Clinical Research in Cardiology最新文献

{"title":"Response to 'Prospective comparison of temporal changes in myocardial function in women with Takotsubo versus anterior STEMI'.","authors":"Anna James, Mahmood Ahmad","doi":"10.1007/s00392-025-02657-w","DOIUrl":"https://doi.org/10.1007/s00392-025-02657-w","url":null,"abstract":"","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977291","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":"Observer variabilities for the diagnosis of coronary artery disease using anatomical and functional testing: the impact of certification.","authors":"Grigorios Korosoglou, Nadine Abanador-Kamper, Christian Tesche, Matthias Renker, Florian André, Loris Weichsel, Michaela Hell, Florian Bönner, Mareike Cramer, Sebastian Kelle, Jeanette Schulz-Menger, Wolfgang Fehske, Andreas Rolf, Norbert Frey, Holger Thiele, Stephan Baldus","doi":"10.1007/s00392-025-02661-0","DOIUrl":"https://doi.org/10.1007/s00392-025-02661-0","url":null,"abstract":"<p><strong>Aim: </strong>To compare the reproducibility in reporting of coronary computed tomography angiography (CCTA) or cardiovascular magnetic resonance imaging (CMR) by certified readers for CCTA and CMR by the German Society of Cardiology (DGK) versus that by non-certified readers.</p><p><strong>Methods: </strong>The study included 40 randomly selected CCTA and vasodilator stress CMR patient datasets. For CCTA, the degree of lumen narrowing, plaque composition, and high-risk plaque features were assessed. For CMR, wall motion and perfusion abnormalities and late gadolinium enhancement (LGE) were rated. All measures were conducted by segments and for individual patients. Intraclass correlation coefficients (ICC) were calculated to assess agreement between non-certified (n = 4) vs. DGK-certified readers (n = 4).</p><p><strong>Results: </strong>ICC for assessment of luminal narrowing, plaque composition, and high-risk features were, respectively, 0.65 (95% confidence intervals [CI] 0.59-0.69), 0.64 (95%CI 0.45-0.80), and 0.45 (95%CI 0.22-0.66) for non-certified versus 0.78 (95%CI 0.74-0.81), 0.88 (95%CI 0.79-0.93), and 0.89 (95%CI 0.81-0.95) for DGK-certified readers (p < 0.001 for all). ICC for the assessment of wall motion, perfusion, and LGE were, respectively, 0.41 (95%CI 0.35-0.48), 0.27 (95%CI 0.18-0.38), and 0.48 (95%CI 0.41-0.54) for non-certified versus 0.71 (95%CI 0.67-0.75), 0.71 (95%CI 0.67-0.75) and 0.67 (95%CI 0.62-0.71) for DGK-certified readers (p < 0.001 for all). The agreement was excellent among DGK-certified readers for obstructive CAD (≥ 70% lumen narrowing) assessed by CCTA and high for abnormal perfusion and for LGE by CMR in a per-patient analysis (0.88; 95%CI 0.79-0.94 and 0.84; 95%CI 0.71-0.92), respectively.</p><p><strong>Conclusion: </strong>Substantially better CCTA and CMR reporting was observed for DGK-certified cardiologists, who achieved high agreement for diagnosing the presence or absence of obstructive CAD by CCTA and abnormal perfusion by CMR. Since important clinical decisions may be based on these readings, our data support quality-controlled education programs for advanced cardiac imaging.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985856","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":"A missed diagnosis: a case of partial pericardial defect.","authors":"Rahul Sharma, Jacopo Bertacchi, Nadim Jaafar, James Porterfield","doi":"10.1007/s00392-025-02659-8","DOIUrl":"https://doi.org/10.1007/s00392-025-02659-8","url":null,"abstract":"<p><p>Congenital pericardial defects (CPDs) are rare congenital abnormalities characterized by the complete or partial absence of the pericardium. They are often asymptomatic and discovered incidentally through imaging. Some individuals can experience non-specific symptoms, whilst others can have serious complications. The gold standard for diagnosing pericardial defects is cardiac MRI. Management is case-dependent and usually reserved for partial defects. Here, we present a case of a 57-year-old male who presented with recurrent chest pain and was found to have partial pericardial defect, a diagnosis missed on prior imaging, and discuss the diagnosis and management.