ESC Heart Failure最新文献

{"title":"The use of echocardiography and echocardiographic findings in patients hospitalized for acute heart failure.","authors":"Koravich Lorlowhakarn, Thanaporn Ratchataswan, Thiratest Leesutipornchai, Aunchalee Jaroenlapnopparat, Palapun Waitayangkoon, Supanee Sinphurmsukskul, Sarawut Siwamogsatham, Sarinya Puwanant, Smonporn Boonyaratavej Songmuang, Aekarach Ariyachaipanich","doi":"10.1002/ehf2.15268","DOIUrl":"https://doi.org/10.1002/ehf2.15268","url":null,"abstract":"<p><strong>Aims: </strong>Transthoracic echocardiography (TTE) is recommended as a key investigation in patients with acute heart failure (AHF) in major guidelines. However, utilization and benefits are yet to be known in Thai patients. The study aims to evaluate the benefits of TTE and identify factors associated with the decision to perform TTE on patients with AHF.</p><p><strong>Methods: </strong>This is a retrospective study of consecutive patients hospitalized for AHF in a tertiary care hospital in Thailand from July 2017 to June 2019. The patients were identified by the International Classification of Diseases (ICD) coding, and the diagnosis of AHF was confirmed by the Framingham criteria. Characteristics and outcomes of the patients who received TTE and those who did not were compared. Factors determining the use of TTE during hospitalization were identified using regression analysis.</p><p><strong>Results: </strong>A total of 697 patients were enrolled (mean age 69 ± 14.6 years, 50.5% women, mean ejection fraction 47 ± 18.9%). Of these, 362 patients (51.9%) had TTE during hospitalization. The mean age and comorbidities were similar between groups. The patients with TTE were more likely to be women (54.6% vs. 46.1%, P = 0.03). More severe hospital courses were observed in patients with TTE, including intensive care unit (ICU) admission, mechanical ventilation and inotrope use (26.5% vs. 10.7%, 26.2% vs. 14.9%, and 24% vs. 13.1%, respectively; P < 0.001 for all). The overall in-hospital mortality was 5.5% and not different between groups. The 30 day mortality was lower in patients with TTE but did not reach statistical significance (2.1% vs. 4.7%, P = 0.05). In multivariate analysis, patients with ICU admission [adjusted odds ratio (aOR) = 7.33], longer length of stay (aOR = 3.05), higher haemoglobin (aOR = 1.22) and lower blood urea nitrogen (BUN) level (aOR = 1.37) were independent factors associated with the decision to perform TTE on patients hospitalized for AHF (P < 0.05 for all).</p><p><strong>Conclusions: </strong>TTE was commonly performed in patients hospitalized for AHF, especially ones with more severe hospital courses. The outcomes were not different in patients who received TTE.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854950","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":"Decoding anthracycline- and trastuzumab-related cardiac dysfunction prediction: HFA-ICOS scores versus strain imaging.","authors":"Hai Hoang Nguyen, Nhat Minh Giang, Duc Tan Vo, Tri Huynh Quang Ho, Chau Ngoc-Hoa","doi":"10.1002/ehf2.15399","DOIUrl":"https://doi.org/10.1002/ehf2.15399","url":null,"abstract":"<p><strong>Aims: </strong>Baseline Heart Failure Association-International Cardio-Oncology Society (HFA-ICOS) scores and serial left ventricular global longitudinal strain (LV-GLS) measurements have been found to be useful in predicting cancer therapy-related cardiac dysfunction (CTRCD). However, their integration for the purpose of improving prognostic accuracy remains unclear; and we aimed to develop a predictive model for CTRCD using baseline HFA-ICOS scores and the relative decline of LV-GLS in patients on anthracycline or trastuzumab.</p><p><strong>Methods: </strong>We prospectively enrolled 443 chemotherapy-naïve women with breast cancer and cardiovascular risk factors, scheduled to receive anthracycline (n = 333) or trastuzumab (n = 110). Participants were stratified by the HFA-ICOS risk score. The left ventricular ejection fraction (LVEF) and LV-GLS were evaluated using echocardiography at baseline, before each treatment cycle, and every 3 months in the first year post-chemotherapy. CTRCD was a new LVEF reduction ≥10 percentage points to an LVEF < 50%, irrespective of symptoms.