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| 2. |
- Deedwania, P. C., et al.
(författare)
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Efficacy, safety and tolerability of metoprolol CR/XL in patients with diabetes and chronic heart failure: experiences from MERIT-HF
- 2005
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Ingår i: Am Heart J. - : Mosby, Inc.. - 1097-6744 .- 0002-8703. ; 149:1, s. 159-67
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The objective of the current study was to examine the efficacy and tolerability of the beta-blocker metoprolol succinate controlled release/extended release (CR/XL) in patients with diabetes in the Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF). METHODS: The Cox proportional hazards model was used to calculate hazard ratios (HR) for convenience expressed as relative risks (risk reduction = 1-HR), and 95% confidence intervals (CI). RESULTS: The risk of hospitalization for heart failure was 76% higher in diabetics compared to non-diabetics (95% CI 38% to 123%). Metoprolol CR/XL was well tolerated and reduced the risk of hospitalization for heart failure by 37% in the diabetic group (95% CI 53% to 15%), and by 35% in the non-diabetic group (95% CI 48% to 19%). Pooling of mortality data from the Cardiac Insufficiency Bisoprolol Study II (CIBIS II), MERIT-HF, and the Carvedilol Prospective Randomized Cumulative Survival Study (COPERNICUS) showed similar survival benefits in patients with diabetes (25%; 95% CI 40% to 4%) and without diabetes (36%; 95% CI 44% to 27%); test of diabetes by treatment interaction was non-significant. Adverse events were reported more often on placebo than on metoprolol CR/XL. CONCLUSIONS: Patients with heart failure and diabetes have a much higher risk of hospitalization than patients without diabetes. Regardless of diabetic status, a highly significant reduction in hospitalizations for heart failure was observed with metoprolol CR/XL therapy, which was very well tolerated also by patients with diabetes. Furthermore, the pooled data showed a statistically significant survival benefit in patients with diabetes.
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| 5. |
- Deedwania, P. C., et al.
(författare)
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Efficacy, safety and tolerability of beta-adrenergic blockade with metoprolol CR/XL in elderly patients with heart failure
- 2004
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Ingår i: Eur Heart J. - : Oxford University Press (OUP). - 0195-668X. ; 25:15, s. 1300-9
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To study the efficacy and tolerability of beta-blockade in elderly patients with heart failure in the MERIT-HF study. METHODS AND RESULTS: Cox proportional hazards model was used to calculate hazard ratios (HR) with 95% confidence intervals (CI). Risk reduction was defined as (1-HR). In patients > or = 65 years total mortality was reduced by 37% (95% CI 17% to 52%; p=0.0008), sudden death by 43% (95% CI 17% to 61%; p=0.0032), and death from worsening heart failure by 61% (95% CI 32% to 77%; p=0.0005). Hospitalisations for worsening heart failure was reduced by 36% (p=0.0006). Elderly patients with severe heart failure (NYHA class III/IV with ejection fraction < 0.25; n=425, and patients above 75 years (n=490) showed similar risk reductions. Metoprolol CR/XL was safe and well tolerated both during initiating therapy and during long-term follow-up. CONCLUSIONS: Metoprolol CR/XL was easily instituted, safe and well tolerated in elderly patients with systolic heart failure. The data suggest that these are the patients in whom treatment will have the greatest impact as shown by number of lives saved and number of hospitalisations avoided. The time has come to overcome the barriers that physicians perceive to beta-blocker treatment, and to provide it to the large number of elderly patients with heart failure in need of this therapy.
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- Ghali, J. K., et al.
