Clinical Research in Cardiology最新文献

{"title":"German Cardiac Arrest Registry (G-CAR)-results of the pilot phase.","authors":"Janine Pöss, Christoph Sinning, Michelle Roßberg, Nadine Hösler, Taoufik Ouarrak, Bernd W Böttiger, Sebastian Ewen, Harm Wienbergen, Fabian Voss, Jochen Dutzmann, Eike Tigges, Ingo Voigt, Anne Freund, Steffen Desch, Guido Michels, Holger Thiele, Uwe Zeymer","doi":"10.1007/s00392-024-02468-5","DOIUrl":"10.1007/s00392-024-02468-5","url":null,"abstract":"<p><strong>Background: </strong>In Europe, more than 300,000 persons per year experience out-of-hospital cardiac arrest (OHCA). Despite medical progress, only few patients survive with good neurological outcome. For many issues, evidence from randomized trials is scarce. OHCA often occurs for cardiac causes. Therefore, we established the national, prospective, multicentre German Cardiac Arrest Registry (G-CAR). Herein, we describe the first results of the pilot phase.</p><p><strong>Results: </strong>Over a period of 16 months, 15 centres included 559 consecutive OHCA patients aged ≥ 18 years. The median age of the patients was 66 years (interquartile range 57;75). Layperson resuscitation was performed in 60.5% of all OHCA cases which were not observed by emergency medical services. The initial rhythm was shockable in 46.4%, and 29.1% of patients had ongoing CPR on hospital admission. Main presumed causes of OHCA were acute coronary syndromes (ACS) and/or cardiogenic shock in 54.8%, with ST-elevation myocardial infarction being the most common aetiology (34.6%). In total, 62.9% of the patients underwent coronary angiography; percutaneous coronary intervention (PCI) was performed in 61.4%. Targeted temperature management was performed in 44.5%. Overall in-hospital mortality was 70.5%, with anoxic brain damage being the main presumed cause of death (38.8%). Extracorporeal cardiopulmonary resuscitation (eCPR) was performed in 11.0%. In these patients, the in-hospital mortality rate was 85.2%.</p><p><strong>Conclusions: </strong>G-CAR is a multicentre German registry for adult OHCA patients with a focus on cardiac and interventional treatment aspects. The results of the 16-month pilot phase are shown herein. In parallel with further analyses, scaling up of G-CAR to a national level is envisaged. Trial registration ClinicalTrials.gov identifier: NCT05142124.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1270-1279"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital bioimpedance-derived total body water predicts short-term cardiovascular mortality and re-hospitalizations in acute decompensated heart failure patients.","authors":"Alessandro Faragli, Alexander Herrmann, Mina Cvetkovic, Simone Perna, Eman Khorsheed, Francesco Paolo Lo Muzio, Edoardo La Porta, Lorenzo Fassina, Anna-Marie Günther, Jens Oetvoes, Hans-Dirk Düngen, Alessio Alogna","doi":"10.1007/s00392-024-02571-7","DOIUrl":"10.1007/s00392-024-02571-7","url":null,"abstract":"<p><strong>Background: </strong>Hospital re-admissions in heart failure (HF) patients are mostly caused by an acute exacerbation of their chronic congestion. Bioimpedance analysis (BIA) has emerged as a promising non-invasive method to assess the volume status in HF. However, its correlation with clinically assessed volume status and its prognostic value in the acute intra-hospital setting remains uncertain.</p><p><strong>Methods and results: </strong>In this single-center observational study, patients (n = 49) admitted to the cardiology ward for acute decompensated HF (ADHF) underwent a daily BIA-derived volume status assessment. Median hospital stay was 7 (4-10) days. Twenty patients (40%) reached the composite endpoint of cardiovascular mortality or re-hospitalization for HF over 6 months. Patients at discharge displayed improved NYHA class, lower body weight, plasma and blood volume, as well as lower NT-proBNP levels compared to the admission. Compared to patients with total body water (TBW) less than or equal to that predicted by body weight, those with higher relative TBW levels had elevated NT-proBNP and E/e´ (both p < 0.05) at discharge. In the Cox multivariate regression analysis, the BIA-derived delta TBW between admission and discharge showed a 23% risk reduction for each unit increase (HR = 0.776; CI 0.67-0.89; p = 0.0006). In line with this finding, TBW at admission had the highest prediction importance of the combined endpoint for a subgroup of high-risk HF patients (n = 35) in a neural network analysis.