Circulation: Heart Failure最新文献

{"title":"Letter by Wei et al Regarding Article, \"Survival Odds to Minimize Risk Heterogeneity Bias in Heart Failure Trials: Application to Dapagliflozin\".","authors":"Chengcheng Wei, Liyi Dai, Hengjian Peng, Wu Yiting","doi":"10.1161/CIRCHEARTFAILURE.125.014029","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.125.014029","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014029"},"PeriodicalIF":8.4,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688411","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":"Response by Myte et al to Letter Regarding Article, \"Survival Odds to Minimize Risk Heterogeneity Bias in Heart Failure Trials: Application to Dapagliflozin\".","authors":"Robin Myte, Samvel B Gasparyan, Per Nyström","doi":"10.1161/CIRCHEARTFAILURE.126.014198","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014198","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014198"},"PeriodicalIF":8.4,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688343","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":"Device-Related Adverse Events and Outcomes in Patients With Temporary Mechanical Circulatory Support Placed at Referral Centers Versus Cardiogenic Shock Hub Centers: An Observational Analysis.","authors":"Zachary A Patel, Meg K Ospina, Roxanne Mittelstaedt, Jacob Peller, Stephanie Samani, Charlotte Marchell, Kelly Ohlrich, Brady Gunn, Michael Varrone, Kaylen Dodson, Lindsey Bull, Hajj Jennifer, Mathew J Gregoski, Molly Silkowski, Michele Esposito, Ryan J Tedford, Jeffrey D McMurray, Lucas Witer, Arman Kilic, Brian A Houston, Anthony P Carnicelli","doi":"10.1161/CIRCHEARTFAILURE.125.013742","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.013742","url":null,"abstract":"<p><strong>Background: </strong>Temporary mechanical support (tMCS) devices are often placed for cardiogenic shock (CS) at regional referral centers (RRCs) before transfer to CS hub centers (HCs). We sought to assess for differences in device-related adverse events (DRAEs) and outcomes between patients with tMCS placement for CS at an RRC before transfer to an HC compared with initial tMCS device placement at an HC.</p><p><strong>Methods: </strong>All patients with tMCS for CS from August 2021 to August 2024 at a single center were stratified by location of initial tMCS device placement. Baseline characteristics, adjudicated DRAEs, mortality, and unfavorable outcomes (death before discharge, heart transplant, or durable left ventricular assist device) were compared. DRAE rates were calculated as events/patient-week on tMCS. Multivariable logistic regression was performed to account for baseline differences. Kaplan-Meier and Cox regression were performed to compare mortality.</p><p><strong>Results: </strong>A total of 398 patients (77% HC-implanted, 23% RRC-implanted) were identified. RRC-implanted patients more commonly experienced cardiac arrest and had more advanced CS. DRAE prevalence was higher in RRC-implanted patients (any DRAE in 64% versus 33%), including bleeding (29% versus 12%), hemolysis (30% versus 18%), and vascular injury (22% versus 5%); <i>P</i><0.05 for all. The overall DRAE rate was 0.33 events/patient-week and was numerically higher among RRC-implanted than HC-implanted patients (0.65 versus 0.24 events/patient-week). RRC-implanted patients had higher unadjusted in-hospital mortality (odds ratio, 2.52 [95% CI, 1.52-4.18]; <i>P</i><0.001) and unfavorable outcomes (odds ratio, 2.55 [95% CI, 1.52-4.27]; <i>P</i><0.001). This finding was significant after adjustment for baseline differences, but not after adjustment for CS severity and cardiac arrest (in-hospital mortality odds ratio, 1.72 [95% CI, 0.95-3.12]; <i>P</i>=0.07; unfavorable outcome odds ratio, 1.60 [95% CI, 0.87-2.92]; <i>P</i>=0.13).</p><p><strong>Conclusions: </strong>Initial tMCS placement for CS at an RRC with transfer to an HC is associated with a higher DRAE prevalence and worse outcomes than initial tMCS placement at a CS HC. The higher mortality in RRC-implanted patients may be due to greater CS severity.