Circulation: Heart Failure最新文献

{"title":"Targeting Mitochondrial Dysfunction With Elamipretide (SS-31) Improves Skeletal Muscle Performance in a HFpEF Rat Model.","authors":"Beatrice Vahle, Sven Weidner, André Tomalka, Antje Schauer, Antje Augstein, Anita Männel, Peggy Barthel, Janet Friedrich, Grietje Beck, Siegfried Labeit, T Scott Bowen, Tobias Siebert, Axel Linke, Volker Adams","doi":"10.1161/CIRCHEARTFAILURE.126.014397","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014397","url":null,"abstract":"<p><strong>Background: </strong>Exercise intolerance, promoted by skeletal muscle- and mitochondrial dysfunction, has been identified as a therapeutic target in heart failure with preserved ejection fraction (HFpEF). In the context of mitochondrial dysfunction, altered cardiolipin integrity has been reported in the myocardium of HFpEF, suggesting Elamipretide, a cardiolipin stabilizing agent, as potential therapeutic approach. The present study investigated cardiolipin dysregulation in the skeletal muscle of HFpEF rats and analyzed the effect of Elamipretide treatment.</p><p><strong>Methods: </strong>Female zucker fatty spontaneously hypertensive heart failure F1 hybrid lean (n=10, control) and obese rats (n=24, HFpEF) were included. At 20 weeks of age, HFpEF rats were randomized into 2 groups receiving NaCl (n=12) or Elamipretide (n=12) for 12 weeks. Skeletal muscle tissue was collected for whole-muscle force, single-fiber mechanics, mitochondrial respiration, histology and molecular analyses.</p><p><strong>Results: </strong>HFpEF rats exhibited reduced cardiolipin levels (-6.8%, <i>P</i>=0.007) and maturation (shown via tafazzin expression), contractile dysfunction, titin hyperphosphorylation, fiber atrophy and increased oxidative stress markers. Elamipretide improved whole muscle (soleus: +8.2%, <i>P</i>=0.041, extensor digitorum longus: +10.9%, <i>P</i>=0.016) and single-fiber (soleus: +173.2%, <i>P</i><0.001, extensor digitorum longus: +66.0%, <i>P</i>=ns) contractile function and titin phosphorylation (soleus: -35.4%, <i>P</i><0.001, extensor digitorum longus: -40.2%, <i>P</i><0.001), while preventing atrophy development (soleus: +49%, <i>P</i>=0.001, extensor digitorum longus: +54.8%, <i>P</i><0.001). Improved mitochondrial function, presumably through cardiolipin-mediated improvements in oxidative phosphorylation, could be associated with muscle force and cardiolipin integrity.</p><p><strong>Conclusions: </strong>Our data highlight cardiolipin stabilization as a key modulator of mitochondrial and contractile function in HFpEF, identifying Elamipretide as a promising therapeutic approach for skeletal muscle dysfunction.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014397"},"PeriodicalIF":8.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249169","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":"Skilled Nursing Facility-to-Home Transitions After Heart Failure Hospitalization: A Mixed-Methods Study of Communication, Self-Care, Medication, and Follow-Up.","authors":"Himali Weerahandi, Eli Behar, Carina Ceralde, Nathan Duc-Minh Nguyen, Rebecca S Boxer, W James Deardorff, John A Dodson, Taimur Mirza, Michi Yukawa, Leora I Horwitz, James D Harrison","doi":"10.1161/CIRCHEARTFAILURE.126.014449","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014449","url":null,"abstract":"<p><strong>Background: </strong>Skilled nursing facilities (SNFs) play a critical role in postacute recovery for older adults with heart failure (HF), yet the transition from SNF to home remains a vulnerable and understudied phase of care. Although discharge guidelines emphasize clear communication, HF-specific self-care education, medication management, and follow-up coordination, little is known about how these practices are implemented during SNF-to-home transitions.</p><p><strong>Methods: </strong>We conducted a convergent mixed-methods study across 4 nonprofit SNFs, integrating data from postdischarge patient and caregiver surveys, structured medical record abstraction of discharge instructions, and semi-structured staff interviews. Eligible patients were Medicare beneficiaries aged ≥65 years discharged from SNF to home following HF hospitalization, with SNF stays ≤60 days. Quantitative data were analyzed using descriptive statistics, while qualitative data underwent thematic and directed content analysis. Findings were triangulated across data sources to identify key challenges and actionable strategies.</p><p><strong>Results: </strong>Among 150 respondents, 59% reported receiving written discharge instructions; however, HF-specific self-care elements (eg, daily weight monitoring, low salt diet) were documented in only 15% to 41% of instructions. Although 87% reported receiving a medication list, only 53% had it reflected in the discharge instructions, and adherence support was infrequently addressed (24%). Follow-up coordination was similarly discordant: 37% of respondents reported a scheduled primary care appointment, compared with 13% documented in discharge instructions. Staff interviews revealed nonstandardized discharge workflows, workforce constraints, and reliance on verbal education, contributing to variability in patient preparation and communication across care settings.</p><p><strong>Conclusions: </strong>SNF-to-home transitions after HF hospitalization are marked by discordance between patient-reported education and written documentation, as well as inconsistent medication and follow-up coordination. These gaps represent modifiable vulnerabilities during a high-risk recovery period. Standardized HF-focused discharge workflows and strengthened cross-setting communication may improve transitional care, while long-term solutions must address structural and workforce constraints.