ESC Heart Failure最新文献

{"title":"Global myocardial work index predicts response to biventricular pacing in patients with non-left bundle branch block.","authors":"Shun Kondo, Yasuya Inden, Satoshi Yanagisawa, Kiichi Miyamae, Hiroyuki Miyazawa, Takayuki Goto, Masaya Tachi, Tomoya Iwawaki, Ryota Yamauchi, Kei Hiramatsu, Masafumi Shimojo, Yukiomi Tsuji, Toyoaki Murohara","doi":"10.1002/ehf2.15246","DOIUrl":"https://doi.org/10.1002/ehf2.15246","url":null,"abstract":"<p><strong>Aims: </strong>Cardiac resynchronization therapy (CRT) improves the prognosis of patients with heart failure (HF) and wide QRS complex. However, patients with non-left bundle branch block (LBBB) show a poor response to CRT. This study evaluated myocardial work estimated by pressure-strain loops on echocardiography for predicting response to CRT in patients with non-LBBB.</p><p><strong>Methods and results: </strong>Of 267 patients who underwent CRT implantation, 54 patients with non-LBBB (mean age, 62 ± 12 years, 72% males, and 24% with ischemic cardiomyopathy) were retrospectively included. Two-dimensional speckle-tracking echocardiography was performed before and at 6-month follow-up in all patients. Myocardial work was estimated by pressure-strain loop analysis using speckle-tracking echocardiography and non-invasive blood pressure measurement. CRT response was defined as a ≥15% decrease in left ventricular end-systolic volume on echocardiography at the 6-month follow-up. The mean left ventricular ejection fraction (LVEF) before implantation was 27% ± 8% in total. Six months after implantation, 18 patients (33%) responded to CRT. The absolute LVEF improvement for responders and non-responders were 5.5% ± 6.9% and 1.3% ± 7.5%, respectively (P = 0.021). Baseline global work index (GWI), which is the average myocardial work based on the pressure-strain loop, was significantly higher in the responder group than in the non-responder group (590 ± 271 vs. 409 ± 216 mmHg%; P = 0.010). Multivariable analysis showed GWI to be an independent predictor of CRT response (odds ratio, 1.109; 95% confidence interval [CI], 1.013-1.213; P = 0.024). Receiver operating characteristic curve analysis determined the cut-off value of GWI for response as 456 mmHg% (AUC 0.700, 95% CI 0.553-0.840; P = 0.019). During the median 37-month follow-up, all-cause death occurred in 21 patients (39%). On multivariable analysis, GWI ≤ 456 mmHg% was independently associated with an increased risk of all-cause mortality (hazard ratio, 2.882; 95% CI, 1.157-7.176; P = 0.023).</p><p><strong>Conclusions: </strong>High GWI assessed by speckle-tracking echocardiography and a non-invasively estimated LV pressure curve was independently associated with a favourable response to CRT and improved outcomes in patients with non-LBBB. The use of this non-invasive approach for quantifying myocardial variability and residual contractility can be beneficial for assessing CRT candidates and allow for more accurate patient stratification. Further, large multicentre studies are required to validate these findings.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467342","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":"Discovery of miRNAs unique to actively transcribed erythroparvovirus infection in heart failure patients.","authors":"Ganna Aleshcheva, Sara Salih, Christian Baumeier, Felicitas Escher, C Thomas Bock, Heinz-Peter Schultheiss","doi":"10.1002/ehf2.15194","DOIUrl":"https://doi.org/10.1002/ehf2.15194","url":null,"abstract":"<p><strong>Aims: </strong>miRNAs, small non-coding RNAs, play key roles in gene regulation, cell differentiation and tissue development. They influence viral infection outcomes by directly interacting with viral genomes or modifying the host microenvironment. This study demonstrates miRNAs' ability to selectively suppress transcriptionally active erythroparvovirus, highlighting their potential in antiviral therapies.</p><p><strong>Methods and results: </strong>Seventy-five endomyocardial biopsy (EMB) specimens from patients with unexplained heart failure were analysed. The samples included 19 with dilated cardiomyopathy and inflammation (DCMi), 12 with dilated cardiomyopathy (DCM), 25 with inflammation and active erythroparvovirus infection, 13 with active erythroparvovirus infection only and 6 from undiagnosed patients as controls. miRNA expression was measured using TaqMan assays. miR-98, miR-222, miR-106b and miR-197 were significantly upregulated in patients with transcriptionally active erythroparvovirus infection, independent of inflammation (P < 0.005). These miRNAs differentiated these patients from all other groups with over 90% specificity.