Clinical Research in Cardiology最新文献

{"title":"Electrocardiographic abnormalities attributable to infiltrative cardiomyopathies: review and prevalence in patients with congestive heart failure.","authors":"Mohammed Mustafa, Casey White, Erin Harris, George Tawfellos, Al-Ameen Oredegbe, Mikhail Torosoff","doi":"10.1007/s00392-024-02568-2","DOIUrl":"10.1007/s00392-024-02568-2","url":null,"abstract":"<p><strong>Background: </strong>The electrocardiogram (ECG) is routinely used in patients with suspected infiltrative cardiomyopathies; heart diseases characterized by the abnormal deposition of pathological substances in the myocardium. This study presents a review of ECG features attributable to various infiltrative cardiomyopathies and analyzes the prevalence and overlap of electrocardiographic abnormalities in patients with adjudicated CHF.</p><p><strong>Results: </strong>The study included 573 consecutive CHF patients without severe aortic stenosis, further stratified by LV hypertrophy (LVH) and preserved or decreased LV ejection fraction. Comprehensive ECG analysis revealed at least one ECG abnormality typically associated with infiltrative cardiomyopathies in 95% of patients, and more than one ECG abnormality in 70%. An average number of ECG abnormalities was 2.2 ± 1.2 per patient. There was substantial overlap in ECG abnormalities in individual patients, particularly those attributable to Fabry's disease and hemochromatosis (51.5%) or cardiac amyloidosis (46.1%), and hemochromatosis and cardiac amyloidosis (44.2%). Prevalence of various ECG abnormalities was similar across various patient demographics and co-morbidities, including LVH status and/or history of CAD which did not increase the number of ECG abnormalities (2.155 ± 1.238 vs. 2.228 ± 1.192 in patients without CAD history, p = 0.969). Patients with reduced LV ejection fraction had a higher prevalence of widened QRS and premature ventricular complexes.</p><p><strong>Conclusion: </strong>ECG abnormalities attributable to infiltrative cardiomyopathies are common in heart failure patients, with a significant overlap in findings classically attributed to various infiltrative cardiomyopathies. The presence of LVH and decreased LV ejection fraction do not significantly affect the prevalence of ECG abnormalities.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"700-713"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521221","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":"Clinical characteristics and etiology-specific outcome in pediatric hypertrophic cardiomyopathy.","authors":"Felix Minette, Maximilian Klass, Nikita Meyer, Angela Merzweiler, Sebastian Burkart, Maja Hempel, Norbert Frey, Mirko Völkers, Matthias Gorenflo, Alexander Kovacevic, Christoph Sandmann","doi":"10.1007/s00392-025-02703-7","DOIUrl":"10.1007/s00392-025-02703-7","url":null,"abstract":"<p><strong>Introduction: </strong>Childhood-onset cardiomyopathies are rare disease (incidence 1/100,000) presenting with diverse, potentially severe phenotypes. The etiologies range from idiopathic/sarcomeric forms to syndromic diseases, neuromuscular disorders, and inborn errors of metabolism, but cause-specific outcomes remain incompletely understood. This study analyzed the clinical course of a large cohort of children with hypertrophic cardiomyopathy (HCM), stratified by etiology.</p><p><strong>Methods: </strong>Patients clinically diagnosed with HCM before 18 years of age at Heidelberg University Hospital, Germany (2000-2024) were included (n = 146). The clinical data were compiled by the Medical Data Integration Center and supplemented by manual data extraction. Outcomes included survival, myectomy, ICD and PPM implantation, arrhythmias, heart transplantation, cardiac arrest, and echocardiographic features at first presentation.