Circulation: Heart Failure最新文献

{"title":"High-Sensitivity Cardiac Troponin I for Risk Stratification in Wild-Type Transthyretin Amyloid Cardiomyopathy.","authors":"Laura De Michieli, Giulio Sinigiani, Gianluigi Guida, Giulia Saturi, Giuseppe Sena, Teresa Maria Capovilla, Anna Cantone, Alessandro Cianca, Alessandro Lupi, Aldostefano Porcari, Giacomo Tini, Giuseppe Vergaro, Francesco Cappelli, Riccardo Albertini, Matteo Bianco, Roberta Mussinelli, Matteo Serenelli, Beatrice Musumeci, Stefano Perlini, Marco Merlo, Simone Longhi, Gianfranco Sinagra, Martina Perazzolo Marra, Sabino Iliceto, Allan S Jaffe, Giovanni Palladini, Alberto Cipriani, Paolo Milani","doi":"10.1161/CIRCHEARTFAILURE.125.012816","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.012816","url":null,"abstract":"<p><strong>Background: </strong>Thresholds to define prognosis with hs-cTnI (high-sensitivity cardiac troponin I) have not been systematically addressed in wild-type transthyretin amyloid cardiomyopathy, in part because of the multiplicity of hs-cTnI assays. The aims of this study were: first, to assess the prognostic performance of hs-cTnI measured with different assays in patients with wild-type transthyretin amyloid cardiomyopathy and, second, to identify assay-specific hs-cTnI thresholds for prognosis that could be integrated into staging systems for risk stratification.</p><p><strong>Methods: </strong>Observational multicenter study of stable wild-type transthyretin amyloid cardiomyopathy patients from different cohorts using the Abbott Architect Stat hs-cTnI assay and the Beckman Coulter Access hs-cTnI assay (testing cohorts) and the Siemens Centaur XPT hs-cTnI assay (validation cohort). Outcome was all-cause mortality.</p><p><strong>Results: </strong>In the Abbott cohort (n=136; median follow-up 22 [13-41] months; 31 [23%] deaths) and Beckman cohort (n=98; median follow-up 19 [12-28] months; 16 [16%] deaths), natural log-transformed hs-cTnI was an independent predictor of mortality (age- and sex-adjusted hazard ratio, 1.62 [95% CI, 1.11-2.35]; <i>P</i>=0.012 and 2.47 [95% CI, 1.48-4.14]; <i>P</i><0.001, respectively). The best hs-cTnI threshold for 18-month mortality of the combined Abbott/Beckman cohorts (n=234) was 81 ng/L, rounded to 80 ng/L for simplicity of clinical use. A 2-variable staging system (based on the Mayo Clinic system) using hs-cTnI (>80 ng/L) and NPs (natriuretic peptides; NT-proBNP [N-terminal pro-B-type natriuretic peptide] >3000 ng/L or BNP [B-type natriuretic peptide] >250 ng/L) identified 3 groups with progressively worse prognosis. The staging system (using hs-cTnI >80 ng/L and NT-proBNP>3000 ng/L) was then applied to an independent cohort evaluated with the hs-cTnI Siemens assay (n=345, median follow-up 32 [24-42] months, 119 [34%] deaths). The significant differences between the groups were maintained.</p><p><strong>Conclusions: </strong>In patients with wild-type transthyretin amyloid cardiomyopathy, hs-cTnI is a strong and independent predictor of mortality. A threshold of hs-cTnI of 80 ng/L for these 3 assays provides effective risk stratification alone and in a staging system with NP.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012816"},"PeriodicalIF":8.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076393","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":"High Sensitivity Troponin for Contemporary Risk Stratification in Wild-Type ATTR Amyloidosis.","authors":"Kevin M Alexander","doi":"10.1161/CIRCHEARTFAILURE.125.013129","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.013129","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013129"},"PeriodicalIF":8.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641926","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":"Determinants of Right Heart Hemodynamic Derangement in Patients With and Without Tricuspid Regurgitation.","authors":"Sergio Caravita, Michele Liberatore, Luigi P Badano, Maria Felicia Gagliardi, Leila De Lorenzo, Antonio Sorropago, Cosmo Godino, Michele Tomaselli, Ettore Lanzarone, Giovanni Battista Perego, Jean-Luc Vachiéry, Marat Fudim, Gianfranco Parati, Denisa Muraru, Claudia Baratto","doi":"10.1161/CIRCHEARTFAILURE.125.012813","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.012813","url":null,"abstract":"<p><strong>Background: </strong>The determinants of tricuspid regurgitation (TR) hemodynamic severity remain to be established. We explored the hemodynamic correlates of right atrial (RA) pressure and stroke volume (SV) in patients with and without TR, and assessed the reliability of the indirect Fick method in relation to TR severity.</p><p><strong>Methods: </strong>In this observational study, right ventricular (RV) 3-dimensional echocardiography (3DE) was obtained simultaneously with direct Fick right heart catheterization. RVSV_3DE and SV_RHC were combined to determine the TR regurgitant fraction (RegFr=RVSV_3DE-RVSV_RHC/RVSV_3DE). RA pressures and strain (or 3DE volumes) were combined to derive RA compliance.