Clinical Research in Cardiology最新文献

{"title":"Early discharge after clinical stabilization in acute decompensated heart failure: associations with short-term outcomes.","authors":"Gil Marcus, Shiri L Maymon, Eran Kalmanovich, Gil Moravsky, Ido Minha, Avishay Grupper, Shmuel Fuchs, Sa'ar Minha","doi":"10.1007/s00392-026-02858-x","DOIUrl":"10.1007/s00392-026-02858-x","url":null,"abstract":"<p><strong>Background: </strong>Hospital length of stay (LOS) in acute decompensated heart failure (ADHF) lacks standardized thresholds. Prior studies using administrative data have reported neutral all-cause outcomes with very short hospital stays (1-2 days) despite higher cardiovascular readmissions, raising concerns about residual confounding from unmeasured clinical severity.</p><p><strong>Methods: </strong>This is a retrospective cohort study of adults (≥ 18 years) hospitalized with ADHF at a single center in Israel between 2007 and 2017. We excluded in-hospital deaths and coronary artery bypass grafting (CABG) surgery cases. LOS was categorized as short (1-2 days), standard (3-6 days, reference), or prolonged (≥ 7 days).</p><p><strong>Primary outcome: </strong>30-day all-cause readmission or mortality. Cox models adjusted for age, sex, ischemic heart disease, atrial fibrillation, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, peripheral vascular disease, and anemia. Restricted cubic splines with three knots at approximately the 10th, 50th, and 90th percentiles modeled continuous LOS, using 5 days as reference.</p><p><strong>Results: </strong>Among 8332 patients with first ADHF hospitalization, 7455 were analyzed after excluding 707 in-hospital deaths and 170 CABG cases. Distribution by LOS: 1072 short (14.4%), 3457 standard (46.4%), 2926 prolonged (39.2%). Patients with a short LOS were younger (median 75 vs. 78 and 79 years), less often female, and had lower CKD (29.9% vs. 33.5% and 35.2%) and anemia (61.9% vs. 65.0% and 70.2%; all p ≤ 0.006), with favorable discharge labs. Unadjusted 30-day composite rates were 19.9% (short), 21.6% (standard), and 28.6% (prolonged; p < 0.001). Adjusted HR for short vs. standard: 0.86 (95% CI 0.73-1.02, p = 0.081); prolonged vs. standard: 1.37 (95% CI 1.23-1.52, p < 0.001). Spline analysis showed a J-shaped curve: protective effect (HR < 1.0) for LOS 2-5 days, risk rising significantly beyond 6 days.</p><p><strong>Conclusion: </strong>In a clinically detailed ADHF cohort, discharge after 1-2 days was not associated with higher 30-day readmission or mortality among patients selected for early discharge. In contrast, prolonged hospitalization identified a subgroup at substantially higher short-term risk, underscoring hospital length of stay as a marker of clinical complexity rather than a determinant of outcomes.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1629-1639"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164528","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 heart failure as a determinant of outcomes after left ventricular assist device implantation: an international multicenter study.","authors":"Miloud Cherbi, Raphael Martins, Paul Gautier, Karim Benali, Kerstin Bode, Elena Efimova, Alexey Dashkevich, Jackson Liang, John Larson, Blandine Mondesert, Jacinthe Boulet, Pierre-Emmanuel Noly, François Picard, Jean Luc Pasquié, Jean-Baptiste Gourraud, Sandro Ninni, Laurence Jesel, Alexandre Sebestyen, Marylou Para, Jean-Claude Deharo, Frederic Anselme, Laure Champ-Rigot, Katrien Blanchart, Soundous M'Rabet, Bertrand Pierre, Romain Eschalier, Mathieu Echivard, Anne-Céline Martin, Nicolas Lellouche, Matteo Pozzi, Pierre Groussin, Erwan Flecher, Vincent Galand, Clément Delmas","doi":"10.1007/s00392-026-02938-y","DOIUrl":"10.1007/s00392-026-02938-y","url":null,"abstract":"<p><strong>Background: </strong>While heart failure (HF) duration before left ventricular assist device (LVAD) implantation may influence postoperative outcomes, data evaluating this relationship remains limited. This study investigated the association between HF duration and outcomes following LVAD implantation.