Circulation: Heart Failure最新文献

{"title":"Mixed Shock Complicating Cardiogenic Shock: Frequency, Predictors, and Clinical Outcomes.","authors":"Luca Baldetti, Guglielmo Gallone, Gaia Filiberti, Luca Pescarmona, Andrea Cesari, Vincenzo Rizza, Edoardo Roagna, Davide Gurrieri, Beatrice Peveri, Lorenzo Nocera, Lorenzo Cianfanelli, Gianluca Marcelli, Giulia De Lio, Paolo Boretto, Filippo Angelini, Mario Gramegna, Vittorio Pazzanese, Stefania Sacchi, Francesco Calvo, Silvia Ajello, Gaetano Maria De Ferrari, Simone Frea, Anna Mara Scandroglio","doi":"10.1161/CIRCHEARTFAILURE.123.011404","DOIUrl":"10.1161/CIRCHEARTFAILURE.123.011404","url":null,"abstract":"<p><strong>Background: </strong>Patients presenting with cardiogenic shock (CS) are at risk of developing mixed shock (MS), characterized by distributive-inflammatory phenotype. However, no objective definition exists for this clinical entity.</p><p><strong>Methods: </strong>We assessed the frequency, predictors, and prognostic relevance of MS complicating CS, based on a newly proposed objective definition. MS complicating CS was defined as an objective shock state secondary to both an ongoing cardiogenic cause and a distributive-inflammatory phenotype arising at least 12 hours after the initial CS diagnosis, as substantiated by predefined longitudinal changes in hemodynamics, clinical, and laboratory parameters.</p><p><strong>Results: </strong>Among 213 consecutive patients admitted at 2 cardiac intensive care units with CS, 13 with inflammatory-distributive features at initial presentation were excluded, leading to a cohort of 200 patients hospitalized with pure CS (67±13 years, 96% Society of Cardiovascular Angiography and Interventions CS stage class C or higher). MS complicating CS occurred in 24.5% after 120 (29-216) hours from CS diagnosis. Lower systolic arterial pressure (<i>P</i>=0.043), hepatic injury (<i>P</i>=0.049), and suspected/definite infection (<i>P</i>=0.013) at CS diagnosis were independent predictors of MS development. In-hospital mortality (53.1% versus 27.8%; <i>P</i>=0.002) and hospital stay (21 [13-48] versus 17 [9-27] days; <i>P</i>=0.018) were higher in the MS cohort. At logistic multivariable analysis, MS diagnosis (odds ratio [OR], 3.00 [95% CI, 1.39-6.63]; <i>P</i>_adj=0.006), age (OR, 1.06 [95% CI, 1.03-1.10] years; <i>P</i>_adj<0.001), admission systolic arterial pressure <100 mm Hg (OR, 2.41 [95% CI, 1.19-4.98]; <i>P</i>_adj=0.016), and admission serum creatinine (OR, 1.61 [95% CI, 1.19-2.26]; <i>P</i>_adj=0.003) conferred higher odds of in-hospital death, while early temporary mechanical circulatory support was associated with lower in-hospital death (OR, 0.36 [95% CI, 0.17-0.75]; <i>P</i>_adj=0.008).</p><p><strong>Conclusions: </strong>MS complicating CS, objectively defined leveraging on longitudinal changes in distributive and inflammatory features, occurs in one-fourth of patients with CS, is predicted by markers of CS severity and inflammation at CS diagnosis, and portends higher hospital mortality.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011404"},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"REALM-DCM: A Phase 3, Multinational, Randomized, Placebo-Controlled Trial of ARRY-371797 in Patients With Symptomatic <i>LMNA</i>-Related Dilated Cardiomyopathy.","authors":"Pablo Garcia-Pavia, Jose Fernando Rodriguez Palomares, Gianfranco Sinagra, Roberto Barriales-Villa, Neal K Lakdawala, Robert L Gottlieb, Randal I Goldberg, Perry Elliott, Patrice Lee, Huihua Li, Franca S Angeli, Daniel P Judge, Calum A MacRae","doi":"10.1161/CIRCHEARTFAILURE.123.011548","DOIUrl":"10.1161/CIRCHEARTFAILURE.123.011548","url":null,"abstract":"<p><strong>Background: </strong><i>LMNA</i> (<i>lamin A/C</i>)-related dilated cardiomyopathy is a rare genetic cause of heart failure. In a phase 2 trial and long-term extension, the selective p38α MAPK (mitogen-activated protein kinase) inhibitor, ARRY-371797 (PF-07265803), was associated with an improved 6-minute walk test at 12 weeks, which was preserved over 144 weeks.