ESC Heart Failure最新文献

{"title":"Role of NPPB for recovery post ventricular assist device in paediatric dilated cardiomyopathy: Single-cell multiomics.","authors":"Yosuke Kugo, Takuji Kawamura, Akima Harada, Yuji Tominaga, Kenji Miki, Hidekazu Ishida, Takayoshi Ueno, Shigeru Miyagawa","doi":"10.1002/ehf2.15430","DOIUrl":"https://doi.org/10.1002/ehf2.15430","url":null,"abstract":"<p><strong>Aims: </strong>Paediatric heart transplantation requires lifelong immunosuppression, highlighting the need for recovery-oriented strategies. A subset of children with dilated cardiomyopathy (DCM) recovers left ventricular (LV) function after LV assist device (LVAD) implantation, allowing for device explantation. We aimed to identify factors associated with LV functional recovery using single-nucleus multiomics analysis of LV tissue collected at LVAD implantation.</p><p><strong>Methods: </strong>We included children with idiopathic DCM who underwent LVAD implantation between 2013 and 2023. Patients who achieved device explantation and medical stabilization were classified as the recovery group while those who required transplantation or died were classified as the non-recovery group. Single-nucleus RNA and ATAC sequencing were performed in six representative cases. Differential gene expression, chromatin accessibility and gene ontology (GO) enrichment analyses were conducted. Candidate markers were validated histologically and serologically in the full cohort.</p><p><strong>Results: </strong>Twenty-five cases were included (non-recovery, n = 15; recovery, n = 10). Age at LVAD implantation [median (range)] was 0.9 (0.1-4.6) versus 0.8 (0.3-5.6) years (P = 0.8), sex 27% versus 30% male (P > 0.9) and body weight 5.9 (3.8-14.0) versus 7.5 (5.0-26.0) kg (P = 0.049). LV ejection fraction at implantation was similar (24 (10-44) % vs. 15 (10-25) %, P = 0.2). RNA sequencing showed elevated NPPB, MYL7 and PCDH9 in recovery-group cardiomyocytes, with NPPB highest expression [baseMean = 16 305; log₂Fold Change (FC) = 2.698; P < 0.001] and an accessible chromatin peak at its locus (log₂FC = 1.17; P < 0.01). GO analysis indicated enrichment in apoptosis-related pathways (coefficient = 1.77, P = 0.023). Serum brain natriuretic peptide (BNP), the protein product of NPPB, was significantly higher in the recovery group at implantation [732 (372-4179) vs. 3048 (642-6032) pg/mL, P = 0.04] as was the proportion of non-apoptotic cardiomyocytes [0.21 (0.02-0.37) vs. 0.37 (0.19-0.48), P = 0.03].</p><p><strong>Conclusions: </strong>Elevated NPPB expression and BNP levels at LVAD implantation are associated with LV recovery in paediatric DCM. These findings support an anti-apoptotic role of BNP in successful bridge-to-recovery outcomes.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336706","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":"Haemodynamic effects of istaroxime in SCAI stage B HF-related cardiogenic shock: Insights from the SEISMiC trial.","authors":"Matteo Pagnesi, Gad Cotter, Beth Davison, Daniel Burkhoff, Alexander Mebazaa, Jan Biegus, Ovidiu Chioncel, Christopher Edwards, Koji Takagi, Gerasimos Filippatos, Agnieszka Tycińska, Maria Novosadova, Gaurav Gulati, Marianela Barros, Maria Luz Diaz, Carlos Guardia, Robert Zymliński, Piotr Gajewski, Piotr Ponikowski, Phillip Simmons, Steven Simonson, Marco Metra","doi":"10.1002/ehf2.15448","DOIUrl":"https://doi.org/10.1002/ehf2.15448","url":null,"abstract":"<p><strong>Aims: </strong>The haemodynamic effects of istaroxime in SCAI stage B cardiogenic shock (CS) due to acute decompensated heart failure (ADHF) have not been evaluated. We assessed the impact of istaroxime on specific invasively-obtained haemodynamic measures.