</p><p><strong>Results: </strong>Of 146 patients, 31.5% (n = 46) were followed into adulthood. HCM etiologies included idiopathic/sarcomeric (37%, n = 54), inborn errors of metabolism (21.2%, n = 31), RASopathy (15.7%, n = 23), neuromuscular disorders (6.8%, n = 10), other syndromic (6.2%, n = 9), and other (13%, n = 19). Diagnosis was made in infancy (< 1 year) (47.3%, n = 69), childhood (1-18 years) (40.4%, n = 59), or was confirmed before age 18 without specific timing available (12.3%, n = 18). Early diagnosis correlated with syndromic and multisystem disease. The echocardiographic findings and clinical outcomes varied by etiology. During a mean follow-up of 13.6 ± 10.5 years, 11% (n = 16) died, with 62.5% (n = 10) of deaths occurring within the first two years of life. Survival was highest in idiopathic/sarcomeric HCM (96.7%) and lower in neuromuscular (85.7%), syndromic (76.2%), inborn errors of metabolism (70.5%), RASopathy (57.8%), and other forms (54.2%). Death frequently involved non-cardiovascular causes. Infants had higher early mortality, which normalized among those surviving beyond two years. In idiopathic/sarcomeric HCM, outcomes did not differ between those diagnosed in infancy versus later childhood. Reduced ejection fraction and elevated NT-proBNP levels were predictive of mortality, while the use of Class IV anti-arrhythmics was associated with improved survival.</p><p><strong>Conclusions: </strong>The results of this analysis show significant variability of outcomes by HCM subtype in children. Idiopathic/sarcomeric and neuromuscular disease-associated HCM had the best prognosis, while other non-idiopathic/non-sarcomeric forms of HCM showed worse outcomes. Pediatric HCM presents with diverse underlying causes, unique phenotypes, and clinical trajectories, requiring tailored treatment approaches.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"795-810"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13083408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279047","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":"Mavacamten optimizes myocardial work in patients with obstructive hypertrophic cardiomyopathy: a non-invasive pressure-strain analysis.","authors":"S Scholtz, C Coppée, K Mohemed, M Potratz, F Langkamp, V Rudolph, C Maack, W Scholtz, V Sequeira, J-C Reil","doi":"10.1007/s00392-026-02855-0","DOIUrl":"10.1007/s00392-026-02855-0","url":null,"abstract":"<p><strong>Background: </strong>Mavacamten is the first approved myosin inhibitor for symptomatic obstructive hypertrophic cardiomyopathy (oHCM), addressing hypercontractility and left ventricular outflow tract (LVOT) obstruction.</p><p><strong>Objectives: </strong>This study evaluates left ventricular performance by non-invasive measurements of pressure-strain loops in patients treated with Mavacamten.</p><p><strong>Methods: </strong>In 36 symptomatic oHCM patients, pressure-strain analysis was performed prior to 3 and 12 months after Mavacamten therapy. Echocardiographic measurements included LVOT gradient, left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), left atrial strain (LAS), peak strain time dispersion (PSD), and myocardial work parameters (global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE)). Clinical status was evaluated using the New York Heart Association (NYHA) class and stress biomarkers (NTproBNP and high-sensitivity troponin I).</p><p><strong>Results: </strong>Mavacamten therapy significantly reduced LVOT gradients at rest and under provocation. Gradients decreased from 69 ± 36 to 24 ± 27 mmHg (p < 0.001) at 3 months and further to 11 ± 6 mmHg (p = 0.003) at 12 months. Provoked gradients decreased from 113 ± 33 to 50 ± 31 mmHg (p < 0.001) at 3 months and to 31 ± 19 mmHg (p = 0.01) at 12 months. Clinical symptoms also improved. LVEF was 68 ± 6% at baseline and decreased mildly to 62 ± 5% (p = 0.003), while GLS and LAS remained unchanged. PSD decreased mildly from 116 ± 56 to 97 ± 36 ms and further to 93 ± 38 ms, but this was not statistically significant (p = 0.07). Under Mavacamten, GWE remained stable. In contrast, GWI, GCW, and GWW decreased significantly from baseline to 3 months (GWI, 2098 ± 700 to 1610 ± 440 mmHg%, p < 0.001; GCW, 2514 ± 776 to 1951 ± 466 mmHg%, p < 0.001; GWW, 312 ± 163 to 249 ± 177 mmHg%, p = 0.003), with only mild, non-significant further reductions at 12 months (1538 ± 402, 1901 ± 380, and 207 ± 124 mmHg%, respectively; p = 0.67, p = 0.74, p = 0.30).