Circulation: Heart Failure最新文献

{"title":"Harnessing the Plasma Proteome to Predict Mortality in Heart Failure Subpopulations.","authors":"Jessica Chadwick, Michael A Hinterberg, Folkert W Asselbergs, Hannah Biegel, Eric Boersma, Thomas P Cappola, Julio A Chirinos, Joseph Coresh, Peter Ganz, David A Gordon, Natasha Kureshi, Kelsey M Loupey, Alena Orlenko, Rachel Ostroff, Laura Sampson, Sama Shrestha, Nancy K Sweitzer, Stephen A Williams, Lei Zhao, Isabella Kardys, David E Lanfear","doi":"10.1161/CIRCHEARTFAILURE.123.011208","DOIUrl":"10.1161/CIRCHEARTFAILURE.123.011208","url":null,"abstract":"<p><strong>Background: </strong>We derived and validated proteomic risk scores (PRSs) for heart failure (HF) prognosis that provide absolute risk estimates for all-cause mortality within 1 year.</p><p><strong>Methods: </strong>Plasma samples from individuals with HF with reduced ejection fraction (HFrEF; ejection fraction <40%; training/validation n=1247/762) and preserved ejection fraction (HFpEF; ejection fraction ≥50%; training/validation n=725/785) from 3 independent studies were run on the SomaScan Assay measuring ≈5000 proteins. Machine learning techniques resulted in unique 17- and 14-protein models for HFrEF and HFpEF that predict 1-year mortality. Discrimination was assessed via C-index and 1-year area under the curve (AUC), and survival curves were visualized. PRSs were also compared with Meta-Analysis Global Group in Chronic HF (MAGGIC) score and NT-proBNP (N-terminal pro-B-type natriuretic peptide) measurements and further assessed for sensitivity to disease progression in longitudinal samples (HFrEF: n=396; 1107 samples; HFpEF: n=175; 350 samples).</p><p><strong>Results: </strong>In validation, the HFpEF PRS performed significantly better (<i>P</i>≤0.1) for mortality prediction (C-index, 0.79; AUC, 0.82) than MAGGIC (C-index, 0.71; AUC, 0.74) and NT-proBNP (PRS C-index, 0.76 and AUC, 0.81 versus NT-proBNP C-index, 0.72 and AUC, 0.76). The HFrEF PRS performed comparably to MAGGIC (PRS C-index, 0.76 and AUC, 0.83 versus MAGGIC C-index, 0.75 and AUC, 0.84) but had a significantly better C-Index (<i>P</i>=0.026) than NT-proBNP (PRS C-index, 0.75 and AUC, 0.78 versus NT-proBNP C-index, 0.73 and AUC, 0.77). PRS included known HF pathophysiology biomarkers (93%) and novel proteins (7%). Longitudinal assessment revealed that HFrEF and HFpEF PRSs were higher and increased more over time in individuals who experienced a fatal event during follow-up.</p><p><strong>Conclusions: </strong>PRSs can provide valid, accurate, and dynamic prognostic estimates for patients with HF. This approach has the potential to improve longitudinal monitoring of patients and facilitate personalized care.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011208"},"PeriodicalIF":7.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572318","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":"Transfer to Hub Hospitals and Outcomes in Cardiogenic Shock.","authors":"Shubhadarshini Pawar, Kannu Bansal, J Dawn Abbott, Manreet K Kanwar, Navin K Kapur, Van-Khue Ton, Saraschandra Vallabhajosyula","doi":"10.1161/CIRCHEARTFAILURE.124.012477","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.124.012477","url":null,"abstract":"<p><strong>Background: </strong>There are limited large-scale data on the outcomes of patients with cardiogenic shock (CS) transferred to hub centers. This study aimed to compare the characteristics and outcomes of transferred patients with CS versus those who were not transferred.</p><p><strong>Methods: </strong>Adults (aged ≥18 years) with a primary or secondary diagnosis of CS were identified from the Nationwide Readmissions Database (2016-2020) and stratified by transfer status. Overlap propensity score weighting was performed to assess the association between transfer status and in-hospital mortality. Secondary outcomes, including length of hospital stay, hospitalization costs, and readmissions for cardiac and noncardiac etiologies, were assessed using multivariable regression.</p><p><strong>Results: </strong>Of 314 098 patients with CS (27% with acute myocardial infarction-related CS and 73% with nonacute myocardial infarction-related CS), 30 630 (9.8%) were transferred. In the unweighted population, compared with nontransferred patients, transferred patients were on average younger (65 versus 68 years), had higher comorbidities, and were more likely to be cared for at large teaching hospitals. During the hospitalization, they had higher rates of renal failure, pulmonary artery catheter use, and mechanical circulatory support use. In-hospital mortality was lower in transferred patients-39.1% versus 47.1%; unadjusted odds ratio (OR), 0.71 (95% CI, 0.70-0.73); adjusted OR, 0.73 ([95% CI, 0.71-0.76]; <i>P</i><0.001). This was consistent across subgroups of CS cause, age, sex, hospital location, mechanical circulatory support use, and presence of cardiac arrest. The transferred cohort had lower costs and length of stay, but more frequent all-cause (adjusted OR, 1.21 [95% CI, 1.16-1.27]), cardiac (adjusted OR, 1.16 [95% CI, 1.11-1.22]), heart failure (adjusted OR, 1.14 [95% CI, 1.08-1.21]), and noncardiac readmissions (adjusted OR, 1.68 [95% CI, 1.21-2.33]) at 30 days postdischarge compared with the nontransferred cohort.