ESC Heart Failure最新文献

{"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":"Assessing cardiovascular benefits of intensive blood pressure lowering in high-risk undiagnosed HFpEF patients.","authors":"Xinru Liu, Zhiyan Wang, Chang Hua, Yanfang Wu, Yangyang Tang, Yuling Xiong, Jingwei Liu, Jiaqi Zhang, Qiang Lv, Chao Jiang, Jianzeng Dong, Xin Du","doi":"10.1002/ehf2.15435","DOIUrl":"https://doi.org/10.1002/ehf2.15435","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure with preserved ejection fraction (HFpEF) is often underdiagnosed. This study evaluates the HFpEF-ABA score's ability to identify high-risk, undiagnosed HFpEF subgroups with elevated cardiovascular event rates and assesses the impact of intensive blood pressure control in these populations.</p><p><strong>Methods: </strong>A post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) was performed. The HFpEF-ABA score identified high-risk individuals with undiagnosed HFpEF. Cox proportional hazards regression was used to examine interactions between HFpEF-ABA score groups and intensive blood pressure control on major cardiovascular outcomes. The primary outcome was a composite of myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure and cardiovascular disease death.</p><p><strong>Results: </strong>Among 9265 patients (mean age, 67.9 ± 9.4 years; 35.5% females), 559 primary outcomes occurred during a median follow-up of 3.2 years. An HFpEF-ABA score ≥ 90% was associated with a higher risk of the primary outcome [adjusted hazard ratio (aHR), 1.96 (1.57-2.44); P < 0.001]. When treated as a continuous variable, higher HFpEF-ABA scores were independently associated with an increased risk of the primary composite outcome (P = 0.001), with a modest non-linear relationship observed (P for non-linearity = 0.040). In the intensive treatment group, the absolute reduction in primary outcomes was 5.0 per 1000 patient-years for scores < 90% and 11.2 per 1000 patient-years for ≥ 90%. Intensive blood pressure control reduced primary outcomes in both groups [<90%: aHR, 0.75 (0.62-0.90); ≥90%: aHR, 0.76 (0.51-1.13)] with no significant heterogeneity (P for interaction = 0.944). Serious adverse events did not increase in either group [<90%: aHR, 1.04 (0.96-1.11); ≥90%: aHR, 1.06 (0.88-1.28); P for interaction = 0.801].</p><p><strong>Conclusions: </strong>The HFpEF-ABA score identifies high-risk patients with undiagnosed HFpEF who have elevated cardiovascular event rates and benefit from intensive blood pressure control without an increased risk of serious adverse events.</p>","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":"145238030","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}

{"title":"Percutaneous endocardial alginate-hydrogel injection in the treatment of heart failure: First-in-human study.","authors":"Bo Wang, Shuo Wang, Chao Gao, D Scott Lim, Rutao Wang, Xin Meng, Ying Liu, Cun-Jun Zhu, Yoshinobu Onuma, Yunbing Wang, Patrick W J C Serruys, Runlin Gao, Randall J Lee, Ling Tao","doi":"10.1002/ehf2.15417","DOIUrl":"https://doi.org/10.1002/ehf2.15417","url":null,"abstract":"<p><strong>Aims: </strong>Despite the potential of alginate hydrogel intramyocardial injections in the treatment of heart failure (HF), minimally invasive implantation techniques remain scarce. This study evaluated the safety and feasibility of percutaneous transcatheter endocardial alginate hydrogel injection (TEAi), facilitated by novel implants and a dedicated catheter-based device, in patients with HF with reduced ejection fraction (HFrEF).</p><p><strong>Methods and results: </strong>This first-in-human study enrolled HFrEF patients [New York Heart Association (NYHA) Class III-IV and left ventricular ejection fraction (LVEF) ≤35%]. The primary endpoint was the incidence of procedure- or device-related serious adverse events (SADEs) at 30 days. Secondary endpoints included the device success rate, HF hospitalization at 6 months, and change from baseline to 6 months post-procedure in the following parameters: LVEF as assessed by MRI; NYHA functional class; 6 min walk test distance (6MWT); the quality of life assessed by the Kansas City Cardiomyopathy Heart Failure Questionnaire (KCCQ); and serum N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) level. Pre- and post-procedural biomechanical analysis was also evaluated. Ten patients successfully underwent TEAi with no SADEs at 30 days. There was one death and two HF hospitalizations at 6 months. At 6 months, LVEF improved from 17.7% ± 3.8% to 24.9% ± 11.2% (P = 0.021), end-systolic volume decreased from 297.5 ± 67.9 mL to 264.8 ± 101.4 mL (P = 0.029), and KCCQ scores increased from 49.7 ± 3.9 to 79.0 ± 8.07 (P = 0.008). No statistically significant changes were observed in end-diastolic volume, NT-proBNP and 6MWT at six months compared with the baseline. Biomechanical analysis revealed a reduction in peak left ventricular end-diastolic wall stress (6.5 ± 1.1 kPa vs. 5.9 ± 1.3 kPa, P = 0.043).</p><p><strong>Conclusions: </strong>TEAi is feasible and safe for the treatment of HFrEF, warranting further randomized, efficacy clinical trials.</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":"145225272","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, '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}