Circulation: Heart Failure最新文献

{"title":"Association Between Hospital Tiers and Cardiogenic Shock Mortality: Mitigating the Transfer Penalty Through a Regionalized Hub-and-Spoke Model.","authors":"Ankur Sethi, Emily Hiltner, Ashish Awasthi, Casey Panebianco, Tana LaPlaca, Nancy Rizzuto, Leonard Y Lee, Mark Russo","doi":"10.1161/CIRCHEARTFAILURE.126.014546","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014546","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock remains associated with high short-term mortality despite contemporary advances in care. The association between institutional cardiac capability and outcomes-particularly among transferred patients and after accounting for clinical instability-remains incompletely defined. We sought to evaluate the association between hierarchical hospital cardiac capability and in-hospital mortality using a latent measure of acute physiological severity.</p><p><strong>Methods: </strong>Using the National Inpatient Sample (2016-2022), hospitals were classified into 5 hierarchical tiers ranging from non-percutaneous coronary intervention (tier 1) to heart transplant/durable left ventricular assist device (LVAD) centers (tier 5). Generalized structural equation modeling assessed the relationship between hospital tier and mortality. A latent Acute Severity construct-comprising cardiac arrest, acute kidney and liver injury, and mechanical ventilation-was incorporated to model the effects of clinical instability.</p><p><strong>Results: </strong>Among an estimated 1 177 180 cardiogenic shock hospitalizations, most occurred at cardiac surgical and transplant/LVAD centers. Crude mortality declined stepwise from non-percutaneous coronary intervention hospitals (64.4%) to transplant/LVAD centers (36.5%). After adjustment, a higher hospital tier was independently associated with lower mortality (tier 2 odds ratio [OR], 0.43 [95% CI, 0.38-0.48]; tier 3 OR, 0.37 [95% CI, 0.32-0.43]; tier 4 OR, 0.34 [95% CI, 0.30-0.38]; tier 5 OR, 0.36 [95% CI, 0.31-0.41]). Although transfer-in status was associated with increased mortality (OR 1.36 [95% CI, 1.30-1.43]), this association was attenuated at cardiac surgical and transplant/LVAD centers, consistent with mitigation of transfer-associated risk.</p><p><strong>Conclusions: </strong>Higher hospital cardiac capability is independently associated with lower mortality among patients with cardiogenic shock. Advanced centers are associated with mitigation of transfer-associated risk, supporting regionalized hub-and-spoke systems with early referral to high-capability centers.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":"19 9","pages":"e014546"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976016","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":"Next Generation Temporary Mechanical Circulatory Support for Cardiogenic Shock.","authors":"Holger Thiele, Sebastian von der Emde, Anne Freund","doi":"10.1161/CIRCHEARTFAILURE.126.014202","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014202","url":null,"abstract":"<p><p>Cardiogenic shock remains the leading cause of death in patients with acute myocardial infarction and severe acute heart failure. Temporary mechanical circulatory support devices have emerged as important adjuncts for restoring systemic perfusion, unloading the failing ventricle, and stabilizing patients for cardiogenic shock and during high-risk percutaneous coronary interventions. However, currently available devices are associated with important limitations, including vascular complications, hemolysis, and uncertain survival benefit. Technological innovation has led to the development of new percutaneous mechanical support systems designed to deliver higher cardiac output with more limited vascular access and improved hemocompatibility. This review summarizes the current evidence regarding current and emerging temporary mechanical circulatory support devices used in cardiogenic shock and high-risk percutaneous coronary interventions. Literature from major clinical trials, observational registries, and device development studies was reviewed to evaluate device mechanisms, hemodynamic performance, and emerging technologies.