</p><p><strong>Results: </strong>In terms of HFA-ICOS stratification, 258 patients (58.2%) were low risk, 180 (40.6%) were moderate risk and 5 (1.2%) were high risk. The proportions of low- and moderate-risk patients were similar in the anthracycline and trastuzumab groups. Twenty-four (7.2%) and seven (6.4%) patients treated with anthracycline and trastuzumab, respectively, displayed asymptomatic CTRCD. The addition of the baseline HFA-ICOS risk score did not improve the performance of the significant relative decline of LV-GLS > 15% in predicting both anthracycline [area under the receiver-operating characteristic curve (AUC) 0.93, 95% confidence interval (CI) 0.89-0.96, sensitivity 87.5%, specificity 93.2%] and trastuzumab (AUC 0.97, 95% CI 0.88-0.99, sensitivity 85.7%, specificity 93.2%)-related cardiac dysfunction.</p><p><strong>Conclusions: </strong>Contemporary anthracycline and trastuzumab-based regimens resulted in similarly low incidences of CTRCD. In this context, LV-GLS evolution was the best predictor of CTRCD.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854948","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":"Facilitators, barriers, and insights using an HFA-PEFF-based clinical decision support system: A proof-of-concept study.","authors":"Isidora Milosavljević, Ivan Petrović, Aleksandra Ilić, Dragana Dabović, Aleksandra Milovančev, Goran Remer, Vladimir Vuković, Dimitrije Zdravković, Maja Stefanović, Snežana Stojšić, Ana Balenović, Goran Lončar, Snežana Tadić, Milana Jaraković, Snežana Bjelić, Snežana Čemerlić, Marija Bjelobrk, Tatjana Miljković, Andrej Preveden, Milovan Petrović, Srdjan Maletin, Tanja Popov, Vanja Drljević Todić, Mirko Todić, Aleksandra Vulin, Milenko Čanković, Dragica Andrić, Dragoslava Živkov Šaponja, Aleksandar Redžek, Anastazija Stojšić Milosavljević","doi":"10.1002/ehf2.15397","DOIUrl":"https://doi.org/10.1002/ehf2.15397","url":null,"abstract":"<p><strong>Background and aims: </strong>Knowing that heart failure (HF) with preserved ejection fraction (HFpEF) can be difficult to diagnose, a clinical decision support system (CDSS), with functional, morphological and biomarker domains, was built. Therefore, this research aimed to analyse the possibility of implementing CDSS, compliance of the physicians with the CDSS recommendations, as well as identify obstacles and facilitators to its usage.</p><p><strong>Methods: </strong>This mixed-methods study was conducted over a 1 year period at the Institute of Cardiovascular Diseases of Vojvodina (Sremska Kamenica, Serbia). The retrospective component included an analysis of patients who had symptoms and/or signs of HF, with an ejection fraction (EF) of ≥50%. The Heart Failure Association pre-test assessment, echocardiography and natriuretic peptide, functional testing, final aetiology (HFA-PEFF) score was used to build a CDSS and to calculate the probability scores for these patients. The prospective component involved an electronic survey that was used to gain feedback from physicians about the CDSS.</p><p><strong>Results: </strong>The sample included 225 patients, out of which 194 (86.2%) had the HFA-PEFF score of 5-6, suggesting probable HFpEF. This syndrome was clinically documented in the discharge report in only 32 (16.5%) of these patients. The response rate of the survey was 83.3%, including physicians at different levels of education. Barriers to CDSS usage included a lack of echocardiographic skills and knowledge about phenotype profiling in HFpEF patients. An increase in explainability and transparency, as well as staff education, were mentioned as the main facilitators.</p><p><strong>Conclusions: </strong>The CDSS demonstrated reasonable effectiveness in diagnosing and classifying patients with symptoms of HF if the measured EF was ≥50%. The conducted survey highlighted that physician education, in both CDSS- and HFpEF-related domains, is a key factor in the battle against HFpEF.