</p><p><strong>Conclusions: </strong>Despite higher comorbidity, organ failure, and use of cardiac/noncardiac procedures, patients with CS who were transferred to hub centers had lower in-hospital mortality, hospitalization costs, and length of stay.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012477"},"PeriodicalIF":7.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556039","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":"Hemodynamics of Exercise-Induced Hypertension and Relationship to Outcomes in Adults With Coarctation of the Aorta.","authors":"Alexander C Egbe, Yogesh N V Reddy, William R Miranda, C Charles Jain, Heidi M Connolly, Barry A Borlaug","doi":"10.1161/CIRCHEARTFAILURE.124.012459","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.124.012459","url":null,"abstract":"<p><strong>Background: </strong>Exercise-induced hypertension (EIH) is common in adults with coarctation of the aorta (COA), but there are limited data about hemodynamics and outcomes in such patients. The purpose of this study was to assess changes in arterial load during exercise in patients with COA with versus without EIH, and the relationship to clinical outcomes.</p><p><strong>Methods: </strong>We compared Doppler-derived arterial load indices (effective arterial elastance index, total arterial compliance index, systemic vascular resistance index), and clinical indices of disease severity (pulmonary congestion, aerobic capacity, and cardiovascular biomarkers) between adults with repaired COA and healthy controls. EIH was defined as systolic blood pressure (BP) at peak exercise >210 mm Hg in men or >190 mm Hg in women.</p><p><strong>Results: </strong>In this prospective cohort study, we assessed patients with COA (n=41, age 43±14 years, 26 [63%] men) and healthy controls (n=41). Although both groups had similar resting systolic BP, the COA group had higher Doppler-derived arterial load indices at rest, as well as a greater rise in systolic BP and Doppler-derived arterial load indices at each stage of exercise, leading to a higher prevalence of EIH in the COA group (37% versus 10%; <i>P</i>=0.004). Compared with patients with COA without EIH (n=26, 63%), those with EIH had higher arterial load at rest and during exercise, as well as worse cardiac dysfunction, pulmonary congestion, and biomarkers of cardiovascular remodeling, despite no significant differences in resting systolic BP.</p><p><strong>Conclusions: </strong>BP assessment during exercise can improve risk stratification and identify patients who may benefit from intensification of medical therapy.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012459"},"PeriodicalIF":7.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556037","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":"Insights From a 20-Year Follow-Up of the First Heart Transplant Recipient to Complete an Ironman Triathlon.","authors":"Stephen J Foulkes, Rachel J Skow, Andre La Gerche, Wayne J Tymchak, Mark J Haykowsky","doi":"10.1161/CIRCHEARTFAILURE.124.012027","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012027","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012027"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794269","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":"Importance of N2BA Titin in Maintaining Cardiac Homeostasis and Its Role in Dilated Cardiomyopathy.","authors":"Robbert van der Pijl, Eyad Nusayr, Joshua Strom, Rebecca Slater, Jochen Gohlke, Zaynab Hourani, Chandra Saripalli, Justin Kolb, Kyra Hermanson, Odhin Brynnel, John E Smith, Siegfried Labeit, Mei Methawasin, Henk Granzier","doi":"10.1161/CIRCHEARTFAILURE.124.012083","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012083","url":null,"abstract":"<p><strong>Background: </strong>TTN (titin) is the third myofilament type of the cardiac sarcomere and performs important functions that include generating passive tension. Changes in TTN expression are associated with cardiac dysfunction, and TTN is one of the main genes linked to dilated cardiomyopathy (DCM). DCM is frequently associated with changes in the expression of N2BA (compliant cardiac TTN isoform), 1 of the 2 major TTN isoforms found in the heart (the other isoform being the N2B [stiff cardiac TTN isoform]). Whether altered expression of N2BA TTN causes DCM or is a secondary change remains unclear.