</p><p><strong>Methods: </strong>This international retrospective multicenter study included 1,071 patients who underwent LVAD implantation between 2006-2019. Patients were stratified into quartiles by HF duration before implantation: Q1 ≤ 3.9 months, Q2 > 3.9 months-4 years, Q3 > 4-10.7 years, and Q4 ≥ 10.7 years. Primary outcome was 3-year all-cause mortality. Secondary outcomes included cardiac death, early (≤ 30 days) and late ventricular arrhythmias (VAs), and left ventricular ejection fraction (LVEF) recovery. Multivariable Cox regression and restricted cubic spline analyses were performed.</p><p><strong>Results: </strong>After 3-year follow-up, 426 patients died (31.1% in Q1 vs 48.5% in Q4). Patients with longest HF duration (Q4) had higher mortality risk compared to Q1 (aHR 1.57 [1.18-2.09]) and cardiac death risk (aHR 1.69 [1.13-2.55]). Early VAs increased progressively with HF duration, with Q3 (aHR 1.74 [1.19-2.53]) and Q4 (aHR 1.79 [1.23-2.60]) showing significantly elevated risks. Late VAs demonstrated the most pronounced association (Q4 vs Q1: aHR 5.75 [3.46-9.26]). LVEF recovery decreased progressively, with major LVEF improvement (≥ 10%) occurring in 37% of Q1 versus 19.4% of Q4 patients.</p><p><strong>Conclusion: </strong>Prolonged HF duration before LVAD implantation was associated with worse outcomes, emphasizing the importance of timely referral to specialized centers and optimized care pathways for advanced HF management.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1686-1697"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962539","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":"Native QRS duration and outcomes in heart failure with mildly reduced ejection fraction: results from a large-scaled registry.","authors":"Finn Ole Kronberg, Michael Behnes, Marielen Reinhardt, Noah Abel, Alexander Schmitt, Felix Lau, Thomas Bertsch, Henning Johann Steffen, Kathrin Weidner, Mohammad Abumayyaleh, Jürgen Kuschyk, Ibrahim Akin, Tobias Schupp","doi":"10.1007/s00392-025-02667-8","DOIUrl":"10.1007/s00392-025-02667-8","url":null,"abstract":"<p><strong>Objective: </strong>The study investigates the prognostic impact of the native QRS duration in patients with heart failure and mildly reduced ejection fraction (HFmrEF).</p><p><strong>Background: </strong>The prognostic impact of QRS duration in HFmrEF has rarely been investigated.</p><p><strong>Methods: </strong>Consecutive patients with HFmrEF and available 12-lead electrocardiogram were retrospectively included at one institution from 2016 to 2022. Patients with QRS duration ≥ 120 ms were compared to patients with QRS duration < 120 ms, further risk stratification was performed comparing patients with left and right bundle branch block (LBBB vs. RBBB). The primary endpoint was all-cause mortality at 30 months, secondary endpoints comprised the risk of HF-related rehospitalization.</p><p><strong>Results: </strong>In total, 1627 patients with HFmrEF were included with a median QRS duration of 90 ms (i.e., QRS duration ≥ 120 ms: 15%). Although the risk of long-term all-cause mortality was not affected by a prolonged QRS duration (35.1% vs. 28.7%; p = 0.057; HR = 1.254; 95% CI 0.993-1.583), patients with QRS duration ≥ 120 ms had a higher risk of HF-related rehospitalization (18.2% vs. 11.9%; p = 0.008; HR = 1.574; 95% CI 1.124-2.204). A QRS duration ≥ 120 ms was associated with long-term HF-related rehospitalization even after multivariable adjustment (HR 1.420, 95% CI 1.008-2.002, p = 0.045). Finally, the risks of long-term all-cause mortality and HF-related rehospitalization did not differ among patients with LBBB and RBBB.</p><p><strong>Conclusion: </strong>A prolonged native QRS duration is independently associated with a higher risk of HF-related rehospitalization in HFmrEF, but not long-term all-cause mortality.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1498-1511"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970250","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":"Impact of GLP-1 receptor agonists on cardiovascular outcomes in heart failure with preserved ejection fraction (HFpEF): systematic review and meta-analysis.","authors":"Antony Gonzales-Uribe, Renato Ruiz-Cortez, Nicole Collantes-Silva, Lorenzo Olivero, Raksheeth Agarwal, Sebastian Arambulo-Castillo, Alonso Garcia-Geng, Xiajie Lyu, Daniel Mendoza-Quispe, Victor Becerra-Gonzales, Hoda Butrous","doi":"10.1007/s00392-025-02710-8","DOIUrl":"10.1007/s00392-025-02710-8","url":null,"abstract":"<p><strong>Background: </strong>Pharmacologic therapies for heart failure with preserved ejection fraction (HFpEF) have shown limited efficacy, and the impact of GLP-1 receptor agonists (GLP-1 RAs) remains unclear. This meta-analysis evaluates their effects on mortality and hospitalization in HFpEF.