(författare)
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Consistency of the beneficial effect of metoprolol succinate extended release across a wide range dose of angiotensin-converting enzyme inhibitors and digitalis
- 2004
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Ingår i: J Card Fail. - 1071-9164. ; 10:6, s. 452-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The effects of beta-blockade with different extent of angiotensin-converting enzyme inhibitors (ACEI) and digitalization are unknown. To assess the effect of metoprolol succinate controlled release/extended release (CR/XL) combined with high versus low doses of ACEI and digitalis, we analyzed data from The Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF) in which patients with heart failure and left ventricular ejection fraction < or =40% were randomized to metoprolol CR/XL versus placebo. METHODS AND RESULTS: Outcome was analyzed separately for those on a low dose (< or =median) of the ACEI or digitalis versus high dose (> median). The mean dose of ACEI in the high-dose group (n = 1457) was 3 times higher than that in the low-dose group (n = 2094). Mortality was reduced to a similar extent in the high- and low-dose ACEI subgroups (RR = .69 versus .64, respectively). Corresponding figures for combined mortality/all hospitalization and for mortality/hospitalization for heart failure were .85 versus .83, and .70 versus .68, respectively. Likewise, reduction in total mortality with metoprolol CR/XL was similar in patients receiving no digitalis (n = 1447; RR = .56), low dose (n = 1122; RR = .71), or high dose (n = 1421; RR = .71). CONCLUSION: This analysis of MERIT-HF demonstrates consistent and similar improvement in outcome of patients receiving metoprolol CR/XL when combined with either a high or low dose of an ACEI or digitalis, or no digitalis at all. Thus regardless of ACEI and digitalis dose and whether patients are treated with digitalis or not, it is very important to add a beta-blocker to the existing heart failure therapy. beta-blockers should not be withheld until target doses of ACEI have been achieved.
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| 7. |
- Ghali, Jalal K, et al.
(författare)
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The influence of renal function on clinical outcome and response to beta-blockade in systolic heart failure: insights from Metoprolol CR/XL Randomized Intervention Trial in Chronic HF (MERIT-HF).
- 2009
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Ingår i: Journal of cardiac failure. - : Elsevier BV. - 1532-8414 .- 1071-9164. ; 15:4, s. 310-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Limited information is available on the risk and impact of renal dysfunction on the response to beta-blockade and mode of death in systolic heart failure (HF). METHODS AND RESULTS: Renal function was estimated with glomerular filtration rate (eGFR) using the simplified Modification of Diet in Renal Disease (MDRD) equation. Patients from the Metoprolol CR/XL Controlled Randomized Intervention Trial in Chronic HF (MERIT-HF) were divided into 3 renal function subgroups (MDRD formula): eGFR(MDRD) > 60 (n = 2496), eGFR(MDRD) 45 to 60 (n = 976), and eGFR(MDRD) < 45 mL/min per 1.73 m(2) body surface area (n = 493). Hazard ratio (HR) was estimated with Cox proportional hazards models adjusted for prespecified risk factors. Placebo patients with eGFR < 45 had significantly higher risk than those with eGFR > 60: HR for all-cause mortality, 1.90 (95% confidence interval [CI], 1.28 to 2.81) comparing placebo patients with eGFR < 45 and eGFR > 60, and for the combined end point of all-cause mortality/hospitalization for worsening HF (time to first event): HR, 1.91 (95% CI, 1.44 to 2.53). No significant increase in risk with deceased renal function was observed for those randomized to metoprolol controlled release (CR)/extended release (XL) due to a highly significant decrease in risk on metoprolol CR/XL in those with eGFR < 45. For total mortality, metoprolol CR/XL vs placebo: HR, 0.41 (95% CI. 0.25 to 0.68; P < .001) in those with eGFR < 45 compared with HR, 0.71 (95% CI, 0.54 to 0.95; P < .021) for those with eGFR > 60; corresponding data for the combined end point was HR, 0.44 (95% CI, 0.31 to 0.63; P < .0001) and HR, 0.75 (0.62 to 0.92; P = .005, respectively; P = .095 for interaction by treatment for total mortality; P = .011 for combined end point). Metoprolol CR/XL was well tolerated in all 3 renal function subgroups. CONCLUSIONS: Renal function as estimated by eGFR was a powerful predictor of death and hospitalizations from worsening HF. Metoprolol CR/XL was at least as effective in reducing death and hospitalizations for worsening HF in patients with eGFR < 45 as in those with eGFR > 60.