</p><p><strong>Conclusions: </strong>These specific miRNAs offer a novel diagnostic tool for active erythroparvovirus infections and hold promise as therapeutic targets, providing safer alternatives to traditional antiviral treatments.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457348","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":"Up-titration of medication in patients with new-onset heart failure with and without atrial fibrillation.","authors":"Arietje J L Zandijk, Bernadet T Santema, Friso D J Inkelaar, Martje H L van der Wal, Janke Warink-Riemersma, Michiel Rienstra, Adriaan A Voors","doi":"10.1002/ehf2.15188","DOIUrl":"https://doi.org/10.1002/ehf2.15188","url":null,"abstract":"<p><strong>Aims: </strong>Differences in guideline-directed medical therapy (GDMT) and clinical outcomes have been observed between heart failure (HF) patients with atrial fibrillation (AF) versus those in sinus rhythm. This study evaluated the effects of up-titration of HF therapies, consisting of beta-blockers, angiotensin-converting-enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs) and mineralocorticoid receptor antagonists (MRAs), in patients with new-onset HF with and without AF.</p><p><strong>Methods: </strong>Among 607 patients with new-onset HF (<3 months) from a specialized nurse-led HF clinic in the Netherlands, 187 (31%) patients had AF, and 420 (69%) patients were in sinus rhythm at baseline electrocardiogram. After an up-titration period of 9 months, achieved doses and reasons for not reaching target doses were documented.</p><p><strong>Results: </strong>Patients with AF were older, less likely to have ischaemic heart disease and had higher baseline N-terminal B-type natriuretic peptide levels (all P < 0.05). Left ventricular ejection fraction (LVEF) at baseline was similar between patients with AF and those in sinus rhythm (37% vs. 36%, P = 0.453). Prescription of GDMT was comparable between patients with AF and those in sinus rhythm, except for a lower ACEi/ARB prescription and higher use of diuretics in patients with AF (79% vs. 86%; P = 0.038; 86% vs. 59%, P < 0.001, respectively, compared with sinus rhythm). Up-titration to guideline-recommended target doses of beta-blocker, ACEi/ARB and MRA therapy was similar between patients with and without AF (31% vs. 24%, P = 0.096; 32% vs. 40%, P = 0.098; 23.7% vs. 30.5%, P = 0.125, respectively). Reasons for not further up-titrating to recommended target doses were consistent across patients with AF and sinus rhythm. LVEF improvement of ≥5% and ≥10% after up-titration was more common in patients with AF than those in sinus rhythm (67% vs. 53%, P = 0.017; 48% vs. 36%, P = 0.043). Achieving target doses of ACEi/ARB and MRA therapies was associated with lower mortality and HF rehospitalization rates at 3 years in both patients with AF and those in sinus rhythm.</p><p><strong>Conclusions: </strong>In patients with new-onset HF, up-titration to recommended doses of GDMT was similar in patients with and without AF, but was associated with a greater improvement in LVEF in patients with AF.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448595","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":"Prediction of 90 day mortality in elderly patients with acute HF from e-health records using artificial intelligence.","authors":"Joconde Weller, Johann Gutton, Guillaume Hocquet, Leïla Pellet, Marie-José Aroulanda, Amélie Bruandet, Didier Theis, Fabio Boudis, Romain Cador, Pierre Zweigenbaum, Anne Buronfosse, Pascal de Groote, Michel Komajda","doi":"10.1002/ehf2.15244","DOIUrl":"https://doi.org/10.1002/ehf2.15244","url":null,"abstract":"<p><strong>Aims: </strong>Mortality risk after hospitalization for heart failure (HF) is high, especially in the first 90 days. This study aimed to construct a model automatically predicting 90 day post-discharge mortality using electronic health record (EHR) data 48 h after admission and artificial intelligence.</p><p><strong>Methods: </strong>All HF-related admissions from 2015 to 2020 in a single hospital were included in the model training. Comprehensive EHR data were collected 48 h after admission. Natural language processing was applied to textual information. Deaths were identified from the French national database. After variable selection with least absolute shrinkage and selection operator, a logistic regression model was trained. Model performance [area under the receiver operating characteristic curve (AUC)] was tested in two independent cohorts of patients admitted to two hospitals between March and December 2021.