</p><p><strong>Methods and results: </strong>In the SEISMiC extension study, 30 patients with ADHF-related SCAI stage B CS were randomized to 60-h intravenous infusion of either placebo (n = 11) or istaroxime at maximum 0.5-1.0 μg/kg/min (n = 19). In this post hoc analysis, invasively-obtained haemodynamic measures, simulated group-averaged pressure-volume (PV) loops, and end-systolic elastance (Ees), derived from individual-patient PV relationships, were compared between istaroxime- and placebo-treated patients. Compared with placebo, patients randomized to istaroxime for 48-60 h had greater increases in aortic pulsatility index (API) and left ventricular (LV) stroke work index (LVSWI) at 6, 12, 24, and 48 h; and greater increase in pulmonary artery (PA) compliance and reduction in PA elastance at 48 h. At group-averaged PV loop analysis, LV contractility remained stable and right ventricular (RV) contractility tended to deteriorate over time with placebo, whereas LV contractility improved and RV contractility tended to be stabilized with istaroxime. Greater increases in both LV Ees and RV Ees were observed with istaroxime versus placebo from baseline to 48 h.</p><p><strong>Conclusions: </strong>In patients with ADHF-pre-CS, istaroxime at doses up to 1.0 μg/kg/min for up to 60 h was associated with sustained improvements in measures of LV performance (API and LVSWI), in parallel with increase in PA compliance and reduction in PA elastance at 48 h. As compared with placebo, istaroxime improved LV contractility and preserved RV contractility, which deteriorated on placebo, over time.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285841","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":"Prognostic impact of SCAI shock severity classes in AMI-related cardiogenic shock: A sub-study of the ECLS-SHOCK Trial.","authors":"Janine Pöss, Jacob Jentzer, Steffen Desch, Hans-Josef Feistritzer, Anne Freund, Michelle Roßberg, Christian Jung, Taoufik Ouarrak, Steffen Schneider, Ibrahim Akin, Tienush Rassaf, Tharusan Thevathasan, Uwe Zeymer, Holger Thiele","doi":"10.1002/ehf2.15446","DOIUrl":"https://doi.org/10.1002/ehf2.15446","url":null,"abstract":"<p><strong>Aims: </strong>The Society for Cardiovascular Angiography and Interventions (SCAI) Classification provides risk stratification of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). This sub-study of the ECLS-SHOCK trial investigates the prognostic impact of SCAI stages in AMI-CS and the influence of SCAI stages on the effect of extracorporeal life support (ECLS) therapy in AMI-CS patients.</p><p><strong>Methods: </strong>Patients with AMI-CS enrolled in the multicentre, randomized ECLS-SHOCK trial were included. The outcomes, treatment effect and safety of ECLS were stratified according to SCAI stage at admission using a post-hoc classification.</p><p><strong>Results: </strong>From a total of 417 patients enrolled in the ECLS-SHOCK trial between June 2019 and November 2022, 51.6% (n = 215), 13.4% (n = 56) and 35.0% (n = 146) presented in SCAI Stages C, D and E, respectively. SCAI stages were associated with the risk of 30 day all-cause mortality (C vs. D vs. E: 32.6% vs. 67.9% vs. 64.4%, P < 0.001), with rates of renal replacement therapy at 30 days (C vs. D vs. E: 7.0% vs. 19.6% vs. 13.7%, P = 0.03) and with poor neurological outcomes (C vs. D vs. E: 17.2% vs. 44.4% vs. 36.5%, P < 0.001). No interaction was observed between SCAI stage and the treatment effect of ELCS on 30 day all-cause mortality (ELCS vs. control SCAI C: 32.7% vs. 32.4%; SCAI D: 68.4% vs. 66.7%; SCAI E: 59.7% vs. 68.4%, P for interaction = 0.65).</p><p><strong>Conclusions: </strong>In AMI-CS patients included in the ECLS-SHOCK trial, SCAI stages at admission were predictive for mortality and for the incidence of safety events. The efficacy of ECLS treatment was not affected by SCAI stage.