerular filtration rates (eGFRs) in randomized controlled trials.
MRAs for Treatment of MI Complicated With HF
Authors and Disclosures Bertram Pitt1*, João Pedro Ferreira2–4 and Faiez Zannad4 1Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA; 2Université de Lorraine, Inserm, Centre d'Investigations Cliniques Plurithématique 1433, Nancy, France; 3Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France; and 4Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the...
Generalizability of FIGARO‐DKD and FIDELIO‐DKD Trial Criteria to the US Population Eligible for Finerenone
The FIDELIO‐DKD (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease)1 and the FIGARO‐DKD (Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease)2 trials demonstrated benefits for finerenone in reducing risk for kidney and cardiovascular outcomes in patients with type 2 diabetes and chronic kidney disease (CKD). FIDELIO‐DKD and FIGARO‐DKD enrolled patients with different levels of kidney dysfunction.
Time to Shift our Focus from the Treatment to the Prevention of Heart Failure with a Mineralocorticoid Receptor Antagonist (MRA)?
Corresponding Author Patrick Rossignol MD, PhD p.rossignol@chru-nancy.fr Université de Lorraine, INSERM, Centre d'Investigations Cliniques-Plurithématique 14-33, and INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France Corresponding author. Patrick Rossignol, Centre d'Investigation Clinique Plurithématique -INSERM - CHRU de Nancy, Address: 4, rue du Morvan.
A Promise Unfulfilled : The use of Mineralocorticoid Receptor Antagonists ( MRAs ) in patients with Heart Failure and a Reduced Left Ventricular Ejection Fraction
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The renin‐angiotensin‐aldosterone system and its suppression
Abstract Chronic activation of the renin-angiotensin-aldosterone system (RAAS) promotes and perpetuates the syndromes of congestive heart failure, systemic hypertension, and chronic kidney disease. Excessive circulating and tissue angiotensin II (AngII) and aldosterone levels lead to a pro-fibrotic, -inflammatory, and -hypertrophic milieu that causes remodeling and dysfunction in cardiovascular and renal tissues.
EMPEROR-Preserved: A promise fulfilled
Heart failure with preserved ejection fraction (HFpEF) represents one of the greatest unmet needs in medicine. In the EMPEROR-Preserved trial, recently reported in the NEJM, the SGLT2 inhibitor empagliflozin reduced the primary outcome of heart failure hospitalizations and cardiovascular death by 21% in patients with HFpEF. This represents an important breakthrough in the war against heart failure.
SGLT-2 inhibitors in heart failure: Time for broader eligibility and earlier initiation
In recent years, the treatment of heart failure with reduced ejection fraction (HFrEF) has been revolutionized by collaborative efforts among healthcare practitioners, pharmaceutical industry leaders, and regulators regarding the use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors.1 A series of cardiovascular outcome trials led to the discovery of powerful and broad cardiorenal benefits associated with this class of drugs, originally developed as noninsulin therapy for type 2 diabetes...
Finerenone Reduces New-Onset Atrial Fibrillation in Patients With Chronic Kidney Disease and Type 2 Diabetes:
Abstract Background Patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) are at risk of atrial fibrillation or flutter (AFF) due to cardiac remodeling and kidney complications. Finerenone, a novel, selective, nonsteroidal mineralocorticoid receptor antagonist, inhibited cardiac remodeling in preclinical models.
Detection of Patients at Risk of HF Responsive to MRAs
Mineralocorticoid receptor antagonists (MRAs), in particular spironolactone, have been used alone and in combination with a thiazide diuretic for the treatment of primary hypertension for >70 years.[1] Their use was originally based upon the effect of spironolactone on blocking the effects of aldosterone on the renal absorption of sodium and excretion of potassium.
Does SGLT1 Inhibition Add Benefit to SGLT2 Inhibition in Type 2 Diabetes?
The SGLT2 (sodium-glucose cotransporter-2) inhibitors canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin have been shown to improve cardiac and cardiorenal outcomes in patients with—and in some cases without—type 2 diabetes (T2D) who have heart failure or chronic kidney disease.1 The mechanisms associated with their beneficial effects remain controversial.
Finerenone and Cardiovascular Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes
Abstract Background: The FIDELIO-DKD trial evaluated the effect of the nonsteroidal, selective mineralocorticoid receptor antagonist finerenone on kidney and cardiovascular (CV) outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) with optimized renin-angiotensin system blockade. Compared with placebo, finerenone reduced the composite kidney and CV outcomes.
HOMAGE: Spironolactone has pleiotropic mechanism of action
October 05, 2020 2 min read Save Source/Disclosures Source: Ferreira JP, et al. Late-breaking clinical trials I. Presented at: Heart Failure Society of America Scientific Meeting; Sept. 30-Oct. 6, 2020 (virtual meeting). Disclosures: Ferreira reports he served as a consultant and/or on an advisory board for Boehringer Ingelheim.
Eplerenone prevents an increase in serum carboxy‐terminal propeptide of procollagen type I after myocardial infarction complicated by left ventricular dysfunction and/or heart failure
Research Letter Susan Stienen Corresponding Author E-mail address: s.stienen@amc.uva.nl Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy, F‐CRIN INI‐CRCT, Nancy, France Email: s.stienen@amc.uva.nl Search for more papers by this author No abstract is available for this article. The full text of this article hosted at iucr.org is unavailable due to technical difficulties.
The renin‐angiotensin‐aldosterone system and its suppression
Abstract Chronic activation of the renin‐angiotensin‐aldosterone system (RAAS) promotes and perpetuates the syndromes of congestive heart failure, systemic hypertension, and chronic kidney disease. Excessive circulating and tissue angiotensin II (AngII) and aldosterone levels lead to a pro‐fibrotic, ‐inflammatory, and ‐hypertrophic milieu that causes remodeling and dysfunction in cardiovascular and renal tissues.