</p><p><strong>Results: </strong>The derivation cohort included 2257 admissions (248 deaths after hospitalization). The evaluation cohorts included 348 and 388 admissions (34 and 38 deaths, respectively). Forty-two independent variables were selected. The model performed well in the derivation cohort [AUC: 0.817; 95% confidence interval (CI) (0.789-0.845)] and in both evaluation cohorts [AUC: 0.750; 95% CI (0.672-0.829) and AUC: 0.723; 95% CI (0.644-0.803]), with better performance than previous models in the literature. Calibration was good: 'low-risk' (predicted mortality ≤8%), 'intermediate-risk' (8-12.5%) and 'high-risk' (>12.5%) patients had an observed 90 day mortality rate of 3.8%, 8.4% and 19.4%, respectively.</p><p><strong>Conclusions: </strong>The study proposed a robust model for the automatic prediction of 90 day mortality risk 48 h after hospitalization for decompensated HF. This could be used to identify high-risk patients for intensification of therapeutic management.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413644","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":"Socio-economic status and the effect of guideline-directed medical therapy in the STRONG-HF study.","authors":"Albertino Damasceno, Hadiza Saidu, Gad Cotter, Beth Davison, Christopher Edwards, Jelena Celutkiene, Marianna Adamo, Mattia Arrigo, Marianela Barros, Jan Biegus, Kamilė Čerlinskaitė-Bajorė, Ovidiu Chioncel, Alain Cohen-Solal, Benjamin Deniau, Rafael Diaz, Gerasimos Filippatos, Etienne Gayat, Antoine Kimmoun, Carolyn S P Lam, Marco Metra, Maria Novosadova, Matteo Pagnesi, Peter S Pang, Piotr Ponikowski, Jozine M Ter Maaten, Daniela Tomasoni, Adriaan A Voors, Koji Takagi, Alexandre Mebazaa, Karen Sliwa","doi":"10.1002/ehf2.15156","DOIUrl":"https://doi.org/10.1002/ehf2.15156","url":null,"abstract":"<p><strong>Aims: </strong>Acute heart failure (AHF) impacts millions globally, with outcomes varying based on socio-economic status (SES).</p><p><strong>Methods: </strong>SES measured by annual household income, years of education and medical insurance coverage. Each patient's income and education level relative to the median or mean, respectively, in the country was calculated, and categorized into tertiles (0, 1 or 2 from lowest to highest). SES scores (0-5) were computed as the sum of these levels plus insurance coverage (0 = no or 1 = yes). Patients' baseline characteristics, outcomes (HF readmission, death and their composite) and the effect of high-intensity care (HIC) vs. usual care (UC) were examined by SES scores 0-2, 3 and 4-5.</p><p><strong>Results: </strong>Lower SES patients, who were younger, predominantly female, Black and non-European, had fewer comorbidities such as atrial fibrillation, diabetes and ischaemic heart disease and exhibited milder HF, indicated by a lower NYHA class, lower creatinine and higher cholesterol before discharge. Despite having milder HF and less comorbidities, after adjusting for baseline characteristics, patients with higher SES had numerically better outcomes, though differences were not statistically significant. 180-day hazard ratios (HRs) for HF readmission or death were 0.75 (95% CI 0.48-1.16) for SES scores of 3 and 0.85 (95% CI 0.58-1.23) for scores of 4-5, compared to 0-2. Higher SES patients had numerically better treatment effect from HIC, with HRs of 0.69 for SES 0-2, 0.72 for SES 3 and 0.50 for SES 4-5.</p><p><strong>Conclusions: </strong>In this post hoc analysis of the STRONG-HF study, lower SES was associated with milder acute HF but similar 180-day outcomes. Higher SES patients benefitted more from HIC.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406455","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":"Treatment patterns, outcomes and healthcare resource utilization of obstructive hypertrophic cardiomyopathy in England.","authors":"Faizel Osman, Carla L Zema, Michael Hurst, Belinda Sandler, Florence Brellier, Ovie Utuama, Oksana Kirichek, John Houghton, Teresa Lemmer, Maite Tome Esteban","doi":"10.1002/ehf2.15213","DOIUrl":"https://doi.org/10.1002/ehf2.15213","url":null,"abstract":"<p><strong>Aims: </strong>Describe patient characteristics, treatment patterns, clinical outcomes, healthcare resource utilization (HCRU) and medical costs associated with patients who were diagnosed with obstructive hypertrophic cardiomyopathy (HCM) in clinical practice in England.