ESC Heart Failure最新文献

{"title":"Lower left ventricular ejection time in MYBPC3 variant carriers with overt or subclinical hypertrophic cardiomyopathy","authors":"Isabell Yan, Zoe Möhring, Daniel Reichart, Fanny Kortüm, Julia Münch, Rixa Woitschach, Paulus Kirchhof, Lucie Carrier, Carolyn Y. Ho, Thomas Eschenhagen, Monica Patten","doi":"10.1002/ehf2.15346","DOIUrl":"10.1002/ehf2.15346","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Hypertrophic cardiomyopathy (HCM) is an inherited cardiomyopathy often caused by pathogenic variants in <i>MYBPC3</i> and <i>MYH7</i>, encoding myosin-binding protein C3 and myosin heavy chain 7, respectively. These variants can cause increased actin–myosin crossbridge cycling, resulting in ventricular hypercontractility, but mice lacking <i>Mybpc3</i> exhibited reduced left ventricular ejection time (LVET) as a sign of systolic dysfunction. In this study, we tested whether LVET is specifically altered in patients carrying <i>MYBPC3</i> variants by retrospective echocardiographic analysis in two genotype-defined HCM cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>LVET was measured by echocardiography and adjusted for heart rate [LVET index (LVETI)] in 166 patients. Variant carriers were stratified for the presence (LVH+) or absence of left ventricular hypertrophy with septal thickness of ≥13 mm (LVH−). Multivariate analysis of variance (MANOVA) was used to identify differences in LVETI between variant carriers and controls with LVETI as the dependent variable, adjusted for sex, age, left ventricular ejection fraction (LVEF), interventricular septal diameter in diastole (IVSd), diastolic dysfunction, left ventricular outflow tract (LVOT) gradient at rest and medication history as confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In a total of 166 patients carrying <i>MYBPC3</i> or <i>MYH7</i> pathogenic variants (38 ± 3 years, 45% female), we compared the discovery cohort (40 <i>MYBPC3</i> and 31 <i>MYH7</i>) and the validation cohort (‘Valsartan in Attenuating Disease Evolution in Early Sarcomeric HCM’; 54 <i>MYBPC3</i> and 41 <i>MYH7</i>) with 44 healthy controls. LVETI was lower in <i>MYBPC3</i> and higher in <i>MYH7</i> LVH+ patients than in controls in the discovery, validation and pooled cohorts (pooled: <i>MYBPC3</i> 381 ± 19 ms vs. <i>MYH7</i> 437 ± 38 ms, <i>P</i> < 0.001; <i>MYBPC3</i> vs. controls 411 ± 15 ms, <i>P</i> < 0.001; and <i>MYH7</i> vs. controls, <i>P</i> < 0.001). Similar findings were seen in LVH− (pooled: <i>MYBPC3</i> 380 ± 16 ms vs. <i>MYH7</i> 437 ± 39 ms, <i>P</i> < 0.001; <i>MYBPC3</i> vs. controls, <i>P</i> < 0.001). While <i>MYH7</i> variants were all missense as expected, 87% of the <i>MYBPC3</i> variants were truncating (including nonsense variants, out-of-frame deletion and splice site variants) and 13% were non-truncating (missense and in-frame deletion). LVETI did not differ between the groups and was significantly lower than the control in both.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Con","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3416-3425"},"PeriodicalIF":3.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15346","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559545","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":"Cardiogenic shock requiring VA-ECMO therapy in scorpionism-induced myocarditis","authors":"Alba I. Violino, María Alicia Lozano, Rocio Garcia Moralez, Juan P. Ricarte-Bratti, Julieta Lozita, Elizabeth Y. Ravinovich","doi":"10.1002/ehf2.15368","DOIUrl":"10.1002/ehf2.15368","url":null,"abstract":"<p>It is estimated that approximately 1.2 million scorpion stings occur globally each year. However, the true incidence is likely underestimated due to underreporting, particularly in endemic regions with limited access to healthcare systems. While the vast majority of stings result in only local symptoms, approximately 5% of patients develop systemic manifestations, and up to 1% progress to life-threatening complications such as acute heart failure, arrhythmias and cardiogenic shock.