Circulation: Heart Failure最新文献

{"title":"Identifying the Mechanisms of a Peripherally Limited Exercise Phenotype in Patients With Heart Failure With Preserved Ejection Fraction.","authors":"Rachel J Skow, Satyam Sarma, James P MacNamara, Miles F Bartlett, Denis J Wakeham, Zachary T Martin, Mitchel Samels, Damsara Nandadeva, Tiffany L Brazile, Jimin Ren, Qi Fu, Tony G Babb, Bryce N Balmain, Michael D Nelson, Linda S Hynan, Benjamin D Levine, Paul J Fadel, Mark J Haykowsky, Christopher M Hearon","doi":"10.1161/CIRCHEARTFAILURE.123.011693","DOIUrl":"10.1161/CIRCHEARTFAILURE.123.011693","url":null,"abstract":"<p><strong>Background: </strong>We identified peripherally limited patients using cardiopulmonary exercise testing and measured skeletal muscle oxygen transport and utilization during invasive single leg exercise testing to identify the mechanisms of the peripheral limitation.</p><p><strong>Methods: </strong>Forty-five patients with heart failure with preserved ejection fraction (70±7 years, 27 females) completed seated upright cardiopulmonary exercise testing and were defined as having a (1) peripheral limitation to exercise if cardiac output/oxygen consumption (VO₂) was elevated (≥6) or 5 to 6 with a stroke volume reserve >50% (n=31) or (2) a central limitation to exercise if cardiac output/VO₂ slope was ≤5 or 5 to 6 with stroke volume reserve <50% (n=14). Single leg knee extension exercise was used to quantify peak leg blood flow (Doppler ultrasound), arterial-to-venous oxygen content difference (femoral venous catheter), leg VO₂, and muscle oxygen diffusive conductance. In a subset of participants (n=36), phosphocreatine recovery time was measured by magnetic resonance spectroscopy to determine skeletal muscle oxidative capacity.</p><p><strong>Results: </strong>Peak VO₂ during cardiopulmonary exercise testing was not different between groups (central: 13.9±5.7 versus peripheral: 12.0±3.1 mL/min per kg; <i>P</i>=0.135); however, the peripheral group had a lower peak arterial-to-venous oxygen content difference (central: 13.5±2.0 versus peripheral: 11.1±1.6 mLO₂/dL blood; <i>P</i><0.001). During single leg knee extension, there was no difference in peak leg VO₂ (<i>P</i>=0.306), but the peripherally limited group had greater blood flow/VO₂ ratio (<i>P</i>=0.024), lower arterial-to-venous oxygen content difference (central: 12.3±2.5 versus peripheral: 10.3±2.2 mLO₂/dL blood; <i>P</i>=0.013), and lower muscle oxygen diffusive conductance (<i>P</i>=0.021). A difference in magnetic resonance spectroscopy-derived phosphocreatine recovery time was not detected (<i>P</i>=0.199).</p><p><strong>Conclusions: </strong>Peripherally limited patients with heart failure with preserved ejection fraction identified by cardiopulmonary exercise testing have impairments in oxygen transport and utilization at the level of the skeletal muscle quantified by invasive knee extension exercise testing, which includes an increased blood flow/V̇O₂ ratio and poor muscle diffusive capacity.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04068844.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011693"},"PeriodicalIF":7.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757440","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":"Nonpharmacological Approaches to Managing Heart Failure With Preserved Ejection Fraction.","authors":"Feiyang Tang, Haofu Han, Sheng Fu, Qiming Liu, Shenghua Zhou, Jiapeng Huang, Yichao Xiao","doi":"10.1161/CIRCHEARTFAILURE.123.011269","DOIUrl":"10.1161/CIRCHEARTFAILURE.123.011269","url":null,"abstract":"<p><p>Heart failure with preserved ejection fraction (HFpEF) is a common subtype of heart failure marked by impaired left ventricular diastolic function and decreased myocardial compliance. Given the limited availability of evidence-based pharmacological treatments for HFpEF, there is a growing interest in nonpharmacological interventions as viable therapeutic alternatives. This review aims to explore the pathophysiology of HFpEF and present recent advancements in nonpharmacological management approaches, encompassing noninvasive therapies, invasive procedures and targeted treatments for comorbidities. An extensive literature review was undertaken to identify and synthesize emerging nonpharmacological treatment options for HFpEF, assessing their potential to enhance patient outcomes. Nonpharmacological strategies, such as vagus nerve stimulation, percutaneous pulmonary artery denervation, renal denervation, transcatheter insertion of atrial shunts and pericardial resection, demonstrate promising potential for alleviating HFpEF symptoms and improving patient prognosis. Moreover, addressing comorbidities, such as hypertension and diabetes, may offer additional therapeutic benefits. These cutting-edge techniques, in conjunction with well-established exercise therapies, pave the way for future research and clinical applications in the field. Nonpharmacological interventions hold promise for advancing HFpEF patient care and fostering a deeper understanding of these treatment approaches, which will facilitate new clinical applications and contribute to the development of more targeted therapies.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011269"},"PeriodicalIF":7.