</p><p><strong>Conclusion: </strong>In ADHF patients, BIA-derived TBW is associated with the increased risk of HF hospitalization or cardiovascular death over 6 months. The role of BIA for prognostic stratification merits further investigation.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1337-1348"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiplatelet therapy in acute myocardial infarction complicated by cardiogenic shock.","authors":"Angela Dettling, Kurt Huber, Steen D Kristensen, Daniel Aradi, Benedikt Schrage, Peter Clemmensen","doi":"10.1007/s00392-025-02619-2","DOIUrl":"10.1007/s00392-025-02619-2","url":null,"abstract":"<p><p>Coronary revascularization represents a cornerstone in the treatment of infarct-related cardiogenic shock (CS). Early and effective antithrombotic therapy is critical and has been shown to improve mortality in most patients with acute coronary syndrome. Achieving early effective platelet inhibition and anticoagulation, with minimal risk, is particularly important in those high-risk patients with CS as the mortality remains high at approximately 50%. However, patients with CS are at high risk for both early thrombotic as well as bleeding events and striking the right balance remains a challenge due to a multitude of factors related to drug administration, metabolism and mechanical issues related to therapeutic interventions such as increasing use of mechanical circulatory support (MCS). This review therefore aims to provide an overview of the current practice, the underlying challenges and existing evidence on safety, efficacy and outcomes of adjunctive antiplatelet and antithrombotic therapy in patients with acute myocardial infarction (AMI) complicated by CS and discusses the use of parenteral platelet inhibitors.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1237-1245"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiographic left atrial stiffness index predicts high left ventricular filling pressures in patients with acute heart failure: an observational study.","authors":"Massimiliano Camilli, Ludovica Amore, Federico Ballacci, Giulia Iannaccone, Marco Giuseppe Del Buono, Federica Giordano, Francesca Graziani, Tommaso Sanna, Daniela Pedicino, Francesco Burzotta, Carlo Trani, Gaetano Antonio Lanza, Rocco Antonio Montone, Nadia Aspromonte, Laura Lupi, Marianna Adamo, Filippo Crea, Antonella Lombardo","doi":"10.1007/s00392-024-02562-8","DOIUrl":"10.1007/s00392-024-02562-8","url":null,"abstract":"<p><strong>Background: </strong>In acute heart failure (AHF) patients, non-invasive estimation of left ventricular filling pressures (LVFPs) appears crucial to guide management. Although poorly investigated, left atrial (LA) mechanics play a pivotal role in this setting. This report sought to assess the correlation of echocardiographic LA stiffness index with invasive LVFPs and its diagnostic accuracy as compared to other parameters used in clinical practice.</p><p><strong>Methods: </strong>In this observational, prospective study, 104 patients with suspected acute coronary syndrome and signs/symptoms of AHF were enrolled. Available invasive estimation of LVFPs was required. Comprehensive echocardiography was performed for all patients, including LA reservoir strain (LARS). LA stiffness index was derived by speckle-tracking analysis and Tissue Doppler imaging as early diastolic transmitral inflow velocity/mitral annulus early diastolic velocity [E/e']/LARS.</p><p><strong>Results: </strong>Invasively measured LVFPs showed a strong correlation with LA stiffness index (Spearman ρ = 0.773, p < 0.0001), as well as with LARS and E/e'. Receiver operating characteristic (ROC) curve analysis was used to demonstrate better accuracy performed by LA stiffness index than average E/e', LA volume or LARS alone, in predicting high LVFPs. Guideline-recommended assessment of diastolic function was finally compared to LARS and LA stiffness index performances in an independent population group; we were hence able to obtain a LA stiffness threshold of 0.48 with a positive predictive value of 91.7% and a negative predictive value of 88.9% in identifying patients with high LVFPs.