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285835","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":"Dynamics of urinary chloride and sodium and their link to decongestion in acute heart failure and preserved ejection fraction: NACLOCRo-HF study.","authors":"Jorge Campos, Pau Llàcer, François Croset, Marina García, Carlos Pérez, Alberto Pérez, Marina Vergara, Paul Cevallos, Martín Fabregate, Cristina Fernández, Raúl Ruiz, Daniel Useros, Miriam Menacho, Miriam Domínguez, Esteban Pérez, Julio Núñez, Luis Manzano","doi":"10.1002/ehf2.15436","DOIUrl":"https://doi.org/10.1002/ehf2.15436","url":null,"abstract":"<p><strong>Aims: </strong>In acute heart failure (AHF), precise assessment of congestion is critical to guide therapy. Urinary sodium (uNa) and urinary chloride (uCl) have emerged as potential biomarkers to monitor decongestion, but their comparative trajectories and links to residual congestion remain unclear. This study examined urinary uCl and uNa trajectories during AHF hospitalization in elderly patients with preserved ejection fraction (HFpEF) and their association with fluid overload.</p><p><strong>Methods and results: </strong>This prospective, single-centre study enrolled 70 patients hospitalized for AHF with HFpEF. All received intravenous furosemide for ≥72 h. Serial measurements of uNa, uCl, clinical congestion score (CCS), portal vein pulsatility and estimated plasma volume status (ePVS) were performed. Linear mixed-effects models analysed electrolyte trajectories in relation to residual congestion (CCS ≥ 2, portal vein pulsatility ≥ 30% and ePVS > 5.5 mL/g). The median age was 88 years (IQR: 85-91), and 72.8% were women. Baseline median uCl and uNa were 94 mmol/L (IQR: 68-116) and 81 mmol/L (IQR: 58-97), respectively. uCl declined significantly by 48 h (P = 0.029) and 72 h (P < 0.001). Higher uCl levels at 72 h were associated with CCS ≥ 2 (P for interaction = 0.039), portal vein pulsatility ≥ 30% (P for interaction = 0.018), and ePVS > 5.5 mL/g (P for interaction = 0.035). uNa trajectories differed significantly only across ePVS (P for interaction = 0.015). ROC AUC for predicting residual congestion was slightly higher for uCl (0.819) than uNa (0.790). The optimal cutoff value for uCl to identify residual congestion at 72 h was 61 mmol/L.</p><p><strong>Conclusions: </strong>In a cohort of elderly patients hospitalized for AHF, persistently elevated urinary chloride at 72 h of admission was associated with residual congestion. Urinary chloride may serve as a promising tool to guide the transition to oral medication once euvolaemia has been achieved.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279266","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":"Right ventricle to pulmonary artery coupling as a prognostic factor in tricuspid regurgitation: A systematic review.","authors":"Adam Piasecki, Adam Rdzanek, Piotr Scisło, Ewa Pędzich, Agnieszka Kapłon-Cieślicka, Mariusz Tomaniak","doi":"10.1002/ehf2.15352","DOIUrl":"https://doi.org/10.1002/ehf2.15352","url":null,"abstract":"<p><p>Severe tricuspid regurgitation is a prevalent condition with a poor prognosis. Recent advances in transcatheter techniques resulted in a growing population of patients who are qualified for transcatheter edge-to-edge repair of tricuspid regurgitation. There is evidence that these procedures result in an improvement in heart failure symptoms and patient-reported quality of life; however, the data guiding the qualification process are scarce. The increasing volume of patients that undergo qualification for interventional TR treatment creates the need to improve the tools for risk stratification and outcome prediction. TAPSE/SPAP ratio is an echocardiographic parameter that has been recently proposed as a predictive factor for adverse outcome in various clinical settings including patients undergoing transcatheter procedures. In this systematic review, we gathered the data on the utility of this parameter in patients with significant tricuspid regurgitation. We identified five studies fulfilling the search criteria. In all of the studies, a low TAPSE/SPAP ratio was associated with worse prognosis, but the exact cutoff value remains difficult to define. In available studies, it ranged from 0.26 to 0.49 mm/mmHg. Moreover, greater severity of tricuspid regurgitation results in an underestimation of SPAP potentially reducing the usefulness of TAPSE/SPAP ratio in patients with massive and torrential TR.