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014449"},"PeriodicalIF":8.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435327","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":"Tailored Atrial Pacing: Another Therapeutic Tool for Fontan Failure?","authors":"Jef Van den Eynde, Alexander Van De Bruaene, Yogesh N V Reddy, William R Miranda","doi":"10.1161/CIRCHEARTFAILURE.126.014628","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014628","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014628"},"PeriodicalIF":8.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249173","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":"Aortic Stenosis and Heart Failure With Preserved Ejection Fraction: A Cautionary Tale of Common Partners.","authors":"Jennifer Y Zhou, Shane Nanayakkara, David M Kaye, Dion Stub","doi":"10.1161/CIRCHEARTFAILURE.126.014249","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014249","url":null,"abstract":"<p><p>Aortic stenosis (AS) is increasingly recognized as a disease of both the valve and the myocardium. Beyond valvular obstruction, many patients with aortic stenosis develop extra-valvular abnormalities, including left ventricular hypertrophy, diastolic dysfunction, and atrial and pulmonary vascular remodeling, which have emerged as major determinants of symptoms and prognosis. These abnormalities share many similarities with heart failure with preserved ejection fraction (HFpEF), a condition that is also prevalent in the same aging population. Emerging data suggest that AS and HFpEF frequently coexist and interact, compounded by shared cardiometabolic risk factors, producing convergent phenotypes that complicate diagnosis and influence treatment response. Residual HFpEF appears to underlie much of the persistent heart failure burden after aortic valve replacement, while even mild AS portends worse outcomes in patients with HFpEF. Recent studies have shown that HFpEF-directed therapies, such as sodium-glucose cotransporter 2 inhibitors, may benefit selected patients with AS. As both conditions increase in prevalence and valve interventions are offered to increasingly complex patients, a clearer understanding of the ways in which AS and HFpEF overlap and interact is essential. This review integrates epidemiological, pathophysiological, and clinical perspectives to synthesize emerging evidence on the AS-HFpEF overlap and outlines implications for diagnosis, prognosis, and management.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014249"},"PeriodicalIF":8.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263497","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":"Effects of Acoramidis on Kidney Function in Transthyretin Amyloid Cardiomyopathy.","authors":"Jeffrey M Testani, Daniel P Judge, Barry A Borlaug, David Cherney, Zachary L Cox, Julian D Gillmore, Julia B Lewis, Scott H Adler, Xiaofan Cao, Adam Castaño, Jonathan C Fox, Leonid Katz, Vandana Mathur, Kuangnan Xiong, Javed Butler, Ahmad Masri","doi":"10.1161/CIRCHEARTFAILURE.126.014656","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014656","url":null,"abstract":"<p><strong>Background: </strong>Acoramidis achieves near-complete (≥90%) transthyretin stabilization and is approved to reduce cardiovascular-related mortality and hospitalization in transthyretin amyloid cardiomyopathy. Its effects on kidney function are not well characterized.</p><p><strong>Methods: </strong>Data from randomized phase 2 (N=49) and phase 3 (N=632) studies in transthyretin amyloid cardiomyopathy were included. The estimated glomerular filtration rate (eGFR) slope was generated using a linear spline mixed-effects model. The urinary albumin-to-creatinine ratio was measured longitudinally. Relationships between changes in kidney function and clinical outcomes were explored using Cox proportional hazards models.</p><p><strong>Results: </strong>Acoramidis initiation resulted in a modest acute dip in eGFR that was dose-dependent, reversible, and not associated with adverse kidney-related events. At Day 28, the mean (±SE) dip in eGFR from baseline with acoramidis was 8.5±0.48 mL/min per 1.73 m²; the placebo-corrected reduction in the urinary albumin-to-creatinine ratio was 15.5% (95% CI, 0.4%-28.4%; <i>P</i>=0.044). The rate of decline in kidney function (chronic eGFR slope) was significantly improved with acoramidis versus placebo (-1.01 versus -3.48 mL/min per 1.73 m² per year; <i>P</i><0.001), and the reduction in the urinary albumin-to-creatinine ratio was sustained (13.7% [95% CI, 1.7%-24.2%]; <i>P</i>=0.026) over time. Concomitant tafamidis use did not influence the chronic eGFR slope in either arm. Comparing acoramidis versus placebo subgroups with acute eGFR dips ≥ the median (4.89 mL/min per 1.73 m²) favored acoramidis for all-cause mortality or cardiovascular-related hospitalization (hazard ratio, 0.42 [95% CI, 0.22-0.78]; <i>P</i>=0.006; <i>P</i> interaction=0.043) and cardiovascular-related hospitalization (hazard ratio, 0.34 [95% CI, 0.17-0.66]; <i>P</i>=0.002, <i>P</i> interaction=0.025). Within the placebo arm, eGFR dips portended worse outcomes.</p><p><strong>Conclusions: </strong>Acoramidis initiation resulted in an acute dip in eGFR and reductions in both the chronic eGFR slope and urinary albumin-to-creatinine ratio versus placebo without adverse kidney-related events. Acoramidis effects on kidney function may be mediated through direct kidney-protective hemodynamic effects. Importantly, the acute dip in eGFR was associated with a reduced risk of adverse clinical outcomes within the first year.