</p><p><strong>Conclusion: </strong>Myocardial work indices derived from non-invasive pressure-strain analysis were feasible to obtain in patients with oHCM in this study. Mavacamten therapy decreases workload index, constructive and wasted work, and synchronizes myocardial contractility, reflecting normalization of myocardial energetics. These findings reinforce the role of Mavacamten as a targeted therapy in oHCM.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"875-886"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13083487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225756","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":"Prevalence and prognostic relevance of abnormal liver function tests in critically ill patients with cardiac arrest.","authors":"Nam Gyu Im, Sarah K Stegmann, Julius Hollnberger, Gabriel Allo, Julia Lang-Meli, Sascha Macherey-Meyer, Sebastian Heyne, Christoph Adler, Guido Michels, Stephan Baldus, Christoph Neumann-Haefelin, Philipp Kasper","doi":"10.1007/s00392-026-02919-1","DOIUrl":"https://doi.org/10.1007/s00392-026-02919-1","url":null,"abstract":"<p><strong>Background: </strong>Patients with out-of-hospital cardiac arrest and in-hospital cardiac arrest have a poor prognosis. Laboratory biomarkers that are frequently altered in critically ill patients with cardiac arrest are liver function tests. However, the predictive value of abnormal liver function tests in the cardiac arrest setting remains unclear.</p><p><strong>Methods: </strong>Four hundred seven patients who were treated after cardiac arrest in an intensive care unit at a tertiary-care hospital were included in the analysis. To classify LFT abnormalities, we used established upper limit of normal values and multiples thereof according to the NIH Common Terminology Criteria for Adverse Events (CTCAE). Kaplan-Meier estimates and cox proportional hazard models combined with the CardShock risk score were performed to investigate the association between liver function abnormalities and patient outcomes.</p><p><strong>Results: </strong>Thirty-nine different combinations of elevated liver function tests have been observed in the study cohort. The most common abnormalities included an increase in aspartate aminotransferase (AST) levels, followed by an increase in alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) levels. Kaplan-Meier estimates showed significant differences in 90-day survival rates depending on severity of AST, ALT, bilirubin, and INR elevations. A cox proportional hazard model analysis demonstrated that a combined increase in bilirubin and INR together with the CardShock risk score allowed the highest mortality prediction.</p><p><strong>Conclusions: </strong>Abnormal liver function tests can be frequently observed after cardiac arrest, with different patterns of damage having different prognostic relevance. The combination of elevated bilirubin and INR offers important prognostic information regarding 90-day mortality, particularly when added to validated risk tools, and can be used to identify patients at risk.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764699","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":"Perioperative atrial fibrillation after non-cardiac surgery - A narrative review.","authors":"Elisabeth Richter, Rolf Wachter, David Conen, Ulrich Laufs","doi":"10.1007/s00392-026-02903-9","DOIUrl":"https://doi.org/10.1007/s00392-026-02903-9","url":null,"abstract":"<p><p>Perioperative atrial fibrillation (POAF) in non-cardiac surgery (NCS) is a multifactorial condition with significant prognostic implications. This review summarizes current evidence on the incidence, risk factors, pathophysiology, complications, prevention, and management of POAF in NCS. POAF affects around 3% of all patients undergoing NCS, with rates of 10-15% in thoracic procedures. Key risk factors include advanced age, male sex, pre-existing cardiopulmonary diseases, type, duration, and urgency of surgery as well as perioperative inflammation. Pathophysiological mechanisms are not fully understood but may include gap junction uncoupling triggered by inflammation, ischemia, and autonomic imbalance. POAF in NCS is associated with increased risks of stroke, heart failure, progression to chronic atrial fibrillation and mortality. Available data on patient-reported symptoms, functional status and quality of life are sparse. Preventive strategies and treatment options for POAF after NCS are limited and not standardized. Large trials are needed to define the efficacy and safety of anticoagulation, rhythm control and other treatments.