</p><p><strong>Methods: </strong>We obtained the data from PubMed, Scopus, Embase, and Web of Science for all eligible studies, including clinical trials (RCT) and cohorts comparing GLP-1 RAs to placebo or other hypoglycemic agents in patients with HFpEF published until December 31st, 2024. The Grade and Risk of Bias (ROB) tool assessment was used to evaluate the quality of the evidence. Data on the primary outcome, the composite of all-cause mortality and HF-related hospitalization, was pooled using a random effect meta-analysis with additional subgroup analyses. Risk ratios (RR), hazard ratios (HR), or mean differences with 95% confidence intervals (CI) are presented accordingly.</p><p><strong>Results: </strong>Six studies (five RCTs, one cohort) including 4043 patients were analyzed. Five studies evaluated semaglutide and one tirzepatide. GLP-1 RAs reduced the composite outcome of all-cause mortality and HF hospitalization by 27% (HR 0.73; 95% CI: 0.60-0.90; I² = 0%). Subgroup analyses revealed greater benefits in patients with atrial fibrillation. GLP-1 RAs also reduced HF hospitalizations alone (HR 0.57; 95% CI: 0.32-1.00), though no significant effect was found on all-cause mortality (HR 0.81; 95% CI: 0.58-1.14). RCTs showed a low risk of bias.</p><p><strong>Conclusion: </strong>GLP-1 RAs may significantly lower the combined risk of mortality and hospitalization in patients with HFpEF.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1543-1558"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599650","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":"Revisiting the obesity paradox in patients with heart failure with reduced ejection fraction in the light of contemporary guideline-directed medical therapy.","authors":"Tamás G Gergely, Zsolt Forrai, Ádám Kazay, Pál Péter Schäffer, Máté Vámos, Dávid Pilecky, Tamás Péter Füzesi, Laura Fanni Hanuska, Noémi Nyolczas, Miklós Dékány, Péter Andréka, Zsolt Piróth, Fanni Bánfi-Bacsárdi, Balázs Muk","doi":"10.1007/s00392-026-02865-y","DOIUrl":"10.1007/s00392-026-02865-y","url":null,"abstract":"<p><strong>Background: </strong>The presence of higher body mass index (BMI) accompanied by better outcomes in patients with heart failure with reduced ejection fraction (HFrEF) is described as the obesity paradox. However, recent evidence has questioned the existence of this phenomenon by adjusting for better prognostic factors and using superior anthropometric measures of obesity. Nevertheless, data regarding the association between BMI and mortality in HFrEF patients with the use of contemporary guideline-directed medical therapy (GDMT), including SGLT2is, is scarce.</p><p><strong>Aim: </strong>To assess the association between BMI and mortality in patients with HFrEF treated with modern GDMT across a wide BMI spectrum.</p><p><strong>Patients and methods: </strong>The data of 420 consecutive patients (male sex: 75%, age: 62 [51-71] years, NT-proBNP at admission: 5678 [2647-10501] pg/mL, LVEF: 24 [20-30] %, coronary artery disease: 44%, atrial fibrillation: 45%, normal weight: 33% [group 1: BMI < 25 kg/m²], overweight: 31% [group 2: BMI: 25-29.9 kg/m²], obese: 36% [group 3: BMI ≥ 30 kg/m²], type 2 diabetes [T2D]: 35%, eGFR < 60 mL/min/1.73m²: 55%) hospitalised for HFrEF in 2021-2024 with available BMI were analysed retrospectively. The application of GDMT at hospital discharge was compared between three groups of patients (group 1, 2, and 3). All-cause mortality (ACM) was assessed using Kaplan-Meier curves and the log-rank test. Predictors of ACM were estimated with uni- and multivariate Cox proportional hazards regression. In a sensitivity analysis, BMI groups were propensity score-matched (PSM) at a 1:1:1 ratio, adjusting for possible confounders.