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982075","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":"Etiology of tricuspid regurgitation and mortality: a multicenter cohort study.","authors":"Jorge Rodríguez-Capitán, Paloma Márquez-Camas, Jesús Carmona-Carmona, Diego Félix Arroyo Moñino, Marinela Chaparro-Muñoz, Matías Soler-González, Manuel García Del Río, Teodora Egido de la Iglesia, Jorge Segovia-Reyes, Mora Murri, José Raúl López Salguero, David Couto-Mallón, Miguel Romero-Cuevas, Francisco Javier Pavón-Morón, Mario Gutiérrez-Bedmar, Manuel Jiménez-Navarro","doi":"10.1007/s00392-025-02662-z","DOIUrl":"https://doi.org/10.1007/s00392-025-02662-z","url":null,"abstract":"<p><strong>Background: </strong>Significant tricuspid regurgitation (TR) encompasses a wide range of etiologies, complicating a comprehensive understanding of disease progression and prognostic factors. This study aimed to assess mortality associated with significant TR, focusing on the role of valvular disease etiology and other predictive factors.</p><p><strong>Methods: </strong>This is a retrospective, multicenter, cohort observational study, including all consecutive patients with moderate-to-severe or greater TR. The patients were classified into five etiological groups: organic TR, TR secondary to left valvulopathy, TR secondary to left or right ventricular dysfunction, TR secondary to pulmonary hypertension, and atrial TR. The long-term mortality was assessed (median follow-up: 39.8 months).</p><p><strong>Results: </strong>757 patients were included. The overall mortality incidence rate was 162.5 deaths per 1000 patient-years. Compared to atrial TR, all other etiologies presented a higher mortality risk: organic TR adjusted hazard ratio (aHR) = 2.344 (95% confidence interval [CI]: 1.138-4.829), left valvulopathy-related TR aHR = 1.901 (95% CI: 1.011-3.574), ventricular dysfunction-related TR aHR = 3.683 (95% CI: 1.627-8.338), and pulmonary hypertension-related TR aHR = 2.446 (95% CI: 1.215-4.927). In addition to known factors, male sex was associated with a higher mortality risk (aHR = 1.608, 1.175-2.201), while beta-blocker use was linked to a lower risk (aHR = 0.674, 0.502-0.904).</p><p><strong>Conclusions: </strong>In a large cohort of patients with significant TR, and after adjusting for clinical and echocardiographic variables, all etiological groups exhibited a higher mortality risk compared to atrial TR. Additionally, male patients with TR had a higher mortality risk, while beta-blocker therapy emerged as a protective factor.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977346","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":"Tachycardia-induced cardiomyopathy in de novo heart failure: prevalence, short-term outcomes, and the role of guideline-directed therapy in ejection fraction improvement.","authors":"Alberto Esteban-Fernández, Inés Gómez-Otero, Silvia López-Fernández, Raquel López-Vilella, Francisco Pastor-Pérez, Óscar Otero-García, Miguel Rodríguez-Santamarta, David García-Vega, Paula Fluvià, Víctor Donoso-Trenado, Ester Sánchez-Corral, José Manuel García-Pinilla, Juan Luis Bonilla-Palomas, Andrea López López, José Ramón González-Juanatey, Luis Almenar Bonet","doi":"10.1007/s00392-025-02663-y","DOIUrl":"https://doi.org/10.1007/s00392-025-02663-y","url":null,"abstract":"<p><strong>Introduction: </strong>Heart failure (HF) secondary to tachycardia-induced cardiomyopathy (TIC) is often underdiagnosed due to inconsistent definitions and perceived reversibility. The treatment focuses on early arrhythmia control, but the impact of guideline-directed medical therapy (GDMT) on left ventricular ejection fraction (LVEF) improvement has not been fully explored.</p><p><strong>Materials and methods: </strong>This multicentric prospective registry study included patients with newly onset HF and reduced ejection fraction (HFrEF). Data were collected on clinical characteristics, echocardiographic and laboratory parameters, pharmacological treatment, and follow-up events. The statistical analyses focused on TIC patients, analyzing the event rates and the influence of GDMT on LVEF improvement according to sinus rhythm (SR) restoration.