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11332382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418124","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":"New Perspectives on Early Stage Hypertrophic Cardiomyopathy: Measuring What Matters.","authors":"Fraser C Goldie, Caroline J Coats","doi":"10.1161/CIRCHEARTFAILURE.124.012093","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012093","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012093"},"PeriodicalIF":7.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859193","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":"Beyond Survival: Empowering Women by Enhancing Reproductive Health Education for Heart Transplant Recipients.","authors":"Sophia Airhart, Catriona Bhagra","doi":"10.1161/CIRCHEARTFAILURE.124.012085","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.012085","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012085"},"PeriodicalIF":7.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859192","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":"Quality of Life and Exercise Capacity in Early Stage and Subclinical Hypertrophic Cardiomyopathy: A Secondary Analysis of the VANISH Trial.","authors":"Catherine G Ireland, Danielle S Burstein, Sharlene M Day, Anna Axelsson Raja, Mark W Russell, Kenneth G Zahka, Alexandre Pereira, Charles E Canter, Richard G Bach, Matthew T Wheeler, Joseph W Rossano, Anjali T Owens, Henning Bundgaard, Luisa Mestroni, Matthew R G Taylor, Amit R Patel, Ivan Wilmot, Jonathan H Soslow, Jason R Becker, Ilya Giverts, E John Orav, Brian Claggett, Kimberly Y Lin, Carolyn Y Ho","doi":"10.1161/CIRCHEARTFAILURE.124.011663","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011663","url":null,"abstract":"<p><strong>Background: </strong>The health-related quality of life (HRQOL) and cardiopulmonary exercise testing (CPET) performance of individuals with subclinical and early stage hypertrophic cardiomyopathy (HCM) have not been systematically studied. Improved understanding will inform the natural history of HCM and factors influencing well-being.</p><p><strong>Methods: </strong>VANISH trial (Valsartan for Attenuating Disease Evolution in Early Sarcomeric HCM) participants with early stage sarcomeric HCM (primary analysis cohort) and subclinical HCM (sarcomere variant without left ventricular hypertrophy comprising the exploratory cohort) who completed baseline and year 2 HRQOL assessment via the pediatric quality of life inventory and CPET were studied. Metrics correlating with baseline HRQOL and CPET performance were identified. The impact of valsartan treatment on these measures was analyzed in the early stage cohort.</p><p><strong>Results: </strong>Two hundred participants were included: 166 with early stage HCM (mean age, 23±10 years; 40% female; 97% White; and 92% New York Heart Association class I) and 34 subclinical sarcomere variant carriers (mean age, 16±5 years; 50% female; and 100% White). Baseline HRQOL was good in both cohorts, although slightly better in subclinical HCM (composite pediatric quality of life score 84.6±10.6 versus 90.2±9.8; <i>P</i>=0.005). Both cohorts demonstrated mildly reduced functional status (mean percent predicted peak oxygen uptake 73±16 versus 78±12 mL/kg per minute; <i>P</i>=0.18). Percent predicted peak oxygen uptake and peak oxygen pulse correlated with HRQOL. Valsartan improved physical HRQOL in early stage HCM (adjusted mean change in pediatric quality of life score +4.1 versus placebo; <i>P</i>=0.01) but did not significantly impact CPET performance.</p><p><strong>Conclusions: </strong>Functional capacity can be impaired in young, healthy people with early stage HCM, despite New York Heart Association class I status and good HRQOL. Peak oxygen uptake was similarly decreased in subclinical HCM despite normal left ventricular wall thickness and excellent HRQOL. Valsartan improved physical pediatric quality of life scores but did not significantly impact CPET performance. Further studies are needed for validation and to understand how to improve patient experience.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01912534.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011663"},"PeriodicalIF":7.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859195","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":"Trimethylamine <i>N</i>-Oxide and Related Gut Microbe-Derived Metabolites and Incident Heart Failure Development in Community-Based Populations.","authors":"W H Wilson Tang, Rozenn N Lemaitre, Paul N Jensen, Meng Wang, Zeneng Wang, Xinmin S Li, Ina Nemet, Yujin Lee, Heidi T M Lai, Marcia C de Oliveira Otto, Amanda M Fretts, Nona Sotoodehnia, Joseph A DiDonato, Fredrik Bäckhed, Bruce M Psaty, David S Siscovick, Matthew J Budoff, Dariush Mozaffarian, Stanley L Hazen","doi":"10.1161/CIRCHEARTFAILURE.124.011569","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011569","url":null,"abstract":"<p><strong>Background: </strong>Growing evidence indicates that trimethylamine <i>N</i>-oxide, a gut microbial metabolite of dietary choline and carnitine, promotes both cardiovascular disease and chronic kidney disease risk. It remains unclear how circulating concentrations of trimethylamine <i>N</i>-oxide and its related dietary and gut microbe-derived metabolites (choline, betaine, carnitine, γ-butyrobetaine, and crotonobetaine) affect incident heart failure (HF).