</p><p><strong>Methods: </strong>REALM-DCM (NCT03439514) was a phase 3, randomized, double-blind, placebo-controlled trial in patients with symptomatic <i>LMNA</i>-related dilated cardiomyopathy. Patients with confirmed <i>LMNA</i> variants, New York Heart Association class II/III symptoms, left ventricular ejection fraction ≤50%, implanted cardioverter-defibrillator, and reduced 6-minute walk test distance were randomized to ARRY-371797 400 mg twice daily or placebo. The primary outcome was a change from baseline at week 24 in the 6-minute walk test distance using stratified Hodges-Lehmann estimation and the van Elteren test. Secondary outcomes using similar methodology included change from baseline at week 24 in the Kansas City Cardiomyopathy Questionnaire-physical limitation and total symptom scores, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) concentration. Time to a composite outcome of worsening heart failure or all-cause mortality and overall survival were evaluated using Kaplan-Meier and Cox proportional hazards analyses.</p><p><strong>Results: </strong>REALM-DCM was terminated after a planned interim analysis suggested futility. Between April 2018 and October 2022, 77 patients (aged 23-72 years) received ARRY-371797 (n=40) or placebo (n=37). No significant differences (<i>P</i>>0.05) between groups were observed in the change from baseline at week 24 for all outcomes: 6-minute walk test distance (median difference, 4.9 m [95% CI, -24.2 to 34.1]; <i>P</i>=0.82); Kansas City Cardiomyopathy Questionnaire-physical limitation score (2.4 [95% CI, -6.4 to 11.2]; <i>P</i>=0.54); Kansas City Cardiomyopathy Questionnaire-total symptom score (5.3 [95% CI, -4.3 to 14.9]; <i>P</i>=0.48); and NT-proBNP concentration (-339.4 pg/mL [95% CI, -1131.6 to 452.7]; <i>P</i>=0.17). The composite outcome of worsening heart failure or all-cause mortality (hazard ratio, 0.43 [95% CI, 0.11-1.74]; <i>P</i>=0.23) and overall survival (hazard ratio, 1.19 [95% CI, 0.23-6.02]; <i>P</i>=0.84) were similar between groups. No new safety findings were observed.</p><p><strong>Conclusions: </strong>Findings from REALM-DCM demonstrated futility without safety concerns. An unmet treatment need remains among patients with <i>LMNA</i>-related dilated cardiomyopathy.</p><p><strong>Registration: </strong>URL: https://classic.clinicaltrials.gov; Unique Identifiers: NCT03439514, NCT02057341, and NCT02351856.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011548"},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11244753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporary Mechanical Circulatory Support Coordinator: Conception and Implementation of a Novel Role.","authors":"Anthony P Carnicelli, Kaylen Dodson, Lindsey Bull, Jennifer Hajj, Jeffrey D McMurray, Ryan J Tedford, Lucas J Witer, Jeffrey Yourshaw, Arman Kilic, Brian A Houston","doi":"10.1161/CIRCHEARTFAILURE.124.011603","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011603","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011603"},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141295690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Survival on ECMO: The \"Right\" Parameters.","authors":"Jerome Crowley","doi":"10.1161/CIRCHEARTFAILURE.124.012008","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012008","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012008"},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Artery Pressures and Mortality During Venoarterial ECMO: An ELSO Registry Analysis.","authors":"Clark G Owyang, Brady Rippon, Felipe Teran, Daniel Brodie, Joaquin Araos, Daniel Burkhoff, Jiwon Kim, Joseph E Tonna","doi":"10.1161/CIRCHEARTFAILURE.123.011123","DOIUrl":"10.1161/CIRCHEARTFAILURE.123.011123","url":null,"abstract":"<p><strong>Background: </strong>Systemic hemodynamics and specific ventilator settings have been shown to predict survival during venoarterial extracorporeal membrane oxygenation (ECMO). How the right heart (the right ventricle and pulmonary artery) affect survival during venoarterial ECMO is unknown. We aimed to identify the relationship between right heart function with mortality and the duration of ECMO support.</p><p><strong>Methods: </strong>Cardiac ECMO runs in adults from the Extracorporeal Life Support Organization Registry between 2010 and 2022 were queried. Right heart function was quantified via pulmonary artery pulse pressure (PAPP) for pre-ECMO and on-ECMO periods. A multivariable model was adjusted for modified Society for Cardiovascular Angiography and Interventions stage, age, sex, and concurrent clinical data (ie, pulmonary vasodilators and systemic pulse pressure). The primary outcome was in-hospital mortality.