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764725","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":"Long-term prognosis of coexistent metabolic dysfunction-associated steatotic liver disease and chronic kidney disease following acute myocardial infarction.","authors":"Audrey Zhang, Gwyneth Kong, Grace Cao, Yiming Chen, Vickram Vijay Anand, Jaycie Koh, Yip Han Chin, Bryan Chong, Andie H Djohan, Horng-Ruey Chua, Siew Pang Chan, Anurag Mehta, Mark Muthiah, Mark Yan-Yee Chan, Poay-Huan Loh, Nicholas W S Chew","doi":"10.1007/s00392-026-02925-3","DOIUrl":"https://doi.org/10.1007/s00392-026-02925-3","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) and metabolic dysfunction-associated steatotic liver disease (MASLD) have been associated with an increased risk of cardiovascular disease.</p><p><strong>Objective: </strong>This study seeks to examine the prognostic value of the coexistence of CKD and MASLD in patients presenting with acute myocardial infarction (AMI).</p><p><strong>Methods: </strong>This cohort study describes the clinical characteristics and long-term outcomes of patients following AMI, stratified by the presence of CKD and MASLD. A Kaplan-Meier curve was constructed for 30-day mortality. Cox regression analysis was used to investigate independent predictors of long-term all-cause mortality, adjusted for age, sex, ethnicity, previous AMI, AMI type, and left ventricular ejection fraction (LVEF).</p><p><strong>Results: </strong>A total of 6757 patients with AMI were examined. Those with coexisting CKD and MASLD (CKD(+)/MASLD(+)) had the highest rates of obesity (97.7%, p < 0.001), type 2 diabetes mellitus (85.7%, p < 0.001), hypertension (92.7%, p < 0.001), dyslipidemia (84.1%, p < 0.001), and previous stroke (17.8%, p < 0.001). On discharge, this group was least likely to be prescribed angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) (p < 0.001) and statins (p < 0.001). Additionally, this group had the highest rates of cardiac arrest (5.9%, p = 0.014), cardiogenic shock (15.5%, p < 0.001), and 30-day all-cause mortality (17.8%, p < 0.001). Cox regression demonstrated that the CKD(+)/MASLD(+) (HR 2.412, 95% CI 1.946-2.990, p < 0.001) and CKD(+)/MASLD(-) (HR 2.108, 95% CI 1.789-2.482, p < 0.001) phenotypes were independent predictors of mortality.</p><p><strong>Conclusions: </strong>CKD (+)/MASLD(+) embodied a higher metabolic burden and was the strongest independent predictor of mortality in AMI, with higher rates of cardiac arrest and cardiogenic shock. Further studies of early intervention in this group could help to improve outcomes.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764746","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":"Duration of dual antiplatelet therapy and risk of stent thrombosis in patients undergoing complex PCI: a meta-analysis.","authors":"Fiorenzo Simonetti, Claudia Carassia, Hector Alfonso Alvarez Covarrubias, Michael Joner, Thorsten Kessler, Tobias Rheude, Hendrik Sager, Felix Voll, Moritz von Scheidt, Erion Xhepa, Adnan Kastrati, Salvatore Cassese","doi":"10.1007/s00392-026-02928-0","DOIUrl":"https://doi.org/10.1007/s00392-026-02928-0","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing complex percutaneous coronary intervention (PCI) have a higher risk of ischemic events and often receive extended dual antiplatelet therapy (DAPT), particularly to protect against stent thrombosis (ST). The selection of an optimal DAPT strategy in this setting remains challenging given the intrinsic ischemic and bleeding risk. Previous observations have not clearly established the impact of non-standard DAPT duration regimens on ischemic events in complex PCI patients. This study aims to assess the effect of non-standard DAPT duration on ischemic events in this setting.