</p><p><strong>Methods: </strong>We evaluated 11 768 participants from the Cardiovascular Health Study and the Multi-Ethnic Study of Atherosclerosis with serial measures of metabolites. Cox proportional hazard models were used to examine the associations between metabolites and incident HF, adjusted for cardiovascular disease risk factors.</p><p><strong>Results: </strong>In all, 2102 cases of HF occurred over a median follow-up of 15.9 years. After adjusting for traditional risk factors, higher concentrations of trimethylamine <i>N</i>-oxide (hazard ratio, 1.15 [95% CI, 1.09-1.20]; <i>P</i><0.001), choline (hazard ratio, 1.44 [95% CI, 1.26-1.64]; <i>P</i><0.001), and crotonobetaine (hazard ratio, 1.24 [95% CI, 1.16-1.32]; <i>P</i><0.001) were associated with increased risk for incident HF. After further adjustment for renal function (potential confounder or mediator), these associations did not reach Bonferroni-corrected statistical significance (<i>P</i>=0.01, 0.049, and 0.006, respectively). Betaine and carnitine were nominally associated with a higher incidence of HF (<i>P</i><0.05). In exploratory analyses, results were similar for subtypes of HF based on left ventricular ejection fraction, and associations appeared generally stronger among Black and Hispanic/Latino versus White adults, although there were no interactions for any metabolites with race.</p><p><strong>Conclusions: </strong>In this pooled analysis of 2 well-phenotyped, diverse, community-based cohorts, circulating concentrations of gut microbe-derived metabolites such as trimethylamine <i>N</i>-oxide, choline, and crotonobetaine were independently associated with a higher risk of developing HF.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov/; Unique identifiers: NCT00005133 and NCT00005487.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011569"},"PeriodicalIF":7.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906067","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":"Home Hemodynamic Monitoring to Guide Reduction of Persistently High Pulmonary Artery Pressures in Chronic Heart Failure.","authors":"Stacy Tsai, Natalie Castillo, Lynne Warner Stevenson, Sandip Zalawadiya","doi":"10.1161/CIRCHEARTFAILURE.124.011946","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011946","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011946"},"PeriodicalIF":7.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579123","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":"Antithrombotic Therapy for Mechanical Circulatory Support: Time to Throw the Baby (Warfarin) Out With the Bathwater (Aspirin)?","authors":"Jane T Kelleher, Michael M Givertz","doi":"10.1161/CIRCHEARTFAILURE.124.011568","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011568","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011568"},"PeriodicalIF":7.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757439","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":"Donation After Circulatory Death Heart Transplant: Current State and Future Directions.","authors":"Amrin Kharawala, Sanjana Nagraj, Jiyoung Seo, Sumant Pargaonkar, Mayuko Uehara, Daniel J Goldstein, Snehal R Patel, Daniel B Sims, Ulrich P Jorde","doi":"10.1161/CIRCHEARTFAILURE.124.011678","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011678","url":null,"abstract":"<p><p>Orthotopic heart transplant is the gold standard therapeutic intervention for patients with end-stage heart failure. Conventionally, heart transplant has relied on donation after brain death for organ recovery. Donation after circulatory death (DCD) is the donation of the heart after confirming that circulatory function has irreversibly ceased. DCD-orthotopic heart transplant differs from donation after brain death-orthotopic heart transplant in ways that carry implications for widespread adoption, including differences in organ recovery, storage and ethical considerations surrounding normothermic regional perfusion with DCD. Despite these differences, DCD has shown promising early outcomes, augmenting the donor pool and allowing more individuals to benefit from orthotopic heart transplant. This review aims to present the current state and future trajectory of DCD-heart transplant, examine key differences between DCD and donation after brain death, including clinical experiences and innovations in methodologies, and address the ongoing ethical challenges surrounding the new frontier in heart transplant with DCD donors.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011678"},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426479","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":"Mixed Shock Complicating Cardiogenic Shock: A Corollary or a Ramification?","authors":"Anju Bhardwaj, Mrudula Munagala","doi":"10.1161/CIRCHEARTFAILURE.124.011902","DOIUrl":"10.1161/CIRCHEARTFAILURE.124.011902","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e011902"},"PeriodicalIF":7.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558197","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}