</p><p><strong>Results: </strong>At hospital discharge, triple therapy (TT: RASi + βB + MRA) was applied in 82% (RASi: 92%, βB: 85%, MRA: 95%), while quadruple therapy (QT: TT + SGLT2i) was implemented in 58% of the total cohort (SGLT2i use: 64%). At discharge, higher BMI category was significantly (p < 0.05) associated with increased use of MRA (group 1, 2, 3: 93%, 92%, and 100%), SGLT2i medications (group 1, 2, 3: 58%, 61%, and 71%), and QT (group 1, 2, 3: 51%, 56%, and 65%). During a median follow-up of 534 days, ACM was lower with increasing BMI subgroup category (p = 0.021). In the multivariate analysis, BMI subgroup category was not associated with ACM, whereas age, T2D, peripheral artery disease, NT-proBNP at discharge, and use of QT at discharge were independent predictors of ACM. In the sensitivity analysis, no significant differences were seen in the ACM of each BMI category after PSM.</p><p><strong>Conclusions: </strong>In a consecutive cohort of patients hospitalised due to HFrEF with high rates of modern GDMT use across a wide BMI spectrum, higher BMI subgroup category was not associated with better survival after adjustment for comorbidities and prognostic factors.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1640-1652"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510134","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":"Effects of sympathomodulation on pulse wave properties in heart failure with preserved ejection fraction.","authors":"Luisa Koehler, Karl-Philipp Rommel, Paula Sagmeister, Maximilian von Roeder, Luise Mentzel, Holger Thiele, Philipp Lurz, Karl Fengler","doi":"10.1007/s00392-025-02798-y","DOIUrl":"10.1007/s00392-025-02798-y","url":null,"abstract":"<p><strong>Aims: </strong>One important contributor to the pathogenesis and perpetuation of HFpEF is unfavorable pulse wave reflection, frequently caused by increased arterial stiffness, due to aging and longstanding hypertension. One possible path to address pathological wave reflections is reducing sympathetic overactivity via renal denervation (RDN) with the aim to enhance arterial compliance. We sought to non-invasively quantify pulse wave reflections changes in patients undergoing RDN.</p><p><strong>Methods: </strong>Patients who underwent RDN for resistant hypertension were classified as patients with HFpEF and patients without heart failure, the latter of which served as the control group. Pulse wave analysis (PWA) was assessed using a piezoelectric device, and reflection magnitude was quantified by the augmentation index (AIx), and timing by backward transit time (BTT) before and 3 months after RDN. Ambulatory blood pressure was assessed at baseline and after 3 months to adjust for blood pressure changes.</p><p><strong>Results: </strong>Of 51 patients, 22 had HFpEF, and 29 served as controls. While baseline values in AIx and BTT were not different between HFpEF and control patients, RDN was associated with a significant decrease in AIx by 5.6% (p = 0.04) and a significant prolongation of BTT by 17.8 ms (p = 0.007) in patients with HFpEF. Conversely, no significant changes were observed in control patients for AIx (p = 0.13) and BTT (p = 0.56).</p><p><strong>Conclusions: </strong>The study observed a beneficial change in the timing and magnitude of central wave reflections in HFpEF after RDN. This implies a dynamic component of arterial stiffness in HFpEF patients and renders large artery stiffness a potential therapeutic target.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1583-1591"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145494303","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":"Heart failure burden and care among cardiology inpatients: insights from the Hellenic Cardiorenal Morbidity Snapshot (HECMOS) study.","authors":"Ioannis Leontsinis, Sotiria Liori, Dimitrios Farmakis, Aggeliki Valatsou, Panagiotis Vlachakis, Christina Antonia Verikokou, Ioanna Delia Vlad, Vasileios Giannaris, Georgios Giannopoulos, Kyriakos Dimitriadis, Panagiotis Theofilis, Georgios Karakostas, Christoforos Komporozos, Georgios Konstantinides, Stylianos Lambropoulos, Aikaterini Lionti, Athanasios Makris, Panteleimon Makridis, Ioannis Mamarelis, Maria Marketou, Aikaterini Naka, Georgios Nikitas, Periklis Davlouros, Evaggelos Oikonomou, Nikolaos