<span><sup>1</sup></span></p><p>Scorpion envenomation represents a significant public health issue in tropical and subtropical regions, including parts of Latin America. This case occurred in Córdoba, Argentina, a temperate region in the central part of the country characterized by hot summers and mild winters. The city of Córdoba, where the patient was treated, is a large urban centre surrounded by hilly terrain and natural scorpion habitats. <i>Tityus trivittatus</i>, the most medically relevant scorpion species in Argentina, is endemic to the area, with increasing reports of envenomation during the warm season.<span><sup>2</sup></span></p><p>Cardiovascular complications are among the most severe and life-threatening effects of systemic scorpion envenomation. In a systematic review of over 700 reported cases of scorpion-related myocarditis, pulmonary oedema occurred in approximately 60.7% of cases, and hypotension or cardiogenic shock in 45.8%. Sinus tachycardia was the most common ECG abnormality (82%), followed by ST-T changes (64.6%), with less frequent findings such as ventricular arrhythmias and atrioventricular blocks. Echocardiographic evaluations often reveal global or regional hypokinesia, ventricular dilation and reduced left ventricular ejection fraction (EF)—frequently below 40%. Right ventricular dysfunction and functional mitral or tricuspid regurgitation may also be observed. Despite the severity of these manifestations, many patients—particularly children—exhibit rapid and complete recovery with timely supportive care.<span><sup>3, 4</sup></span></p><p>Although the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been documented in paediatric patients with severe envenomation, no previous cases have been reported in adults.<span><sup>5</sup></span> We present what is, to our knowledge, the first documented case of successful VA-ECMO support in an adult patient with cardiogenic shock secondary to <i>Tityus trivittatus</i> envenomation, underscoring the importance of early recognition and aggressive intervention in such critical scenarios.</p><p>A 21 year-old female with no significant past medical history presented to the emergency department with acute onset of sharp pain in the right foot, radiating proximally along the lower limb, accompanied by sudden-onset vomiting. On admission, she was haemodynamically stable with normal vital signs. According to the patient and her family, the symptoms began approximately 4 h following a","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3780-3784"},"PeriodicalIF":3.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15368","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559544","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":"An unusual presentation of pheochromocytoma accompanied by catecholamine-induced cardiomyopathy","authors":"Hugh O.J. Roberts, Alexandru Munteanu, Jonas E. Mertens","doi":"10.1002/ehf2.15328","DOIUrl":"10.1002/ehf2.15328","url":null,"abstract":"<p>Pheochromocytomas are catecholamine-secreting tumours arising from chromaffin cells in the adrenal medulla. They are rare, with an annual incidence in Europe of 0.2 per 100 000 people.<span><sup>1</sup></span> Diagnosis is challenging due to their rarity and non-specific symptoms. Half are discovered incidentally on computed tomography (CT) or magnetic resonance imaging (MRI). These tumours are histologically indistinguishable from extra-adrenal catecholamine-secreting neoplasms, commonly referred to as paragangliomas. The majority of catecholamine-secreting tumours occur sporadically; however, approximately 40% are associated with hereditary syndromes. Familial cases are more likely to present with bilateral pheochromocytomas or multifocal paragangliomas. All known familial syndromes associated with these tumours follow an autosomal dominant pattern of inheritance, including Von Hippel–Lindau (VHL) syndrome, multiple endocrine neoplasia type 2 (MEN2) and neurofibromatosis type 1 (NF1). The prevalence of pheochromocytoma in individuals with these syndromes is approximately 10%–20% for VHL, 50% for MEN2 and 2%–3% for NF1. Symptoms typically include at least two of the ‘classic triad’: headache, sweating and tachycardia.<span><sup>2</sup></span> Hypertension is the most frequent symptom, although 10% of patients are normotensive.