ESC Heart Failure最新文献

{"title":"Low cardiovascular event rates in patients treated with CAR T-cells: Real-world outcomes from two independent cohorts.","authors":"Jakob Christoph Voran, Lars Fransecky, Hatim Seoudy, Manuel Hecht, Oliver Müller, Philipp Berning, Alexander Pohlmann, Cornelia Baden, Tim Versteegen, Claudia D Baldus, Friedrich Stölzel, Derk Frank, David Baden","doi":"10.1093/eschf/xvag132","DOIUrl":"https://doi.org/10.1093/eschf/xvag132","url":null,"abstract":"<p><strong>Aims: </strong>CAR-T cell therapy is becoming a key pillar of medical oncology, used for an expanding range of indications. Considering the increased risk of cardiovascular disease with increasing age, assessing the impact of cardiac comorbidities can help minimizing complications and improve treatment outcomes.</p><p><strong>Methods: </strong>We evaluated cardiovascular outcomes in patients undergoing CD19- or BCMA-directed CAR T-cell therapy from two large independent databases (DESTATIS (Germany) and the TriNetX network (US)).</p><p><strong>Results: </strong>Among 2,545 CAR T-cell cases from Germany and 1,335 patients from the US, we identified 51 respective 20 short-term severe cardiac events with early death documented in 135 (5%) and 16 (1.2%) patients. Patients with preexisting cardiac conditions did not show an increased risk for immune-related complications like cytokine release (OR 1.19, 95%CI 0.77-1.82) or neurotoxicity syndrome (OR 1.59, 95%CI 0.94-2.69). They faced higher long-term risks for major cardiovascular events (OR 1.89, 95%CI 1.23-2.91) and kidney failure (OR 2.98, 95%CI 1.85-4.81).</p><p><strong>Conclusion: </strong>Cardiovascular complications in CAR T-cell therapy were rare and primarily affected patients with preexisting cardiac conditions. Serious cardiac events were uncommon acutely but increased over time. The analysis underscores the need for risk-adapted follow-up and cardiological assessments to improve outcomes in patients with cardiac comorbidities. Inherent with the databases used, these results should be interpreted with caution, as underreporting and overreporting could introduce bias regarding risik factors and outcomes in both directions.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856131","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":"Glucagon-like peptide-1 receptor agonists for heart failure with reduced ejection fraction: Is it the next step?","authors":"Jan Biegus","doi":"10.1093/eschf/xvag131","DOIUrl":"https://doi.org/10.1093/eschf/xvag131","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835460","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":"AI task-shifting for echocardiographic LVEF assessment in Singapore: an economic evaluation.","authors":"Aprajita Kaushik, Sameera Senanayake, Sanjeewa Kularatna, Khung-Keong Yeo, Nicholas Graves, Carolyn S P Lam, Huang Weiting, Chanchal Chandramouli, Jasper Tromp","doi":"10.1093/eschf/xvag069","DOIUrl":"10.1093/eschf/xvag069","url":null,"abstract":"<p><strong>Background: </strong>Accurate assessment of left ventricular ejection fraction (LVEF) is crucial for heart failure (HF) diagnosis but requires skilled sonographers. Artificial intelligence-enabled point-of-care (AI-POC) devices may enable novices to assess LVEF, potentially reducing healthcare costs. We conducted a cost-minimization analysis comparing conventional sonographer-performed echocardiography versus novice-operated AI-POC devices.</p><p><strong>Methods: </strong>Using a decision tree model, we compared the costs of diagnosing LVEF <50% in patients with suspected heart failure across two pathways: novice-operated AI-POC devices versus standard transthoracic echocardiogram (TTE) performed by sonographers. The model incorporated LVEF <50% prevalence, diagnostic accuracy metrics, and comprehensive cost data for both approaches. We conducted a probabilistic sensitivity analysis to test the robustness of our findings under varying assumptions.</p><p><strong>Results: </strong>The AI-POC pathway demonstrated substantial cost savings, averaging S$1185 [US$1422] per patient compared to S$1403 [US$1684] for conventional TTE. In a single tertiary referral centre in Singapore, implementing AI-POC devices for LVEF assessment in 100 patients resulted in savings of S$21 669 [US$26 013]. Probabilistic sensitivity analysis suggested a 99.9% probability that the AI-POC approach would be cost-saving compared to standard TTE.