</p><p><strong>Results: </strong>A total of 4442 ECMO runs met inclusion criteria and had documentation of hemodynamic and illness severity variables. The mortality rate was 55%; nonsurvivors were more likely to be older, have a worse Society for Cardiovascular Angiography and Interventions stage, and have longer pre-ECMO endotracheal intubation times (<i>P</i><0.05 for all) than survivors. Increasing PAPP from pre-ECMO to on-ECMO time (ΔPAPP) was associated with reduced mortality per 2 mm Hg increase (odds ratio, 0.98 [95% CI, 0.97-0.99]; <i>P</i>=0.002). Higher on-ECMO PAPP was associated with mortality reduction across quartiles with the greatest reduction in the third PAPP quartile (odds ratio, 0.75 [95% CI, 0.63-0.90]; <i>P</i>=0.002) and longer time on ECMO per 10 mm Hg (beta, 15 [95% CI, 7.7-21]; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Early on-ECMO right heart function and interval improvement from pre-ECMO values were associated with mortality reduction during cardiac ECMO. Incorporation of right heart metrics into risk prediction models should be considered.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011123"},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11251849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Tolerability of Angiotensin Receptor-Neprilysin Inhibitor Initiation in High-Risk Acute Myocardial Infarction Relative to Care Setting: A Subgroup Analysis of the PARADISE-MI Trial.","authors":"Carmine G De Pasquale, Brian Claggett, Karola Jering, John J V McMurray, Douglas Mann, Zi Michael Miao, Christopher B Granger, Lars Køber, Aldo P Maggioni, Jean-Lucien Rouleau, Scott D Solomon, Philippe Gabriel Steg, Peter van der Meer, Eugene Braunwald, Marc A Pfeffer","doi":"10.1161/CIRCHEARTFAILURE.123.011393","DOIUrl":"10.1161/CIRCHEARTFAILURE.123.011393","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011393"},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic Common Iliac Artery AV Fistula After Lumbar Discus Surgery Resulting in Severe High-Output Heart Failure in a Young Patient.","authors":"Marie Bayer Elming, Søren Schmiegelow, Rudina Balliu Nielsen, Stephan Bach-Frommer, Kim Kargaard Bredahl, Mads Ersbøll","doi":"10.1161/CIRCHEARTFAILURE.123.010889","DOIUrl":"10.1161/CIRCHEARTFAILURE.123.010889","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e010889"},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood Pressure Target in Out-of-Hospital Cardiac Arrest With Preexisting Heart Failure: (Don't) Go With the Flow?","authors":"Hannah Schaubroeck, Frederik H Verbrugge","doi":"10.1161/CIRCHEARTFAILURE.124.011828","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011828","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011828"},"PeriodicalIF":9.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equity in the Setting of Heart Failure Diagnosis: An Analysis of Differences Between and Within Clinician Practices.","authors":"Anshal Gupta, Rebecca L Tisdale, Jamie Calma, Randall S Stafford, David J Maron, Tina Hernandez-Boussard, Andrew P Ambrosy, Paul A Heidenreich, Alexander T Sandhu","doi":"10.1161/CIRCHEARTFAILURE.123.010718","DOIUrl":"10.1161/CIRCHEARTFAILURE.123.010718","url":null,"abstract":"<p><strong>Background: </strong>Timely heart failure (HF) diagnosis can lead to earlier intervention and reduced morbidity. Among historically marginalized patients, new-onset HF diagnosis is more likely to occur in acute care settings (emergency department or inpatient hospitalization) than outpatient settings. Whether inequity within outpatient clinician practices affects diagnosis settings is unknown.</p><p><strong>Methods: </strong>We determined the setting of incident HF diagnosis among Medicare fee-for-service beneficiaries between 2013 and 2017. We identified sociodemographic and medical characteristics associated with HF diagnosis in the acute care setting. Within each outpatient clinician practice, we compared acute care diagnosis rates across sociodemographic characteristics: female versus male sex, non-Hispanic White versus other racial and ethnic groups, and dual Medicare-Medicaid eligible (a surrogate for low income) versus nondual-eligible patients. Based on within-practice differences in acute diagnosis rates, we stratified clinician practices by equity (high, intermediate, and low) and compared clinician practice characteristics.