</p><p><strong>Results: </strong>Among 808 patients, 174 (21.5%) were diagnosed with TIC, with an age of 67.2 (SD: 9.4) years. After a median follow-up of 3.5 months [IQR: 2.6-4.3], SR was restored in 56.8% of patients, and LVEF improved from 29.6 to 49%. The increase was more pronounced in patients who restored SR compared to those remaining in atrial fibrillation (AF) (22.4% vs. 15.1%; p < 0.05). The natriuretic peptides significantly decreased in the SR group (- 1883.7 pg/mL) but did not in the AF group. The overall readmission rate was 25.1% and the overall mortality rate was 3.6%, with no significant differences between patients who achieved SR and those with persistent AF at the end of up-titration. HF readmission was infrequent (4%) despite AF persistence. Early GDMT was initiated in TIC patients, regardless of SR recovery and significantly improved LVEF, especially in AF patients [RR = 4.24 (95% CI: 1.44-12.45)] compared to SR patients [(RR = 1.41 95% CI: 1.02-1.92)].</p><p><strong>Conclusions: </strong>TIC represents a significant proportion of HFrEF patients, with early restoration of SR leading to greater LVEF improvement. Despite AF persistence, HF readmissions were rare, highlighting the efficacy of early quadruple therapy. Enhanced adherence to GDMT should be prioritized, particularly in patients with persistent AF.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970547","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":"Comparative analysis of therapeutic strategies in atrial fibrillation patients with left atrial appendage thrombus despite optimal NOAC therapy.","authors":"Ferenc Komlósi, Bence Arnóth, Imre Szakál, Patrik Tóth, Henriette Mészáros, Helga Sánta, Gyula Bohus, Péter Vámosi, Elektra Bartha, Márton Horváth, Melinda Boussoussou, Nándor Szegedi, Zoltán Salló, István Osztheimer, Péter Perge, Gábor Széplaki, László Gellér, Béla Merkely, Klaudia Vivien Nagy","doi":"10.1007/s00392-025-02665-w","DOIUrl":"https://doi.org/10.1007/s00392-025-02665-w","url":null,"abstract":"<p><strong>Background and aims: </strong>Left atrial appendage (LAA) thrombus is the primary cause of stroke and systemic embolism in atrial fibrillation (AF). Non-vitamin-K oral anticoagulants (NOACs) effectively reduce LAA thrombus prevalence and stroke risk. However, the optimal treatment of a NOAC-resistant thrombus remains unclear. We aimed to evaluate therapeutic strategies for resolving LAA thrombus in patients on optimal NOAC therapy.</p><p><strong>Methods: </strong>We retrospectively analyzed patients scheduled for cardioversion or catheter ablation of AF between 2014 and 2023 with LAA thrombus on transesophageal echocardiography (TEE) despite being on optimal NOAC therapy. We assessed how the applied management strategy affected thrombus resolution.</p><p><strong>Results: </strong>Among the analyzed 120 patients, a change to a different NOAC occurred in 41% of cases, a transition to a VKA in 30%, and the supplementation with antiplatelet therapy in 11%. In contrast, 18% of the patients received unchanged therapy. Follow-up imaging at 65 [44 - 95] days showed successful thrombus resolution in 92 (77%) of cases, predicted by a lower CHA2DS2-VASc score (p = 0.01). Any modification of antithrombotic therapy was an independent predictor of thrombus resolution (OR 5.28 [1.55-18], p = 0.01). Of the four strategies, there was a trend toward better thrombus resolution with switching to a VKA (OR 3.23 [1.03-10.1], p = 0.04).</p><p><strong>Conclusion: </strong>Resolution of LAA thrombus in patients already on adequate NOAC treatment may require a revision of the anticoagulation strategy. In addition, transitioning from NOAC to VKA might be considered.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986159","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":"Sex differences in guideline adherence for coronary angiography in patients with suspected chronic coronary syndrome in Germany: insights from the ENLIGHT-KHK trial.","authors":"Hannah Kentenich, Arim Shukri, Dirk Müller, Bastian Wein, Oliver Bruder, Stephanie Stock, Yana Kampfer","doi":"10.1007/s00392-025-02655-y","DOIUrl":"https://doi.org/10.1007/s00392-025-02655-y","url":null,"abstract":"<p><strong>Background: </strong>For the management of acute coronary syndrome, literature shows lower healthcare providers' guideline adherence for women than for men. Since less is known about the management of chronic coronary syndrome (CCS), this study investigated patient-related sex differences in providers' guideline adherence for invasive coronary angiography (CA) performed in patients with suspected CCS.