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- Mansurbeg, Howri, et al.
(författare)
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Diagenesis and reservoir quality evolution of paleocene deep-water, marine sandstones, the Shetland-Faroes Basin, British Continental Shelf
- 2008
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Ingår i: Marine and Petroleum Geology. - : Elsevier BV. - 0264-8172 .- 1873-4073. ; 25:6, s. 514-543
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Tidskriftsartikel (refereegranskat)abstract
- The Palaeocene, deep-water marine sandstones recovered from six wells in the Shetland-Faroes Basin represent lowstand, transgressive and highstand systems tract turbiditic sediments. Mineralogic, petrographic, and geochemical analyses of these siliciclastics are used to decipher and discuss the diagenetic alterations and subsequent reservoir quality evolution. The Middle-Upper Palaeocene sandstones (subarkoses to arkoses) from the Shetland-Faroes Basin, British continental shelf are submarine turbiditic deposits that are cemented predominantly by carbonates, quartz and clay minerals. Carbonate cements (intergranular and grain replacive calcite, siderite, ferroan dolomite and ankerite) are of eogenetic and mesogenetic origins. The eogenetic alterations have been mediated by marine, meteoric and mixed marine/meteoric porewaters and resulted mainly in the precipitation of calcite (δ18OV−PDB=−10.9‰ and −3.8‰), trace amounts of non-ferroan dolomite, siderite (δ18OV−PDB=−14.4‰ to −0.6‰), as well as smectite and kaolinite in the lowstand systems tract (LST) and highstand systems tract (HST) turbiditic sandstone below the sequence boundary. Minor eogenetic siderite has precipitated between expanded and kaolinitized micas, primarily biotite. The mesogenetic alterations are interpreted to have been mediated by evolved marine porewaters and resulted in the precipitation of calcite (δ18OV−PDB=−12.9‰ to −7.8‰) and Fe-dolomite/ankerite (δ18OV−PDB=−12.1‰ to −6.3‰) at temperatures of 50–140 and 60–140 °C, respectively. Quartz overgrowths and outgrowth, which post- and pre-date the mesogenetic carbonate cements is more common in the LST and TST of distal turbiditic sandstone. Discrete quartz cement, which is closely associated with illite and chlorite, is the final diagenetic phase. The clay minerals include intergranular and grain replacive eogenetic kaolinite, smectite and mesogenetic illite and chlorite. Kaolinite has been subjected to mesogenetic replacement by dickite. The K-feldspar and plagioclase grains have been albitized. Dissolution of calcite cement and of framework grain (feldspar, volcanic fragments and mud intraclasts) has resulted in a considerable enhancement of reservoir quality.
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| 9. |
- Mansurbeg, Howri, et al.
