ESC Heart Failure最新文献

{"title":"Letter to the Editor, 'Haemodynamic consequences of acute pulmonary embolism predict risk of CTPA-related acute kidney injury'.","authors":"Ahmed Raza, Shahzadi Gulfishan","doi":"10.1002/ehf2.15441","DOIUrl":"https://doi.org/10.1002/ehf2.15441","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211910","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":"Circulating oxylipins predict mortality in heart failure with preserved ejection fraction.","authors":"Vaishnavi Aradhyula, Sareeta Manandhar, Alborz Sherafati, Alex Kloster, Anas Fares, Prabhatchandra Dube, Pamela S Brewster, George V Moukarbel, Krishna Rao Maddipati, Steven T Haller, David J Kennedy, Rajesh Gupta, Samer J Khouri","doi":"10.1002/ehf2.15425","DOIUrl":"https://doi.org/10.1002/ehf2.15425","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure with preserved ejection fraction (HFpEF) poses significant diagnostic, prognostic and therapeutic challenges, with high morbidity and mortality rates. Currently, there are limited predictors of outcomes in HFpEF patients. Circulating oxidized polyunsaturated fatty acyl lipids, or oxylipins, are known to initiate and resolve inflammation in cardiovascular diseases. However, their ability to predict mortality in HFpEF has not been established. We hypothesize that a panel of oxylipins can predict and stratify mortality risk in HFpEF patients.</p><p><strong>Methods and results: </strong>Venous and arterial blood samples were collected during right heart catheterization from 90 HFpEF patients at a single institution. Patients were followed for 5 years to determine morbidity and mortality rates. We measured 143 arterial and 143 venous oxylipins in all study participants using liquid chromatography-mass spectrometry. Volcano plots were used to visualize differences in oxylipins between survived and deceased groups. Receiver operator characteristic (ROC) curves were used to determine optimal biomarker cut-points, and the relationship between the most significant oxylipins and mortality was assessed with Kaplan-Meier (KM) curves. HFpEF patients with 5-year mortality had increased age, decreased body mass index, decreased diastolic blood pressure and worse renal function at baseline. They also had more severe pulmonary hypertension (PH) and right heart dysfunction. Volcano plot analysis revealed that arterial oxylipin 15-keto prostaglandin F2a (PGF2a) was significantly associated with 5-year mortality. ROC curve analysis identified an optimal cut-point for 15-keto PGF2a, and participants with elevated arterial 15-keto PGF2a had significantly increased 5-year mortality on KM curves. Multivariable adjusted analysis identified 15-keto PGF2a as a significant predictor of 5-year mortality (OR 1.82; CI 1.03, 3.5).</p><p><strong>Conclusions: </strong>In this cohort of patients with HFpEF, arterial 15-keto PGF2a, a stable metabolite of PGF2a, significantly predicted 5-year mortality.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198701","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":"Mapping of current practices of palliative care for patients with heart failure throughout Europe: A scoping review.","authors":"Tania Pastrana, Matthew Grant, Paula Hidalgo Andrade, Daniele Marelli, Klaus Witte, Geert-Jan Geersing, Carla Ripamonti, Roman Rolke, Marco Metra, Matteo Pagnesi, Everlien De Graaf, Cosimo Chelazzi","doi":"10.1002/ehf2.15431","DOIUrl":"https://doi.org/10.1002/ehf2.15431","url":null,"abstract":"<p><p>Heart failure (HF) is a growing health and societal challenge in Europe, due to an increasingly elderly, frail and multimorbid population. Many patients with HF experience a high burden of complex and multidimensional symptoms leading to a reduced quality of life and significant socioeconomic impact. Despite proven benefits, the integration of palliative care into HF management pathways remains inconsistent and underutilized. We aim to map how current national and international guidelines recommend integrating palliative care into HF management across the 10 countries represented by the EU-funded RAPHAEL consortium (Horizon Europe programme, No 101137170): Belgium, Germany, Lithuania, the Netherlands, Spain, Italy, Poland, Sweden, Switzerland and the United Kingdom. A systematic search was conducted across six databases (EMBASE, Global Health, MEDLINE, PsycINFO, The Cochrane Library and Web of Science) for publications from 1 January 2000 to 25 May 2024. Eligible publications focused on adults with HF and models of palliative care integration. Data were synthesized using content analysis. Of 1543 records screened, 13 publications were included. Most studies were guidelines, consensus or position papers; only one was qualitative research. The definition of the population with HF eligible for palliative care was heterogeneous