</p><p><strong>Methods: </strong>Using data from the German ENLIGHT-KHK trial, patients with suspected CCS who underwent a CA were analysed. To assess the association between patient sex and physicians' adherence to the German National Disease Management Guideline \"Chronic coronary artery disease\" of 2019, binary logistic regression models were developed. Covariates included age, symptoms, risk factors, comorbidities, and non-invasive testing and its results. To examine sex differences in predictors of guideline adherence, models were run separately for women and men.</p><p><strong>Results: </strong>Two hundred seventy-three women and three hundred eighty-six men were included (aged 67 ± 10 years). Physicians' guideline adherence for CA was lower for women than for men (19.4% vs. 30.1%, p = 0.002). CAs were less likely to be guideline-adherent for women with suspected CCS than men (OR 0.4, p < 0.05). Guideline adherence predictors differed between women and men. For example, men's predictors included non-invasive testing and its results, age, typical angina and smoking; of these, only a positive non-invasive test result had an impact for women.</p><p><strong>Conclusion: </strong>Our results indicate a less guideline-adherent diagnostic workup of CA for women with suspected CCS than men. This might reflect a limited awareness of CCS in women and insufficiently sex-specific guideline recommendations.</p><p><strong>Trial registration: </strong>German Clinical Trials Register DRKS00015638, Registered February 19, 2019; Universal Trial Number (UTN): U1111-1227-8055.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957422","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":"Mutational landscape and impact of clonal hematopoiesis of indeterminate potential in severe aortic valve stenosis.","authors":"Raúl Nicolas Jamin, Baravan Al-Kassou, Theresa Kleuker, Jasmin Shamekhi, Benedikt Bartsch, Ansgar Ackerschott, Muntadher Al Zaidi, Hannah Billig, Claus Moritz Graef, Malte Kelm, Stephan Baldus, Georg Nickenig, Eicke Latz, Sebastian Zimmer","doi":"10.1007/s00392-025-02658-9","DOIUrl":"https://doi.org/10.1007/s00392-025-02658-9","url":null,"abstract":"<p><strong>Background: </strong>Clonal hematopoiesis of indeterminate potential (CHIP) has been progressively established as a risk factor for cardiovascular disease and associated with worsened outcomes in patients with aortic valve stenosis (AVS). This cohort study aimed to evaluate the mutational landscape of CHIP and its' influence on clinical outcomes.</p><p><strong>Methods: </strong>194 patients with AVS undergoing transcatheter aortic valve replacement (TAVR) were sequenced using a capture panel for multiple CH driver mutations and follow up conducted for three years.</p><p><strong>Results: </strong>We found high prevalences (77.8%) of a broad spectrum of CH-driver mutations across 38 genes, with 34% of patients fulfilling the diagnostic criteria for CHIP. Evaluating the impact of CHIP driver mutations on outcomes, the presence of CHIP was associated with mortality only when adjusting for confounding factors (HR: 2.143, 95% CI: 1.029-4.461, p = 0.042), while the presence of CH driver mutations at low VAF showed no association with mortality (p = 0.377). However, when excluding DNMT3A-CHIP, we found a significant association of CHIP with mortality in univariate (p = 0.022) and multivariable (HR: 2.976, 95% CI: 1.381-6.411, p = 0.005) analyses.</p><p><strong>Conclusions: </strong>As the first study to evaluate a broad spectrum of CH driver mutations at all variant allele frequencies in the context of aortic valve stenosis, we found CHIP to be a frequent phenomenon and CH-driver mutations to be highly prevalent in patients with severe AVS. CHIP, other than DNMT3A-CHIP, was associated with increased mortality even after successful TAVR. The presence of CH driver mutations at low allele frequencies was not associated with mortality.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964843","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":"Atrial fibrillation first? Investigating rhythm control in de novo high-grade functional mitral regurgitation and atrial fibrillation.","authors":"Felix Ausbuettel, Harald Schuett, Hans-Helge Mueller, Georgios Chatzis, Sebastian Weyand, Julian Mueller, Carlo-Federico Fichera, Bernhard Schieffer, Ulrich Luesebrink, Christian Waechter","doi":"10.1007/s00392-025-02656-x","DOIUrl":"https://doi.org/10.1007/s00392-025-02656-x","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) and functional mitral regurgitation (FMR) frequently coexist, presenting significant challenges for therapeutic management. Current evidence offers limited direction on the prioritization of treatment for these conditions. This study aims to evaluate the impact of rhythm control on high-grade FMR and identify predictors of persistent high-grade FMR after AF treatment.