Papaioannou, Athanasios Pipilis, Assaf Sawafta, Pavlos Skantzikas, Michael Siarkos, Theodoros Sinanis, Konstantinos Skordis, Georgios Spiromitros, Ioannis Stamoulopoulos, Konstantinos Tsatiris, Dimitrios Tsiachris, Michael Fosteris, Emmanouel Foukarakis, Chistina Chrysochoou, Gerasimos Filippatos, Konstantinos Tsioufis","doi":"10.1007/s00392-025-02610-x","DOIUrl":"10.1007/s00392-025-02610-x","url":null,"abstract":"<p><strong>Purpose: </strong>Heart failure (HF) burden and care varies significantly across different countries. We aimed to illustrate the clinical characteristics and HF-related care among cardiology inpatients in Greece.</p><p><strong>Methods: </strong>We collected information about all cardiology inpatients on the 3rd of March 2022. The current analysis focuses on acute or chronic HF.</p><p><strong>Results: </strong>Among a total of 923 participants, 280 (30%) concerned cases of acute HF whereas 351 patients (38%), (median age 79 ± 12 years, male gender 63.8%) had a history of chronic HF, with their majority presenting with multiple comorbidities and previous HF hospitalizations. 173 (49%) of chronic HF participants had reduced LVEF. Ischemic heart disease was the predominant HF etiology (182, 51.9%). Prior to the index admission, chronic HF cases were receiving diuretics, beta blockers, ACEi/ARBs, ARNI, MRAs, and SGLT2i at 79.8%, 74.4%, 43.3%, 10.8%, 40.7%, and 14%, respectively. Independent predictors of lower prescription rates of Guideline Directed Medical Therapy (GDMT) included advanced age (p < 0.001), chronic kidney disease (RASi OR 0.392, p = 0.008, MRA OR 0.523 p = 0.097), and lack of follow-up in dedicated HF clinics (p = 0.006). No regional differences with regards to GDMT were identified.</p><p><strong>Conclusion: </strong>In this nation-wide real-world snapshot study, patients with chronic and acute HF accounted for a significant proportion of cardiology inpatients, while ischemic heart disease was the leading HF cause. GDMT and device therapy can be improved. Follow-up in dedicated HF units was related with increased prescription rates of GDMT, whereas this was not affected by geographical region.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1467-1485"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971852","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":"Clinical outcomes according to the average daily dose of sacubitril/valsartan: a nationwide longitudinal cohort study.","authors":"Jaehyun Lim, Hyun-Jung Lee, Soongu Kwak, Bongseong Kim, Kyung-Do Han, Heesun Lee, Jun-Bean Park, Yong-Jin Kim, Hyung-Kwan Kim","doi":"10.1007/s00392-025-02602-x","DOIUrl":"10.1007/s00392-025-02602-x","url":null,"abstract":"<p><strong>Aims: </strong>A minority of patients with heart failure (HF) are prescribed the maximal dose of the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan. We investigated the effectiveness of submaximal doses of sacubitril/valsartan in a real-world cohort.</p><p><strong>Methods and results: </strong>Patients with HF with reduced ejection fraction prescribed sacubitril/valsartan for ≥ 180 days between 2016 and 2020 were included from a nationwide database, and categorized into tertiles based on the average daily sacubitril/valsartan dosage. Baseline characteristics were balanced using inverse probability of treatment weighting with propensity scores. The primary outcome was a composite of HF hospitalization and all-cause mortality. The study included 3,953 patients (age 62.6 ± 12.4 years, 73.0% men). Patients on lower sacubitril/valsartan doses were older, more likely to be women, and had more comorbidities, with lower blood pressure, reduced kidney function, and lower body mass index; however, baseline characteristics were well balanced across the groups after weighting. During a mean follow-up of 2.0 ± 0.7 years, there were 808 events (20.4%). The risk of the primary outcome in the middle (HR 0.93, 95% CI 0.78-1.10) and the highest dosage tertiles (HR 0.88, 95% CI 0.74-1.06) did not significantly differ compared with the lowest dosage tertile (p-value = 0.384). Regarding individual outcomes, there was no significant difference in HF hospitalization; however, there was a trend toward lower mortality with higher sacubitril/valsartan dose (p-value = 0.047).