</p><p><strong>Methods and results: </strong>This observational, retrospective, cohort study of adults who were diagnosed with obstructive HCM in routine clinical practice in England used electronic health records from Clinical Practice Research Datalink (CPRD) GOLD/Aurum and linked Hospital Episode Statistics (HES) databases (1 April 2007 to 30 October 2020). Adults (≥18 years at index date) with at least one diagnosis code (ICD-10, Read, SNOMED, or OPCS) indicative of HCM with ≥1 year of continuous registration in CPRD, data of acceptable research quality and eligibility for HES linkage were included. Outcomes from the obstructive HCM cohort were stratified by New York Heart Association (NYHA) class at baseline and during follow-up. Owing to the paucity of NYHA coding, patients with obstructive HCM and no record of NYHA class were assigned a proxy NYHA classification using an algorithm that considered patient symptoms and treatments. The study included 6440 patients in the overall HCM cohort with a mean follow-up duration of 4.84 [standard deviation (SD): 2.95] years. The study population was predominantly male (61.9%) and white (79.1%), with a mean (SD) age of 61.02 (15.61) years. The proportion of patients with obstructive HCM who had a pre-specified prior medical condition relevant to understanding disease burden increased with higher NYHA class (66.5% vs. 83.0% for NYHA class I and NYHA class II+, respectively), as did the proportion of patients with at least one baseline active prescription for cardiovascular-related medication. Among patients with at least one record of a prescription for the treatment of symptomatic obstructive HCM, 41.7% experienced a treatment change during the follow-up period. Atrial fibrillation or flutter, ischaemic stroke and heart failure were the most observed clinical events among patients in the obstructive HCM cohort, and the first in-study incidence of these events increased with higher NYHA class. Total HCRU costs per patient-year increased from £3033 to £4517 for NYHA classes I and II+, respectively, with secondary care costs consistently being the main driver in the obstructive HCM cohort.</p><p><strong>Conclusions: </strong>Obstructive HCM is associated with a large clinical and economic burden in England, and this burden increases with higher NYHA class. These findings support the need for new and more effective strategies for the management of HCM.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406458","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":"Training-induced change of diastolic function in heart failure with preserved ejection fraction.","authors":"Andreas B Gevaert, Ephraim B Winzer, Stephan Mueller, Stephanie De Schutter, Paul J Beckers, Jennifer Hommel, Axel Linke, Ulrik Wisløff, Volker Adams, Burkert Pieske, Martin Halle, Emeline M Van Craenenbroeck, Caroline M Van De Heyning","doi":"10.1002/ehf2.15225","DOIUrl":"https://doi.org/10.1002/ehf2.15225","url":null,"abstract":"<p><strong>Aims: </strong>Exercise training improves aerobic capacity (V̇O₂peak) in patients with heart failure and preserved ejection fraction (HFpEF), but underlying mechanisms remain unclear. We aimed to evaluate whether exercise training could improve systolic and diastolic function during exercise.</p><p><strong>Methods: </strong>This was a substudy of the multicentre Optimizing Exercise Training in HFpEF (OptimEx-Clin) trial, in which 180 patients with HFpEF were randomized 1:1:1 to guideline control, moderate continuous training or high-intensity interval training. All patients included at two out of five participating sites underwent exercise echocardiography at baseline and 3 months. Patients of both training groups were pooled and compared with guideline control.</p><p><strong>Results: </strong>A total of 61 patients (mean age 73 ± 7 years, 72% female) were included. At baseline, E/e' increased from 17.0 ± 5.7 to 19.5 ± 6.1 and systolic pulmonary artery pressure from 31 ± 8 to 51 ± 11 mmHg (both P < 0.001). Right ventricular function did not change significantly (maximal tricuspid annular plane systolic excursion 24.7 ± 4.0 mm, P = 0.051 vs. baseline). At 3 months, patients randomized to exercise training improved V̇O₂peak (control +0.2, training +2.7 mL/kg/min, P = 0.006) and demonstrated small but significant improvements in exercise E/e' (control 21.7 ± 7.5 to 22.8 ± 9.2, training 18.3 ± 5.0 to 17.2 ± 4.1, P = 0.044). No significant changes were observed in ejection fraction, mitral or tricuspid annular plane systolic excursion, S', A' or systolic pulmonary artery pressure (P > 0.05). Changes in E/e' were not associated with the change in V̇O₂peak.