and inconsistently defined, mostly by symptoms (4/13 publications; 31%) and pathophysiology (2/13; 15%). The most frequent triggers for palliative care referral were clinical features and symptoms (8/13; 62%), patients approaching the end of life (8/13; 62%), and symptomatic deterioration despite optimal therapy (7/13; 54%). Additional triggers included multiple (>1) unplanned hospitalizations (6/13; 46%) and spiritual, emotional or social issues (7/13; 54%). Outcomes of palliative care referral for HF patients focused on quality of life (9/13; 69%) and symptom control (9/13; 69%). Multiprofessional involvement was emphasized with cardiologists (12/13; 92%), nurses (10/12; 77%), palliative care specialists (9/13; 69%) and primary care physicians (4/13; 31%). Publications generally noted that despite increased awareness and recommendations, referrals remain low and mostly late stages. This review underscores the need for structured, early integration of palliative care in HF management across Europe with clear triggers for palliative care referral, application of standardized pathways and fostering of multiprofessional collaboration. Developing these, while simultaneously addressing implementation challenges through policy development, could improve patient outcomes and quality of life.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184862","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":"Early in-hospital treatment of acute heart failure. Part 2 of the international expert opinion series on AHF management.","authors":"Anika S Naidu, Andrew P Ambrosy, Gad Cotter, Edimar A Bocchi, Javed Butler, Ovidiu Chioncel, Beth Davison, Anastase Dzudie, Yonathan Freund, Marat Fudim, Sivadasanpillai Harikrishnan, Ivna G Cunha, Alexandre Mebazaa, Robert J Mentz, Òscar Miró, Siti E Nauli, Mateo Pagnesi, Naoki Sato, Gianluigi Savarese, Karen Sliwa-Hahnle, Yuhui Zhang, Jingmin Zhou, Jan Biegus","doi":"10.1002/ehf2.15389","DOIUrl":"https://doi.org/10.1002/ehf2.15389","url":null,"abstract":"<p><p>Acute heart failure (AHF) remains a major global health challenge, contributing significantly to morbidity, mortality and healthcare resource utilization. It is one of the leading causes of hospitalization, with persistently high readmission rates underscoring the need for improved early management strategies. Despite its prevalence, clear and evidence-based guidance for the early evaluation and treatment of AHF is limited. Congestion is the primary reason for emergency admission, making rapid and effective decongestion a top priority, but diuretics are often underdosed in AHF patients. Medications proven to improve mortality are often not started. In this state-of-the-art review, we address this critical gap by outlining a practical, evidence-based framework for the early management of AHF. Key components include early identification of co-existing conditions, bedside haemodynamic profiling, a structured diagnostic approach incorporating both standard and individualized assessments, a stepwise pharmacologic diuretic strategy beginning with high-dose intravenous loop diuretics, and early in-hospital initiation of guideline-directed medical therapy.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181955","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":"Poor cardiovascular outcomes of underweight abdominal obesity in the entire population of newly diagnosed heart failure.","authors":"Joongmin Kim, Sungyoun Chun, Jong-Kwan Park, Hancheol Lee, Ji-Yong Jang, Hyeongsoo Kim, Geunhee Park, Seung-Jin Oh, Se-Jung Yoon","doi":"10.1002/ehf2.15413","DOIUrl":"https://doi.org/10.1002/ehf2.15413","url":null,"abstract":"<p><strong>Aims: </strong>Body mass index (BMI) has been widely used as a simple tool for predicting cardiovascular risk. Here we aimed to analyse the distribution and cardiovascular outcomes according to BMI and waist circumference (WC) of the newly diagnosed heart failure (HF) patients in the entire population of the Republic of Korea for 10 years.</p><p><strong>Methods: </strong>A total of 999 127 patients newly diagnosed with HF between 2012 and 2021 among the entire population were included. The epidemiologic data of each subgroup according to BMI and WC were analysed, and cardiovascular outcomes were evaluated.</p><p><strong>Results: </strong>Over the decade from 2012 to 2021, the obese group accounted for 47.1% of the newly diagnosed HF population. Kaplan-Meier curve and hazard ratio of cardiovascular events in each subgroup revealed significantly increased rates of hospitalization, death from all causes, cardiovascular death, acute myocardial infarction, atrial fibrillation and composite cardiac events in the underweight group compared with other groups (P value < 0.05). The subgroups of abdominal obesity in normal, overweight and obese patients revealed significantly high hazard ratio in almost all cardiovascular events (P value < 0.05). Conversely, the overweight and obese groups without abdominal obesity showed the best cardiovascular outcomes. Increased cardiovascular risk was shown in groups with abdominal obesity even at the same BMI.