</p><p><strong>Results: </strong>Out of 74 patients, 61% had moderate or severe TR. TR severity was associated with larger right heart chambers, lower RA compliance, higher values and lower inspiratory decrease of RA pressure, and lower cardiac index (<i>P</i><0.01). In univariate analysis, RA V wave was associated with RegFr (<i>r</i>=-0.57) and with ln-transformed RA compliance_strain (<i>r</i>=-0.74); SV index was associated with RegFr (<i>r</i>=-0.65). The effect of RegFr on V wave was mediated by ln-transformed RA compliance_strain (β, 13.9 [95% CI, 7.6-20.2]). In multivariable analysis, RA V wave remained associated with 1/RA compliance_strain (β, 2.1 [95% CI, 1.4-2.7]), while SV index was associated with RegFr (β, -97.6 [95% CI, -120.1 to -75.0]). The indirect Fick method overestimated cardiac index proportionally to RegFr (<i>P</i><0.01).</p><p><strong>Conclusions: </strong>SV index is related to TR severity, while the effect of TR on RA V wave is mediated by RA compliance. Respiratory-related changes in RA hemodynamics are associated with TR severity. The indirect Fick method overestimates cardiac index proportionally to TR severity.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012813"},"PeriodicalIF":8.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539192","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":"Voice Assessment and Vocal Biomarkers in Heart Failure: A Systematic Review.","authors":"Maximilian Bauser, Fabian Kraus, Friedrich Koehler, Kristen Rak, Rüdiger Pryss, Christof Weiß, Andreas Hotho, Guy Fagherazzi, Stefan Frantz, Stefan Stoerk, Fabian Kerwagen","doi":"10.1161/CIRCHEARTFAILURE.124.012303","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012303","url":null,"abstract":"<p><p>Despite major advances in recent years, the timely detection and prevention of incipient congestion in patients with chronic heart failure remains challenging. Most approaches are either invasive or require the acquisition of additional hardware. Leveraging voice analysis for the purposes of diagnosing, predicting risks, and telemonitoring clinical outcomes of patients with heart failure represents a promising, cost-effective, and convenient alternative compared with hitherto deployed methods. To expand this field, close collaboration of several disciplines of medicine and computer science is an obligatory requirement. The current review aims to lay out the state-of-the-art in this quickly advancing area of research. It elucidates the foundation for voice feature extraction, describes the prospective capabilities of this evolving technology, and outlines the challenges involved in identifying vocal biomarkers both in general and in the context of heart failure.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012303"},"PeriodicalIF":8.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973936","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":"Narrowing the Gap: Addressing Sex-Based Factors in VA-ECMO Care.","authors":"Michael C Hill, Esther E Vorovich","doi":"10.1161/CIRCHEARTFAILURE.125.013199","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.013199","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013199"},"PeriodicalIF":8.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494975","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":"Prolonged Extreme Asymptomatic Hypertroponinemia as a Milestone in Diagnosis of Familial Arrhythmogenic Right Ventricular Cardiomyopathy.","authors":"Sergej Prijic, Ivana Cerovic, Vladislav Vukomanovic, Sasa Popovic, Maja Popovic, Sanja Ninic, Stasa Krasic, Marija Zdravkovic","doi":"10.1161/CIRCHEARTFAILURE.124.012713","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012713","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012713"},"PeriodicalIF":8.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179572","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":"Endothelin-1 and Accelerated Cardiac Allograft Vasculopathy After Heart Transplantation.","authors":"Rushi V Parikh, Alexandra Klomhaus, Juka S Kim, Abdul Assi, David M Tehrani, Danielle Campbell, Lisa Bang, Rubine G Fleming, Kan Saito, Takeshi Nishi, Yasuhiro Honda, Kiran K Khush, William F Fearon, Ali Nsair, Gregg C Fonarow","doi":"10.1161/CIRCHEARTFAILURE.125.013288","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.013288","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013288"},"PeriodicalIF":8.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552481","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":"Left Heart Abnormalities in Patients With Lung Disease, OSA, and Chronic Thromboemboli at Risk for or With Known Pulmonary Hypertension.","authors":"Yogesh N V Reddy, Robert P Frantz, Paul M Hassoun, Anna Hemnes, Evelyn Horn, Jane A Leopold, Franz Rischard, Erika B Rosenzweig, Nicholas S Hill, Serpil C Erzurum, Gerald J Beck, J Emanuel Finet, Christine L Jellis, Stephen C Mathai, Reena Mehra, W H Wilson Tang, Barry A Borlaug","doi":"10.1161/CIRCHEARTFAILURE.125.012912","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.012912","url":null,"abstract":"<p><strong>Background: </strong>Patients with lung disease, sleep apnea, and chronic thromboemboli can develop pulmonary hypertension, currently classified as group 3 or 4. Many of these patients also have risk factors for heart failure with preserved ejection fraction (HFpEF), but the optimal approach to identify the disease overlap remains unclear.