</p><p><strong>Methods: </strong>Here, we present a mouse model, the Ttn^Δ112-158 model, which specifically shortens the proline, glutamate, valine, lysine region of the N2BA isoform.</p><p><strong>Results: </strong>Echocardiography and pressure-volume analysis revealed a DCM phenotype characterized by systolic dysfunction and dilation. RNA sequencing studies showed the absence of proline, glutamate, valine, lysine exons, as expected, but also reduced expressions of exons specific to the N2BA isoform of TTN. Protein studies revealed a reduction in the overall expression level of the N2BA isoform with a concomitant increase in N2B TTN, with preserved TT (total TTN) levels. Passive tension was modestly increased in the Ttn^Δ112-158 model. Western blotting revealed that the N2BA TTN-associated protein MARP1 (muscle ankyrin repeat protein 1) is downregulated during both the pre-DCM and DCM phase. Downregulation of MARP1 coincided with the downregulation of the transcription factor Gata-4 (GATA binding protein 4), an MARP1-regulating and interacting protein, which is associated with DCM development.</p><p><strong>Conclusions: </strong>Thus, N2BA TTN is essential for maintaining cardiac health, and perturbed N2BA-MARP1 signaling contributes to DCM development.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012083"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390396","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":"Trajectory of Cognitive Function After Incident Heart Failure.","authors":"Supriya Shore, Hanyu Li, Min Zhang, Rachael T Whitney, Alden L Gross, Ankeet S Bhatt, Brahmajee K Nallamothu, Bruno Giordani, Emily M Briceño, Jeremy B Sussman, Jose Gutierrez, Kristine Yaffe, Michael E Griswold, Michelle C Johansen, Oscar L Lopez, Rebecca F Gottesman, Stephen Sidney, Susan R Heckbert, Tatjana Rundek, Timothy M Hughes, W T Longstreth, Deborah A Levine","doi":"10.1161/CIRCHEARTFAILURE.124.011837","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011837","url":null,"abstract":"<p><strong>Background: </strong>The magnitude of cognitive changes after incident heart failure (HF) is unclear. We assessed whether incident HF is associated with changes in cognition after accounting for pre-HF cognitive trajectories and known determinants of cognition.</p><p><strong>Methods: </strong>This pooled cohort study included adults without HF, stroke, or dementia from 6 US population-based studies from 1971 to 2019. Linear mixed-effects models estimated cognitive change with incident HF diagnosis and the rate of cognitive change over the years after HF, controlling for pre-HF cognitive trajectories and participant factors. Outcomes included change in global cognition (primary outcome), executive function, and memory (secondary outcomes). Cognitive outcomes were standardized to a <i>t</i> score metric (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition.</p><p><strong>Results: </strong>We included 29 614 adults (mean [SD] age was 61 [10] years, 55% female, 70% White). During a median follow-up of 6.6 (Q1-Q3, 5.0-19.8) years, 1407 (5%) adults received an incident diagnosis of HF. Incident HF diagnosis was associated with initial decreases in global cognition (-1.1 points [95% CI, -1.4 to -0.8]) and executive function (-0.6 points [95% CI, -1.0 to -0.3]). Larger decreases in global cognition after HF were seen with older age, female sex, and White race. Participants with incident HF diagnosis demonstrated faster and long-term declines in global cognition (-0.1 points per year [95% CI, -0.2 to -0.1]) and executive function (-0.2 points per year [95% CI, -0.2 to -0.1]). The change in memory with incident HF diagnosis was not statistically significant but showed a similar trend with an initial decline of -0.5 points (95% CI, -1.4 to +0.3) and a slope of -0.1 points per year (95% CI, -0.3 to 0.0).</p><p><strong>Conclusions: </strong>In this pooled cohort study, incident HF diagnosis was associated with initial decreases in global cognition and executive function and faster, persistent declines in these domains at follow-up.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011837"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439995","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 Aronson et al to Letter Regarding Article, \"Enhancing Sweat Rate Using a Novel Device for the Treatment of Congestion in Heart Failure\".","authors":"Doron Aronson, Yaacov Nitzan, Daniel Burkhoff, William T Abraham","doi":"10.1161/CIRCHEARTFAILURE.124.012560","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012560","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012560"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045337","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":"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}