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013742"},"PeriodicalIF":8.4,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13082456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670948","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":"Mavacamten Versus Alcohol Septal Ablation in Obstructive Hypertrophic Cardiomyopathy: An Echocardiography-Derived Pressure-Volume Analysis.","authors":"Jan-Christian Reil, Vasco Sequeira, Cédric Coppée, Karina Peters, Jan M Federspiel, Paul Steendijk, Christoph Maack, Mark T Waddingham, Volker Rudolph, Gert-Hinrich Reil, Smita Scholtz","doi":"10.1161/CIRCHEARTFAILURE.125.013392","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.125.013392","url":null,"abstract":"<p><strong>Background: </strong>Obstructive hypertrophic cardiomyopathy (oHCM) is characterized by left ventricular (LV) outflow tract obstruction, which increases afterload and chronically activates the Anrep response, a compensatory (afterload-driven) state of hyperdynamic systole, prolonged systolic ejection time, and increased myocardial workload. We investigated whether the myosin inhibitor mavacamten reverses this state, comparing its effects to the anatomic relief achieved by alcohol septal ablation.</p><p><strong>Methods: </strong>Thirty-six patients with symptomatic oHCM were treated with mavacamten. Of these, 29 who achieved a resting LV outflow tract gradient <50 mm Hg at 3 months (responders) underwent echocardiography-derived pressure-volume analysis before and after therapy. For comparison, a separate cohort of 13 patients with oHCM underwent identical pressure-volume analysis before and 3 months post-alcohol septal ablation. Anrep-related indices were quantified: afterload (LV end-systolic pressure and effective arterial elastance), contractility (end-systolic elastance and end-systolic volume at 150 mm Hg), and systolic ejection time. Myocardial workload (stroke work, potential energy, and pressure-volume area) and diastolic function (LV end-diastolic pressure, end-diastolic volume, and volume at 15 mm Hg LV end-diastolic pressure) were also assessed.</p><p><strong>Results: </strong>At baseline, all patients showed chronic activation of the Anrep response: elevated afterload (high LV end-systolic pressure and effective arterial elastance), hypercontractility (high end-systolic elastance and low end-systolic volume at 150 mm Hg), and prolonged systolic ejection time, accompanied by increased mechanical workload (elevated stroke work, potential energy, and pressure-volume area). After 3 months, both mavacamten responders and alcohol septal ablation responders showed comparable ventricular unloading: reductions in afterload and contractility, shortened systolic ejection time, and decreased myocardial workload, all while preserving stroke volume. Diastolic indices improved (increased end-diastolic volume and volume at 15 mm Hg LV end-diastolic pressure, and decreased LV end-diastolic pressure). Conversely, in mavacamten nonresponders (persistent LV outflow tract gradient ≥50 mm Hg at 3 months), Anrep-related indices and myocardial workload did not change.</p><p><strong>Conclusions: </strong>In oHCM, chronic Anrep activation maintains cardiac output against elevated afterload at high energetic cost. Our finding that mavacamten and alcohol septal ablation produce comparable hemodynamic corrections establishes the reversal of this afterload-driven state as a central mechanistic target of therapy in oHCM.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013392"},"PeriodicalIF":8.4,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670889","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":"Delivery Is Not the Finish Line: Critical Transition of Care in the Fourth Trimester.","authors":"M Elisabeth Leong","doi":"10.1161/CIRCHEARTFAILURE.126.014141","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014141","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014141"},"PeriodicalIF":8.4,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644224","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":"Phenomapping of Heart Failure Patients: All Clusters Are Wrong, But Are They Useful?","authors":"Brian L Claggett","doi":"10.1161/CIRCHEARTFAILURE.125.013582","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.125.013582","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013582"},"PeriodicalIF":8.4,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644279","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":"Heart Failure Guideline-Directed Medical Therapy Scoring Systems: A Scoping Review.","authors":"Aaryan Dwivedi, Zachary Cox, Nathaniel M Hawkins, Nima Moghaddam, Margaret Sidsworth, Sean Virani, Douglas S Lee, Ricky D Turgeon","doi":"10.1161/CIRCHEARTFAILURE.125.013881","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.125.013881","url":null,"abstract":"<p><strong>Background: </strong>Guideline-directed medical therapy (GDMT) is central to the care of heart failure with reduced ejection fraction, yet no standard metric exists to quantify its implementation.