ESC Heart Failure最新文献

{"title":"Nurse-coordinated multidisciplinary comprehensive heart failure management programme: A propensity-matched trial.","authors":"Cecilia Miu-Ching Chan, Polly Wai-Chi Li, Derek Pok-Him Lee, Esmond Yan-Hang Fong, Ivy Sin-Yee Ng, Samantha Ki-Man Chiu, Clara Woon-Shan Fok, Frederick Kin-Wa Li, Shirley Ka-Wai Lee, Karen K Y Ho, Wilson Y S Leung, Cathy Cheuk-Sum Chan, Cindy Yiu-Ning Tsang, Michael Kang-Yin Lee","doi":"10.1002/ehf2.15418","DOIUrl":"https://doi.org/10.1002/ehf2.15418","url":null,"abstract":"<p><strong>Aims: </strong>Despite therapeutic advancements, the prognosis of heart failure (HF) remains poor, with high rates of mortality and readmission, particularly following a HF exacerbation. This study aimed to evaluate the effects of a nurse-coordinated multidisciplinary comprehensive HF management programme on HF patients.</p><p><strong>Methods and results: </strong>This retrospective cohort study involved patients admitted for acute HF exacerbation at a regional hospital in Hong Kong. We established two patient cohorts: the control cohort, recruited between January and December 2021, received standard care, while the programme cohort, recruited from October 2022 to December 2023, participated in a comprehensive programme. This programme included multidisciplinary ward rounds, early initiation of guideline-directed medical therapy (GDMT), discharge education, post-discharge transitional care and cardiac rehabilitation. The primary outcome was the composite endpoint of all-cause mortality and HF-related readmission at 6 months. Secondary endpoints included HF-related readmission and all-cause mortality. We also assessed patient satisfaction and health-related quality of life (HRQoL) in the programme cohort. The study included 732 patients, 24.0% female, 81.6% with HFrEF, mean age of 67.9 ± 13.2 years. After matching for age, sex and type of HF, 366 patients were allocated to each cohort. The programme cohort demonstrated significantly lower rates of the composite endpoint [12.0% vs. 38.0%, adjusted hazard ratio (aHR) = 0.26, 95% confidence interval (CI) = 0.19-0.37, P < 0.001]) and HF-related readmissions (10.1% vs. 25.4%, aHR = 0.36, 95% CI = 0.24-0.52, P < 0.001) compared with the control cohort. All-cause mortality was also significantly reduced (4.4% vs. 18.3%, aHR = 0.22, 95% CI = 0.13-0.38, P < 0.001). Improvements in HRQoL and high patient satisfaction were noted in the programme cohort.</p><p><strong>Conclusions: </strong>The nurse-coordinated comprehensive HF management programme significantly reduced readmissions and mortality, with consistent benefits across different subgroups. Further research is needed to confirm these benefits and explore mechanisms.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023060","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":"Mid-term survival in patients awaiting heart and kidney transplantation with Impella 5.5 support.","authors":"Smruti Desai, Smit Paghdar, Jose Ruiz, Ji-Min Jang, Sharan Malkani, Daniel S Yip, Juan Leoni, Jose Nativi, Basar Sareyyupoglu, Kevin Landolfo, Si Pham, Parag Patel, Rohan Goswami","doi":"10.1002/ehf2.15189","DOIUrl":"https://doi.org/10.1002/ehf2.15189","url":null,"abstract":"<p><strong>Background: </strong>Patients with end-stage heart failure and chronic kidney disease requiring dual-organ transplantation (DOT) face significant challenges in utilizing durable mechanical circulatory support due to the risks associated with renal replacement therapies (RRTs) and multi-organ failure. Given the limited options available for long-term support in this patient population, there remains a critical need for alternative strategies to optimize end-organ function and bridge patients safely to transplant. With prolonged waitlist times for DOT, we present our experience with the Impella 5.5 as temporary mechanical circulatory support, demonstrating its potential to provide hemodynamic stability and support as a bridge to transplantation (BTT) in this complex cohort.</p><p><strong>Methods: </strong>A single-centre retrospective review was completed of all patients listed for single-organ transplantation or DOT between December 2019 and November 2022 at Mayo Clinic in Florida, supported by the Impella 5.5 intended as BTT. The focus of this analysis was patients requiring RRT or listed for heart/kidney transplantation. Data were extracted from the electronic health record at baseline and during their transplant episode of care after institutional review board approval as exempt status for retrospective data collection.