</p><p><strong>Methods: </strong>This single-center study analyzed patients with newly diagnosed AF and concomitant high-grade FMR. Predictors of persistent high-grade FMR after rhythm control of AF were assessed by logistic regression.</p><p><strong>Results: </strong>Among 795 patients hospitalized with new-onset AF, 14% (111/795) were diagnosed with high-grade FMR. Rhythm control successfully restored sinus rhythm in 86.3% of cases. FMR severity improved in 58.8% of patients, effectively eliminating the need for further interventions in these cases. Independent baseline predictors of persistent high-grade FMR at follow-up included New York Heart Association (NYHA) class IV heart failure symptoms, mean pulmonary artery pressure (mPAP) > 20 mmHg, effective regurgitant orifice area (EROA) > 0.4 cm², vena contracta > 8 mm, and left atrial volume index (LAVI) > 48 mL/m².</p><p><strong>Conclusions: </strong>Rhythm control of AF significantly reduced the severity of FMR in most patients, eliminating the need for mitral valve (MV) intervention in these cases. The identified predictors of persistent high-grade FMR could contribute to refined risk assessment and assist in treatment decision-making, potentially supporting early referral for MV intervention in appropriate patients.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981939","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":"Heart failure with supranormal ejection fraction: clinical characteristics and outcomes compared to mildly reduced and preserved ejection fraction.","authors":"Amitai Segev, Rotem Tal-Ben Ishay, Marco Metra, Elad Maor, Dov Freimark, Anan Younis, Roy Beigel, Shlomi Matetzky, Avishay Grupper","doi":"10.1007/s00392-025-02620-9","DOIUrl":"10.1007/s00392-025-02620-9","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the recently emerging entity, heart failure with supranormal ejection fraction (HFsnEF).</p><p><strong>Objective: </strong>To describe the clinical characteristics and outcome of HFsnEF, compared to HF with mildly reduced EF (HFmrEF) and HF with preserved EF (HFpEF) patients.</p><p><strong>Design: </strong>A single center retrospective analysis.</p><p><strong>Patients: </strong>Hospitalized and ambulatory heart failure (HF) patients who underwent echocardiography with left ventricular ejection fraction (LVEF) > 40%.</p><p><strong>Main measures: </strong>Clinical and echocardiographic parameters, hospitalization rates and mortality.</p><p><strong>Key results: </strong>A total of 6,202 patients (mean age 81.4 ± 14.1 years, 52% females) were analyzed: 750 in the HFmrEF group (LVEF 41-49%), 4360 in the HFpEF group (LVEF 50-64%), and 1092 in the HFsnEF group (LVEF ≥ 65%). Patients were followed for a median of 32 (11-65) months. HFsnEF patients were older, predominantly female, exhibited higher hypertension prevalence, more severe LV hypertrophy, smaller LV dimensions, and higher filling pressures compared to the other groups (p < 0.001 for all). These features were consistent in both hospitalized and ambulatory patients. In a univariable model, HFsnEF patients had higher mortality rates compared to HFmrEF and HFpEF patients (HR 1.258, 95% CI 1.117-1.418; p < 0.001 and HR 1.112, 95% CI 1.023-1.208; p = 0.012, respectively). However, in a multivariable model, adjusted for age, sex, comorbidities, and echocardiographic parameters, there was no significant difference in the mortality rates between all groups. The total hospitalization rate was similar between the HFpEF and HFsnEF groups, and lower in the HFmrEF group (p = 0.022). However, the HFsnEF group had the lowest rate of HF-related hospitalizations (p = 0.002).</p><p><strong>Conclusion: </strong>HFsnEF represents a group of patients with a distinct clinical and echocardiographic profile accompanied by worse outcomes, likely mediated by older age and a higher comorbidity burden, compared to HFmrEF and HFpEF. Therefore, the supranormal EF may serve as a marker rather than an independent prognostic factor.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"665-675"},"PeriodicalIF":3.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482393","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}