Circulation: Heart Failure最新文献

{"title":"Pulmonary Circulation in Advanced Heart Failure and Cardiogenic Shock: State-of-the-Art Review.","authors":"Sara L Hungerford, Kay D Everett, Edmund Lau, Daniel Burkhoff, Navin K Kapur","doi":"10.1161/CIRCHEARTFAILURE.124.012611","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012611","url":null,"abstract":"<p><p>The pulsatile nature of blood flow and the hydrostatic effect of pulmonary capillary wedge pressure are 2 fundamental, yet often overlooked features of right ventricular-pulmonary arterial interactions in advanced heart failure and cardiogenic shock. These 2 features (above all others) define both the mechanical forces experienced by the pulmonary arteries, and in turn, the vascular afterload imposed by the pulmonary circulation on the right ventricular. For over half a century, it has been assumed that the pulsatile components of the pulmonary circulation exist in predictable and constant proportion to resistive afterload. In other words, that the vascular afterload can be estimated from mean pulmonary arterial pressure and pulmonary vascular resistance alone. While this tenet holds true for most forms of pulmonary hypertension, pulmonary hypertension resulting from the passive transmission of elevated left atrial pressure is a notable exception. In these cases, arterial compliance decreases proportionally more than any increase in pulmonary vascular resistance and is highly dependent upon recruitment and distensibility of the pulmonary circulation. As questions regarding the optimal method to predict right ventricular failure resurface, along with a modern armamentarium of techniques to assess pulsatile pressure-flow relations, it serves as a timely reminder that, in those with normal or near-normal pulmonary arterial pressures, the pulsatile component of pulmonary vascular afterload may account for anywhere between one-quarter and half of the total power of the right ventricular. In this State-of-the-Art Review, we address the role of pulmonary circulation in those with advanced heart failure and cardiogenic shock. Unlike previous discussions on this topic, we set aside considerations of established precapillary disease, focusing specifically on the process by which an acute or chronic elevation of pulmonary capillary wedge pressure results in pulmonary hypertension from left-sided heart failure. In doing so, we create a framework to assess pulmonary vascular afterload in an era of advanced therapeutics and device technologies to treat advanced heart failure and cardiogenic shock.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012611"},"PeriodicalIF":8.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198379","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":"Lowering Cardiac Branched-Chain Keto Acid Levels Enhances Cardiac Glucose Oxidation and Cardiac Efficiency via Enhancing Mitochondrial Insulin Signaling in Heart Failure.","authors":"Qutuba G Karwi, Liyan Zhang, Keshav Gopal, Cory S Wagg, Kim L Ho, Qiuyu Sun, Sai Panidarapu, Kaya Persad, Betüol Altuany, Shaden Damen, Ezra Ketema, Jody Levasseur, Thomas Pulinilkunnil, John R Ussher, Jason R B Dyck, Gary D Lopaschuk","doi":"10.1161/CIRCHEARTFAILURE.124.012012","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012012","url":null,"abstract":"<p><strong>Background: </strong>Elevated levels of cardiac branched-chain amino acids (BCAAs) and their metabolites, namely branched-chain keto acids (BCKAs), contribute to the development of insulin resistance, contractile dysfunction, and adverse remodeling in the failing heart. However, there is still confusion about whether BCAA or BCKA mediate these detrimental effects in the failing heart.</p><p><strong>Methods: </strong>Cardiac-specific mitochondrial branched-chain aminotransferase, the enzyme that converts BCAA into BCKA, knockout (BCAT2^-^/-) mice underwent a sham or transverse aortic constriction surgery to induce heart failure. Changes in cardiac function and structure were monitored pre- and posttransverse aortic constriction using echocardiography, and metabolic flux through the tricarboxylic acid cycle was measured by perfusing isolated working hearts with radiolabeled energy substrates. Direct effects of BCAA and BCKA on cell hypertrophy were characterized using phenylephrine-induced cell hypertrophy in differentiated cells.