</p><p><strong>Conclusions: </strong>For the first time, diagnostic performance of LA stiffness index has been investigated in a heterogeneous AHF population, providing correlations with invasively measured LVFPs and comparisons with established diastolic function metrics.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1324-1336"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular function in patients with advanced heart failure and continuous-flow or pulsatile ventricular assist devices.","authors":"Valentina A Rossi, Delia Nebunu, Matthias P Nägele, Jens Barthelmes, Thomas Haider, Natallia Laptseva, Konstantinos Bitos, Leonie Kreysing, Michelle Frank, Frank Enseleit, Markus J Wilhelm, Omer Dzemali, Frank Ruschitzka, Isabella Sudano, Andreas J Flammer","doi":"10.1007/s00392-024-02519-x","DOIUrl":"10.1007/s00392-024-02519-x","url":null,"abstract":"<p><strong>Background: </strong>A significant proportion of patients with heart failure (HF) progress to an advanced stage, which is associated with a substantial increase in morbidity and mortality. These patients may be eligible for advanced treatment strategies such as mechanical circulatory support with ventricular assist devices (VAD). Vascular dysfunction is a hallmark of heart failure pathophysiology and prognosis. However, whether and to what degree the hemodynamic benefits of VADs influence vascular function remain unknown.</p><p><strong>Methods and results: </strong>In this study, we evaluated endothelial vascular function with flow-mediated vasodilatation (FMD) and with flicker-light induced retinal vasodilatation (FID). 34 patients with a VAD (age 58 ± 10 years, 85% male, 74% ischemic heart disease, 26 continuous-flow (CF)-LVAD, and 8 pulsatile biventricular (bi)-VAD) were compared to 34 propensity-matched patients (mean age 62 ± 9 years, 68% male, 59% ischemic heart disease) with advanced HF (AdvHF). Endothelial function of larger arteries (FMD) was significantly better in patients after VAD implantation compared to matched AdvHF patients (7.2 ± 4.6% vs. 5.0 ± 3.2%, p = 0.03), whereas microvascular arteriolar function (FIDart) did not differ (0.99 ± 1.43% vs. 1.1 ± 1.7%, p = 0.78). The arterio-venous ratio (AVR) was higher in the VAD group (0.90 ± 0.06 vs 0.85 ± 0.09, p = 0.01), reflecting wider retinal arteriolar and narrower venular diameters. There was no difference in vascular function between patients with CF-LVAD and pulsatile Bi-VAD.</p><p><strong>Conclusion: </strong>In patients with advanced heart failure, VAD implantation was associated with better endothelial function at the level of large arteries, but not in the microcirculation.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1290-1299"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium after cardiac arrest: incidence, risk factors, and association with neurologic outcome-insights from the Freiburg Delirium Registry.","authors":"Dawid Leander Staudacher, Laura Heine, Alexander Maier, Klaus Kaier, Adrian Heidenreich, Jonathan Rilinger, Felix Arne Rottmann, Paul Marc Biever, Alexander Supady, Tobias Wengenmayer, Dirk Westermann, Markus Jäckel","doi":"10.1007/s00392-024-02575-3","DOIUrl":"10.1007/s00392-024-02575-3","url":null,"abstract":"<p><strong>Aim: </strong>Delirium in patients treated in the intensive care unit (ICU) is linked to adverse outcome, according to previous observations. However, data on patients recovering after cardiac arrest are sparse. The aim of this study was to assess incidence, risk factors, and outcome of patients with delirium after cardiac arrest in the Freiburg Delirium Registry (FDR).</p><p><strong>Methods: </strong>In this retrospective registry study, all patients after cardiac arrest treated in the Freiburg University Medical Center medical ICU between 08/2016 and 03/2021 were included. Delirium was diagnosed using the Nursing Delirium screening scale (NuDesc), assessed three times daily. Favorable neurological outcome was defined as cerebral performance category (CPC) score at ICU discharge ≤ 2.