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":"19 9","pages":"e014202"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975953","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":"Kidney Failure in Cardiogenic Shock.","authors":"Thomas C Hanff, Elric Zweck, Jackson S Burton, Nirupama Ramkumar, Aniket S Rali, Esther E Vorovich","doi":"10.1161/CIRCHEARTFAILURE.126.014189","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014189","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is a frequent and prognostically decisive complication of cardiogenic shock (CS), conferring substantially increased short- and long-term mortality. As understanding of CS has evolved beyond an isolated low-output model, AKI is increasingly recognized as a consequence of multifactorial pathophysiology encompassing venous congestion, neurohormonal dysregulation, microcirculatory dysfunction, inflammation, and iatrogenic injury from shock therapies. Despite this expanded mechanistic framework, approaches to the diagnosis and management of AKI in CS remain highly variable, and no single strategy has consistently improved renal or survival outcomes. Emerging data suggest multiple biologically distinct phenotypes of AKI in CS that may enable future targeted therapeutics. This review synthesizes contemporary evidence on the classification, epidemiology, and mechanisms of AKI in CS across distinct phenotypes, including early- versus late-onset, acute versus acute-on-chronic, and cardiorenal versus cardiometabolic presentations. We further discuss the renal effects of contemporary shock therapies, including vasoactive agents, temporary mechanical circulatory support, and renal replacement strategies. Finally, we highlight emerging diagnostic tools, including noninvasive vascular imaging and renal biomarkers, alongside novel device-based approaches to improve renal perfusion and congestion. Advancing care in CS will depend on redefining AKI not only as a binary marker of renal dysfunction but also as a mechanistically heterogeneous component of shock biology amenable to targeted intervention.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":"19 9","pages":"e014189"},"PeriodicalIF":8.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976011","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":"Healthcare System Resilience and Adaptation: A 6-Year Analysis of Heart Failure Care in the Veterans Affairs System.","authors":"Nicholas K Brownell, Moira Inkelas, Lillian Chen, Mei Leng, Anthony Anh Quoc Doan, Evan Shannon, Nicholas Jackson, Priscilla Hsue, Michael Ong, Elizabeth Yano, Gregg C Fonarow, Boback Ziaeian","doi":"10.1161/CIRCHEARTFAILURE.126.014478","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014478","url":null,"abstract":"<p><strong>Background: </strong>The Veterans Health Administration (VA) healthcare system cares for almost 200 000 Veterans with heart failure with reduced ejection fraction. It is not known how this population fared regarding continuity of care quality measures and access over the past 6 years, including during the COVID-19 pandemic and its aftermath. This study describes temporal trends in heart failure care delivery and clinical outcomes for Veterans with heart failure with reduced ejection fraction from January 1, 2019 to December 31, 2024.</p><p><strong>Methods: </strong>An interrupted time series analysis examined care patterns across prepandemic, early COVID, and late COVID periods using linear regression models with monthly fixed effects.</p><p><strong>Results: </strong>The study included 210 535 individuals (mean age, 73.1 years; 2.2% women; mean ejection fraction, 32.8%). Heart failure with reduced ejection fraction medication prescriptions were maintained or improved over the 6-year study, with upward trends for most medications in the early COVID period and for all medications in the late COVID period (range, 0.1-0.9 percentage point increase per 6-week period, compared with pre-COVID baseline), although treatment gaps for all medication classes persisted. The onset of COVID led to a 2- to 4-fold increase in telehealth utilization (primary care, 12.4 [95% CI, 9.5-15.2] percentage points; cardiology, 5.5 [95% CI, 4.5-6.5] percentage points). There was a 31% relative decrease in all-cause hospitalization and 27% relative decrease in heart failure hospitalization, but a 13% increase in mortality at pandemic onset, compared with pre-COVID baseline.</p><p><strong>Conclusions: </strong>Heart failure with reduced ejection fraction medication rates for Veterans were generally sustained or improved during the study period, but care gaps remain. Telehealth replaced some in-person primary and specialty care early in the pandemic, and in-person primary care has sustained at lower rates than before the pandemic. The rate of hospitalization sustained at lower levels while mortality has increased.