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03458130, NCT03536767, NCT03860935, NCT04988386.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014656"},"PeriodicalIF":8.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367489","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 Ali et al Regarding Article, \"Decoding the Heart Failure Peptidome\".","authors":"Zeeshan Ali, Muhammad Anwar, Syeda Alizay Safdar Kirmani","doi":"10.1161/CIRCHEARTFAILURE.126.014551","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014551","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014551"},"PeriodicalIF":8.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210387","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":"Universal Pulmonary Resistance-Compliance Relationship - And Why It Matters?","authors":"Sara L Hungerford, Audrey I Adji, Navin K Kapur, Daniel Burkhoff","doi":"10.1161/CIRCHEARTFAILURE.125.014002","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.014002","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014002"},"PeriodicalIF":8.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263484","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 Individual Patient Outcomes After Interatrial Shunt Treatment in Heart Failure With Reduced and Preserved Ejection Fraction: The RELIEVE-HF Trial.","authors":"Gregg W Stone, JoAnn Lindenfeld, Michael R Zile, Stefan D Anker, Josep Rodés-Cabau, Clayton Snyder, Saibal Kar, Michael P Pfeiffer, Antoni Bayes-Genis, Jeroen J Bax, Alan J Bank, Julio Núñez, Elizabeth C Lee, Michal Laufer-Perl, Gil Moravsky, Sheldon E Litwin, Richard Holcomb, Neal L Eigler, William T Abraham","doi":"10.1161/CIRCHEARTFAILURE.125.014100","DOIUrl":"10.1161/CIRCHEARTFAILURE.125.014100","url":null,"abstract":"<p><strong>Background: </strong>Among 508 patients randomized to interatrial shunt implantation versus a placebo procedure in the RELIEVE-HF trial (Reducing Lung Congestion Symptoms Using the V-Wave Shunt in Advanced Heart Failure), 2-year clinical outcomes were improved in heart failure with reduced ejection fraction (HFrEF, n=206) and worsened in heart failure with preserved ejection fraction (HFpEF, n=302). However, randomized trials typically include therapeutic responders and nonresponders. We sought to determine the independent predictors of outcomes and model individual patient risk after atrial shunt implantation in HFrEF and HFpEF.</p><p><strong>Methods: </strong>The primary outcome included all-cause death, cardiac transplantation or left ventricular assist device implantation, heart failure hospitalizations, and outpatient worsening heart failure events. From 37 baseline clinical, laboratory, echocardiographic, and hemodynamic covariates, the cumulative mean function of recurrent events during follow-up was modeled by the Lin-Wei-Yang-Ying method.</p><p><strong>Results: </strong>Among control patients with HFrEF, independent baseline predictors of outcomes were atrial fibrillation, elevated troponin, lower left ventricular ejection fraction, and greater right atrial pressure. In contrast, independent predictors of outcomes in shunt-treated patients with HFrEF were lower systolic blood pressure and elevated right ventricular end-diastolic area index, pulmonary artery pressure, and pulmonary vascular resistance. Among control patients with HFpEF, independent predictors of outcomes were diabetes, higher heart rate and left ventricular end-systolic volume, and lower right ventricular fractional area change. Conversely, independent predictors in shunt-treated patients with HFpEF were hypertension, smoking, lower 6-minute walk distance, reduced estimated glomerular filtration rate, elevated troponin, and moderate or greater tricuspid regurgitation. Risk modeling estimated that 67.2% of patients with HFrEF might benefit from shunt placement compared with 21.4% of patients with HFpEF.</p><p><strong>Conclusions: </strong>In RELIEVE-HF, distinct baseline risk factors influenced cardiovascular outcomes before and after atrial shunt treatment in HFrEF and HFpEF. Despite markedly different group responses to atrial shunt treatment in the randomized HFrEF and HFpEF strata, given individual differences in patient risk factor profiles, most but not all patients with HFrEF may benefit, and some patients with HFpEF may also improve after shunt treatment.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03499236.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014100"},"PeriodicalIF":8.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668630","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":"Cost of Idling: Skeletal Muscle Myosin ATPase Dysfunction and the Energetic Basis of Exercise Intolerance in HFrEF.","authors":"Alessandro Pocai","doi":"10.1161/CIRCHEARTFAILURE.126.014672","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014672","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014672"},"PeriodicalIF":8.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223697","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 Voors et al Regarding Article, \"Decoding the Heart Failure Peptidome\".","authors":"Adriaan Voors, Christian Toft Madsen","doi":"10.1161/CIRCHEARTFAILURE.126.014571","DOIUrl":"10.1161/CIRCHEARTFAILURE.126.014571","url":null,"abstract":"","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e014571"},"PeriodicalIF":8.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210459","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}