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854949","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":"Clinical characteristics and outcomes of adults with acute heart failure in a South African teaching hospital.","authors":"Umar G Adamu, Muzi Maseko, Nqoba Tsabedze","doi":"10.1002/ehf2.15394","DOIUrl":"https://doi.org/10.1002/ehf2.15394","url":null,"abstract":"<p><strong>Aims: </strong>In sub-Saharan Africa (SSA), the clinical profile and in-hospital outcomes of adults with acute heart failure (HF) based on left ventricular ejection fraction (LVEF) categories are unknown. This study aimed to describe the prevalence and clinical characteristics of patients admitted with acute HF based on LVEF categories and their association with in-hospital outcomes.</p><p><strong>Methods: </strong>Four hundred six consecutive patients with acute HF were enrolled in this prospective study between February and November 2023. The patients were stratified into three categories: HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF) and HF with preserved ejection fraction (HFpEF). The primary outcome measure was all-cause in-hospital mortality. The prevalence and outcomes of various LVEF phenotypes were evaluated in adult patients with acute HF.</p><p><strong>Results: </strong>The mean age of the patients was 54.94 ± 15.83 years, of whom 207 (51%) were female (P = 0.004). Two hundred fifty-seven (63.3%) patients had HFrEF, 62 (15.3%) had HFmrEF, and 87 (21.4%) had HFpEF. Patients with HFpEF were older and predominantly female and had a higher median global longitudinal score and lower N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (P < 0.001). The all-cause in-hospital mortality was 3.4% [95% confidence interval (CI): 2.0-6.0] without significant variation across LVEF phenotypes (P = 0.70). In the multivariable model after adjusting for age and sex, higher C-reactive protein levels [odds ratio (OR): 1.02; 95% CI: 1.00-1.03; P = 0.009], elevated neutrophil-lymphocyte ratio (OR: 1.15; 95% CI: 1.03-1.29; P = 0.012), elevated serum potassium (OR: 3.41; 95% CI: 1.23-9.43; P = 0.018), moderate aortic regurgitation (AR) (OR: 12.80; 95% CI: 1.12-101.29; P = 0.016) and severe AR (OR: 34.49; 95% CI: 3.77-353.47; P = 0.002) were observed. Low diastolic blood pressure was associated with a reduced mortality risk (OR: 0.94; 95% CI: 0.89-0.99; P = 0.045).</p><p><strong>Conclusions: </strong>In our study, HFrEF was the predominant phenotype, and each phenotype exhibited distinct clinical and biomarker profiles. All-cause in-hospital mortality was low and did not differ significantly across the phenotypes. Independent predictors of mortality included markers of inflammation, electrolyte imbalance and moderate-to-severe AR. These findings highlight the need for targeted risk stratification and management strategies to improve the outcomes in this population.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834537","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 peak oxygen consumption in heart failure: A systematic review and meta-analysis.","authors":"Konstantinos Prokopidis, Krzysztof Irlik, Julia Piaśnik, Zuzanna Michalska, Mirela Hendel, Katarzyna Nabrdalik, Gregory Y H Lip","doi":"10.1002/ehf2.15391","DOIUrl":"https://doi.org/10.1002/ehf2.15391","url":null,"abstract":"<p><strong>Background and aims: </strong>Heart failure (HF) is a multifactorial disease for which peak oxygen uptake (VO₂peak) may potentially be a prognostic marker of adverse clinical outcomes. This systematic review and meta-analysis aimed to assess published data on the prognostic impact of VO₂peak in HF.</p><p><strong>Methods: </strong>A literature search of observational studies was conducted through PubMed, Scopus, Web of Science and Cochrane Library from inception until January 2025. A meta-analysis was conducted using the random-effects inverse-variance model through hazard ratios (HRs). Increased heterogeneity among studies was evaluated through meta-regressions and publication bias via Egger's test.