</p><p><strong>Results: </strong>Among 315 439 Medicare patients with incident HF, 173 121 (54.9%) were first diagnosed in acute care settings. Higher adjusted acute care diagnosis rates were associated with female sex (6.4% [95% CI, 6.1%-6.8%]), American Indian (3.6% [95% CI, 1.1%-6.1%]) race, and dual eligibility (4.1% [95% CI, 3.7%-4.5%]). These differences persisted within clinician practices. With clinician practice adjustment, dual-eligible patients had a 4.9% (95% CI, 4.5%-5.4%) greater acute care diagnosis rate than nondual-eligible patients. Clinician practices with greater equity across dual eligibility also had greater equity across sex and race and ethnicity and were more likely to be composed of predominantly primary care clinicians.</p><p><strong>Conclusions: </strong>Differences in HF diagnosis rates in the acute care setting between and within clinician practices highlight an opportunity to improve equity in diagnosing historically marginalized patients.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e010718"},"PeriodicalIF":9.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Blood Pressure Targets in Patients With Heart Failure Undergoing Postresuscitation Care: A Subgroup Analysis From a Randomized Controlled Trial.","authors":"Johannes Grand, Christian Hassager, Henrik Schmidt, Simon Mølstrøm, Benjamin Nyholm, Laust E R Obling, Martin A S Meyer, Emma Illum, Jakob Josiassen, Rasmus P Beske, Henrik Høigaard Frederiksen, Jordi S Dahl, Jacob E Møller, Jesper Kjaergaard","doi":"10.1161/CIRCHEARTFAILURE.123.011437","DOIUrl":"10.1161/CIRCHEARTFAILURE.123.011437","url":null,"abstract":"<p><strong>Background: </strong>To assess the effect of targeting higher or lower blood pressure during postresucitation intensive care among comatose patients with out-of-hospital cardiac arrest with a history of heart failure.</p><p><strong>Methods: </strong>The BOX trial (Blood Pressure and Oxygenation Targets After Out-of-Hospital Cardiac Arrest) was a randomized, controlled, double-blinded, multicenter study comparing titration of vasopressors toward a mean arterial pressure (MAP) of 63 versus 77 mm Hg during postresuscitation intensive care. Patients with a history of heart failure were included in this substudy. Pulmonary artery catheters were inserted shortly after admission. History of heart failure was assessed through chart review of all included patients. The primary outcome was cardiac index during the first 72 hours. Secondary outcomes were left ventricular ejection fraction, heart rate, stroke volume, renal replacement therapy and all-cause mortality at 365 days.</p><p><strong>Results: </strong>A total of 134 patients (17% of the BOX cohort) had a history of heart failure (patients with left ventricular ejection fraction, ≤40%: 103 [77%]) of which 71 (53%) were allocated to a MAP of 77 mm Hg. Cardiac index at intensive care unit arrival was 1.77±0.11 L/min·m^-2 in the MAP63-group and 1.78±0.17 L/min·m^-2 in the MAP77, <i>P</i>=0.92. During the next 72 hours, the mean difference was 0.15 (95% CI, -0.04 to 0.35) L/min·m^-2; <i>P</i>_group=0.22. Left ventricular ejection fraction and stroke volume was similar between the groups. Patients allocated to MAP77 had significantly elevated heart rate (mean difference 6 [1-12] beats/min, <i>P</i>_group=0.03). Vasopressor usage was also significantly increased (<i>P</i>=0.006). At 365 days, 69 (51%) of the patients had died. The adjusted hazard ratio for 365 day mortality was 1.38 (0.84-2.27), <i>P</i>=0.20 and adjusted odds ratio for renal replacement therapy was 2.73 (0.84-8.89; <i>P</i>=0.09).</p><p><strong>Conclusions: </strong>In resuscitated patients with out-of-hospital cardiac arrest with a history of heart failure, allocation to a higher blood pressure target resulted in significantly increased heart rate in the higher blood pressure-target group. However, no certain differences was found for cardiac index, left ventricular ejection fraction or stroke volume.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03141099.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011437"},"PeriodicalIF":7.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}