Circulation最新文献

{"title":"Evidence-Based Application of Natriuretic Peptides in the Evaluation of Chronic Heart Failure With Preserved Ejection Fraction in the Ambulatory Outpatient Setting.","authors":"Yogesh N V Reddy, Atsushi Tada, Masaru Obokata, Rickey E Carter, David M Kaye, M Louis Handoko, Mads J Andersen, Kavita Sharma, Ryan J Tedford, Margaret M Redfield, Barry A Borlaug","doi":"10.1161/CIRCULATIONAHA.124.072156","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.072156","url":null,"abstract":"<p><strong>Background: </strong>Plasma NT-proBNP (N-terminal pro-B-type natriuretic peptide) is commonly used to diagnose heart failure with preserved ejection fraction (HFpEF), but its diagnostic performance in the ambulatory/outpatient setting is unknown because previous studies lacked objective reference standards.</p><p><strong>Methods: </strong>Among patients with chronic dyspnea, diagnosis of HFpEF or noncardiac dyspnea was determined conclusively by exercise catheterization in a derivation cohort (n=414), multicenter validation cohort 1 (n=560), validation cohort 2 (n=207), and a nonobese Japanese validation cohort 3 (n=77). Optimal NT-proBNP cut points for HFpEF rule out (optimizing sensitivity) and rule in (optimizing specificity) were derived and tested, stratified by obesity and atrial fibrillation. Derived cut points were tested in 3 additional validation cohorts (cohorts 4-6) in whom HFpEF was diagnosed by resting catheterization only (n=260), previous hospitalization for heart failure (n=447), or exercise echocardiography (n=517), respectively.</p><p><strong>Results: </strong>Current recommended rule-out NT-proBNP threshold <125 pg/mL had 82% sensitivity (95% CI, 77%-88%) with a body mass index (BMI) <35 kg/m<sup>2</sup>, decreasing to 67% (95% CI, 58%-77%) with a BMI ≥35 kg/m<sup>2</sup>. A lower rule-out NT-proBNP threshold <50 pg/mL displayed good sensitivity with a BMI <35 kg/m<sup>2</sup> (97% [95% CI, 95%-99%]), with a modest decline in sensitivity with a BMI ≥35 kg/m<sup>2</sup> (86% [95% CI, 79%-93%]); diagnostic thresholds were confirmed in validation cohorts 1 and 2 (91% [95% CI, 88%-95%] and 86% [95% CI, 80%-93%] with a BMI <35 kg/m<sup>2</sup>; 80% [95% CI, 74%-87%] and 84% [95% CI, 74%-93%] with a BMI ≥35 kg/m<sup>2</sup>). Current consensus age- and BMI-stratified rule-in thresholds demonstrated only 65% specificity (95% CI, 57%-72%). Rule-in NT-proBNP threshold ≥500 pg/mL had 85% specificity (95% CI, 78%-91%) with a BMI <35 kg/m<sup>2</sup> (87% [95% CI, 80%-94%] and 90% [95% CI, 81%-99%] in validation cohorts), with 100% specificity at a BMI ≥35 kg/m<sup>2</sup> (93% [95% CI, 81%-100%] and 100% in validation cohorts). With a BMI ≥35 kg/m<sup>2</sup>, lower rule-in thresholds (≥220 pg/mL) provided good specificity (88% [95% CI, 73%-100%]; 93% [95% CI, 81%-100%] and 100% in validation cohorts). Findings were consistent in validation cohorts 3 through 6 (sensitivity of <50 pg/mL, 93%-98%; specificity of ≥500 pg/mL, 82%-89%). NT-proBNP provided no incremental discrimination among patients with history of AF; ≥98% of patients with AF and dyspnea were found to have HFpEF in our cohorts.</p><p><strong>Conclusions: </strong>In patients with chronic unexplained dyspnea, current rule-in and rule-out NT-proBNP diagnostic thresholds lead to unacceptably high error rates, with important interactions by obesity and AF status. In our study, NT-proBNP provided little value in those with AF and dyspnea because the presence of AF is b","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":35.5,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001270","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":"ADMET-AI Enables Interpretable Predictions of Drug-Induced Cardiotoxicity.","authors":"Souhrid Mukherjee, Kyle Swanson, Parker Walther, Rabindra V Shivnaraine, Jeremy Leitz, Paul D Pang, James Zou, Joseph C Wu","doi":"10.1161/CIRCULATIONAHA.124.070413","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.070413","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 3","pages":"285-287"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000565","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":"SGLT Inhibitors in Persons With Heart Failure and Type 1 Diabetes: Filling the Therapeutic Gap.","authors":"Ify R Mordi, Rory J McCrimmon, Chim C Lang","doi":"10.1161/CIRCULATIONAHA.124.069695","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.069695","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 