</p><p><strong>Conclusions: </strong>No significant difference was observed in the composite risk of HF hospitalization and all-cause mortality across different sacubitril/valsartan dosage groups. This suggests that the benefits of sacubitril/valsartan treatment may not necessarily be dose-dependent.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1455-1466"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656025","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":"Update on clinical heart failure trials.","authors":"Julian Hoevelmann, Mert Tokcan, Saarraaken Kulenthiran, Amr Abdin, Charle Viljoen, Michael Böhm","doi":"10.1007/s00392-025-02784-4","DOIUrl":"10.1007/s00392-025-02784-4","url":null,"abstract":"<p><p>Heart failure (HF) remains a major global health burden, with rising prevalence and significant morbidity and mortality despite advances in diagnosis and management. Over the past years, the therapeutic landscape of HF has evolved substantially, driven by a growing number of pivotal clinical trials addressing not only heart failure with reduced ejection fraction (HFrEF), but also heart failure with mildly reduced (HFmrEF) and preserved ejection fraction (HFpEF). The following review provides a comprehensive update on key clinical trials published or presented in the recent past such as DIGIT-HF, VICTORIA and VICTOR, STRONG-HF, SUMMIT or STEP-HFpEF trials, highlighting novel pharmacological therapies, patient phenotyping, and treatment of co-morbidities. Special attention is given to trials with practice changing implications and those shaping future guidelines.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1443-1454"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145539365","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":"NT-proBNP in the very old population: reference values and heart failure specificity from the AugUR-study.","authors":"Maria A Heinrich, Klaus J Stark, Martina E Zimmermann, Janina M Herold, Caroline Brandl, Alexander D Schober, Ralph Burkhardt, Lars S Maier, Andreas Luchner, Iris M Heid, Alexander Dietl","doi":"10.1007/s00392-025-02785-3","DOIUrl":"10.1007/s00392-025-02785-3","url":null,"abstract":"<p><strong>Background: </strong>High NT-proBNP is an established marker of heart failure. However, old individuals have elevated values even when cardiovascularly healthy. Reference values remain scarce.</p><p><strong>Objectives: </strong>We sought to provide reference values of NT-proBNP for the healthy old and very old population and the proportion above the AHA- and ESC-recommended rule-out cut-off for heart failure diagnosis in a non-acute setting (≥ 125 pg/mL).</p><p><strong>Methods: </strong>We analyzed cross-sectional data from the population-based AugUR study of inhabitants ≥ 70 years of age. NT-proBNP was determined in serum. Cardiac morphology and function were evaluated by echocardiography.</p><p><strong>Results: </strong>A total of 2304 subjects aged 70 to 95 years were analyzed (52% women; 35% ≥ 80 years). Median NT-proBNP increased by age group (70-74/75-79/80-84/ ≥ 85 years: 153.0/176.9/228.5/395.0 and 116.1/171.5/217.6/437.0 pg/mL for women or men, respectively); 68% had NT-proBNP ≥ 125 pg/mL. In a subgroup free of cardiovascular risk factors, renal failure, coronary artery disease, and atrial fibrillation (n = 685), 50% (70-79 years) and 70% (≥ 80 years) had NT-proBNP ≥ 125 pg/mL; 97.5% quantiles were considerably higher than 125 pg/mL (70-79 years: 559.5 or 424.5 for women or men; 80-95 years: 809.2 or 722.0 pg/mL for women or men). When further restricting to normal left ventricular mass, E/e' ratio, and ejection fraction (n = 65), 53% of subjects (70-79 years) or 50% (≥ 80 years) had NT-proBNP ≥ 125 pg/mL.</p><p><strong>Conclusions: </strong>NT-proBNP levels continue to rise in the very old population. More than 50% of healthy subjects aged 70 years and older have NT-proBNP values above the decision-making cut-off at 125 pg/mL, potentially causing unnecessary further diagnostics and referrals.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1571-1582"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145376278","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}