</p><p><strong>Results: </strong>A total of 41 patients were supported with Impella 5.5, intended as BTT. All patients underwent successful transplantation. We focus on the 10 patients with Impella support who underwent DOT. In the DOT group, the median age at transplantation was 63 years (59-66), with nine males and one female. The baseline median ejection fraction was 19% (15-22), with 50% Caucasian and 50% African American and an even split between ischaemic and non-ischaemic aetiology. Median body mass index was 30 kg/m² (26-31), and 60% were in blood group O. The median time on the waitlist for DOT patients was 53 days (29-75). Perioperative management of DOT Impella patients demonstrated baseline haemodynamics of RA 11 mmHg (7-16), mean PA 36 mmHg (32-47), PCWP 29 mmHg (21-35), mixed venous saturation (SVO₂%) 51 (46-61) and Fick CI 2.03 L/min/m² (1.66-2.5). Post-Impella placement haemodynamics demonstrated significant improvements in RA pressure to 5 mmHg (4-8), P = 0.02, SVO₂ to 70% (65-72), P = 0.002, and Fick CI to 5.5 (5.2-8), P = 0.03. The average duration of support was 44 days (range 10-94). The median glomerular filtration rate at baseline was 27 mmol/L (16-29). Twenty-four hour urine protein averaged 168 mg/24 h (range 87-328), with the 24 h creatinine clearance of 29 mg/24 h (range 24-35). Eight of the 10 patients required continuous or intermittent RRT before DOT. The median total duration of RRT (including Impella support) was 36 days (9-72). DOT recipients had a 1 year survival of 90%, with an average follow-up of 432 days.</p><p><strong>Conclusions: </stro","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023034","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":"A novel treatment score (QUAD score) to promote treatment optimization in heart failure with a reduced ejection fraction.","authors":"Henry Oluwasefunmi Savage, Jason N Dungu, Anthony Dimarco, Brian Li, Samantha Langley, Jonathan Kojo Amoah, Paraic Cliffe, Archana Ganapathy, Peter Watters, Patricia Campbell, Nicola Melarkey, Simon Duckett, Sean Davies, Matthew Dewhurst, Karen Hann, Louise Clayton, Rhys Williams, Victoria Ruszala, Teresa Onwere-Tan, Fozia Zahir Ahmed, Ibrahim Arosi, Kimberly Gray, Mark C Petrie, John G F Cleland","doi":"10.1002/ehf2.15407","DOIUrl":"https://doi.org/10.1002/ehf2.15407","url":null,"abstract":"<p><strong>Aims: </strong>To help avoid therapeutic inertia, we developed a pragmatic treatment score (QUAD Score) for use in daily practice by healthcare professionals managing patients with a left ventricular ejection fraction (LVEF) < 50% and heart failure. We now investigate the association between achieved QUAD scores and 1 year outcomes.</p><p><strong>Methods: </strong>This was a multicentre cohort study in consecutive patients with incident heart failure and LVEF <50%, who completed therapy titration between January 2021 and June 2023. The primary outcome was a composite of first hospitalization for heart failure (HHF) and all-cause mortality at 1 year after final therapy titration, for QUAD scores that were poor (<8), good (8-14) or excellent (15-24).</p><p><strong>Results: </strong>Data were analysed from 1691 participants, collected from 10 UK centres, of whom 30% were women and 82% were White. Median age, N terminal pro-B-type natriuretic peptide (NTproBNP) and LVEF were 70 (59-78.5) years, 1624 (536-4138) ng/L and 34 (25-38) %, respectively. At the start of therapy titration, only 97 (5%) patients were naïve to any of the four pillars of therapy. After investigator-declared final titration, QUAD scores were excellent in 806 (48%), good in 382 (22%) and poor in 503 (30%) patients. Patients who failed eventually to achieve a good or excellent QUAD score were more often women, older and had poorer renal function and higher plasma NTproBNP (P < 0.01). The median number of days to final therapy titration was longer in those who achieved an excellent QUAD score, [174 (99-290) days,133 (80-232) days and 108 (57-193) days P < 0.01, for excellent, good and poor QUAD groups, respectively. There was wide variation in titration schedules across participating centres and overall, 33% of patients completed therapy titration within 90 days, 63% within 6 months and 88% within 1 year. The primary composite outcome at 1 year for those with poor, good and excellent QUAD scores were respectively 16.9%, 9.4% and 5.6%, (log rank P < 0.01), for mortality were 13.1%, 6.5% and 2.4% (log rank P < 0.001) and for first HHF were 7.7%, 3.9% and 3.2% (log rank P < 0.001).