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@article{Halliday:2022,
author = {Halliday, B and Owen, R and Gregson, J and Vazir, A and Wassall, R and Khalique, Z and Lota, A and Tayal, U and Hammersley, D and Jones, R and Pennell, D and Cowie, M and Cleland, J and Prasad, S},
journal = {ESC Heart Failure},
title = {Changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathy},
url = {https://onlinelibrary.wiley.com/doi/10.1002/ehf2.13872},
volume = {9},
year = {2022}
}

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TY  - JOUR
AB  - Aims: To profile the changes in non-invasive clinical, biochemical and imaging markers during withdrawal of therapy in patients with recovered dilated cardiomyopathy, providing insights into the pathophysiology of relapse.Methods: Clinical, biochemical and imaging data from patients during phased withdrawal of therapy in the randomised or single-arm cross-over phases of TRED-HF were profiled.  Clinical variables were measured at each study visit and imaging variables were measured at baseline, 16 weeks and 6 months. Results: Amongst the 49 patients (35% women, mean age 53.6 years [standard deviation 11.6]) who withdrew therapy, 20 relapsed. Increases in mean heart rate (7.6 beats per minute [95% CIs 4.5,10.7]), systolic blood pressure (6.6mmHg [95% CI 2.7,10.5]) and diastolic blood pressure (5.8mmHg [95% CI 3.1,8.5]) were observed within 4-8 weeks of starting to withdraw therapy. A rise in mean LV mass (5.1g/m2 [95%CI 2.8,7.3]) and LV end-diastolic volume (3.9ml/m2 [95% CI 1.1,6.7]) and a reduction in mean LV ejection fraction (-4.2 [95% CI -6.6, -1.8]) were seen by 16 weeks, the earliest imaging follow-up. Plasma NT-pro-BNP fell immediately after withdrawing beta-blockers and only tended to increase 6 months after beginning therapy withdrawal (mean change in log NT-pro-BNP at 6 months: 0.2, 95% CI -0.1,0.4). Conclusion: Changes in plasma NT-pro-BNP are a late feature of relapse, often months after a reduction in LV function. A rise in heart rate and blood pressure are observed soon after withdrawing therapy in recovered dilated cardiomyopathy, typically accompanied or closely followed by early changes in LV structure and function.
AU  - Halliday,B
AU  - Owen,R
AU  - Gregson,J
AU  - Vazir,A
AU  - Wassall,R
AU  - Khalique,Z
AU  - Lota,A
AU  - Tayal,U
AU  - Hammersley,D
AU  - Jones,R
AU  - Pennell,D
AU  - Cowie,M
AU  - Cleland,J
AU  - Prasad,S
PY  - 2022///
SN  - 2055-5822
TI  - Changes in clinical and imaging variables during withdrawal of heart failure therapy in recovered dilated cardiomyopathy
T2  - ESC Heart Failure
UR  - https://onlinelibrary.wiley.com/doi/10.1002/ehf2.13872
UR  - http://hdl.handle.net/10044/1/95177
VL  - 9
ER  -

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