</p><p><strong>Methods: </strong>We conducted a scoping review to catalogue and characterize all published heart failure GDMT scores and summarize their application in clinical studies. We searched MEDLINE, Embase, CENTRAL, and Web of Science from October 2020 to March 2025.</p><p><strong>Results: </strong>From 544 records, we included 26 studies (19 cohorts, 7 randomized trials; 354 281 patients). Of the 26 studies, 25 (96%) utilized different scores, including 13 adaptations of the Optimal Medical Therapy score originally proposed by the Heart Failure Collaboratory in 2020. All counted RASi (renin-angiotensin system inhibitors), beta-blockers, and mineralocorticoid receptor antagonists; 18 separated sacubitril-valsartan from other RASi, 15 incorporated sodium-glucose cotransporter-2 inhibitors, and 8 captured additional drug classes. Only 2 scores were adjusted for contraindications or intolerance. Across studies, GDMT scores served as a descriptor (N=14), covariate (N=11), predictor of future outcomes (N=12), and end point for GDMT optimization interventions (N=8).</p><p><strong>Conclusions: </strong>Multiple, disparate scores have been developed to quantify heart failure with reduced ejection fraction GDMT optimization, undermining the original intent. Key gaps in scores include heterogeneous weighting of drug classes and doses, minimal incorporation of intolerance to identify maximum-tolerated therapy, and heterogeneous incorporation of therapies beyond quadruple therapy. Future studies should focus on clear reporting and justification of the selected GDMT score, and the use of existing scores that incorporate relevant contemporary agents.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013881"},"PeriodicalIF":8.4,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638164","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":"Incidence, Timing and Clinical Significance of Immune-Mediated Myocardial Injury and Myocarditis After Gene Replacement Therapy: A Systematic Review and Meta-Analysis.","authors":"Niccolò Maurizi, Enrico Ammirati, Elizabeth Silver, Kimberly Hong, Quan Bui, Alessia Argirò, Iacopo Olivotto, Eric D Adler","doi":"10.1161/CIRCHEARTFAILURE.125.013771","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.125.013771","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although adeno-associated virus (AAV) gene-replacement therapy is a potentially transformative therapy for severe genetic diseases, its cardiac immunotoxicity may challenge broad clinical use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Medical Literature Analysis and Retrieval System Online, Embase, and PubMed databases were searched from January 2005 to March 2025. Studies including patients treated with AAV-replacement therapy were deemed eligible. Prespecified items (type of vector, dose, timing, and clinical significance of the adverse event) were extracted by 2 independent observers. Random-effects models were fitted using restricted maximum likelihood estimation and the method of Hartung, Knapp, Sidik, and Jonkman (International Prospective Register of Systematic Reviews [PROSPERO], REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD420251046546). VigiBase and the US Food and Drug Administration Adverse Event Reporting System were searched for the occurrence of myocarditis with commercially available AAV-replacement drugs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eighty studies including 1939 human patients were analyzed. A total of 734 adverse events were reported over 2122 patient-years of pooled observation. Seventy-one cases of myocarditis were identified. The pooled incidence rate per 100 patient-years was 8.6 (95% CI, 5.8-10.7; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=63.2%). Events occurred in patients with Duchenne muscular dystrophy, spinal muscular atrophy, and X-linked myotubular myopathy, with recombinant AAVs and adeno-associated virus serotype 8. All received an intravenous dose &gt;10&lt;sup&gt;13&lt;/sup&gt; vector genomes per kilogram body weight. Myocardial injury