</p><p><strong>Conclusions: </strong>The QUAD score is a simple tool that can help audit and incentivize uptake of guideline-recommended therapy for HFrEF and prevent treatment inertia. Excellent QUAD scores are associated with better outcomes.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023021","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":"Ethnic differences in protein biomarkers of peripartum cardiomyopathy: a proteomic study on the EORP cohort.","authors":"Vitaris Kodogo, Karen Sliwa, Alice M Jackson, Hasan Al-Farhan, Sorel Goland, Jasper Tromp, Peter van der Meer, Kamilu Karaye, Alexandre Mebazaa, Johann Bauersachs, Liam Bell, Julian Hoevelmann, Charle Viljoen","doi":"10.1002/ehf2.15419","DOIUrl":"https://doi.org/10.1002/ehf2.15419","url":null,"abstract":"<p><strong>Aims: </strong>The diagnosis of peripartum cardiomyopathy (PPCM) is often delayed due to the absence of disease-specific biomarkers. Recently, serum proteins-QSOX1, adiponectin (ADIPOQ) and ITIH3-have shown potential for improving diagnostic accuracy, especially when used with NT-proBNP. However, the influence of ethnicity on their expression remains unclear. We aimed to assess whether serum biomarker profiles differ among ethnic groups in a multinational PPCM cohort.</p><p><strong>Methods and results: </strong>Eighty-two PPCM patients from seven countries in the EURObservational Research Programme (EORP) provided demographic data and serum samples. Ethnicity was self-reported. Proteomic profiling at diagnosis was performed using DIA-based label-free LC-MS, and data were analysed with Spectronaut v15. Ethnic variation was evaluated through principal component analysis (PCA). Participants had a mean age of 30.5 ± 6.7 years; 75% had no hypertension during pregnancy. Median LVEF was 35% (IQR 27.0-41.1), with no ethnic differences. Middle Eastern women showed more severe LV dilatation. PCA revealed no significant clustering by ethnicity; PC1 and PC2 explained 15.2% and 12.0% of variance, respectively.</p><p><strong>Conclusions: </strong>QSOX1, ADIPOQ and ITIH3 exhibited consistent expressions across ethnic groups, supporting their use as universal PPCM biomarkers.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999965","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":"Re-PERFUSE: Phase 1b study of AZD3427, a novel relaxin receptor agonist, on renal perfusion in HFrEF patients.","authors":"Marcin Ufnal, Macarena P Quintana-Hayashi, Kathleen Connolly, Daniel Pettersen, Zsolt Cselényi, Aurelija Jucaite, Magnus Schou, Andrea Varrone, Melanie Chan, Lars H Lund","doi":"10.1002/ehf2.15412","DOIUrl":"https://doi.org/10.1002/ehf2.15412","url":null,"abstract":"<p><strong>Aims: </strong>Renal impairment frequently coexists with heart failure (HF) and is associated with increased risk of poor clinical outcomes. This highlights the urgent need for therapies targeting both cardiac and renal dysfunction. AZD3427, a long-acting recombinant fusion protein and relaxin analogue that selectively activates the relaxin family peptide receptor 1 (RXFP1), showed trends of increased stroke volume and estimated glomerular filtration rate (eGFR) in HF patients (NCT04630067). The hypothesis is that AZD3427 may enhance GFR by expanding the functional renal cortex volume and improving renal perfusion.</p><p><strong>Methods and results: </strong>The Re-PERFUSE study (NCT06611423) is a Phase 1b, randomised, double-blind, placebo-controlled trial aimed at evaluating the effects of AZD3427 on renal perfusion in patients with HF and reduced ejection fraction (HFrEF) with reduced eGFR. Patients with HF, EF ≤ 40% and an eGFR of 30 to 90 mL/min/1.73 m², assessed by the CKD-EPI 2021, will receive a single dose of subcutaneous AZD3427 (n = 6) or placebo (n = 6). Intravenous dopamine will serve as a positive control for increased renal blood flow. Positron emission tomography (PET) imaging with [¹⁵O]-labelled water will be used to measure renal cortex blood flow pre- and post-treatment, allowing differentiation between global and focal renal blood flow changes and providing insights into potential nephron recruitment and increased filtration membrane area. Safety and tolerability will be assessed through monitoring of adverse events, clinical laboratory tests and vital signs.