</p><p><strong>Methods and results: </strong>We searched for randomized trials comparing DAPT duration regimens in patients undergoing complex PCI. The primary outcome was definite/probable ST. Other outcomes were myocardial infarction (MI), all-cause death, and major bleeding. Seven trials with a total of 46,696 patients undergoing either complex (n = 13,469) or non-complex (n = 33,227) PCI were included in the analysis. In complex PCI patients, the risk of definite/probable ST was not significantly different between the non-standard DAPT and standard DAPT groups (incidence rate ratio (IRR) 1.08; 95% confidence intervals (CI) 0.63-1.82). Consistently, the risk of MI (IRR 0.87; 95% CI 0.70-1.09), all-cause death (IRR 0.85; 95% CI 0.51-1.39), and major bleeding (IRR 0.63; 95% CI 0.33-1.19) did not differ significantly between DAPT strategies. Treatment effect for definite/probable ST by DAPT duration strategy was independent of PCI complexity.</p><p><strong>Conclusions: </strong>In patients undergoing complex PCI, we found no significant differences in stent thrombosis, myocardial infarction, all-cause death, and major bleeding between DAPT duration strategies.</p><p><strong>Prospero registration number: </strong>CRD42024617534.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764735","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":"Catheter-directed thrombectomy in acute pulmonary embolism and angiographic signs of chronic thromboembolic pulmonary disease.","authors":"Parham Shahidi, Luise Mentzel, Lucas Lauder, Sandra Stojanovic, Maike Knorr, Karl Friedrich Drummer, Dmitry Sulimov, Holger Thiele, Felix Mahfoud, Sven Möbius-Winkler, Michael Piorkowski, Lukas Hobohm, Janine Pöss, Karl Fengler","doi":"10.1007/s00392-026-02893-8","DOIUrl":"https://doi.org/10.1007/s00392-026-02893-8","url":null,"abstract":"<p><strong>Background: </strong>Angiographic signs of chronic thromboembolic pulmonary hypertension or disease (CTEPH/D) are frequently found during large-bore thrombectomy (LBT) in acute pulmonary embolism (PE). Data on the incidence of CTEPH/D signs and outcome after LBT are lacking. These angiographic signs are not equivalent to a confirmed diagnosis of CTEPH/D.</p><p><strong>Aims: </strong>To investigate the efficacy and safety of LBT in patients with acute PE and angiographic signs of CTEPH/D compared to patients without (N-CTEPH/D).</p><p><strong>Methods: </strong>In total, 250 patients from five centers (CTEPH/D = 98, N-CTEPH/D = 152) were retrospectively analyzed. Efficacy of LBT was assessed by comparing clinical, echocardiographic, and invasive data between the groups. Safety endpoints included periprocedural death, procedural complications, or bleeding defined as the need for blood transfusion or hemoglobin drop of at least 5 g/dl.</p><p><strong>Results: </strong>At baseline, the CTEPH/D group had higher systolic pulmonary artery pressure (sPAP) (CTEPH/D: 54 ± 14 mmHg, N-CTEPH/D: 49 ± 13 mmHg, p = 0.006). After LBT, right ventricular/left ventricular-ratio (CTEPH/D: - 0.30 ± 0.26, N-CTEPH/D: - 0.27 ± 0.32, p < 0.001 for both), sPAP (CTEPH/D: - 13 ± 8, N-CTEPH/D: - 11 ± 8 mmHg, p < 0.001 for both), heart rate (CTEPH/D: - 19 ± 20 beats/min, N-CTEPH/D: - 21 ± 15 beats/min, p < 0.001 for both) and respiratory rate (CTEPH/D: - 6 ± 6 respirations/min, N-CTEPH/D: by - 8 ± 7 respirations /min, p < 0.001 for both) were significantly reduced in both groups without significant differences. Peri-interventional safety was comparable between groups.</p><p><strong>Conclusion: </strong>LBT appears to be safe and effective in patients with acute PE and angiographic signs of CTEPH/D. Long-term effects should be further investigated.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764718","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":"ADA-HF: acetazolamide as a chloride sparing diuretic in patients admitted to hospital with heart failure.","authors":"J J Cuthbert, E Luo, A S M Ahmed, M Ajith, H Butt, H Pinhol, F Baffour Korsah, J Bulemfu, S Ford, G Constable, L Cox, A S Rigby, A L Clark","doi":"10.1007/s00392-026-02915-5","DOIUrl":"https://doi.org/10.1007/s00392-026-02915-5","url":null,"abstract":"<p><strong>Background: </strong>We assessed whether oral acetazolamide (ACZ) increases diuresis and reduces chloride loss when given alongside high-dose intravenous (IV) furosemide in patients admitted to hospital with HF.