<span><sup>1</sup></span> Rarely, pheochromocytoma is associated with cardiomyopathy attributed to catecholamine excess (catecholamine-induced cardiomyopathy, CICM) that is similar to stress-induced cardiomyopathy (also known as takotsubo syndrome, TTS).<span><sup>3</sup></span> Twenty-nine percent of pheochromocytomas are malignant, but the commonest causes of mortality are complications related to high circulating levels of catecholamines, including stroke, acute renal failure, ischaemic heart disease, arrhythmias, heart failure and pulmonary oedema.<span><sup>4, 5</sup></span> Definitive management is by resection, requiring careful surgical technique and anaesthesia management to avoid inducing catecholamine release and subsequent uncontrolled hypertension. Principles of management of paragangliomas are the same, but anatomical location can make resection challenging. The most typical paraganglioma sites are the carotid body, jugular bulb, middle ear and vagus nerve, and lower cranial nerve deficits are frequent complications of surgery.<span><sup>6</sup></span> Genetic testing is recommended for all individuals diagnosed with catecholamine-secreting tumours and is typically performed following resection and histopathological confirmation. In cases where a hereditary syndrome is identified, genetic evaluation is also indicated for first-degree relatives to facilitate early detection and management.</p><p>A 39-year-old female patient presented to the emergency department with intractable vomiting and a 2-year history of recurrent shaking episodes with palpitations, tingling in her limbs and hot flushes. Migraine assoc","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3776-3779"},"PeriodicalIF":3.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559543","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":"Angiotensin receptor-neprilysin inhibitors in concurrent heart failure with reduced ejection fraction and kidney failure","authors":"Mi-Hyang Jung,&nbsp;Dong-Hyuk Cho,&nbsp;Jimi Choi,&nbsp;Mi-Na Kim,&nbsp;Chan Joo Lee,&nbsp;Jung-Woo Son,&nbsp;Yaeni Kim,&nbsp;Jong-Chan Youn,&nbsp;Byung-Su Yoo","doi":"10.1002/ehf2.15359","DOIUrl":"10.1002/ehf2.15359","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Angiotensin receptor-neprilysin inhibitor (ARNI) therapy has demonstrated improved outcomes in heart failure with reduced ejection fraction (HFrEF). However, its benefits in patients with concomitant kidney failure undergoing replacement therapy remain uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>Using the National Health Insurance Service database, we identified individuals with HFrEF and kidney failure receiving replacement therapy who were prescribed either ARNI or renin-angiotensin system (RAS) blockers between 2017 and 2021. After applying inverse probability of treatment weighting, we compared 2104 patients on ARNI with 2191 on RAS blockers. The primary endpoint was a composite of all-cause mortality and any hospitalization. Secondary endpoints included all-cause mortality, any hospitalization and cardiovascular mortality. During a median follow-up of 19.1 months, ARNI use was associated with a significantly lower risk of the primary endpoint (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.75–0.97) compared with RAS blockers. ARNI also showed a reduced risk of all-cause mortality (HR 0.68, 95% CI 0.54–0.86), any hospitalization (HR 0.86, 95% CI 0.75–0.98) and cardiovascular mortality (HR 0.68, 95% CI 0.52–0.89). Subgroup analyses demonstrated consistent associations across age, sex, comorbidities and medications. Good adherence to ARNI was linked to a lower risk of the primary outcome, whereas non-adherence showed no benefit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among HFrEF patients with kidney failure receiving replacement therapy, ARNI use was associated with lower risks of all-cause mortality, any hospitalization and cardiovascular mortality compared with RAS blockers, particularly in those with good adherence to therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3405-3415"},"PeriodicalIF":3.