</p><p><strong>Conclusions: </strong>In patients with HFpEF, exercise echocardiography revealed increases in filling pressures as well as a failure to augment right ventricular function during exercise. After 3 months of exercise training, HFpEF patients demonstrated a small improvement in diastolic function (exercise E/e'), but this did not explain the improved aerobic capacity.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398810","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":"Prevalence of iron deficiency in acute and chronic heart failure according to different clinical definitions.","authors":"Lukas Lanser, Gerhard Pölzl, Moritz Messner, Maria Ungericht, Marc-Michael Zaruba, Jakob Hirsch, Stefan Hechenberger, Stefan Obersteiner, Bernhard Koller, David Haschka, Hanno Ulmer, Guenter Weiss","doi":"10.1002/ehf2.15170","DOIUrl":"https://doi.org/10.1002/ehf2.15170","url":null,"abstract":"<p><strong>Aims: </strong>Iron is essential to maintain cellular energy metabolism in the myocardium. Impaired cellular iron availability negatively affects myocardial physiology and can aggravate heart failure (HF). Iron deficiency (ID) is frequently found in patients with acute and chronic HF (AHF, CHF) and associated with clinical outcome. The aim of this analysis was to assess the true ID prevalence in HF patients on the basis of different ID definitions.</p><p><strong>Methods: </strong>We performed a retrospective analysis of 329 AHF and 613 CHF patients, recruited between 02/2021 and 05/2022 at the Innsbruck Medical University (47%/32% female, median age 81/64 years). ID was defined according to a general definition, gastroenterology and cardiology guidelines as ferritin <30 or <45 ng/mL or <100/ng/mL (absolute ID), ferritin 30-100 or 45-150 or 100-299 ng/mL plus TSAT <20% (combined ID), and ferritin >100 or >150 or ≥300 ng/mL plus TSAT <20% (functional ID).</p><p><strong>Results: </strong>ID prevalence was significantly higher in AHF compared with CHF patients: general definition (74.8% vs. 32.6%, P < 0.001), gastroenterology guidelines (75.7% vs. 34.7%, P < 0.001), cardiology guidelines (79.9% vs. 47.3%, P < 0.001). We found distinctive differences in prevalence of ID types between the three definitions. Absolute ID prevalence was highest when applying cardiology compared with gastroenterology guidelines and general definition (AHF: 44.7% vs. 20.4% vs. 7.0%; CHF: 34.1% vs. 13.4% vs. 7.2%), while frequency of combined ID was almost equally distributed. Functional ID prevalence was highest when applying general definition compared with gastroenterology and cardiology guidelines (AHF: 34.7% vs. 23.4% vs. 11.6%; CHF: 13.1% vs. 9.0% vs. 3.4%). Out of 494 patients classified as having absolute or combined ID according to the cardiology guidelines, only 252 patients received the same classification while 107 and 135 patients were classified having no and functional ID when applying the general definition.</p><p><strong>Conclusions: </strong>We show that ID prevalence is higher in AHF versus CHF patients in a continuous cohort of HF patients managed at the same institution over the same period of time. There were distinctive differences in detection of ID and the type of ID when applying several recommended definitions thus affecting sensitivity and specificity for absolute and functional ID detection. This may result in exclusion of patients, which may benefit from iron supplementation and inclusion of those who may not respond or even anticipate site effects. Our study calls for the urgent need of prospective trials for redefinition of ID and identification of biomarkers associated with therapeutic response to optimize patient outcomes.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390563","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":"Burst steroid therapy and quality of life in patients with acute heart failure: Insights from the CORTAHF trial.","authors":"Matteo Pagnesi, Gad Cotter, Beth A Davison, Yonathan Freund, Adriaan A Voors, Christopher Edwards, Maria Novosadova, Koji Takagi, Hamlet Hayrapetyan, Andranik Mshetsyan, Mayranush Drambyan, Alain Cohen-Solal, Jozine M Ter Maaten, Jan Biegus, Piotr Ponikowski, Gerasimos Filippatos, Ovidiu Chioncel, Malha Sadoune, Tabassome Simon, Douglas L Mann, Alexandre Mebazaa, Marco Metra","doi":"10.1002/ehf2.15235","DOIUrl":"https://doi.org/10.1002/ehf2.15235","url":null,"abstract":"<p><strong>Aims: </strong>Patients hospitalized with acute heart failure (AHF) treated with a 7 day prednisone course in the CORTAHF pilot trial had a greater improvement in health-related quality of life (QoL) at Day 7 in both the overall population and in patients with baseline interleukin 6 > 13 pg/mL. This post-hoc analysis examines the specific QoL domains and the relationship between clinical signs of congestion and QoL.