</p><p><strong>Results: </strong>Lowering cardiac BCKA levels in BCAT2^-/- failing hearts increases insulin-stimulated glucose oxidation rates via enhancing mitochondrial protein kinase B and pyruvate dehydrogenase complex activities. Increased glucose oxidation rates in BCAT2^-/- failing hearts enhanced cardiac efficiency by decreasing myocardial oxygen consumption rates. However, cardiac BCAA accumulation was associated with excessive stimulation of the mammalian target of rapamycin signaling and aggravation of adverse cardiac remodeling in BCAT2^-/- failing hearts. As a result, the impact of BCAA accumulation offsets the beneficial effects of lowering cardiac BCKA levels on cardiac insulin sensitivity and cardiac efficiency.</p><p><strong>Conclusions: </strong>Lowering BCKA levels enhances cardiac glucose oxidation and cardiac efficiency by enhancing mitochondrial insulin signaling. BCAA accumulation worsens adverse cardiac remodeling by exacerbating cardiac mammalian target of rapamycin signaling.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012012"},"PeriodicalIF":8.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706552","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":"Simultaneous or Rapid Sequence Optimization of Medical Therapy for Heart Failure: Time to Keep Score.","authors":"Satoshi Shoji, Gregg C Fonarow, Stephen J Greene","doi":"10.1161/CIRCHEARTFAILURE.125.013417","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.013417","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013417"},"PeriodicalIF":8.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834292","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":"Feasibility, Reproducibility, and Prognostic Value of Exercise Echocardiography for Cardiac Output Reserve Assessment in Fontan Physiology.","authors":"Alexander C Egbe, Omar Abozied, Ahmed T Abdelhalim, Sara ElZalabany, Zeyad Kholeif, Yogesh N V Reddy, Barry A Borlaug","doi":"10.1161/CIRCHEARTFAILURE.125.012908","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.012908","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to assess the feasibility and prognostic value of cardiac output (CO) reserve assessment using exercise echocardiography in Fontan patients. We hypothesized that adults with Fontan palliation had lower CO reserve compared with controls, and impaired CO reserve was associated with greater congestion (NT-proBNP [N-terminal pro-B-type natriuretic peptide]) and cardiovascular events (death/transplant/heart failure hospitalization) in Fontan patients.</p><p><strong>Methods: </strong>Thirty-seven Fontan patients and 61 controls underwent exercise echocardiography using a supine cycle ergometer. Doppler-derived CO and oxygen consumption (VO₂) were assessed at rest and every stage of exercise. CO reserve was calculated as ∆CO/Watt (∆CO/W) and ∆CO/∆VO₂.</p><p><strong>Results: </strong>Assessment of CO reserve was feasible in 95% of the Fontan group with modest reproducibility. Although both groups had similar CO at rest, the Fontan group had lower CO reserve with exercise as evidenced by lower ∆CO/W ratio (46±17 versus 57±19 mL/W; <i>P</i><0.001) and lower ∆CO/∆VO₂ ratio (4.48±1.02 versus 5.37±2.18 mL/mL; <i>P</i>=0.03). There was a correlation between ∆CO/W ratio and log NT-proBNP (r=0.65; <i>P</i><0.001), and between ∆CO/∆VO₂ ratio and log NT-proBNP (r=0.53; <i>P</i>=0.009). Impaired CO reserve was associated with congestion and cardiovascular events and provided improved prognostication (higher area under the curve and C statistics) above conventional echocardiographic indices and treadmill peak VO₂.</p><p><strong>Conclusions: </strong>Patients with Fontan palliation had lower CO reserve, and impaired CO reserve was associated with congestion and cardiovascular events. Further studies are required to determine whether cardiac interventions can improve CO reserve and whether changes in CO reserve can be used as a surrogate end point for therapeutic response.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012908"},"PeriodicalIF":8.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945035","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":"Myosin Mayhem: Losing (or Gaining) Its Chill in Hypertrophic Cardiomyopathy.","authors":"Brett A Colson","doi":"10.1161/CIRCHEARTFAILURE.125.013248","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.013248","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013248"},"PeriodicalIF":8.