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014478"},"PeriodicalIF":8.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13533450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863727","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":"Electronic Nudges to Increase Influenza Vaccination Uptake in Young and Middle-Aged Patients with Heart Failure: A Prespecified Analysis of the NUDGE-FLU-CHRONIC Trial.","authors":"Niklas Dyrby Johansen, Muthiah Vaduganathan, Ankeet S Bhatt, Daniel Modin, Safia Chatur, Brian L Claggett, Kira Hyldekaer Janstrup, Carsten Schade Larsen, Lykke Larsen, Lothar Wiese, Michael Dalager-Pedersen, Lars Køber, Scott D Solomon, Pradeesh Sivapalan, Jens Ulrik Stæhr Jensen, Cyril Jean-Marie Martel, Tyra Grove Krause, Tor Biering-Sørensen","doi":"10.1161/CIRCHEARTFAILURE.126.014891","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014891","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857006","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":"Sex Differences in Skeletal Muscle Inflammation and Dysfunction in Patients With Heart Failure and Reduced Ejection Fraction.","authors":"Andreas Bugge Tinggaard, Jakob Wang, Jean Farup, Mette Bjerre, Jonas Brorson, Benjamin Chousterman, Emma Börgeson, P Christian Schulze, Helene Nørrelund, Niels Jessen, Henrik Wiggers","doi":"10.1161/CIRCHEARTFAILURE.125.014062","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.125.014062","url":null,"abstract":"<p><strong>Background: </strong>Women with heart failure with reduced ejection fraction (HFrEF) experience greater symptom burden than men, potentially due to skeletal muscle dysfunction. Skeletal muscle abnormalities are linked to systemic low-grade inflammation, a hallmark of HFrEF pathophysiology, and may be driven by altered inflammatory regulation of skeletal muscle homeostasis. In patients with HFrEF and age-matched controls, we investigated sex differences in skeletal muscle inflammation, muscle stem cells, fibro-adipogenic progenitor cells, and their associations with skeletal muscle mass and strength.</p><p><strong>Methods: </strong>Participants underwent dual x-ray absorptiometry, cardiopulmonary exercise testing, and dynamometry. Vastus lateralis muscle biopsies were analyzed by flow cytometry to quantify immune cell populations, muscle stem cells, and fibro-adipogenic progenitor cells. Outcomes were log-transformed and analyzed using linear regression with sex-by-HFrEF interaction. Between-group differences were expressed as geometric mean ratios (GMRs).</p><p><strong>Results: </strong>We included 86 patients with HFrEF and 41 age- and sex-matched healthy controls (mean age, 71±7 years; 32% women). Skeletal muscle immune cell composition differed by sex in HFrEF, with significant sex-by-HFrEF interactions for macrophage fraction (<i>P</i>=0.006), lymphocyte content (<i>P</i>=0.045), and lymphocyte fraction (<i>P</i>=0.039). In HFrEF, women showed an increased lymphocyte fraction (GMR, 1.27 [1.06-1.53]; <i>P</i>=0.014), whereas men had an increased macrophage content (GMR, 1.75 [1.16-2.64]; <i>P</i>=0.009). Macrophage content was associated with greater muscle mass and strength in women (mass, R=0.42, <i>P</i>=0.014; strength, R=0.42, <i>P</i>=0.013), but with reduced mass and strength in men (mass, R=-0.25, <i>P</i>=0.017; strength, R=-0.21, <i>P</i>=0.046). Muscle stem cells (GMR, 1.92 [0.99-3.74]; <i>P</i>=0.054) and fibro-adipogenic progenitor cells (GMR, 1.72 [1.03-2.85]; <i>P</i>=0.038) were reduced in HFrEF.</p><p><strong>Conclusions: </strong>Skeletal muscle immune cell alterations, particularly macrophage and lymphocyte imbalances, are associated with muscle dysfunction in HFrEF, exhibiting distinct sex-specific patterns. These findings demonstrate sex-specific skeletal muscle inflammation and dysfunction in HFrEF.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014062"},"PeriodicalIF":8.