</p><p><strong>Results: </strong>Sixty-four studies were included in this systematic review and meta-analysis. Per 1 mL/kg/min increase in VO₂peak, all-cause mortality [HR: 0.86, 95% confidence interval (CI) 0.82-0.90, I² = 85%, P < 0.01] and incident ventricular assist device, transplant and all-cause mortality (HR: 0.84, 95% CI 0.79-0.89, I² = 33%, P < 0.01) were significantly reduced, but statistical significance of VO₂peak with cardiovascular mortality was not observed (HR: 0.92, 95% CI 0.82-1.02, I² = 0%, P = 0.12) using adjusted models. Variance among studies was detected based on age, sex, body mass index, left ventricular ejection fraction, atrial fibrillation, hypertension, chronic kidney disease, diabetes and treatment. A significant risk of publication bias was evident.</p><p><strong>Conclusions: </strong>VO₂peak is a prognostic marker for multiple causes of mortality and hospitalization in patients with HF, which may promote further insights into patient risk stratification for adverse events and targeted management.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820940","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":"Multiorgan characterization of inflammasome component expression in a rat model of advanced heart failure.","authors":"Dávid Nagy, Zsófia Onódi, Márton Kocsis, Artúr Tóth, Tímea Bálint, Attila Oláh, Alex Ali Sayour, Bálint András Barta, Béla Merkely, Péter Ferdinandy, Tamás Radovits, Zoltán V Varga, Mihály Ruppert","doi":"10.1002/ehf2.15362","DOIUrl":"https://doi.org/10.1002/ehf2.15362","url":null,"abstract":"<p><strong>Aims: </strong>Targeting inflammasomes in heart failure (HF) might represent a novel therapeutic option. Nevertheless, previous studies focused only on myocardial inflammasome alterations, and data are scarce regarding their regulation and role in HF-associated multiorgan dysfunction. Therefore, we aimed to determine the myocardial, pulmonary, hepatic and renal expression of various inflammasome components in a rat model of advanced HF.</p><p><strong>Methods and results: </strong>Rats underwent transverse aortic constriction (TAC) and were followed-up for 15 weeks. Animals featuring two to three clinical signs of advanced HF were included in the TAC-HF group (n = 6). TAC rats with mild HF were also investigated (0-1 signs, TAC-M group, n = 6). Six sham-operated animals served as controls. The expressions of inflammasome component proteins in left ventricle (LV), right ventricle (RV), lung, liver and kidney tissue were measured with Western blot. Despite the differences between the clinical state of the TAC-HF and TAC-M groups, severe cardiac dysfunction and myocardial remodelling developed in all TAC animals. Absent in melanoma 2 (AIM2) and NLR family CARD domain-containing protein 4 (NLRC4) inflammasome sensors were up-regulated in both the LV and RV of the TAC-HF group compared with sham. AIM2 and NLR family pyrin domain-containing protein 3 (NLRP3), but not NLRC4 expression were elevated in the lungs of the TAC-HF animals. Additionally, pulmonary congestion and CD68-positive leukocyte infiltration were observed in both TAC groups. Inflammasome components were down-regulated in the liver and remained unchanged in the kidneys of the TAC-HF group, despite the presence of renal atrophy and fibrosis. Inflammasome changes were predominantly absent in TAC-M animals.</p><p><strong>Conclusions: </strong>Inflammasome expression shows distinct patterns in specific organs in advanced HF. Future studies aiming to antagonize inflammation in HF should take these findings into consideration.