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945052","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":"Gaps and Knowledge in the Contemporary Management of Acute Right Ventricular Failure.","authors":"Paolo Manca, Vincenzo Nuzzi, Massimiliano Mulè, Sergio Sciacca, Matteo Castrichini, Uwe Schulz, Naveen L Pereira, Holger Thiele, Jacob C Jentzer, Manlio Cipriani","doi":"10.1161/CIRCHEARTFAILURE.124.012030","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012030","url":null,"abstract":"<p><p>Acute right ventricular failure (ARVF) is commonly seen in the intensive care unit and constitutes a significant clinical challenge, with associated high in-hospital mortality. Recently, the treatment of ARVF has significantly changed, with the progressive implementation of mechanical circulatory support devices that now represent important tools for clinicians in treating this condition. However, despite recent advancements, the optimal approach for ARVF remains elusive, and precise treatment algorithms and comprehensive management protocols are still lacking. In the present review, we explore the pathophysiology of ARVF, highlighting the different mechanisms that may lead to this clinical entity and emphasizing the left and right heart's complex interplay. We analyze the different therapeutic options that are now available for short- and long-term management of ARVF, with a particular focus on the advantages and disadvantages of the mechanical circulatory support devices actually used. Furthermore, we propose future directions in the field and a possible flowchart for the treatment of this condition.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012030"},"PeriodicalIF":8.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965049","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":"Hypokalemia During Decongestion With Loop Diuretics and Hydrochlorothiazide, a Post Hoc Analysis of the CLOROTIC Trial.","authors":"Alicia Conde-Martel, Marta Hernández-Meneses, José Luís Morales-Rull, Jesús Casado, Margarita Carrera-Izquierdo, Marta León, Marta Sánchez-Marteles, Melitón Francisco Dávila-Ramos, Carolina Hernández-Carballo, Pau Llácer, Mari Carmen Moreno-García, Prado Salamanca-Bautista, Francesc Formiga, Luís Manzano, Joan Carles Trullàs","doi":"10.1161/CIRCHEARTFAILURE.125.012914","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.012914","url":null,"abstract":"<p><strong>Background: </strong>In patients with acute heart failure, the addition of hydrochlorothiazide (HCTZ) to furosemide increased the diuretic response in the CLOROTIC trial (Combining Loop with Thiazide Diuretics for Decompensated Heart Failure). The aim of this subanalysis was to evaluate the incidence and risk factors for hypokalemia, and its impact on mortality and readmissions.</p><p><strong>Methods: </strong>This is a post hoc analysis of the CLOROTIC trial that randomized 230 patients with acute heart failure and volume overload to receive HCTZ or placebo in addition to intravenous furosemide. The incidence and risk factors for the development of hypokalemia (K⁺ <3.5 mmol/L) and its association with 30- and 90-day mortality and readmissions were analyzed. The Monte Carlo simulation method was applied to predict the development of hypokalemia.</p><p><strong>Results: </strong>The incidence of hypokalemia was significantly higher in the HCTZ group (compared with the placebo group) at 48 and 96 hours after randomization, and at discharge (<i>P</i><0.001). In a multivariate analysis, the following variables were independently associated with the development of hypokalemia: baseline K⁺ values (OR per 0.1 units, 0.82 [95% CI, 0.76-0.87]; <i>P</i><0.001), treatment with HCTZ (OR, 4.90 [95% CI, 2.50-9.90]; <i>P</i><0.001), and treatment with a mineralocorticoid receptor antagonist at baseline (OR, 0.42 [95% CI, 0.20-0.84]; <i>P</i>=0.017). There was no association between the development of hypokalemia and 30- and 90-day mortality and readmissions. The Monte Carlo simulation method predicted in patients treated with furosemide alone a higher risk of hypokalemia when baseline K⁺ values are ≤3.7 mmol/L. When HCTZ is added to furosemide, the risk of hypokalemia is present with higher baseline K⁺ values (≤4.3 mmol/L).