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274089","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":"The association between polypharmacy and mortality in patients with heart failure: Results from the PULSE dataset.","authors":"Janine Beezer, Andrew L Clark, Adam Todd, Andrew Kingston, Andrew Husband","doi":"10.1002/ehf2.15445","DOIUrl":"https://doi.org/10.1002/ehf2.15445","url":null,"abstract":"<p><strong>Aims: </strong>Mortality remains high in heart failure despite advances in heart failure therapy. Heart failure patients are generally older, with multiple long-term conditions, and polypharmacy is common. This study explores the association between polypharmacy and mortality.</p><p><strong>Methods: </strong>This retrospective longitudinal observational cohort study collected medication data on admission and discharge from the first heart failure hospitalisation. Association with mortality was explored using Cox proportional hazard models and inverse probability weighting regression analysis.</p><p><strong>Results: </strong>A total of 660 patients were included, 367 (56%) male, mean age 76.1 (SD ±12.3) and almost 60% (338/660) had died at study end. Median follow-up time was 2.9 years (25th and 75th quartiles 1.6 and 4.5). It was rare to be discharged from hospital with no polypharmacy (5%, n = 31). Heart failure with preserved ejection fraction (HFpEF) was associated with a 32% (HR 1.32, CI 1.08-1.61, P = 0.007) higher mortality compared to HFrEF. In those with heart failure with reduced ejection fraction (HFrEF), univariable analysis showed hyperpolypharmacy was associated with twice the mortality compared to polypharmacy (HR 1.95, CI 1.36-2.82, P < 0.001). In multivariable analysis, the association between polypharmacy and mortality was lost. The average treatment effect for hyperpolypharmacy was associated with 26% (Coeff. -0.26, CI -0.43 to -0.09, P = 0.003) higher mortality than polypharmacy. The chance of survival to the end of follow-up was 80% (Coeff. 0.80, CI 0.64-0.95, P < 0.01) for those with polypharmacy, and 54% (Coeff. 0.54, CI 0.46-0.61, P < 0.01) for those with hyperpolypharmacy. In HFpEF, hyperpolypharmacy, univariable analysis was not associated with mortality (HR 0.93, CI 0.70-1.24, P = 0.63). Average treatment effect also showed that hyperpolypharmacy was not associated with mortality (Coeff. -0.03, CI -0.15 to 0.08, P = 0.55). The chance of survival to the end of follow-up was 67% (Coeff. 0.67, CI 0.58-0.77, P < 0.01) with polypharmacy and 64% (Coeff. 0.64, CI 0.57-0.71, P < 0.01) with hyperpolypharmacy.</p><p><strong>Conclusions: </strong>Age, sex, CCI, and CFS are strong mortality predictors for HF irrespective of HF subgroup. Rigorous confounding adjustment suggests polypharmacy is associated with mortality following hospitalisation for HFrEF but not HFpEF. Further studies are needed to address the complex interplay between polypharmacy, age, comorbidity, and frailty.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term prognosis of pure and impure tachycardiomyopathy.","authors":"Giulia Stronati, Michele Alfieri, Niki Tombolesi, Alessandro Barbarossa, Samuele Principi, Federico Gullì, Arianna Massari, Gianmarco Bastianoni, Francesca Roccetti, Michela Casella, Antonio Dello Russo, Federico Guerra","doi":"10.1002/ehf2.15444","DOIUrl":"https://doi.org/10.1002/ehf2.15444","url":null,"abstract":"<p><strong>Background and aims: </strong>Tachycardia-induced cardiomyopathy (TCM) is a reversible form of heart failure (HF) driven by arrhythmias, often atrial fibrillation (AF). While reversible, TCM's long-term prognosis remains unclear, especially in comparison to HF with reduced ejection fraction (HFrEF). This study examines the prognosis of pure and impure TCM against other causes of HFrEF.</p><p><strong>Methods: </strong>Prospective, monocentric, observational study of 456 patients hospitalized with de novo, acute decompensated HFrEF, classified into pure TCM, impure TCM, ischaemic HF and non-ischaemic HF. The primary endpoint was all-cause mortality, and the secondary endpoint was the incidence of unplanned cardiovascular hospitalisations. Sensitivity analyses were performed using propensity score matching between the four groups.