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15359","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552695","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":"Right ventricular global work efficiency: A reliable non-invasive estimate of right ventricular contractility","authors":"Paolo Manca,&nbsp;Vincenzo Nuzzi,&nbsp;Alessandro Lucchino,&nbsp;Gerardo Rugiano,&nbsp;Massimiliano Mulè,&nbsp;Alessandra Carvelli,&nbsp;Stefano Cannata,&nbsp;Sergio Sciacca,&nbsp;Francesca Parisi,&nbsp;Sabato Sorrentino,&nbsp;Francesco Fulvio Faletra,&nbsp;Paolo C. Colombo,&nbsp;Manlio Gianni Cipriani","doi":"10.1002/ehf2.15354","DOIUrl":"10.1002/ehf2.15354","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Right ventricular (RV) myocardial work (RVMW) recently emerged as a non-invasive alternative for the assessment of RV contractility. However, none of the prior studies assessed its variations under different haemodynamic conditions. We aimed to evaluate the variations of the components of RVMW in heart failure (HF) patients with pulmonary hypertension (PH) undergoing a reversibility test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive HF patients with reduced ejection fraction who underwent right heart catheterization and echocardiography at our institution were prospectively enrolled. Patients with PH and augmented pulmonary vascular resistance who achieved normalization of pulmonary pressures after the reversibility test using vasodilators underwent a second echocardiographic assessment under the same haemodynamic conditions. Four components of RVMW were analysed: (1) RV global work index (mmHg%); (2) RV global constructive work (mmHg%); (3) RV global wasted work (RVGWW) (mmHg%); (4) RV global work efficiency (RVGWE) (%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred two patients were enrolled (53 with PH and 49 without). Global RVMW was higher in patients with PH, due to a significantly higher RVGWW [81 (55–119) mmHg% vs. 49 (28–72) mmHg%; <i>P</i> = 0.013], while RVGWE was similar between the two groups (80 ± 10% vs. 82 ± 12%; P = 0.332). In patients with PH, 27/52 (51.9%) had combined PH, while 25/52 (48.1%) had isolated post-capillary PH. A reversibility test was performed in 26/27 (96.2%) patients with combined PH and pulmonary pressure normalization was observed in 16/26 (61.5%) subjects. In patients with PH normalization, RVGWE remained almost unchanged (from 82.8 ± 6.9% to 85.3 ± 6.6%; <i>P</i> = 0.596), while RVGWW significantly decreased [from 60 (49–90) mmHg% to 41 (31–53) mmHg%; <i>P</i> = 0.027]. Among all the echocardiographic and haemodynamic parameters adopted for assessing RV function, RVGWE was the least variable during the reversibility test (mean variation 3 ± 10%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RVGWE is comparable between HF patients with and without PH and remains stable across different haemodynamic conditions. This consistency suggests that it can be a reliable parameter for assessing RV contractility. Larger studies are needed to confirm this hypothesis and to test its prognostic significance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3719-3730"},"PeriodicalIF":3.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552697","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":"Home-operated ultrasound exam for detection of worsening heart failure (HOUSE-HF)","authors":"Stuart B. Prenner,&nbsp;Kevin Dougherty,&nbsp;Frances S. Shofer,&nbsp;Lee R. Goldberg,&nbsp;Nova Panebianco","doi":"10.1002/ehf2.15343","DOIUrl":"10.1002/ehf2.15343","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Acute decompensated heart failure (ADHF) is associated with a high degree of morbidity and mortality. Dynamic lung ultrasound artefact called B-lines can be obtained at the bedside and directly correlate with pulmonary vascular congestion. Obtaining patient-performed lung ultrasound images in the outpatient setting is novel. We assessed the feasibility of patients recently hospitalized for ADHF to self-perform a limited lung ultrasound using a handheld ultrasound probe and upload the images to a secure cloud for physician interpretation.