</p><p><strong>Conclusions: </strong>Adding HCTZ to intravenous furosemide increases the risk of hypokalemia a especially when baseline K⁺ is ≤4.3 mmol/L and when patients are not treated with a mineralocorticoid receptor antagonist. In patients treated with furosemide and HCTZ, it is advisable to add potassium supplements or a mineralocorticoid receptor antagonist.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01647932.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012914"},"PeriodicalIF":8.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526622","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":"Prognostic Value of Malnutrition, Frailty, and Physical Performance in Transthyretin Cardiac Amyloidosis: Insights From a Prospective Multicenter Cohort Study.","authors":"Carlo Fumagalli, Mattia Zampieri, Roberto Presta, Greta Pini, Giulia Vetere, Alessia Argirò, Simone Longhi, Giacomo Tini, Beatrice Musumeci, Giuseppe Limongelli, Giuseppe Palmiero, Federica Verrillo, Matteo Beltrami, Mario Bo, Gaetano De Ferrari, Lorenzo Tofani, Celestino Sardu, Raffaele Marfella, Niccolò Marchionni, Federico Perfetto, Iacopo Olivotto, Stefano Fumagalli, Mathew S Maurer, Marianna Fontana, Andrea Ungar, Francesco Cappelli","doi":"10.1161/CIRCHEARTFAILURE.125.012777","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.012777","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of transthyretin cardiac amyloidosis among older adults (often octogenarians) is increasing. We aimed to determine whether age and geriatric syndromes bear any impact on the management and outcomes in transthyretin cardiac amyloidosis and assess the risk of ageism.</p><p><strong>Methods: </strong>In a prospective, multicenter cohort study, 256 patients diagnosed with transthyretin cardiac amyloidosis from March 2021 to March 2024 underwent comprehensive geriatric assessment (CGA). The study evaluated the prevalence and clinical associations of CGAs across different disease stages (National Amyloidosis Centre stage). Key CGA domains included disability, malnutrition, depression, frailty, Short Physical Performance Battery, and cumulative deficits (sum of the single CGA items). Associations of these measures with disease-modifying therapy and overall mortality were analyzed.</p><p><strong>Results: </strong>Median age was 82 years (men: n=223 [87%]; variant: n=19 [7.4%]); 129 (50.3%) patients received disease modifiers. Those ≥85 years had significantly lower odds of receiving disease-modifying therapy even after adjusting for disability, frailty, and cumulative deficits. Over 1.9 (interquartile range, 1.0-2.3) years, 45 (17.6%) patients died. After adjustment for National Amyloidosis Centre stage, diuretics and disease modifiers, CGA domains of disability, malnutrition, Short Physical Performance Battery, frailty, and number of deficits, but not age, were significantly associated with mortality. Assessment of CGA domains improved National Amyloidosis Centre prognostic accuracy.</p><p><strong>Conclusions: </strong>In a national prospective cohort of patients with transthyretin cardiac amyloidosis, older age was associated with lower prescription of disease modifiers, even among individuals with a low burden of geriatric syndromes. However, when adjusted for geriatric domains, age was not associated with survival, indicating potential ageism. Because some geriatric syndromes may be modifiable, a CGA could enhance risk stratification, reduce age-related bias, and improve outcomes.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012777"},"PeriodicalIF":8.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539193","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":"Guideline-Directed Medical Therapy Use in the STRONG-HF Trial.","authors":"Xiang Zhang, Beth Davison, Marianna Adamo, Mattia Arrigo, Jan Biegus, Ovidiu Chioncel, Alain Cohen Solal, Gad Cotter, Christopher Edwards, Antoine Kimmoun, Carolyn S P Lam, Alexandre Mebazaa, Marco Metra, Maria Novosadova, Peter S Pang, Karen Sliwa, Koji Takagi, Adriaan A Voors, Justin A Ezekowitz","doi":"10.1161/CIRCHEARTFAILURE.124.012716","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012716","url":null,"abstract":"<p><strong>Background: </strong>Assessment of medication changes in heart failure trials and registries is complex and may not capture the entirety of care. A comprehensive and standardized method is needed. We used different methods to assess the use of guideline-directed medical therapies (GDMT) and verified the association between GDMT intensity score with the STRONG-HF trial (Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing of Heart Failure Therapies) clinical outcomes.