</p><p><strong>Conclusions: </strong>This study, alongside other ongoing AZD3427 studies, aims to evaluate the dual effects of AZD3427 in improving both cardiac and renal function. These insights could guide the development of future therapeutic strategies for managing HF and renal impairment.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999968","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":"Pathogenic glycosyltransferase genes and potential therapeutic drugs in pressure overload-induced heart failure.","authors":"Jiahe Wu, Yi Lu, Xinchen Gao, Xiaorong Hu, Zhibing Lu, Chenze Li","doi":"10.1002/ehf2.15409","DOIUrl":"https://doi.org/10.1002/ehf2.15409","url":null,"abstract":"<p><strong>Aims: </strong>Protein glycosylation regulated by glycosyltransferases is an important type of post-translational modification. The role of the glycosyltransferase genes (GTGs) in heart failure (HF) remains unclear and requires further investigation.</p><p><strong>Methods: </strong>Differential expression analysis was performed on the transverse aortic constriction (TAC)-related dataset GSE36074 to screen out the differentially expressed GTGs. Enrichment and protein-protein interaction analyses explored their functional mechanisms and interconnections. Pearson correlation analysis revealed the relationship between GTGs and pathological cardiac remodelling. The upstream miRNAs of GTGs were predicted using corresponding online databases, and the downstream target genes were identified by weighted correlation network analysis (WGCNA). Computer virtual screening and molecular docking predicted potential therapeutic drugs. The identified GTGs were validated in vivo, in vitro and in the human HF-related dataset GSE57338.</p><p><strong>Results: </strong>Twenty-one differentially expressed GTGs were identified, and these genes were significantly up-regulated in the TAC model except for C1galt1, Extl2 and Pigh. Pearson correlation analysis revealed that 11 GTGs were significantly associated with pathological cardiac remodelling. Fifty-six miRNAs and 31 drugs were predicted to target these GTGs. WGCNA indicated that these GTGs were associated with lipid metabolism-related genes and pathways. Up-regulation of B3gnt9, C1galt1, Gcnt1, Gxylt2 and Mgat5b was observed in the TAC model. GXYLT2 is up-regulated and has high disease-predictive value in patients with dilated cardiomyopathy and ischaemic cardiomyopathy. Knockdown of GXYLT2 in human AC16 cardiomyocytes significantly attenuated angiotensin II (AngII)-induced hypertrophy.</p><p><strong>Conclusions: </strong>Dysregulation of GTG expression may affect TAC-induced HF through metabolic pathways, and GXYLT2 may be a new potential therapeutic target for HF.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991853","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":"Cardiac rehabilitation and health-related quality of life in preserved ejection fraction heart failure: A meta-analysis.","authors":"Chenyao Ding, Yawen Gao, Rod S Taylor","doi":"10.1002/ehf2.15404","DOIUrl":"10.1002/ehf2.15404","url":null,"abstract":"<p><strong>Aims: </strong>The study aims to evaluate the effects of exercise-based cardiac rehabilitation (ExCR) on the health-related quality of life (HRQoL) in people with heart failure preserved ejection fraction (HFpEF).</p><p><strong>Methods: </strong>This study is a systematic review and meta-analysis. Six bibliographic databases (Medline, Embase, Web of Science, Cumulative Index of Nursing and Allied Health Literature, Cochrane CENTRAL and China National Knowledge Infrastructure database) were searched to April 2024 for randomized controlled trials (RCTs), involving adults with HFpEF undertaking ExCR compared with no exercise control. Subgroup and sensitivity analyses were conducted to explore potential sources of statistical heterogeneity.