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825693","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":"Plasma Proteins Associated With the Immune Response to Anthracycline Cardiotoxicity in Patients With Hematologic Malignancies.","authors":"Abraham L Bayer, Abul Ariza, Monica Urias, Jose Max Narvaez-Paliza, Casie Curtin, Yogesh Purushotham, Sanam Alilou, Andrea Nathalie Rosas Diaz, Jacob Barber, Laurie Farrell, Jenica N Upshaw, Christopher W Hoeger, Michael Leukam, Robert Gerszten, Pilar Alcaide, Aarti Asnani","doi":"10.1161/CIRCHEARTFAILURE.125.013683","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.013683","url":null,"abstract":"<p><strong>Background: </strong>Anthracyclines such as doxorubicin are well recognized to induce dose-dependent cardiotoxicity. However, traditional imaging and blood biomarkers of myocardial injury are inadequate for early risk stratification. We aimed to discover plasma proteins that correlate with the subsequent development of anthracycline-induced systolic dysfunction in patients, with validation studies in preclinical models.</p><p><strong>Methods: </strong>We used an aptamer-based proteomics platform to measure over 7000 proteins in the plasma obtained at baseline (before anthracycline chemotherapy) in a prospectively enrolled cohort of patients with hematologic malignancies (n=34). The correlation between protein levels and change in left ventricular ejection fraction was assessed. Candidate biomarkers were validated in a second patient cohort treated with anthracyclines for hematologic malignancies (n=32), as well as in a mouse model of delayed doxorubicin cardiotoxicity.</p><p><strong>Results: </strong>In both discovery and validation cohorts, baseline levels of CPVL (carboxypeptidase vitellogenic-like protein) and PIGR (poly immunoglobulin receptor) measured in the plasma before anthracycline treatment correlated with a subsequent decline in left ventricular ejection fraction (PIGR: <i>R</i>=-0.74; <i>P</i>=0.0022; CPVL: <i>R</i>=-0.74; <i>P</i>=0.0022). Findings were confirmed in human plasma samples using ELISA or Western blot, and similar changes in proteins were observed in mice treated with doxorubicin. In further support of PIGR as a biomarker representing the systemic adaptive immune response, doxorubicin treatment was associated with increased circulating levels of IgA⁺ (immunoglobulin A) B cells in mice, which similarly correlated with the decline in left ventricular ejection fraction. The highest quartile of PIGR and CPVL levels was associated with decreased overall survival but not progression-free survival.</p><p><strong>Conclusions: </strong>Preanthracycline levels of the plasma immunologic proteins CPVL and PIGR were associated with a subsequent decline in cardiac function, representing potentially new inflammatory biomarkers of anthracycline cardiotoxicity.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013683"},"PeriodicalIF":8.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825735","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":"Transcriptomic Changes Elicited by Semaglutide in Human Ventricular Tissue Support Cell Survival and Lipid Metabolism.","authors":"Lilly Underwood, Chun-Sun Jiang, Rohail Bhatti, Gessica de Assis Silva, Ihsan Buker, Ajay Rao, Joao Pereira, Satwik Acharyya, Sunil Karhadkar, David K Crossman, Priscila Y Sato","doi":"10.1161/CIRCHEARTFAILURE.126.014421","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014421","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014421"},"PeriodicalIF":8.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825826","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 Wu et al Regarding Article, \"Exploring Medication Adherence in Heart Failure From a Patient Perspective: A Qualitative Study\".","authors":"Wentao Wu, Gaojun Xu, Xia Gao","doi":"10.1161/CIRCHEARTFAILURE.126.014681","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014681","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014681"},"PeriodicalIF":8.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789030","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 Wu et al to Letter Regarding Article, \"Exploring Medication Adherence in Heart Failure From a Patient Perspective: A Qualitative Study\".","authors":"Ingibjorg Gunnthorsdottir, Anna I Gunnarsdottir, Karl Andersen, Erla Svansdottir, Inga S Thrainsdottir, Paul Forsyth, Inga Jona Ingimarsdottir, Anna B Almarsdottir","doi":"10.1161/CIRCHEARTFAILURE.126.014751","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.126.014751","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014751"},"PeriodicalIF":8.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789002","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}