</p><p><strong>Methods: </strong>Pretest probability for HFpEF was determined using the HFpEF-ABA (age, body mass index, atrial fibrillation) algorithm among adjudicated group 3 or 4 patients at risk for pulmonary hypertension in the PVDOMICS study (Redefining Pulmonary Hypertension Through Pulmonary Vascular Disease Phenomics). Patients were stratified by current resting right heart catheterization criteria, and in a separate analysis, stratified only by HFpEF-ABA probability into low (<25%), intermediate, and high (≥75%) HFpEF probability groups.</p><p><strong>Results: </strong>Among 598 patients with group 3 disease, 27% (n=161) had elevated pulmonary capillary wedge pressure (PCWP) with postcapillary pulmonary hypertension even at rest, which was associated with the highest exercise PCWP. However, regardless of this resting PCWP-based classification, a larger subset had intermediate-to-high HFpEF-ABA probabilities (32% [n=197] high and 57% [n=358] intermediate HFpEF probability). High HFpEF probability in group 3 disease was associated with higher resting and dynamic PCWP response to NO, fluid, and exercise (<i>P</i><0.0001 for all). These changes were comparable with more traditionally defined HFpEF without pulmonary vascular disease (n=61) but less severe than those with combined precapillary and postcapillary pulmonary hypertension HFpEF (n=31; interaction <i>P</i>=0.006). Increasing HFpEF probability in group 3 disease was associated with worse left heart remodeling, quality of life, 6-minute walk distance, and peak VO₂ (<i>P</i><0.0001 for all). Findings were replicated in group 4 disease (n=102).</p><p><strong>Conclusions: </strong>Quantifying pretest probability for HFpEF in patients with sleep apnea, lung disease, or chronic thromboemboli identifies a progressive gradient for dynamic PCWP abnormalities with worse functional status and quality of life. These subclinical left heart abnormalities are not universally detectable by resting right heart catheterization alone and call for further study of whether strategies to prevent or treat HFpEF might improve functional status in these patients with high risk of occult HFpEF.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012912"},"PeriodicalIF":8.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172947","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":"Changing Treatment Landscape in Transthyretin Cardiac Amyloidosis.","authors":"Marianna Fontana, John L Berk, Brian Drachman, Pablo Garcia-Pavia, Mazen Hanna, Olivier Lairez, Ronald Witteles","doi":"10.1161/CIRCHEARTFAILURE.124.012112","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012112","url":null,"abstract":"<p><p>The demographics of patients with transthyretin amyloidosis with cardiomyopathy have evolved over the past decade, mostly driven by improved awareness of the disease among clinicians, noninvasive imaging tools for diagnosis, and new, effective treatments. Patients are now diagnosed earlier in their disease course, and treatment is initiated in those with milder disease, leading to improved outcomes. Earlier treatment of patients with milder disease may lead to accelerated disease stabilization and greater preservation of function. In addition, identification of patients with transthyretin amyloidosis with cardiomyopathy at an earlier disease stage translates to healthier study populations at enrollment in clinical trials, with slower disease progression compared with patients in prior trials. In this context, effect sizes between active treatment and placebo arms will likely be smaller than those seen in historic trials, although it is still possible to observe clinically relevant differences. In this review, we discuss how patient characteristics have changed from the ATTR-ACT trial to the more recent APOLLO-B, ATTRibute-CM, and HELIOS-B studies. In addition, we consider how measures of the minimal clinically important difference for particular end points can assist in clinical decision-making and targeting treatment goals. Treatment goals are evolving over time with the need for evidence-based recommendations in this clinical space. Lastly, we address unmet needs and future expectations for the management of transthyretin amyloidosis with cardiomyopathy.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012112"},"PeriodicalIF":8.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751244","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":"Response by Papathanasiou to Letter Regarding Article, \"Disseminated Intracardiac Thrombosis Due to Long-Standing, Asymptomatic Ventricular Fibrillation Under LVAD Support\".","authors":"Lara S Schlender, Reza Wakili, David M Leistner, Maria Papathanasiou","doi":"10.1161/CIRCHEARTFAILURE.125.013260","DOIUrl":"https://doi.org/10.1161/CIRCHEARTFAILURE.125.013260","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e013260"},"PeriodicalIF":7.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590581","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}