The renin‐angiotensin‐aldosterone system and its suppression
Abstract Chronic activation of the renin‐angiotensin‐aldosterone system (RAAS) promotes and perpetuates the syndromes of congestive heart failure, systemic hypertension, and chronic kidney disease. Excessive circulating and tissue angiotensin II (AngII) and aldosterone levels lead to a pro‐fibrotic, ‐inflammatory, and ‐hypertrophic milieu that causes remodeling and dysfunction in cardiovascular and renal tissues.
Future large‐scale clinical trials in cardiovascular medicine: challenges and uncertainties
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Revisiting hyperkalaemia guidelines: rebuttal
Corresponding Author E-mail address:jbutler4@umc.edu University of Mississippi Medical Center, Department of Medicine (L650), Jackson, MS, USA Corresponding author. University of Mississippi Medical Center, Department of Medicine (L650), 2500 N. State Street, Jackson, MS 39216, USA. Email: jbutler4@umc.edu Search for more papers by this author
Need to revisit heart failure treatment guidelines for hyperkalaemia management during the use of mineralocorticoid receptor antagonists
Corresponding Author E-mail address:javed.butler@stonybrookmedicine.edu Division of Cardiology, Department of Medicine, Stony Brook UniversityStony Brook, NY, USA Corresponding Author. Division of Cardiology, Stony Brook University, Health Sciences Center, T‐16, Room 080, SUNY at Stony Brook, NY 11794, USA. Tel: +1 631 444 1066, Fax: +1 631 444 1054, Email: E-mail address:javed.butler@stonybrookmedicine.eduSearch for more papers by this author
Mineralocorticoid Receptor Antagonists in ST-Segment Elevation Myocardial Infarction
Therapy for patients with ST-segment elevation myocardial infarction (STEMI) has been the focus of considerable investigation over the past decade. Our improved understanding of the adequacy, timing, consequences, and extent of early reperfusion and the development of new anticoagulants and antiplatelet drugs have resulted in improved clinical outcomes.
Factors associated with underuse of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: an analysis of 11 215 patients from the Swedish Heart Failure Registry - Savarese - - European Journal of Heart Failure - Wiley Onl
Mineralocorticoid receptor antagonists (MRAs) improve outcomes in heart failure with reduced ejection fraction (HFrEF), but are underutilized. Hyperkalaemia may be one reason, but the underlying reasons for underuse are unknown. The aim of this study was to investigate the independent predictors of MRA underuse in a large and unselected HFrEF cohort.
Factors associated with underuse of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: an analysis of 11 215 patients from the Swedish Heart Failure Registry - Savarese - - European Journal of Heart Failure - Wiley Onl
Mineralocorticoid receptor antagonists (MRAs) improve outcomes in heart failure with reduced ejection fraction (HFrEF), but are underutilized. Hyperkalaemia may be one reason, but the underlying reasons for underuse are unknown. The aim of this study was to investigate the independent predictors of MRA underuse in a large and unselected HFrEF cohort.
Is hyperkalaemia in heart failure a risk factor or a risk marker? Implications for renin-angiotensin-aldosterone system inhibitor use
Corresponding Author E-mail address:lars.lund@alumni.duke.edu Department of Medicine, Karolinska Institutet, Stockholm, Sweden Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden Corresponding author. Department of Medicine, Karolinska Institutet, 171 76 Stockholm, Sweden. Tel: +46 8 51770000, Fax: +46 8 311044, Email: E-mail address:lars.lund@alumni.duke.eduSearch for more papers by this author
Is hyperkalaemia in heart failure a risk factor or a risk marker? Implications for renin-angiotensin-aldosterone system inhibitor use
Editorial CommentIs hyperkalaemia in heart failure a risk factor or a risk marker? Implications for renin–angiotensin–aldosterone system inhibitor useAuthorsLars H. Lund,Corresponding authorDepartment of Medicine, Karolinska Institutet, Stockholm, SwedenHeart and Vascular Theme, Karolinska University Hospital, Stockholm, SwedenCorresponding author. Department of Medicine, Karolinska Institutet, 171 76 Stockholm, Sweden.
Systolic blood pressure and cardiovascular outcomes in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial
We analysed participants from the Americas from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study with available baseline and 8-week visit SBP data (n?=?1645). We related baseline SBP to several efficacy and safety outcomes.
Influence of ejection fraction on cause-specific mortality in heart failure with preserved ejection fraction
Research LetterInfluence of ejection fraction on cause-specific mortality in heart failure with preserved ejection fractionAuthorsNavkaranbir S. Bajaj,Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USASearch for more papers by this authorBrian Claggett,Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USASearch for more papers by this authorEldrin F.
Tailoring mineralocorticoid receptor antagonist therapy in heart failure patients: are we moving towards a personalized approach?
The aim of personalized medicine is to offer a tailored approach to each patient in order to provide the most effective therapy, while reducing risks and side effects. The use of mineralocorticoid receptor antagonists (MRAs) has demonstrated major benefits in heart failure with reduced ejection fraction (HFrEF), results with challenging inconsistencies in heart failure with preserved ejection fraction (HFpEF), and ‘neutral’ preliminary results in acute heart failure.
Prognostic importance of left ventricular mechanical dyssynchrony in heart failure with preserved ejection fraction
Of 3445 patients with HFpEF enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, dyssynchrony analysis was performed on 424 patients (12%) by multiple speckle tracking echocardiography strain-based criteria. The primary dyssynchrony analysis was the standard deviation of the time to peak longitudinal strain (SD T2P LS).
Characterization of Mineralocorticoid Receptor Antagonist Therapy Initiation in High-Risk Patients With Heart Failure
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