Population Health Research Institute
Heart Failure/LV Dysfunction

Heart Failure/LV Dysfunction
Combating the decline of heart muscles

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Chronic heart failure (CHF) is a clinical problem of increasing importance. Overall, CHF affects approximately two per cent of the population, but this increases rapidly with age. In spite of new medical interventions, age-adjusted death rates and the rates of important morbidity like hospitalizations have increased over the last few decades. It is estimated that approximately one-third of all hospital bed-days used because of cardiac diseases are associated with CHF. It can be foreseen that chronic heart failure will become an increasing problem in the aging population in the industrial world. Despite new and efficacious treatment strategies, mortality and morbidity rates remain unacceptable. Thus, there is a strong need for improved medical therapy.


The Heart Failure Research Group has evaluated diverse areas, ranging from the effects of exercise training, the impact of heart failure on cognitive function and various drugs, such as angiotensin receptor blockers and growth hormones. Novel areas include documenting and understanding the causes of frailty and cognitive dysfunction in heart failure patients. This research group has become increasingly interested in understanding the role of exercise in heart failure. A majority of work completed in this area occurs in the Heart Function Clinic at Hamilton Health Sciences and is composed of a group of physicians, including a geriatrician and nurse clinicians.


Main Publications

McKelvie RS, Teo KK, Roberts R, McCartney N, Humen D, Montague T, Hendrican K, Yusuf S. Effects of exercise training in heart failure patients: the Exercise Rehabilitation Trial (EXERT). Am Heart J 2002; 144(1): 23-30.

McKelvie RS, Rouleau J-L, White M, Afzal R, Young JB, Maggioni AP, Held P, Yusuf S. Comparative impact of enalapril, candesartan or metoprolol alone or in combination on ventricular remodeling in patients with congestive heart failure. Eur Heart J 2003; 24(19): 1727-1734.

Heckman GA, Misiaszek B, Merali F, Turpie I, Patterson CJ, Flett N, McKelvie RS. Management of heart failure in Canadian long-term care facilities. Can J Cardiol, 2004; 20(10): 963-969.

Roccaforte R, Demers C, Baldassarre F, Yusuf S, Teo K. Effectiveness of Research Management Programmes in Improving Clinical Outcomes in Heart Failure Patients. Eur J Heart Failure 2005; 7:1133-44.

Yan RT, White M, Yan AT, Yusuf S, Rouleau J-L, Maggioni AP, Hall C, Latini R, Afzal R, Floras J, Masson S, McKelvie RS, and Randomized Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) investigators. Usefulness of temporal changes in neurohormones as markers of ventricular remodeling and prognosis in patients with left ventricular systolic dysfunction and heart failure receiving either Candesartan or Enalapril or both. Am J Cardiol 2005; 96(5): 698-704

Demers C, McMurray JJV, Swedberg K, Pfeffer MA, Granger CB, Olofsson B, McKelvie RS, Östergren J, Michelson EL, Johansson PA, Wang D, Yusuf S. Impact of Candesartan on Non-Fatal Myocardial Infarction and Cardiovascular Death: Results from the Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity (CHARM) Program. JAMA 2005;294:1794-1798

Misiaszek B, Heckman GA, Merali F, Turpie ID, Patterson CJ, Flett N, McKelvie RS. Digoxin  Prescribing for Heart Failure in Elderly Residents of Canadian Long-term Care Facilities. Canadian Journal of Cardiology 2005;21:281-286.

Heckman GA, Misiaszek BC, Merali F, Turpie ID, Patterson CJ, Flett N, McKelvie RS. Association between psychotropic drug utilization and heart failure therapy in elderly long-term care residents. Journal of the American Geriatrics Society 2006;54:1973-1975.

Yan AT, Yan RT, Spinale FG, Rizwan AM, Gunasinghe HR, Arnold M, Demers C, McKelvie RS, Liu, P. Plasma Matrix Metalloproteinase-9 Level is Correlated with Left Ventricular Volumes and Ejection Fraction in Patients with Heart Failure. J Card Failure, 2006;12:514-519

Harkness K, Tranmer J. Measurement of the Caregiving Experience in Caregivers of Patients with Heart Failure: A Review of Current Instruments and Recommendations for Future Research, Journal of Cardiac Failure September 2007

Heckman GA, Patterson CJ, Demers C, St.Onje J, Turpie ID, McKelvie RS.  Heart Failure and Cognitive Impairment: Challenges and Opportunities. Clinical Interventions in Aging 2007;2:209-218.

Caldwell PH, Arthur HM, Demers C. Preferences of Patients with Heart Failure for Prognosis Communication. Canadian Journal of Cardiology;2007:23: 791-6.

Persson HE, Lonn E, Edner M, Baruch L, Lang CC, Morton JJ, Ostergren J, McKelvie RS, for the investigators of the CHARM Echocardiography Substudy - CHARMES.  Diastolic dysfunction in heart failure with preserved systolic function: need for objective evidence.  Results from the CHARM Echocardiographic Substudy - CHARMESJACC, 2007:Vol 49(6):687-94.

McMurray JJV, Komajda M, McKelvie R, Zile MR, Ptaszynska A, Staiger C, Carson PE, Massie, BM.  Heart failure with preserved ejection fraction: clinical characteristics of 4,133 patients enrolled in the I-PRESERVE trial.  Eur J Heart Fail 2008:10:149-156. 

Yan AT, Yan RT, Spinale FG, Afzal R, Gunasinghe HR, Stroud RE, McKelvie RS, Liu PP.  Relationships between plasma levels of matrix metalloproteinases and neurohormonal profile in patients with heart failure.  Eur J Heart Fail 2008;10:125-128.

Heckman GA, Demers C, Hogan DB, McKelvie RS.  Heart Failure:  old disease, older adults, fresh perspective.  Geriatrics & Aging, 2008;11(1):15-21.

Grewal J, McKelvie R, Lonn E, Tait P, Carlsson J, Gianni M, Persson H.  BNP and NT-proBNP predict echocardiographic severity of diastolic dysfunction.  Eur J Heart Fail, 2008;10:252-259.

MacDonald MR, Petrie MC, Hawkins NM, Petrie JR, Fisher M, McKelvie R, Aguilar D, Krum H, McMurray JV.  Diabetes, left ventricular systolic dysfunction, and chronic heart failure.  Eur Heart J, 2008;29:1224-1240.

Grewal J, McKelvie RS, Persson H, Tait P, Carlsson J, Swedberg K, Ostergren J, Lonn E. Usefulness of N-terminal pro-brain natriuretic peptide and brain natriuretic peptide to predict cardiovascular outcomes in patients with heart failiure and preserved left ventricular ejection fraction.  Am J Cardiol, 2008;102:733-737.

Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, Anderson S, Donovan M, Iverson E, Staiger C, Ptaszynska A, for the I-PRESERVE Investigators.  Irbesartan in patients with heart failure and preserved ejection fraction.  N Engl J Med 2008:359(Nov 11 edition any JM.org):x-xx.

Massie BM, Collins JF, Ammon SE, Armstrong PW, Cleland JGF, Ezekowitz M, Jafri SM, Krol WF, O'Connor CM, Schulman KA, Teo K, Warren SR, on behalf of the WATCH Trial Investigators.  Randomized trial of warfarin, aspirin and clopidogrel in patients with chronic heart failure: The Warfarin and Antiplatelet Therapy in Chronic Heart Failure Trial (WATCH). Circulation 2009;119:1616-1624.


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