Circulation: Heart Failure最新文献

{"title":"Precision Medicine Is in the Eye of the Beholder.","authors":"Kenneth B Margulies","doi":"10.1161/CIRCHEARTFAILURE.125.012759","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.012759","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012759"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596409","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":"Modeling Heart Failure With Preserved Ejection Fraction Using Human Induced Pluripotent Stem Cell-Derived Cardiac Organoids.","authors":"Idan Refael Haim, Amit Gruber, Noam Kazma, Caroline Bashai, Hava Lichtig Kinsbruner, Oren Caspi","doi":"10.1161/CIRCHEARTFAILURE.124.011690","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011690","url":null,"abstract":"<p><strong>Background: </strong>The therapeutic armamentarium for heart failure with preserved ejection fraction (HFpEF) remains notably constrained. A factor contributing to this problem could be the scarcity of in vitro models for HFpEF, which hinders progress in developing new therapeutic strategies. Here, we aimed at developing a novel, comorbidity-inspired, human, in vitro model for HFpEF.</p><p><strong>Methods: </strong>Human induced pluripotent stem cells-derived cardiomyocytes were used to produce cardiac organoids. The generated organoids were then subjected to HFpEF-associated, comorbidity-inspired conditions, such as hypertension, diabetes, and obesity-related inflammation. To assess the development of HFpEF pathophysiological features, organoids were thoroughly evaluated for their structural, functional, electrophysiological, and metabolic properties.</p><p><strong>Results: </strong>Exposure to the combination of all comorbidity-mimicking conditions resulted in the largest cellular volume of 1692±52 versus 1346±84 µm³ in RPMI (Roswell Park Memorial Institute medium) control group (<i>P</i>=0.003), while lower in obesity, hypertension, and diabetes groups: 1059±40 µm³ (<i>P</i>=0.014), 1276±35 µm³ (<i>P</i>=0.940), and 1575±70 µm³ (<i>P</i>=0.146), respectively. Similarly, ultrastructural fibrosis was most significantly observed after exposure to the combination of all HFpEF-inducing conditions 14.6±1.2% compared with single condition exposure 5.2±1.3% (obesity), 6.7±3.5% (hypertension), and 9.0±1.1% (diabetes; <i>P</i><0.001). Moreover, HFpEF-related conditions led to an increase in passive force compared with control (7.52±1.08 versus 2.33±0.46 mN/mm, <i>P</i><0.001), whereas no significant alterations were noted in active contractile forces. Relaxation constant τ was significantly prolonged after exposure to HFpEF conditions showing a prolongation of 95.9 ms (36.4-106.4; <i>P</i>=0.028) compared with a shortening of 35.6 ms (43.3-67.3; <i>P</i>=0.80) in the control. Finally, organoid exposure to HFpEF conditions led to a significant increase in oxidative stress levels and a significant decline in oxygen consumption rate.</p><p><strong>Conclusions: </strong>We established a novel, human, in vitro model for HFpEF, based on comorbidity-inspired conditions. The model faithfully recapitulated the structural, functional, and mechanistic features of HFpEF. This model holds the potential to provide mechanistic insights and facilitate the identification of novel therapeutic targets.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011690"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051715","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":"Functional Sarcopenia and Physical Rehabilitation Response in Older Adults Hospitalized for Acute Heart Failure: A Secondary Analysis of the REHAB-HF Trial.","authors":"Saeid Mirzai, Haiying Chen, Amy M Pastva, Gordon R Reeves, Robert J Mentz, Dalane W Kitzman, David J Whellan, M Benjamin Nelson, Anthony E Peters, Ambarish Pandey, Stephen B Kritchevsky, Alain G Bertoni","doi":"10.1161/CIRCHEARTFAILURE.124.012550","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012550","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012550"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405975","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":"Letter by Xing et al Regarding Article, \"Enhancing Sweat Rate Using a Novel Device for the Treatment of Congestion in Heart Failure\".","authors":"Han Xing, Chengeng Deng, Huihui Zhao","doi":"10.1161/CIRCHEARTFAILURE.124.012466","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012466","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012466"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045202","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":"Pseudo-Severe Mitral Stenosis From Obesity-Related HFpEF and Atrial Myopathy.","authors":"Jenny Jia Ling Cao, William R Miranda, Barry A Borlaug, Yogesh N V Reddy","doi":"10.1161/CIRCHEARTFAILURE.124.012703","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012703","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012703"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051716","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":"Impaired Exercise Capacity in High-Risk Diabetic Cardiomyopathy: The ARISE-HF Cardiopulmonary Exercise Testing Subanalysis.","authors":"W H Wilson Tang, Yuxi Liu, Javed Butler, Stefano Del Prato, Justin A Ezekowitz, Nasrien E Ibrahim, Carolyn S P Lam, Thomas H Marwick, Riccardo Perfetti, Julio Rosenstock, Scott D Solomon, Faiez Zannad, James L Januzzi, Gregory D Lewis","doi":"10.1161/CIRCHEARTFAILURE.124.012200","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012200","url":null,"abstract":"<p><strong>Background: </strong>Objective indices of functional capacity in patients with diabetic cardiomyopathy and stage B heart failure (HF) have not been comprehensively defined. We sought to characterize the cardiopulmonary exercise characteristics of individuals with diabetic cardiomyopathy at high risk for overt HF.