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816107","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":"Relationship of malnutrition and frailty on prolonged stay at the hospital in heart failure patients.","authors":"Katarzyna Lomper, Maria Jędrzejczyk, Marta Wleklik, Izabella Uchmanowicz","doi":"10.1002/ehf2.15390","DOIUrl":"https://doi.org/10.1002/ehf2.15390","url":null,"abstract":"<p><strong>Background: </strong>Nutritional status is a critical determinant of clinical outcomes in patients with chronic heart failure (CHF), potentially contributing to adverse prognosis and suboptimal therapeutic response. Despite growing interest, the interplay between malnutrition and frailty syndrome (FS) in the CHF population remains inadequately elucidated.</p><p><strong>Aims: </strong>The study aims to evaluate the association between malnutrition risk and the presence of FS in individuals hospitalized with CHF.</p><p><strong>Methods: </strong>A total of 200 patients (mean age: 72.28 years) hospitalized due to CHF were enrolled. Data collection included retrospective analysis of medical records and application of validated instruments: the Mini Nutritional Assessment (MNA) for nutritional evaluation and the Fried phenotype criteria for frailty assessment.</p><p><strong>Results: </strong>Based on MNA, 63.5% of participants demonstrated normal nutritional status, 35.0% were at risk of malnutrition and 1.5% were malnourished (mean MNA score: 24.25). According to the Fried phenotype, 35% were classified as pre-frail and 65% as frail (mean frailty score: 2.67). A statistically significant association was identified between MNA score and frailty status (P < 0.05), with the highest prevalence of frailty observed in malnourished individuals (P = 0.002). No significant correlations were found between frailty and anthropometric parameters such as calf circumference (P = 0.17), arm circumference (P = 0.687) or body mass index (BMI) (P = 0.643).</p><p><strong>Conclusions: </strong>These findings highlight the clinical importance of routine, comprehensive nutritional screening in patients with CHF. Early identification and management of malnutrition may play a pivotal role in mitigating frailty and enhancing clinical outcomes in this high-risk population.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816118","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":"TTN-related dilated cardiomyopathy in a patient with positive unknown familiarity for heart failure and bicuspid aortic valve.","authors":"Simone Sarzilla, Elia Rigamonti, Laura Anna Leo, Francesca Romana Scopigni, Giorgio Moschovitis","doi":"10.1002/ehf2.15360","DOIUrl":"https://doi.org/10.1002/ehf2.15360","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793776","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":"Diagnostic value of computed tomography-based muscle quality and metabolic signatures in heart failure with sarcopenia.","authors":"Wataru Kawaharata, Hidemichi Kouzu, Keishi Ogura, Toshiyuki Yano, Satoshi Katano, Ryo Numazawa, Ryohei Nagaoka, Hiroki Aida, Katsuhiko Ohori, Ryo Nishikawa, Takefumi Fujito, Nobutaka Nagano, Marenao Tanaka, Masato Furuhashi","doi":"10.1002/ehf2.15371","DOIUrl":"https://doi.org/10.1002/ehf2.15371","url":null,"abstract":"<p><strong>Aims: </strong>Sarcopenia is a major comorbidity in heart failure (HF) patients, but its comprehensive evaluation remains challenging due to resource limitations. Computed tomography (CT) imaging allows opportunistic assessment of both muscle quantity and quality; however, its diagnostic utility and relationships with physical performance and underlying metabolic alterations remain unclear. We investigated the diagnostic utility of single-slice abdominal CT for sarcopenia assessment and explored its association with plasma amino acid profiles in HF patients.</p><p><strong>Methods and results: </strong>We retrospectively analysed 212 HF patients (73 ± 13 years old; 41% females) who underwent dual-energy X-ray absorptiometry (DXA), abdominal CT imaging, and amino acid profiling, of whom 186 had complete sarcopenia assessment. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia 2019 criteria using DXA-measured appendicular skeletal muscle mass index and grip strength, with severe sarcopenia additionally requiring low Short Physical Performance Battery scores. CT-measured skeletal muscle area index (SMI) at the lumbar vertebral level combined with grip strength showed high diagnostic accuracy for sarcopenia [area under the receiver operating characteristic curve (AUC): 0.96 for males, 0.88 for females], with optimal cut-off values of 54 cm²/m² for males and 40 cm²/m² for females. SMI was similarly reduced in non-severe and severe sarcopenia patients, whereas mean muscle attenuation (MMA), an index of intramuscular lipid infiltration, was decreased exclusively in patients with severe sarcopenia. In multivariable analysis adjusted for age, sex, HF functional class and diabetes, decreased MMA remained the only CT-measured index significantly associated with low physical performance. MMA showed higher predictive value than SMI for severe sarcopenia in males (AUC 0.81 vs. 0.54, P = 0.039). Several amino acids (leucine, β-alanine and 3-methylhistidine) and the Fischer ratio were significantly associated with MMA, independent of SMI and established MMA determinants including sex, age, and body mass index.</p><p><strong>Conclusions: </strong>Single-slice abdominal CT provides accurate sarcopenia diagnosis in HF patients with reduced muscle strength, with muscle quality rather than quantity determining physical performance. Specific amino acid profiles associated with muscle quality changes suggest potential therapeutic targets for preventing sarcopenia progression.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764785","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 role of intra-abdominal pressure and point of care ultrasound to guide decongestive therapies in acute heart failure.","authors":"C Josa-Laorden, A Campos-Saenz de Santamaría, S Crespo-Aznarez, J Pérez-Silvestre, E Montero-Hernandez, P Llacer-Iborra, J Torres-Macho, M Méndez-Bailon, J L Morales-Rull, P Salamanca-Bautista, N Fernández-Villa, I Torres-Courchoud, M A Vázquez-Ronda, R Martínez-Gutiérrez, P Serrano-Irigoyen, N García-Lorente, J C Trullas, M Cobo-Marcos, M J Pinilla, M Sánchez-Marteles, J Rubio-Gracia","doi":"10.1002/ehf2.15380","DOIUrl":"https://doi.org/10.1002/ehf2.15380","url":null,"abstract":"<p><strong>Aims: </strong>Effective decongestion is crucial in managing acute decompensated heart failure (ADHF). Persistent congestion post-diuretic therapy correlates with adverse outcomes. This study evaluates whether a strategy guided by intra-abdominal pressure (IAP) and point-of-care ultrasound (POCUS) enhances decongestion compared to standard diuretic titration.</p><p><strong>Methods and results: </strong>ABDOPOCUS-HF is a randomized, multicentre, open-label, pragmatic clinical trial involving 168 patients hospitalized with ADHF across 14 Spanish hospitals. Inclusion criteria encompass clinical signs of congestion and elevated natriuretic peptides (NT-proBNP >1000 pg/mL or BNP > 250 pg/mL). Participants are randomized 1:1 to either standard care or an intervention arm where diuretic therapy is guided by baseline IAP measurements and POCUS assessments, including lung ultrasound, inferior vena cava diameter and VExUS score. The primary endpoint is the resolution of systemic congestion at 72 h, measured by the ADVOR score. Secondary endpoints include changes in pulmonary congestion (B-lines), intravascular congestion (VExUS and IVC), biomarkers (NT-proBNP and CA125), total diuretic dose, diuretic response, hospital length of stay and rates of cardiovascular death, rehospitalization and need for intravenous diuretics at 30 and 90 days. Safety endpoints encompass worsening renal function, electrolyte disturbances and catheter-related infections.</p><p><strong>Conclusions: </strong>The ABDOPOCUS-HF trial investigates whether integrating IAP and POCUS into decongestion strategies improves diuretic response and clinical outcomes in ADHF patients. Findings may inform future protocols for volume management in acute heart failure.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752667","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}