</p><p><strong>Results: </strong>During a median follow-up of 3 years (interquartile range 1.5-5.1 years), pure TCM had the highest survival rate, and ischaemic HF had the lowest (pure TCM 78.2%; impure TCM 64.8%; non-ischaemic HF 73.4%; ischaemic HF 58.5%; log-rank P < 0.0001). Pure and impure TCM presented the lowest free-from-readmission estimates over follow-up (pure TCM 43.2%; impure TCM 60.0%; non-ischaemic HF 83.2%; ischaemic HF 69.9%; log-rank P < 0.0001). An initial rhythm control strategy was associated with better overall survival in TCM (79% vs. 63%; log-rank P < 0.0001) but similar rates of unplanned hospitalization.</p><p><strong>Conclusions: </strong>Pure TCM shows a favourable survival prognosis but high readmission rates, emphasizing the need for early rhythm control and sustained monitoring for arrhythmia recurrence. An initial rhythm control strategy seems associated with an increased survival, highlighting the importance of early recognition of arrhythmias as a culprit of HF worsening.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250468","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 sodium-glucose cotransporter 2 inhibitors on pulmonary artery pressure in patients with chronic heart failure.","authors":"Judith Rovira-Solé, Evelyn Santiago-Vacas, Pau Codina, Andrea Borrellas, Mar Domingo, Antoni Bayes-Genís","doi":"10.1002/ehf2.70002","DOIUrl":"https://doi.org/10.1002/ehf2.70002","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250403","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":"Reply to letter to the editor.","authors":"Micha T Maeder, Laura A Rechsteiner, Philipp K Haager, Hans Rickli","doi":"10.1002/ehf2.15421","DOIUrl":"https://doi.org/10.1002/ehf2.15421","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238044","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":"Worsening versus advanced heart failure: Management and challenges.","authors":"Alberto Palazzuoli, Marco Giuseppe Del Buono, Giulia La Vecchia, Stephen J Greene, Andrew P Ambrosy, Ovidiu Chioncel, Finn Gustafsson, Selim R Krim, Carl J Lavie, Marianna Adamo, Tuvia Ben Gal, Oliviana Geavlete, Laura Antohi, Giuseppe Rosano, Sean Collins, Filippo Crea","doi":"10.1002/ehf2.15437","DOIUrl":"https://doi.org/10.1002/ehf2.15437","url":null,"abstract":"<p><p>Heart failure (HF) is a progressive condition marked by recurrent episodes of symptom exacerbation, leading to worsening cardiac function, increased hospitalization and mortality risk. Worsening HF (WHF) and advanced HF (AdvHF) represent two distinct stages in this progression, each with unique clinical features and therapeutic needs. WHF is characterized by a deterioration of pre-existing symptoms requiring intensified treatment, such as diuretic escalation, which often reflects disease progression. Conversely, AdvHF involves severe cardiac dysfunction with persistent symptoms despite optimal medical management, requiring advanced interventions such as inotropic support or heart transplant. Although both stages share some pathophysiological and clinical features, they differ significantly in haemodynamic profiles, disease severity and response to treatment. This review argues that recognizing the transition from WHF to AdvHF is a pivotal issue in patient care. We explore the distinct natural histories, clinical presentations and diagnostic markers of WHF and AdvHF to provide a framework for earlier, more targeted interventions aimed at altering the disease trajectory and preventing the decline associated with the advanced stage. While WHF symptoms are typically reversible with appropriate interventions, AdvHF represents the end stage of HF with often irreversible dysfunction and multi-organ involvement. A clearer understanding and standardized definition of these phenotypes are essential for improving patient outcomes and guiding future clinical research.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225278","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}