</p><p><strong>Methods: </strong>The relationships from cardiopulmonary exercise testing with clinical and laboratory characteristics of participants with diabetic cardiomyopathy were evaluated using baseline data from the ARISE-HF trial (Aldose Reductase Inhibition for Stabilization of Exercise Capacity in Heart Failure). Cluster phenogroups with different comorbidities and their corresponding functional capacity profiles were identified.</p><p><strong>Results: </strong>Among study participants (n=689), the median (Q1, Q3) peak oxygen uptake and ventilatory efficiency (slope of the ratio of minute ventilation/carbon dioxide production) were 15.7 (interquartile range, 13.0-18.0) mL/kg per minute and 31.2 (interquartile range, 27.2-34.1), respectively. Lower peak oxygen uptake was associated with older age, female sex, higher body mass index, higher N-terminal pro-B-type natriuretic peptide, and an increasing burden of noncardiac comorbid conditions but was not associated with cardiac troponin T or echocardiogram-derived strain, left atrial volume index, E/e', or right ventricular systolic pressure. Elevated left ventricular mass index was the only echocardiographic abnormality associated with lower peak oxygen uptake. Multivariable analysis revealed that female sex, higher body mass index, and no history of dyslipidemia were independently associated with lower baseline peak oxygen uptake. Cluster analysis revealed 3 clusters with profiles of different cardiovascular/exercise parameters and health status profiles.</p><p><strong>Conclusions: </strong>Baseline cardiopulmonary exercise testing data from the ARISE-HF trial highlight predominant associations of extracardiac clinical and demographic variables with significant impairment in exercise capacity despite strict fulfillment of diagnostic criteria for stage B HF.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04083339.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012200"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063964","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":"Biomarkers of RV Dysfunction in HFrEF Identified by Direct Tissue Proteomics: Extracellular Proteins Fibromodulin and Fibulin-5.","authors":"Matěj Běhounek, Denisa Lipcseyová, Ondřej Vít, Petr Žáček, Pavel Talacko, Zuzana Husková, Soňa Kikerlová, Tereza Tykvartová, Peter Wohlfahrt, Vojtěch Melenovský, Jan Beneš, Jiří Petrák","doi":"10.1161/CIRCHEARTFAILURE.124.011984","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011984","url":null,"abstract":"<p><strong>Background: </strong>Right ventricular dysfunction (RVD) is common in patients with heart failure with reduced ejection fraction, and it is associated with poor prognosis. However, no biomarker reflecting RVD is available for routine clinical use.</p><p><strong>Methods: </strong>Proteomic analysis of myocardium from the left ventricle and right ventricle (RV) of patients with heart failure with reduced ejection fraction with (n=10) and without RVD (n=10) who underwent heart transplantation was performed. Concentrations of 2 ECM (extracellular matrix) proteins with the highest myocardial upregulation in RVD, FMOD (fibromodulin) and FBLN5 (fibulin-5), were assayed in the blood and tested in a separate cohort of patients with heart failure with reduced ejection fraction (n=232) to test for the association of the 2 proteins with RV function and long-term outcomes.</p><p><strong>Results: </strong>Multivariable linear regression revealed that plasma concentrations of both FMOD and FBLN5 were significantly associated with RV function regardless of the RV function assessment method. No association of FMOD or FBLN5 with left ventricular dysfunction, cardiac index, body mass index, diabetes status, or kidney function was found. Plasma levels of FMOD and FBLN5 were significantly associated with patient outcomes (<i>P</i>=0.005; <i>P</i>=0.004). Area under the curve analysis showed that the addition of FBLN5 or FMOD to RV function assessment had a significantly higher area under the curve after 4 years of follow-up (0.653 and 0.631, respectively) compared with RV function alone (0.570; <i>P</i><0.05 for both). Similarly, the combination of MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) score, FBLN5, and FMOD had a significantly larger area under the curve (0.669) than the combination of MAGGIC score+RVD grade (0.572; <i>P</i>=0.02). The Kaplan-Meier analysis demonstrated that patients with the elevation of both FMOD and FBLN5 (ie, FMOD >64 ng/mL and FMOD >27 ng/mL) had a worse prognosis than those with the elevation of either FBLN5 or FMOD (<i>P</i>=0.03) demonstrating the additive prognostic value of both proteins.</p><p><strong>Conclusions: </strong>Our study proposes that circulating levels of FMOD and FBLN5 may serve as new biomarkers of RVD in patients with heart failure with reduced ejection fraction.