</p><p><strong>Conclusion: </strong>The cardiovascular prognosis was significantly worse in the underweight group than in the obese group, especially in the underweight abdominal obesity group. Even in the same BMI group, the prognosis is worse in the group with abdominal obesity. For a more accurate cardiovascular prognosis analysis, it is necessary to use WC along with BMI.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148402","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":"Impact of epicardial adipose tissue on myocardial function and structure in patients with severe aortic valve stenosis.","authors":"Judith Gronwald, Torben Lange, Sören J Backhaus, Bo E Beuthner, Ruben Evertz, Miriam Puls, Johannes T Kowallick, Karl Toischer, Gerd Hasenfuß, Andreas Schuster, Alexander Schulz","doi":"10.1002/ehf2.15422","DOIUrl":"https://doi.org/10.1002/ehf2.15422","url":null,"abstract":"<p><strong>Aims: </strong>Epicardial adipose tissue (EAT) is closely associated with the development of heart failure and adverse myocardial remodelling. In patients with severe aortic valve stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), increased EAT has been identified as a predictor of adverse outcomes; however, the underlying pathophysiological mechanisms remain unclear. This study aims to explore the effects of increased EAT volumes on myocardial remodelling and dysfunction in patients with severe AS.</p><p><strong>Methods and results: </strong>One hundred thirty-seven patients with severe AS (median age 80 years, 62% male) underwent cardiac magnetic resonance imaging (CMR) prior to TAVR. Myocardial volumes and function as well as EAT volumes were quantified from CMR acquisitions. The cohort was dichotomised at the median EAT volume. Patients with increased EAT volumes above the median (≥46.5 mL/m²) showed impaired left atrial (LA) reservoir strain (Es) as a distinct functional feature compared with patients with lower EAT volumes (11.8% [7.6-16.7] vs. 15.0% [10.9-19.1], P = 0.011), while left ventricular (LV) morphology and function (all P ≥ 0.216), right atrial and ventricular morphology and function (all P ≥ 0.090), as well as tissue characteristics (all ≥ 0.229) were similar between both groups. In a subgroup analysis of the four types of severe AS, the difference was most prominent in patients with low ejection fraction high-gradient AS. In multivariable regression analyses, EAT was independently associated with impaired LA Es, irrespective of co-morbidities, ventricular function, tissue characteristics and functional characteristics of AS.</p><p><strong>Conclusions: </strong>In patients with severe AS, increased EAT volume is independently associated with impaired LA function but not with other features of biventricular morphology, function or tissue composition. The incremental deterioration of LA function, in addition to the afterload imposed by AS in these patients, could increase vulnerability to heart failure and may require consideration as a therapeutic target beyond TAVR.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148398","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":"Simultaneous vaccination against influenza and respiratory syncytial virus in high-risk heart failure patients.","authors":"Jan Biegus, Leszek Szenborn, Michał Tkaczyszyn, Robert Zymlinski, Gad Cotter, Michał Zakliczynski, Krzysztof Reczuch, Mateusz Guzik, Szymon Urban, Marta Rosiek-Biegus, Berenika Jankowiak, Gracjan Iwanek, Marta Wleklik, Marat Fudim, Piotr Ponikowski","doi":"10.1002/ehf2.15432","DOIUrl":"https://doi.org/10.1002/ehf2.15432","url":null,"abstract":"<p><strong>Background: </strong>There is a scarcity of prospective data on the impact of available vaccinations against respiratory viruses on hard clinical endpoints in patients with heart failure (HF).</p><p><strong>Aims: </strong>We investigated whether, in the population of high-risk HF patients, simultaneous vaccination against influenza and respiratory syncytial virus (RSV) improves outcomes during the subsequent infection season.</p><p><strong>Methods: </strong>We conducted a prospective, randomized, single-centre, open-label study in which patients with high-risk HF were randomized 1:1 to simultaneous influenza and RSV vaccination or standard of care (SOC). The primary composite endpoint comprised all-cause death, HF hospitalization (HFH) or clinical signs/symptoms of infection within a 6 month follow-up period (regular structured telephone interview). Secondary endpoints were components of the composite primary endpoint.