(författare)
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Diagenetic evolution and porosity destruction of turbiditic hybrid arenites and siliciclastic sandstones of foreland basins: Evidence from the Eocene Hecho Group, Pyrenees, Spain
- 2009
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Ingår i: Journal of Sedimentary Research. - : Society for Sedimentary Geology. - 1527-1404 .- 1938-3681. ; 79:9-10, s. 711-735
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Tidskriftsartikel (refereegranskat)abstract
- This study aims to unravel the impact of diagenetic alterations on porosity loss of foreland-basin turbiditic hybrid arenites and associated siliciclastic sandstones of the Eocene Hecho Group (south-central Pyrenees, Spain). In this succession, hybrid arenites and calclithites are extensively cemented by mesogenetic calcite cement (delta O-18(VPDB) = -10.0 parts per thousand to -5.8 parts per thousand; T-h, mode = 80 degrees C salinity mode = 18.8 wt% eq. NaCl), Fe-dolomite (delta(18)(OVPDB) = -8.5 parts per thousand to -6.3 parts per thousand) and trace amounts of siderite. The extent of carbonate cementation is interpreted to be related to the amounts of extrabasinal and intrabasinal carbonate grains, which provided nuclei and sources for the precipitation and growth of carbonate cements. Other diagenetic alterations, such as pyrite and albitization, had no impact on reservoir quality. Scarce early diagenetic cements, coupled with abundant ductile carbonate and siliciclastic framework grains, have led to rapid porosity loss owing to compaction. Conversely, abundant quartz in the sandstones prevented rapid loss of porosity by mechanical compaction. Reservoir quality was affected by mesogenetic cementation by quartz overgrowths, calcite and dolomite intergranular pressure dissolution of quartz grains, and formation of fracture-filling calcite cement (delta O-18(V-PDB) values from -10.4 parts per thousand to -7.8 parts per thousand; T-h temperatures of approximate to 150 degrees C), which are attributed to deep circulation of hot meteoric waters during extensional stages of tectonism. The results of this study illustrate that diagenetic evolution pathways of the arenites and sandstones are closely linked to the variation in detrital composition, particularly the proportion and types of extrabasinal noncarbonates, extrabasinal carbonates, and intrabasinal carbonate grains. These insights suggest that marine turbiditic hybrid arenites and calclithites of foreland basins are subjected to more rapid and extensive porosity loss owing to compaction and cementation than associated siliciclastic sandstones. Degradation of reservoir quality makes these hybrid arenites, calclithites, and sandstones suitable as tight gas reservoirs, but only if fracture porosity and permeability develop during tectonic deformation.
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| 10. |
- Mansurbeg, Howri, et al.
(författare)
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Meteoric-water diagenesis in late Cretaceous canyon-fill turbidite reservoirs from the Espirito Santo Basin, eastern Brazil
- 2012
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Ingår i: Marine and Petroleum Geology. - : Elsevier BV. - 0264-8172 .- 1873-4073. ; 37:1, s. 7-26
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Tidskriftsartikel (refereegranskat)abstract
- Parameters controlling the diagenetic evolution of passive margin, marine turbidites, which are important targets of hydrocarbon exploration, are poorly constrained in the literature. This study aims to unravel the conditions of diagenesis and its impact on the reservoir quality evolution from late Cretaceous canyon-filling turbiditic sandstones of the onshore portion of Espirito Santo Basin, eastern Brazil. Kaolinization (delta O-18 = +13.3 parts per thousand to +15.2 parts per thousand; delta D = 96.6 parts per thousand to -79.6 parts per thousand) and dissolution of framework silicate grains is attributed to meteoric water incursion during eodiagenesis in response to a considerable fall in relative sea-level. Eogenetic alterations also include cementation by siderite (average delta O-18 = -72 parts per thousand; delta C-13 = +9.3 parts per thousand) and pyrite. Progressive sediment burial (present depths = 1530-2027 m) resulted in the formation of poikilotopic calcite, ferroan dolomite-ankerite (average delta O-18 = -7.9 parts per thousand; delta C-13 = +2.9 parts per thousand), minor amounts of quartz overgrowths and in partial dickitization of kaolinite. Isotopic values of calcite and dolomite-ankerite follow two trends of co-variance of delta C-13 with decreasing delta O-18 and increasing temperature. From a composition closer to marine (approximate to 0 parts per thousand), one trend goes towards positive delta C-13 values (up to +22.4 parts per thousand for calcite; +18.6 parts per thousand for dolomite-ankerite), indicating increasing input of carbonate from methanogenic fermentation. The other trend develops towards negative delta C-13 values (down to -17.2 parts per thousand for calcite; 15 parts per thousand for dolomite-ankerite), suggesting increasing contribution from thermal decarboxylation with increasing temperature and depth. Despite the presence of various cement types, mechanical compaction was more important than cementation in reducing depositional porosity in the onshore Urucutuca sandstones.
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