</p><p><strong>Conclusions: </strong>This study provides economic evidence that task-shifting echocardiographic assessment of LVEF to novices using AI-POC devices is likely cost-saving compared to standard TTE. This task-shifting strategy offers a cost-saving alternative to conventional sonographer-led TTE.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354563","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":"Congestion and renal function in patients with chronic heart failure.","authors":"Ahmad Alsaeed, Htet Htet Ei Khin, Elisabetta Caiazzo, Moustafa I Morsy, Joe Cuthbert, Andrew L Clark, John G F Cleland, Pasquale Maffia, Pierpaolo Pellicori","doi":"10.1093/eschf/xvag126","DOIUrl":"https://doi.org/10.1093/eschf/xvag126","url":null,"abstract":"<p><strong>Background: </strong>Cardiac and renal dysfunction often conspire to cause water and salt retention. We assessed the relation between renal function and congestion, both clinically and by ultrasound, in chronic heart failure (CHF).</p><p><strong>Method: </strong>At a routine clinic visit, patients with CHF were classified as clinically congested if they had a raised jugular venous pressure, pulmonary congestion, or peripheral oedema, regardless of severity, blind to a subsequent ultrasound assessment of congestion, including inferior vena cava (IVC) diameter, jugular vein diameter Valsalva/rest ratio (JVD-ratio) and lung B-lines. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI 2021 equation.</p><p><strong>Results: </strong>Of 342 patients, eGFR was <30 in 9%, 30-44 in 18%, 45-59 in 26% and >60 ml/min/1.73m2 in 47%. Many patients had both clinical and ultrasound evidence of congestion, especially when eGFR was low (respectively for each eGFR group: 51%, 30%, 39%, and 25%). Isolated ultrasound congestion was also common (19%, 29%, 34%, and 26%) but isolated clinical congestion less so (11%, 11%, 4%, and 9%)..Congestion, especially when detected by both methods, was associated with higher NT-proBNP concentrations and a greater probability of heart failure (HF) hospitalisation or death (adjusted HR: 2.16, 95% CI [1.25, 3.75]; P=0.006 vs no congestion).</p><p><strong>Conclusion: </strong>Patients with CHF often have clinical evidence of congestion, confirmed by ultrasound, which is associated with a poor prognosis. Patients with a low eGFR are more likely to be congested. Whether ultrasound assessment of congestion can improve the management of patients with CHF requires more attention.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812526","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":"Diet-Gut Microbiota Interaction Index and Heart Failure Risk in Diabetes and Prediabetes: Evidence from NHANES 2007-2018.","authors":"Yuqing Huang, Yuling Yang, Jia Feng, Qiming Gong, Yueli Pu, Xia Fang, Yong Xu","doi":"10.1093/eschf/xvag125","DOIUrl":"https://doi.org/10.1093/eschf/xvag125","url":null,"abstract":"<p><strong>Aims: </strong>Diabetes and prediabetes markedly increase the risk of heart failure (HF), but the role of diet-gut microbiota interactions remains unclear. This study examined the association between the Dietary Index for Gut Microbiota (DI-GM) and HF risk among individuals with diabetes or prediabetes.</p><p><strong>Methods: </strong>Data were obtained from 15 219 adults with diabetes or prediabetes in the US National Health and Nutrition Examination Survey (NHANES) 2007-2018. DI-GM scores were calculated from two 24-h dietary recalls covering 14 food groups linked to gut microbiota. Associations between DI-GM and prevalent HF were estimated using weighted logistic regression and restricted cubic spline models, adjusting for demographic, lifestyle, and metabolic factors.</p><p><strong>Results: </strong>Participants had a mean age of 59.7 ± 13.2 years, and 48.3% were women. Higher DI-GM scores were independently associated with lower HF risk (adjusted odds ratio [OR] per 1-point increase = 0.93, 95% confidence interval [CI] 0.89-0.98; p = 0.005). Compared with scores 0-3, DI-GM ≥ 6 was linked to 27% lower HF risk (OR = 0.73, 95% CI 0.58-0.92; p = 0.007). The inverse association was stronger in prediabetes (OR = 0.89, 95% CI 0.82-0.96; p = 0.004) but not significant in diabetes.