</p><p><strong>Results: </strong>Two hundred twenty patients were randomized. During the follow-up period, the primary endpoint occurred in 59% of patients in the vaccination group versus 75% in the SOC group [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.48-0.92, P = 0.01]. Regarding the secondary endpoint analyses, during 6 month follow-up, 3% in the vaccination group died compared with 5% of patients in the SOC arm (HR 0.50, 95% CI 0.12 1.99, P = 0.32), and 18% versus 16% of study participants were hospitalized for HF in the two study arms, respectively (HR 0.86, 95% CI 0.45-1.62, P = 0.64). Infection occurred in 53% of vaccinated patients compared with 68% in SOC (HR 0.68, 95% CI 0.48-0.96, P = 0.03).</p><p><strong>Conclusions: </strong>In the population of high-risk HF, simultaneous vaccination against influenza and RSV reduced the incidence of the primary outcome. The effect was driven by a significant reduction in infections.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148354","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":"Methodological issues in outpatient worsening heart failure research.","authors":"Karim Hnid","doi":"10.1002/ehf2.15438","DOIUrl":"https://doi.org/10.1002/ehf2.15438","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136962","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":"'Letter to the editor: Epicardial, visceral and subcutaneous adipose tissue in heart failure with preserved ejection fraction'.","authors":"Ahmed Raza, Ahmad Furqan Anjum","doi":"10.1002/ehf2.15433","DOIUrl":"https://doi.org/10.1002/ehf2.15433","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130095","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":"Finerenone in diabetic chronic kidney disease-Real-world insights including patients with HFpEF or HFmrEF.","authors":"Kristian Hellenkamp, Sophia Kaebe, Miroslava Valentova, Stephan von Haehling, Fani Delistefani, Katja Gollisch, Dirk Raddatz, Ann-Kathrin Schäfer, Michael J Koziolek, Manuel Wallbach","doi":"10.1002/ehf2.15424","DOIUrl":"https://doi.org/10.1002/ehf2.15424","url":null,"abstract":"<p><strong>Purpose: </strong>Finerenone, a highly selective non-steroidal mineralocorticoid receptor antagonist, was approved for the treatment of patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (diabetic kidney disease, DKD). Finerenone reduced the composite endpoint of heart failure events and cardiovascular death in patients with heart failure with preserved or mildly reduced ejection fraction (HFpEF/HFmrEF). This study aimed to investigate the safety and cardiac effects of finerenone in patients with DKD with or without HFpEF/HFmrEF in a real-world setting.</p><p><strong>Methods: </strong>Patients with DKD were prospectively enrolled and were treated with finerenone according to best clinical practice. Clinical, laboratory and echocardiographic assessments were performed before, 4 weeks and 6 months after starting finerenone.</p><p><strong>Results: </strong>Thirty-one patients with DKD were included. At baseline, patients had a typical risk profile with arterial hypertension (90.3%) and hyperlipoproteinemia (87.1%). Most patients were treated with a sodium-glucose cotransporter 2 (SGLT2) inhibitor (93.5%). Treatment with finerenone was safe and well tolerated: after 4 weeks, the glomerular filtration rate decreased slightly from 52 (43-78) mL/min/1.73 m² to 48.0 (39.0-71.0) mL/min/1.73 m² (P = 0.002 vs. baseline), but stabilized thereafter. Similarly, the median potassium value increased from 4.2 (3.8-4.5) mmol/L to 4.4 (4.2-4.8) mmol/L (P = 0.017) after 4 weeks, but remained stable thereafter [4.4 (4.1-4.6) mmol/L (P = 0.079)]. Only one patient (3.2%) had an unplanned hospitalization and concomitant hyperkalaemia up to 6.0 mmol/L. HFpEF/HFmrEF was frequently found in patients with DKD (71.0%), although most patients had a rather early stage with only mild symptoms and a median N-terminal pro B-type natriuretic peptide (NT-proBNP) value of 150.8 (54.5-325.7) ng/L. During treatment with finerenone, NT-proBNP and left ventricular mass index (LVMI) remained stable. In contrast, left atrial volume index (LAVI) decreased from baseline [31.2 (26.8-39.7) mL/m²] to 4 weeks follow-up [29.7 (20.8-33.6) mL/m², P = 0.027] and decreased further after 6 months [26.6 (20.8-34.9) mL/m², P = 0.029]. In the subgroup of patients with HFpEF/HFmrEF, E/e' decreased from 11.9 (8.7-14.5) at baseline to 9.9 (8.0-12.4) after 6 months (P = 0.043).</p><p><strong>Conclusions: </strong>In a real-world setting, treatment with finerenone is safe and well-tolerated in patients with DKD and may improve functional and structural cardiac parameters. Further investigation is warranted.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124475","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}