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011984"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001115","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":"Ubiquity of Multimorbidity: Comorbid Conditions and Mortality in HFpEF.","authors":"Ishan Kamat, Ajith Nair","doi":"10.1161/CIRCHEARTFAILURE.124.012432","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012432","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012432"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536615","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":"Challenges Related to Out-of-Pocket Costs in Heart Failure Management.","authors":"Birju R Rao, Larry A Allen, Alexander T Sandhu, Neal W Dickert","doi":"10.1161/CIRCHEARTFAILURE.124.011584","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011584","url":null,"abstract":"<p><p>High out-of-pocket costs and financial toxicity related to heart failure treatment are substantial concerns. Two of 4 pillars of guideline-directed medical therapy for heart failure with reduced ejection fraction, for example, carry high costs that may attenuate their uptake. Furthermore, heart failure rarely occurs in isolation. Many patients have other comorbidities that require treatment, further driving up patients' out-of-pocket costs. Developing treatment plans that improve mortality without subjecting patients to financial toxicity can be challenging for several reasons. First, patients with heart failure can accrue out-of-pocket costs from multiple domains and can depend on a variety of insurance and pharmacy-related factors that can make determining patient-specific out-of-pocket cost estimates complicated. Second, strategies to mitigate financial toxicity involve health policy-level interventions and patient-level interventions. These have their own unique sets of challenges. Third, integrating out-of-pocket costs into shared decision-making requires nuanced and challenging discussions about whether a therapy is worth the cost. Though shared decision-making has been advocated, there are little data on how to best conduct these discussions. Health policies like the Inflation Reduction Act of 2022 may provide relief to some patients, and efforts to improve transparency have the potential to be beneficial. Over the long term, policy solutions such as value-based insurance design and patient engagement solutions that emphasize enhancing shared decision-making have important potential to yield durable results.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011584"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522606","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":"Impact of Multimorbidity on Mortality in Heart Failure With Mildly Reduced and Preserved Ejection Fraction.","authors":"Mingming Yang, Toru Kondo, Pooja Dewan, Akshay S Desai, Carolyn S P Lam, Martin P Lefkowitz, Milton Packer, Jean L Rouleau, Muthiah Vaduganathan, Michael R Zile, Pardeep S Jhund, Lars Køber, Scott D Solomon, John J V McMurray","doi":"10.1161/CIRCHEARTFAILURE.124.011598","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011598","url":null,"abstract":"<p><strong>Background: </strong>How different combinations of comorbidities influence risk at the patient level and population level in patients with heart failure with mildly reduced ejection fraction/heart failure with preserved ejection fraction is unknown. We aimed to investigate the prevalence of different combinations of cardiovascular and noncardiovascular comorbidities (ie, multimorbidity) and associated risk of death at the patient level and population level.</p><p><strong>Methods: </strong>Using patient-level data from the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) and PARAGON-HF trial (Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction), we investigated the 5 most common cardiovascular and noncardiovascular comorbidities and the resultant 45 comorbidity pairs. Cox proportional hazard models were used to calculate the population-attributable fractions for all-cause mortality and the relative excess risk due to interaction for each comorbidity pair.</p><p><strong>Results: </strong>Among 6504 participants, 95.2% had at least 2 of the 10 most prevalent comorbidities. The comorbidity pair with the greatest patient-level risk was stroke and peripheral artery disease (adjusted hazard ratio, 1.88 [95% CI, 1.27-2.79]), followed by peripheral artery disease and chronic obstructive pulmonary disease (1.81 [95% CI, 1.31-2.51]), and coronary artery disease and stroke (1.67 [95% CI, 1.33-2.11]). The pair with the highest population-level risk was hypertension and chronic kidney disease (CKD; adjusted population-attributable fraction, 14.8% [95% CI, 9.2%-19.9%]), followed by diabetes and CKD (13.3% [95% CI, 10.6%-16.0%]), and hypertension and diabetes (11.9% [95% CI, 7.1%-16.5%). A synergistic interaction (more than additive risk) was found for the comorbidity pairs of stroke and coronary artery disease (relative excess risk due to interaction, 0.61 [95% CI, 0.13-1.09]), diabetes and CKD (relative excess risk due to interaction, 0.46 [95% CI, -0.15 to 0.77]), and obesity and CKD (relative excess risk due to interaction, 0.24 [95% CI, 0.01-0.46]).</p><p><strong>Conclusions: </strong>The risk associated with comorbidity pairs differs at the patient and population levels in heart failure with mildly reduced ejection fraction/heart failure with preserved ejection fraction. At the population level, hypertension, CKD, and diabetes account for the greatest risk, whereas at the patient level, polyvascular disease and chronic obstructive pulmonary disease are the most important.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011598"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536613","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}