</p><p><strong>Conclusions: </strong>Higher DI-GM was associated with lower HF risk, particularly in prediabetes. Microbiota-related dietary patterns may play a role in HF prevention among metabolically at-risk populations.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835463","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":"Comments on 'The cardio-pancreatic axis in heart failure: from conceptual framework to empirical evidence\".","authors":"Han Naung Tun, Omar Rahal, Ivan R Figueroa Baez, Omar Santana-Sánchez, Timothy Gardner","doi":"10.1093/eschf/xvag122","DOIUrl":"https://doi.org/10.1093/eschf/xvag122","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835538","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":"Out-of-hours primary care management for patients with heart failure.","authors":"Anne P Nelissen, Sander van Doorn, Carline J van den Dries, Michelle Spek, Dorien L Zwart, Roderick P Venekamp, Linda W van Laake, Frans H Rutten, Geert-Jan Geersing","doi":"10.1093/eschf/xvag124","DOIUrl":"https://doi.org/10.1093/eschf/xvag124","url":null,"abstract":"<p><strong>Aims: </strong>Little is known about the management and disease trajectories of heart failure (HF) patients in the pre-hospital setting when experiencing exacerbating symptoms. Shortness of breath (SOB) is a main reason for contacting out-of-hours primary care (OHS-PC). We aim to describe the care trajectories of these patients with heart failure at the OHS-PC with exacerbating symptom SOB, and to assess 6-months outcomes regarding mortality and hospital admissions.</p><p><strong>Methods: </strong>We included patients who contacted Dutch OHS-PC for SOB between September 2020 and August 2021. We selected those in whom HF was considered to be the cause for consultation and further clinical evaluation. We applied descriptive analyses to characterize these patients and their disease trajectories following this OHS-PC contact, and compared patients referred to the Emergency Department (ED) to those who remained in primary care.</p><p><strong>Results: </strong>Of 1,833 calls for SOB, 102 (5.1%) concerned patients with HF, who had a mean age of 79.6 ± 11.1 years, and 53% were women. Ten (9.8%) patients were directly referred to the ED. The remaining 92 (90.2%) were first assessed by a general practitioner (GP): 62 (60.8%) received a home visit, 15 (14.7%) were seen at the OHS-PC clinic, and 15 (14.7%) received a telephone advice only. Of these 92 patients, 41 (44.6%) patients were subsequently referred to the ED, and 39 (42.4%) were kept at home and received loop diuretics (newly initiated or increased dose). Of the 51 patients referred to the ED (directly or after assessment with the GP), 42 patients (82.4%, p-value < 0.001) were admitted. Six-month all-cause mortality of the 102 patients was 32.3%.</p><p><strong>Conclusions: </strong>At the OHS-PC, one in every 20 contacts for SOB is a HF patient who has a high six-month mortality risk. Patients were directly referred to the hospital, or received initiation or up-titration of loop diuretics.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812574","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":"Real-World Incidence of Cancer Therapy-Related Cardiac Dysfunction in a Large, Diverse, and Contemporary Cohort.","authors":"Samir R Thadani, Alan S Go, Jane Y Liu, Rishi V Parikh, Elisha A Garcia, Elizabeth M Cespedes Feliciano, Ankeet S Bhatt, Sirtaz Adatya, Marilyn L Kwan, Amy Y Lin, Raymond Liu, Alfredo Lopez, Joshua R Nugent, David Ouyang, Alberta H Yen, Jonathan G Zaroff, Andrew P Ambrosy","doi":"10.1093/eschf/xvag113","DOIUrl":"https://doi.org/10.1093/eschf/xvag113","url":null,"abstract":"<p><strong>Aims: </strong>Cancer therapy-related cardiac dysfunction (CTRCD) is a significant complication of contemporary oncologic treatment and a key contributor to incident heart failure (HF) in cancer survivors. Although certain potentially cardiotoxic cancer therapies are known to increase risk, contemporary population-based estimates in large, diverse, and contemporary cohorts remain limited. The aim of the Kaiser Permanente Cardiovascular Health Enhancement and Monitoring for Oncology (KP CHEMO) study was to determine the incidence, timing, and treatment-specific variation in CTRCD among adults receiving potentially cardiotoxic cancer therapies within an integrated United States (U.S.) health system.