</p><p><strong>Methods and results: </strong>ADA-HF was a single-centre, open-label, randomised controlled trial. Patients were randomised to ACZ 250 mg twice daily plus high-dose (240 mg per day) IV furosemide infusion (standard of care (SoC)) versus SoC alone for 4 days. The co-primary endpoints were (1) daily net fluid loss between baseline and day 4 and (2) change in serum chloride level from baseline to day 4. A total of 46 patients (median age, 76; 65% male; median N-terminal pro-B-type natriuretic peptide, 4097 ng/L) from a screened population of 207 were randomised (23 to ACZ, 23 to SoC). The median daily net fluid loss was 1073 mL (1st-3rd quartile range 682-1419 mL) in the ACZ arm vs. 1029 mL (201-1432 mL) in the SoC arm (P = 0.51). There was no change in serum chloride concentration in the ACZ arm, whereas chloride fell by 7 (2-10) mmol/L in the SoC arm (P < 0.001). The number of adverse and serious adverse events ((S)AE) was numerically greater in the ACZ arm (51 events in 16 patients vs. 29 events in 10 patients, P = 0.24). Overall, 8 patients (30%) experienced (S)AEs possibly related to ACZ, and two of whom withdrew from the trial.</p><p><strong>Conclusions: </strong>Acetazolamide has a significant \"chloride-sparing\" effect in patients given high-dose IV furosemide. However, ACZ did not significantly increase diuresis, and side effects from oral ACZ were frequent.</p><p><strong>Trial registration: </strong>ISRCTN13060336; 9/2/2023.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764694","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":"HI-PLUS: design of a cluster-randomized trial evaluating structured case management with telemonitoring to improve quality of life in heart failure.","authors":"Martha Schutzmeier, Viktoria Rücker, Jonas Widmann, Peer Papior, Lisa Kimmelmann, Fabian Kerwagen, Lorenz Heil, Helena Manger, Andrea Szczesny, Yannick Maaser, Bettina Zippel-Schultz, Thomas Helms, Peter U Heuschmann, Stefan Störk","doi":"10.1007/s00392-026-02904-8","DOIUrl":"https://doi.org/10.1007/s00392-026-02904-8","url":null,"abstract":"<p><strong>Introduction: </strong>Heart failure (HF) remains a leading cause of hospitalization and death in Germany, significantly impairing patients' quality of life (QoL) despite advances in therapy. Structured, multidisciplinary care programs may improve long-term outcomes. HI-PLUS is a pragmatic trial investigating whether a complex intervention can improve QoL in HF patients. We describe the trial design and pilot feasibility study findings.</p><p><strong>Methods and results: </strong>HI-PLUS is a cluster-randomized, parallel-arm controlled trial (DRKS00031997) targeting 56 clusters, each comprising a cardiology practice and up to five general practitioners (GPs), targeting 1350 patients. The control arm receives guideline-recommended care. The intervention adds five elements: (a) care supported by specially trained non-physician staff HF qualified (HF-MPA); (b) accredited HF-MPA training curriculum certified by the German Society of Cardiology; (c) eHealth platform for telemonitoring and symptom reporting; (d) portable telemedical devices, if needed; and (e) enhanced communication between cardiologists and GPs facilitated by HF-MPAs and the eHealth platform. The primary endpoint is change in HF-specific QoL after 12 months, measured by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS). A pilot feasibility study that was conducted prior to commencement of patient recruitment confirmed the feasibility and acceptability of the proposed trial procedures.</p><p><strong>Conclusion: </strong>The HI-PLUS trial addresses recognized gaps in HF care. If effective, it could serve as a scalable model for integrated HF care throughout Germany.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764716","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}