3","pages":"199-201"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001023","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":"Letter by Wang and Peng Regarding Article, \"Ertugliflozin for Functional Mitral Regurgitation Associated With Heart Failure: EFFORT Trial\".","authors":"Junwen Wang, Yong Peng","doi":"10.1161/CIRCULATIONAHA.124.070565","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.070565","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 3","pages":"e27"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000944","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":"In Which Patients Will Percutaneous Coronary Intervention Relieve Angina?","authors":"William F Fearon","doi":"10.1161/CIRCULATIONAHA.124.072466","DOIUrl":"10.1161/CIRCULATIONAHA.124.072466","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"215-217"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496241","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":"Correction to: Risk of Stroke or Systemic Embolism According to Baseline Frequency and Duration of Subclinical Atrial Fibrillation: Insights From the ARTESiA Trial.","authors":"","doi":"10.1161/CIR.0000000000001301","DOIUrl":"https://doi.org/10.1161/CIR.0000000000001301","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 3","pages":"e29"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000803","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":"From the Literature.","authors":"Tracy Hampton","doi":"10.1161/CIRCULATIONAHA.124.073443","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.073443","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 3","pages":"272-273"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000939","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":"AL or ATTR Amyloidosis? Never Two Without Three.","authors":"Mario Nuvolone, Giuseppe D Sanna, Giovanni Palladini","doi":"10.1161/CIRCULATIONAHA.124.072460","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.072460","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 3","pages":"274-281"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000723","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":"A Latent Cardiomyocyte Regeneration Potential in Human Heart Disease.","authors":"Wouter Derks, Julian Rode, Sofia Collin, Fabian Rost, Paula Heinke, Anjana Hariharan, Lauren Pickel, Irina Simonova, Enikő Lázár, Evan Graham, Ramadan Jashari, Michaela Andrä, Anders Jeppsson, Mehran Salehpour, Kanar Alkass, Henrik Druid, Christos P Kyriakopoulos, Iosif Taleb, Thirupura S Shankar, Craig H Selzman, Hesham Sadek, Stefan Jovinge, Lutz Brusch, Jonas Frisén, Stavros Drakos, Olaf Bergmann","doi":"10.1161/CIRCULATIONAHA.123.067156","DOIUrl":"10.1161/CIRCULATIONAHA.123.067156","url":null,"abstract":"<p><strong>Background: </strong>Cardiomyocytes in the adult human heart show a regenerative capacity, with an annual renewal rate of ≈0.5%. Whether this regenerative capacity of human cardiomyocytes is employed in heart failure has been controversial.</p><p><strong>Methods: </strong>We determined cardiomyocyte renewal in 52 patients with advanced heart failure, 28 of whom received left ventricular assist device support. We measured the concentration of nuclear bomb test-derived ¹⁴C in cardiomyocyte genomic DNA and performed mathematical modeling to establish cardiomyocyte renewal in heart failure with and without LVAD unloading.</p><p><strong>Results: </strong>We show that cardiomyocyte generation is minimal in end-stage heart failure patients at rates 18 to 50× lower compared with the healthy heart. However, patients receiving left ventricle support device therapy, who showed significant functional and structural cardiac improvement, had a >6-fold increase in cardiomyocyte renewal relative to the healthy heart.</p><p><strong>Conclusions: </strong>Our findings reveal a substantial cardiomyocyte regeneration potential in human heart disease, which could be exploited therapeutically.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"245-256"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680970","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":"Correction to: Comparative Cardiovascular Effectiveness of Empagliflozin Versus Dapagliflozin in Adults With Treated Type 2 Diabetes: A Target Trial Emulation.","authors":"","doi":"10.1161/CIR.0000000000001302","DOIUrl":"https://doi.org/10.1161/CIR.0000000000001302","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 3","pages":"e30"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000832","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}