</p><p><strong>Results: </strong>Two hundred seventeen patients were included and among them, delirium was detected in one hundred ninety-nine (91.7%) patients. Age was independently associated with the incidence of delirium (p = 0.003), and inversely associated with the number of delirium-free days (p < 0.001). Favorable neurological outcome was present in 145/199 (72.9%) with, and 17/18 (94.4%) patients without delirium (p = 0.048). While the incidence of delirium was not independently associated with a favorable neurologic outcome, the number of delirium-free days strongly predicted the primary endpoint [OR 2.14 (1.73-2.64), p > 0.001].</p><p><strong>Conclusion: </strong>Delirium complicated the ICU course in almost all patients after cardiac arrest. The number of delirium-free days was associated with favorable outcome while incidence of delirium itself was not.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1349-1357"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circumstances in a young German cohort with sudden cardiac arrest: systematic insights and implications.","authors":"Fabienne Kreimer, Pia Thiesing, Ibrahim Akin, Jens Tiesmeier, Hendrik Milting, Andreas Mügge, Nazha Hamdani, Assem Aweimer, Ibrahim El-Battrawy","doi":"10.1007/s00392-025-02593-9","DOIUrl":"10.1007/s00392-025-02593-9","url":null,"abstract":"<p><strong>Introduction: </strong>Data on circumstances of sudden cardiac arrest (SCA) in Germany are limited. The present study aimed to investigate systematically the current pre- and in-hospital circumstances of a SCA cohort at young age (65 years or younger) in Germany.</p><p><strong>Methods: </strong>In the period from 2010 to 2021, we enrolled 191 consecutive patients with SCA at a university hospital in the Ruhr area, Germany. Clinical baseline characteristics and cardiopulmonary resuscitation (CPR) data were assessed.</p><p><strong>Results: </strong>A total of 191 patients (median age: 56 years (ranging from 16 to 65 years); 82% males) were included. The median duration of hospitalization was nine days. 97 patients (50.8%) deceased during hospitalization. The patients suffered SCA during non-stressful daily activities (41.4%), while working (14.7%), exercising (12.0%) or resting (8.9%). Patients experienced SCA most often at home (41.9%), in public (31.9%), at work (14.7%), or in the emergency ambulance (6.3%). Bystander-witnessed cardiac arrest was reported in 80.6% of cases. However, lay resuscitation was performed in only 46.1% of cases. The first-monitored rhythm was most frequently ventricular fibrillation (67.0%), followed by asystole (18.3%), ventricular tachycardia (5.8%), pulseless electrical activity (5.2%) and bradycardia (2.1%).</p><p><strong>Conclusion: </strong>Compared to other studies, we detected lower rates of SCA occurring at home and higher rates in public, at work or during sports. This may be related to the fact that only younger patients under the age of 65 were included in this SCA cohort.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1440-1444"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventilation strategies in cardiogenic shock: insights from the FRENSHOCK observational registry.","authors":"Kim Volle, Hamid Merdji, Vincent Bataille, Nicolas Lamblin, François Roubille, Bruno Levy, Sebastien Champion, Pascal Lim, Francis Schneider, Vincent Labbe, Hadi Khachab, Jeremy Bourenne, Marie-France Seronde, Guillaume Schurtz, Brahim Harbaoui, Gerald Vanzetto, Charlotte Quentin, Nicolas Combaret, Benjamin Marchandot, Benoit Lattuca, Caroline Biendel, Guillaume Leurent, Laurent Bonello, Edouard Gerbaud, Etienne Puymirat, Eric Bonnefoy, Nadia Aissaoui, Clément Delmas","doi":"10.1007/s00392-024-02551-x","DOIUrl":"10.1007/s00392-024-02551-x","url":null,"abstract":"<p><strong>Background: </strong>Despite scarce data, invasive mechanical ventilation (MV) is widely suggested as first-line ventilatory support in cardiogenic shock (CS) patients. We assessed the real-life use of different ventilation strategies in CS and their influence on short and mid-term prognosis.</p><p><strong>Methods: </strong>FRENSHOCK was a prospective registry including 772 CS patients from 49 centers in France. Patients were categorized into three groups according to the ventilatory supports during hospitalization: no mechanical ventilation group (NV), non-invasive ventilation alone group (NIV), and invasive mechanical ventilation group (MV). We compared clinical characteristics, management, and occurrence of death and major adverse event (MAE) (death, heart transplantation or ventricular assist device) at 30 days and 1 year between the three groups.