</p><p><strong>Methods and results: </strong>We conducted a retrospective cohort study of adult Kaiser Permanente Northern California (KPNC) members diagnosed with malignant tumors between 2012 and 2022 who received anthracyclines, human epidermal growth factor receptor (HER2) inhibitors, immune checkpoint inhibitors (ICIs), or tyrosine kinase inhibitors (TKIs). CTRCD was defined as a >10% decline in left ventricular ejection fraction (LVEF) to <53% or incident HF identified by natural language processing. Crude and cumulative incidence rates were calculated overall and by drug class. Early CTRCD was ≤12 months; late was >12 months. Among 26,646 patients (mean age 62±14 years; 64% women; 57% non-Hispanic White), the cumulative incidence of CTRCD was 8.4% (95% CI 7.7-9.1). Incidence was highest with HER2 inhibitors (10.7%) and lowest with ICIs (5.2%) (P<0.001). Nearly half of all events occurred within the first year.</p><p><strong>Conclusions: </strong>CTRCD was common and occurred predominantly within the first year after therapy initiation, potentially reflecting both early susceptibility and more intensive early surveillance. Variation across drug classes highlights differing cardiotoxic risk profiles. These findings support early risk prediction models and targeted surveillance strategies to reduce downstream HF risk.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812521","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":"Evaluation and management of recent onset cardiomyopathy in the current era of heart failure therapeutics. A clinical consensus statement of the Heart Failure Association of the ESC.","authors":"Hadi Skouri, Amr Abdin, Wilfried Mullens, Chiara Bucciarelli Ducci, Randall C Starling, Peter Van der Meer, Gianluigi Savarese, Tuvia Ben Gal, Antoni Bayes-Genis, Stephane Heymans, Karin Klingel, Sanjay K Prasad, Dimitrios Farmakis, Ovidiu Chioncel, Arsen Ristic, Giuseppe Rosano, Petar Seferovic, Piotr Ponikowiski, Marco Metra, Carsten Tschöpe","doi":"10.1093/eschf/xvag115","DOIUrl":"https://doi.org/10.1093/eschf/xvag115","url":null,"abstract":"<p><p>Recent-onset cardiomyopathy represents a clinically dynamic and potentially reversible clinical framework of non-ischemic cardiomyopathy, characterized by high variability in left ventricular (LV) function and arrhythmic risk. This clinical consensus statement provides a structured diagnostic and therapeutic approach based on two prognostic axes: the potential for left ventricular reverse remodeling (LVRR) and the risk of sudden cardiac death (SCD). We operationalize four trajectories in the LV evolution, ranging from recovered LV ejection fraction (LVEF) to persistently reduced LVEF. Multimodal stratification including echocardiography, cardiac magnetic resonance (CMR), genetic profiling, biomarkers, and early treatment response allows tailored decision-making on pharmacological and device-based therapies. We propose a unified management algorithm emphasizing early initiation of guideline-directed medical therapy, structured reassessment at 3 and 6 months, and individualized consideration of defibrillators, resynchronization therapy, arrhythmia ablation, transcatheter valve leaflet edge to edge repair, and advanced HF assessment. This document aims to support clinicians in risk stratification and timely management or referrals.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766291","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 on: Worse Long-Term Outcomes in New-Onset HFpEF vs HFrEF and HFmrEF: Findings from the Stockholm PREFERS Study.","authors":"Maria Giulia Bellicini","doi":"10.1093/eschf/xvag121","DOIUrl":"https://doi.org/10.1093/eschf/xvag121","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766312","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}