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This was a prospective observational convenience sample. Patients were enrolled from an urban academic tertiary care centre and were eligible if they had chronic left-sided heart failure regardless of ejection fraction. While hospitalized, patients were educated for 20 min on a six-lung-zone image protocol, how to use the cloud archival system and given a handheld ultrasound transducer and smart tablet. A brief instructional video was also available to patients on the smart tablet throughout the study (https://www.dropbox.com/scl/fi/bii7ovdcv21ps7yxyqsy1/120-21080-00-Rev-01-BNI-041-UPENN-IN-APP-TRAINING-VIDEO.mp4?rlkey=f5vu55xbnugdoz6jzyb8lv872&amp;st=56es4qif&amp;dl=0). Patients were asked to upload images three times weekly, for 3 weeks, for a total of nine studies. All images were reviewed and a B-line score was calculated for each lung zone, and a total B-line score for the entire exam. Additionally, patients completed a survey to assess the patient-centred experience.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 15 patients were enrolled, all of whom completed seven or more studies (10 patients completed all 9). Median patient age was 63 years (range: 28 –86 years), the majority were male (73%), white (60%) and average body mass index was 33 kg/m&lt;sup&gt;2&lt;/sup&gt;. Of them,33.3% had an ejection fraction &gt;50%, average hospital length of stay was 6.3 days. Of the 792 potential images, 788 were obtained (99.5%). Of these, a total of 637 scans were interpretable (80.8%). The right upper apical lung zone (zone 1R) was most often adequate for interpretation (96.2%), where left lower mid-axillary (zone 3L) was least often interpretable (69.5%). The average number of B-lines per six-image scan was three (with a range of 0–13). Patient survey data identified zone 3L as the most challenging to obtain with overall high satisfaction with the study educational materials.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This pilot stud","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3372-3380"},"PeriodicalIF":3.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15343","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552696","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":"Prognostic utility of advanced lung cancer inflammation index in heart failure with preserved ejection fraction","authors":"Daisuke Sakamoto,&nbsp;Yuki Matsuoka,&nbsp;Masahiro Seo,&nbsp;Takahisa Yamada,&nbsp;Daisaku Nakatani,&nbsp;Katsuki Okada,&nbsp;Akihiro Sunaga,&nbsp;Hirota Kida,&nbsp;Taiki Sato,&nbsp;Tetsuhisa Kitamura,&nbsp;Shunsuke Tamaki,&nbsp;Masamichi Yano,&nbsp;Takaharu Hayashi,&nbsp;Akito Nakagawa,&nbsp;Yusuke Nakagawa,&nbsp;Yoshio Yasumura,&nbsp;Shungo Hikoso,&nbsp;Yohei Sotomi,&nbsp;Yasushi Sakata,&nbsp;the OCVC-Heart Failure Investigators","doi":"10.1002/ehf2.15313","DOIUrl":"10.1002/ehf2.15313","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Malnutrition and inflammation are associated with poor outcomes with heart failure (HF). As a marker integrating inflammation and nutritional status, the advanced lung cancer inflammation index (ALI), calculated by body mass index × serum albumin level / neutrophil-to-lymphocyte ratio, has been developed for the prognosis of several diseases including HF. The aim of this study is to investigate the prognostic value of ALI in elderly multimorbid HF patients with HF with preserved ejection fraction (HFpEF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study utilized data from the Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with preserved Ejection Fraction (PURSUIT-HFpEF). Patients with acute decompensated HF and left ventricular ejection fraction ≥50% were included. ALI levels were calculated from discharge data. The primary endpoint was all-cause death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1238 patients [83 (77, 87) years, 555 (45%) male] were enrolled, with 1121 analysed for prognostic value of ALI. In the multivariable Cox model, ALI was significantly associated with the primary endpoint [adjusted hazard ratio (HR) for log-transformed ALI: 0.50, 95% confidence interval (CI): 0.34–0.75, <i>P</i> = 0.001]. ALI appears to enhance the prognostic value of the MAGGIC risk score [net reclassification improvement (NRI) = 46% (95% CI: 28%–65%), <i>P</i> &lt; 0.001; integrated discrimination improvement (IDI) = 4.6% (95% CI: 2.8%–6.5%), <i>P</i> &lt; 0.001], the geriatric nutritional risk index [NRI = 16% (95% CI: −3% to 35%), <i>P</i> = 0.103; IDI = 2.0% (95% CI: 0.8%–3.1%), <i>P</i> &lt; 0.001] and C-reactive protein [NRI = 39% (95% CI: 20%–58%), <i>P</i> &lt; 0.001; IDI = 4.8% (95% CI: 2.9%–6.6%), <i>P</i> &lt; 0.001].