</p><p><strong>Methods: </strong>In the CORTAHF pilot trial, patients with AHF and high-sensitivity C-reactive protein (hsCRP) > 20 mg/L were randomized 1:1 to once-daily oral 40 mg prednisone for 7 days plus usual care or usual care alone. Patients completed the EQ-5D-5L, including the EQ-VAS, at baseline and Days 7 and 31. We estimated baseline-adjusted treatment effects on each of the five QoL dimensions and evaluated the interaction between baseline EQ-VAS and treatment effect on hsCRP change at Day 7 (the primary endpoint). The correlation between changes in signs of congestion and EQ-VAS were evaluated.</p><p><strong>Results: </strong>Among 100 randomized patients, the improvement in QoL at Day 7 was driven by significant effects on the EQ-5D-5L mobility [win odds 1.48, 95% confidence interval (CI) 1.05-2.12] and usual activities (win odds 1.50, 95% CI 1.05-2.20) domains. The treatment effect on 7 day hsCRP change was independent of baseline EQ-VAS (interaction P = 0.13). Decongestion and EQ-VAS improvement were correlated (r = -0.528, P < 0.0001).</p><p><strong>Conclusions: </strong>In patients with AHF and high hsCRP levels, 7 day burst steroid therapy improved QoL mostly by affecting the mobility and usual activities domains. QoL improvement was correlated with decongestion and may therefore not be a direct effect of steroid therapy, but mediated through improvement in HF symptoms and signs. Inflammatory activation was reduced by prednisone irrespective of baseline EQ-VAS.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398807","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":"Predictors of sustained reverse remodelling in patients with heart failure with reduced ejection fraction.","authors":"Silas Ramos Furquim, Edimar Alcides Bocchi, Maria Tereza Sampaio de Sousa Lira, Mauro Rogerio de Barros Wanderley, Daniel Catto de Marchi, Pamela Camara Maciel, Andre Zimerman, Felix Jose Alvarez Ramires, Luciano Nastari, Bruno Biselli, Paulo Roberto Chizzola, Robinson Tadeu Munhoz, Fábio Fernandes, Silvia Moreira Ayub-Ferreira","doi":"10.1002/ehf2.15241","DOIUrl":"https://doi.org/10.1002/ehf2.15241","url":null,"abstract":"<p><strong>Background: </strong>Patients with heart failure with reduced ejection fraction (HFrEF) who achieve reverse remodelling (RR) can experience a new decrease in ejection fraction (EF), and the predictors of sustained RR (SRR) are not completely understood.</p><p><strong>Objectives: </strong>The study aims to identify predictors of SRR in patients with HFrEF after an increase in EF and evaluate SRR prognosis.</p><p><strong>Methods: </strong>In this retrospective, observational study, we evaluated a real-life cohort of patients with HFrEF and ≥2 consecutive echocardiograms, divided according to left ventricular EF (LVEF) trajectory: no RR (NRR: 3/3 LVEF measurements < 40%), non-SRR (NSRR: second LVEF ≥ 40%, third LVEF < 40%), and SRR (SRR: second and third LVEF ≥ 40%).</p><p><strong>Results: </strong>We included 3628 of 8072 assessed HF patients in the analysis, with mean age 56.2 (±13.4) years, 64.4% male and 77.7% New York Heart Association (NYHA) I-II. Improved EF was observed for 1342 (37%) patients. Among those who achieved RR, 310 (23%) were NSRR, and 1032 (77%) were SRR. The mean (±SE) survival after the second echocardiogram was 10.6 (±0.2) years. The SRR group had the longest survival (12.2 ± 0.3 years), followed by the NSRR (10.6 ± 0.5) and NRR (9.8 ± 0.2 years) groups (P < 0.001). According to logistic multivariable regression, second LVEF [odds ratio (OR) = 1.06, confidence interval (CI) = 1.03-1.90, P < 0.001], second left ventricular end-systolic diameter (LVESD) (OR = 0.93, CI = 0.90-0.96, P < 0.001), second IV septum thickness (OR = 1.12, CI = 1.03-1.23, P = 0.012), systolic blood pressure (OR = 1.01, CI = 1.00-1.02, P = 0.014), NYHA I-II (OR = 1.86, CI = 1.27-2.74, P = 0.001) and furosemide non-use (OR = 1.87, CI = 1.27-2.74, P < 0.001) independently predicted SRR.</p><p><strong>Conclusions: </strong>Patients with greater EF increases and LVESD reductions at EF recovery, greater septum thickness, higher blood pressure, no need for diuretics and NYHA I/II maintenance had the best chance of maintaining recovered ventricular function.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381943","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}