</p><p><strong>Results: </strong>Seven hundred sixty-eight patients were included in this analysis. Mean age was 66 years and 71% were men. Among them, 359 did not receive any ventilatory support (46.7%), 118 only NIV (15.4%), and 291 MV (37.9%). MV patients presented more severe CS with more skin mottling, higher lactate levels, and higher use of vasoactive drugs and mechanical circulatory support. MV was associated with higher mortality and MAE at 30 days (HR 1.41 [1.05-1.90] and 1.52 [1.16-1.99] vs NV). No difference in mortality (HR 0.79 [0.49-1.26]) or MAE (HR 0.83 [0.54-1.27]) was found between NIV patients and NV patients. Similar results were found at 1-year follow-up.</p><p><strong>Conclusions: </strong>Our study suggests that using NIV is safe in selected patients with less profound CS and no other MV indication. NCT02703038.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1311-1323"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"J-shaped relationship between serum creatinine and mortality in Korean patients with acute heart failure.","authors":"Yun-Ho Cho, Jin Joo Park, Hae-Young Lee, Kye Hun Kim, Byung-Su Yoo, Seok-Min Kang, Sang Hong Baek, Eun-Seok Jeon, Jae-Joong Kim, Myeong-Chan Cho, Shung Chull Chae, Byung-Hee Oh, Dong-Ju Choi","doi":"10.1007/s00392-024-02469-4","DOIUrl":"10.1007/s00392-024-02469-4","url":null,"abstract":"<p><strong>Background: </strong>Cachexia and sarcopenia are common among heart failure (HF) patients and are linked to poor outcomes. As serum creatinine levels are influenced by both renal function and muscle mass, our study aimed to investigate the relationship between serum creatinine levels and mortality in acute HF patients.</p><p><strong>Methods: </strong>We enrolled 5198 consecutive acute HF patients from the Korea Acute Heart Failure (KorAHF) registry, excluding those on renal replacement therapy. Patients were categorized into five groups based on their discharge serum creatinine levels: low (< 0.6 mg/dL), reference (0.6-0.89 mg/dL), upper normal (0.9-1.19 mg/dL), high (1.2-1.49 mg/dL), and very high (≥ 1.5 mg/dL). The primary endpoint was post-discharge all-cause mortality.</p><p><strong>Results: </strong>The mean creatinine level was 1.20 ± 0.88 mg/dL. Notably, 335 (6.4%) patients had serum creatinine levels < 0.6 mg/dL. These patients were younger (mean age, 67 years) and more likely to have a low BMI (< 18.5 kg/m²) compared to the reference group (15.3% vs. 6.4%). Over a median follow-up of 975 days, 1743 (34.8%) patients died. We observed a J-shaped relationship between serum creatinine levels and mortality, with both low and high levels associated with increased mortality. After adjusting for covariates, including age, sex, body mass index, diabetes, hypertension, smoking, malignancy, atrial fibrillation on electrocardiography, levels of C-reactive protein, sodium, hemoglobin, albumin, brain natriuretic peptide, de novo heart failure, use of beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists, patients with serum creatinine levels < 0.6 mg/dL had a 33% higher risk of all-cause mortality (HR, 1.33; 95% CI, 1.06 to 1.66) compared to those with levels of 0.6-0.89 mg/dL. However, BUN, which is not affected by muscle metabolism, exhibited a linear relationship with mortality.</p><p><strong>Conclusions: </strong>Among acute HF patients, there exists a J-shaped relationship between discharge serum creatinine levels and mortality, highlighting the increased mortality risk in individuals with very low serum creatinine levels.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1280-1289"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of eplerenone in acute heart failure using a win ratio approach.","authors":"Masatake Kobayashi, Akira Yamashina, Kazuhiro Satomi, Ayako Tezuka, Kevin Duarte, Shin Ito, Masanori Asakura, Masafumi Kitakaze, Nicolas Girerd","doi":"10.1007/s00392-024-02578-0","DOIUrl":"10.1007/s00392-024-02578-0","url":null,"abstract":"","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1436-1439"},"PeriodicalIF":3.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}