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Low ALI levels were significantly associated with poor prognosis in elderly multimorbid HFpEF patients. ALI might complement existing risk indices for prognostic assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3361-3371"},"PeriodicalIF":3.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539624","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 impact of follow-up endomyocardial biopsy in myocarditis during or after immune-suppressive therapy","authors":"Anna Baritussio,&nbsp;Andrea Silvio Giordani,&nbsp;Stefania Rizzo,&nbsp;Cristina Vicenzetto,&nbsp;Monica De Gaspari,&nbsp;Elisa Carturan,&nbsp;Giuseppe Toscano,&nbsp;Federico Scognamiglio,&nbsp;Giuseppe Tarantini,&nbsp;Sabino Iliceto,&nbsp;Cristina Basso,&nbsp;Renzo Marcolongo,&nbsp;Alida Linda Patrizia Caforio","doi":"10.1002/ehf2.15349","DOIUrl":"10.1002/ehf2.15349","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>While the diagnostic role of endomyocardial biopsy (EMB) in myocarditis is unquestioned, little is known about its indications and clinical value during long-term follow-up. We aim to report our experience on the clinical relevance of repeating EMB in a cohort of biopsy-proven myocarditis patients treated with immune-suppressive therapy (IMT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>We retrospectively included 92 patients with virus-negative EMB-proven myocarditis treated with IMT, of whom 22 [73% male, 37 years, interquartile range (IQR) 33–48] received at least one, uneventful, follow-up EMB, 3.5 years (IQR 2.5–5.3) after the first one. Follow-up EMB was performed because of clinical worsening (<i>n</i> = 12) or suspected myocarditis relapse (<i>n</i> = 7) and to assess IMT response (<i>n</i> = 3). Patients receiving follow-up EMB more likely had abnormal troponin levels (<i>P</i> = 0.048) and a trend towards lower prevalence of anti-heart auto-antibodies positivity at diagnosis (<i>P</i> = 0.05) and showed worse imaging findings at follow-up. Active or borderline myocarditis on follow-up EMB was found in 12 patients, leading to a change in IMT regimen in 10 (83%); among patients with evidence of healed myocarditis, 2 had a change in IMT regimen, 2 underwent heart transplant evaluation check list, 2 had mitral valve treatment, 1 received ventricular tachycardia ablation and 1 primary prevention implantable cardioverter-defibrillator implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>One-fourth of EMB-proven myocarditis patients had a clinical indication to repeat EMB at least once during long-term follow-up. Follow-up EMB was safe in all cases; it showed active or borderline myocarditis in 55% of patients and lead to a change in management in the majority of patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3707-3718"},"PeriodicalIF":3.7,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526938","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":"Improvements in medical therapy and prognosis for patients with HFrEF following the 2021 ESC HF guidelines","authors":"Kristian Berge,&nbsp;Henrik Schirmer,&nbsp;Tarjei Øvrebotten,&nbsp;Hamza Nahoui,&nbsp;Lars Gullestad,&nbsp;Charlotte Björk Ingul,&nbsp;Torstein Hole,&nbsp;Rune Mo,&nbsp;Kristina Larsby,&nbsp;Tone M. Norekvål,&nbsp;Torbjørn Omland,&nbsp;Stein Ørn,&nbsp;Peder L. Myhre","doi":"10.1002/ehf2.15337","DOIUrl":"10.1002/ehf2.15337","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The guideline-directed medical therapy (GDMT) sequencing strategy for patients with heart failure (HF) and reduced ejection fraction (HFrEF) underwent a paradigm shift with the 2021 ESC HF guidelines, from stepwise escalation to rapid simultaneous initiation of quadruple therapy. We aimed to assess the temporal trends in the use of GDMT and prognosis for patients with HFrEF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>Through the Norwegian HF Registry, we obtained data on patients treated at HF outpatient clinics with left ventricular ejection fraction ≤40% from 2016 through 2023 (<i>n</i> = 13 992), including GDMT, HF hospitalisations and mortality. Since 2016, &gt;90% of patients have been treated with beta-blockers and renin-angiotensin-system-inhibitors, with angiotensin receptor-neprilysin inhibitors (ARNI) utilisation increasing from 4% in 2016 to 54% in 2023. Mineralocorticoid-receptor-antagonists (MRA) utilisation was at 36% in 2016, increased by 3% per year to 54% in 2021, and thereafter increased by 12% per year to 78% in 2023. Sodium-glucose cotransporter-2-inhibitors (SGLT2i) utilisation increased rapidly from 3% in 2020 to 85% in 2023. The utilisation of ≥50% of target dose followed similar trends. From 2016 to 2021, the crude 6-month mortality rate remained at 2.7%, followed by a decline of approximately 0.5% per year to 1.8% in 2023. HF hospitalisations declined steadily from 12.9% in 2016 to 8.2% in 2021, with a further decline to 6.8% in 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The utilisation of GDMT in Norwegian HF clinics has increased markedly since 2016, with a fourfold acceleration in MRA and a substantial increase in SGLT2i use following the 2021 ESC HF guidelines. HF hospitalisations have consistently declined, while mortality rates first declined after 2021.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3343-3352"},"PeriodicalIF":3.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15337","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505219","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 transplantation outcomes with donation after circulatory death in patients with left ventricular assist device","authors":"Aris Karatasakis,&nbsp;Edwin Grajeda Silvestri,&nbsp;Gatha G. Nair,&nbsp;Benjamin Zuniga,&nbsp;Song Li,&nbsp;Claudius Mahr,&nbsp;Richard K. Cheng,&nbsp;April S. Stempien-Otero,&nbsp;Ioannis Dimarakis,&nbsp;Maziar Khorsandi,&nbsp;Jay D. Pal,&nbsp;Jorge R. Kizer,&nbsp;Marc A. Simon,&nbsp;Claudio A. Bravo","doi":"10.1002/ehf2.15357","DOIUrl":"10.1002/ehf2.15357","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Donation after circulatory death (DCD) has emerged as a strategy to increase the donor pool for heart transplantation (HT). Left ventricular assist device (LVAD) patients represent a discrete and unique population. We sought to explore the early outcomes of DCD-HT compared with donation after brain death (DBD) HT in LVAD patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>We obtained data from the United Network of Organ Sharing database. The main cohort consisted of adults listed for HT between 17 October 2018 and 3 July 2024, with LVAD implanted before or after listing. The primary outcome was survival within the first year post-HT. There were 3336 patients with LVAD underwent HT during the study period (median age 55 years (interquartile range 45–62), 24% women, 29% Black, 89% DBD). The short-term post-HT mortality in LVAD patients who underwent DCD HT was not significantly different from DBD (adjusted hazard ratio [aHR] 1.00, 95% CI 0.70–1.42, <i>P</i> value &gt; 0.9). The likelihood of transplantation within 1 year was higher at centres performing DCD (aHR 1.44, 95% CI 1.39–1.49, <i>P</i> &lt; 0.001). Despite the longer donor-recipient distance in DCD-HT, in-hospital outcomes (stroke and acute kidney injury requiring dialysis) were not different from DBD-HT. A higher incidence of primary graft dysfunction (adjusted risk ratio [aRR] 3.8, 95% CI 2.5–5.7, <i>P</i> &lt; 0.001), and treated rejection was observed with DCD-HT (aRR 1.48, 95% CI 1.14–1.93, <i>P</i> = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In LVAD patients who received DCD HT, early post-transplant survival, stroke, acute kidney injury and length of stay were not significantly different from those who underwent DBD HT. There were increased rates of primary graft dysfunction and treated rejection among LVAD patients who underwent DCD HT. Patients in a DCD centre were significantly more likely to be transplanted earlier.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3333-3342"},"PeriodicalIF":3.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15357","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505218","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}