peaked in week 1 after injection (90% [95% CI, 85.7%-96.2%]; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=43.2%), whereas myocarditis occurred mostly after week 2 (55% [95% CI, 48.7%-65.2%]; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=33.1%), with no cases after the first month. Most myocarditis/myocardial injury did not have a relevant clinical impact (62, 87%), with only 8 (12%) cases having transient left ventricular dysfunction. The latter recovered during the follow-up. The only death occurred in the setting of cytokine-mediated capillary leak syndrome with cardiac dysfunction. Myocarditis occurred in relation to delandistrogene moxeparvovec (1/16 [6%]) and onasemnogene abeparvovec (14/217 [6%]) in the Food and Drug Administration Adverse Event Reporting System and VigiBase.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Immune-mediated myocarditis/myocardial injury after systemic AAV gene therapy occurred in &lt;10 per 100 patient-years (peaking at weeks 1-3) and was usually clinically mild, with a minority showing transient dysfunction. All events followed intravenous doses &gt;1×10&lt;sup&gt;1&lt;/sup&gt;&lt;sup&gt;3&lt;/sup&gt; vector genomes per kilogram body weight, clustered in neuromuscular programs, and were associated with certain recombinant capsids/serotypes. These data support intensive early cardiac monitoring, cautious dose ","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013771"},"PeriodicalIF":8.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627387","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":"Compensating Heart Failure Cardiologists: Is the RVU Model the Right Model?","authors":"Nir Uriel, Boaz Elad, Yevgeniy Brailovsky, Kevin Clerkin, Justin Fried, Nikhil Narang, Dor Lotan, Ilan Richter, Jayant Raikhelkar, Adil Yunis, Ersilia M DeFilippis, Thomas M Cascino, Snehal R Patel, Shashank S Sinha, Jennifer Haythe, Marc E Richmond, Manreet Kanwar, Gabriel Sayer, Ulrich P Jorde","doi":"10.1161/CIRCHEARTFAILURE.125.013838","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.125.013838","url":null,"abstract":"<p><p>Physician compensation models in the United States are diverse, shaped by practice settings, specialties, and institutional factors. A notable shift in academic medical centers has been the transition from salary-based compensation to relative value unit (RVU)-based models. While this shift may align compensation with clinical productivity and facilitate budgetary planning, it has profound implications for physician satisfaction, burnout, and clinical practice, particularly in primarily cognitive/nonprocedural based specialties like advanced heart failure (AHF). This article explores the benefits and drawbacks of the RVU model, with a focus on its application in AHF care. The RVU system, designed to measure physician work, practice expenses, and malpractice risk, is associated with efficiency incentives but also risks prioritizing quantity over quality, especially in multidisciplinary fields like AHF. Patients with AHF often have multiple comorbidities requiring extensive management and care coordination across multiple subspecialties, outside of the work effort captured by a clinic visit. The RVU model may undervalue the comprehensive, longitudinal care AHF specialists provide. Through a detailed examination of inpatient and outpatient AHF management, we argue that the RVU model may inadequately capture the full scope of AHF care, which may contribute to systemic challenges, physician burnout, and a decline in interest in AHF subspecialty training. Hence, we call for a reconsideration of AHF physician compensation and productivity measurement that more accurately reflects the full breadth of comprehensive AHF care.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013838"},"PeriodicalIF":8.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627334","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":"Letter by van IJzendoorn Regarding Article, \"Network Meta-Analysis of Quality of Life in Heart Failure With Reduced Ejection Fraction\".","authors":"Marinus H van IJzendoorn","doi":"10.1161/CIRCHEARTFAILURE.126.014314","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014314","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014314"},"PeriodicalIF":8.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627303","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}