</p><p><strong>Methods: </strong>We used data from the STRONG-HF trial to examine the baseline GDMT use for all randomized patients by applying the GDMT intensity score and evaluated its change over time. We also examined their basic adherence, indication-corrected adherence, and dose-corrected adherence, and the association with clinical outcomes up to 180 days.</p><p><strong>Results: </strong>At 90 days, triple therapy indication-corrected use increased from 4.5% to 36% in the usual care group, and from 5.2% to 93.5% in the high-intensity care group (<i>P</i><0.001 between the 2 groups). Triple therapy dose-corrected use increased from 4.5% to 20.5% in the usual care group, and from 3.3% to 77.4% in the high-intensity care group (<i>P</i><0.001). The GDMT intensity score at baseline was <6 in 358 (33%) patients, 6 to 7 in 329 (31%) patients, and >7 in 386 (36%) patients. At 90 days, 88.4% of patients in the high-intensity arm achieved a score >7 versus 14.3% in the usual care arm (<i>P</i><0.0001). The GDMT intensity score was correlated with clinical outcomes at 180 days.</p><p><strong>Conclusions: </strong>The GDMT intensity score provides a comprehensive description of medication use by means of standardized measurements and is linked to clinical outcomes. Future studies should consider utilizing this as a trial end point.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03412201.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012716"},"PeriodicalIF":8.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552482","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":"Abnormal Left Atrial Strain by CMR is Associated with Left Heart Disease in Patients with Pulmonary Hypertension.","authors":"Ben N Schmermund, Andreas J Rieth, Matthias Rademann, Pauline C Borst, Steffen Kriechbaum, Jan S Wolter, Andreas Schuster, Christoph B Wiedenroth, Julia M Treiber, Andreas Rolf, Samuel Sossalla, Sören J Backhaus","doi":"10.1161/CIRCHEARTFAILURE.125.013480","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.125.013480","url":null,"abstract":"<p><p><b>Background:</b> Pulmonary hypertension (PH) is classified as pre-capillary, isolated postcapillary (IpcPH), combined post- and pre-capillary (CpcPH), or exercise PH. IpcPH associated with left heart disease can lead to pulmonary vascular remodeling and eventually CpcPH. Conversely, pre-capillary PH may be diagnosed in the presence of cardiovascular comorbidities including left heart disease. Atrial functional impairment is a frequent finding in cardio-pulmonary disease reflecting both intrinsic atrial cardiomyopathy and congestion. Consequently, we sought to investigate this across the PH spectrum. <b>Methods:</b> Patients referred to both right heart catheterization (RHC) and cardiovascular magnetic resonance (CMR) imaging were enrolled in this monocentric registry. Patients were classified by RHC according to current guideline recommendations. CMR assessment included left/right ventricular (LV/RV) and atrial (LA/RA) volumes and deformation imaging. <b>Results:</b> The study population consisted of n=209 patients (n=55 normal, n=72 pre-capillary, n=27 CpcPH, n=15 IpcPH, n=34 exercise and n=6 unclassified PH). N=126 patients underwent additional exercise-stress RHC. Median LA total strain (Es) was lowest and similar in IpcPH (10.0%) and CpcPH (10.0%) which were significantly impaired compared to normal hemodynamics (30.8%, both p<0.001), pre-capillary (28.2%, both p<0.001) and exercise PH (26.9%, IpcPH: p=0.039, CpcPH: p=0.048). LA Es and LV global longitudinal strain (GLS) showed good diagnostic performance to identify patients with left cardiac involvement evident at rest (pulmonary capillary wedge pressure (PCWP) ≥15mmHg) (AUC 0.81 vs 0.77, p=0.20) whilst LA Es emerged superior for identification of exercise-stress induced PCWP ≥25mmHg (AUC 0.79 vs 0.70, p=0.039). <b>Conclusions:</b> LA functional impairment is a sign of left heart involvement in PH patients. LA Es emerged superior for identification of left heart disease unmasked during exercise-stress compared to GLS. Consequently, LA strain may become an innovative method to detect early stage left heart disease in PH.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945028","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}