</p><p><strong>Results: </strong>Twelve RCTs recruiting a total of 1005 HFpEF patients with a median of 16 weeks follow-up were included. Four trials defined HFpEF as an ejection fraction of ≥45% and eight trials as ≥50%. Compared with control, ExCR participation was associated with improvements in disease-specific HRQoL as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) [weighted mean difference (WMD): -6.72, 95% confidence interval (Cl): -12.00 to -1.44, P = 0.013] and Kansas City Cardiomyopathy Questionnaire (KCCQ) total scores (WMD: 5.34, 95% CI: 1.75 to 8.93, P < 0.0001) and generic HRQoL assessed by Short-Form 36 and EQ-5D. There was evidence (P ≤ 0.05) of greater improvements in MLHFQ total score with ExCR in trials with shorter exercise duration (<60 min/session), the presence of risk of bias, and larger sample size (>45 patients). Included trials were small and demonstrated substantial clinical and statistical heterogeneity with a range of: (1) population definitions (e.g., definition of HFpEF of ≥45% vs. ≥50%, level and nature of comorbidities), (2) ExCR interventions (e.g., exercise only vs. comprehensive CR programmes, different modes and intensity of exercise, centre- and home-based delivery) and (3) methods of HRQoL assessment (e.g., disease specific vs. generic measure).</p><p><strong>Conclusions: </strong>This meta-analysis of RCT evidence shows that participation in ExCR provides important gains in HRQoL of people with HFpEF. However, the results should be interpreted with caution given the substantial clinical and statistical heterogeneity. Well reported, fully powered RCTs with longer follow-up are needed to confirm these findings.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947511","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":"A new staging system for hereditary transthyretin amyloidosis in the era of specific amyloidosis therapies.","authors":"Gabriela Neculae, Amira Zaroui, Robert Adam, Mounira Kharoubi, Benoit Funalot, Daniel Coriu, Ruxandra Jurcut, Thibaud Damy","doi":"10.1002/ehf2.15414","DOIUrl":"https://doi.org/10.1002/ehf2.15414","url":null,"abstract":"<p><strong>Objectives: </strong>Currently, there are two prognosis staging systems validated for transthyretin amyloidosis (ATTR). We sought to develop a new staging system dedicated to hereditary transthyretin amyloidosis (ATTRv) patients on specific treatments.</p><p><strong>Methods and results: </strong>A total of 258 patients diagnosed with ATTRv from two cardiac amyloidosis reference centres in France and Romania were stratified into three disease stages based on NT-proBNP, estimated glomerular filtration rate (eGFR) and global longitudinal strain (GLS). A staging system was created using the following criteria: GLS ≥ -11%, NT-proBNP ≥ 2000 ng/L and eGFR ≤ 65 mL/min. Stage I was defined as the presence of none of the criteria. Stage III was defined as GLS ≥ -11% and either one or both NT-proBNP and eGFR criteria, while the remaining patients were defined as Stage II. Stage I patients had a 98.5% (95% CI 94.8-100) 5-year survival rate, Stage II patients 75.1% (95% CI 64.8-87.1) and Stage III patients a 29.4% (95% CI 18.6-46.5) 5-year survival rate (Stage I vs. Stage II, P = 0.001; Stage II vs. Stage III, P < 0.001). After age is adjusted for, compared to Stage I, the hazard ratio (HR) for death was 9.9 (95% CI 1.28-76.27, P = 0.02) for Stage II and 39.75 (95% CI 5.28-299.54, P < 0.001) for Stage III patients. HRs and statistical significance were maintained across different ATTR genotypes. The staging system was validated in a cohort of 138 patients.</p><p><strong>Conclusions: </strong>We propose a novel staging system for ATTRv patients on specific treatment, based on two biological markers and one echocardiographic parameter, common in clinical practice.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991869","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":"A pilot study on DNA methylation changes for non-invasive molecular diagnostics in heart failure.","authors":"Giuditta Benincasa, Francesco Cacciatore, Mark E Pepin, Francesco Curcio, Rosaria Chiappetti, Adam R Wende, Enrico Coscioni, Claudio Napoli","doi":"10.1002/ehf2.15402","DOIUrl":"10.1002/ehf2.15402","url":null,"abstract":"<p><strong>Aims: </strong>The current therapeutic approach to ischaemic (IsHF) and non-ischaemic (NIsHF) heart failure (HF) mainly overlooks the underlying aetiology owing to a lack knowledge of the differential molecular pathways that contribute to HF with reduced ejection fraction (HFrEF). Alterations in myocardial DNA methylation levels have been identified as potential biomarkers for HF irrespective of its aetiology. Due to the limited availability of cardiac tissues in clinics, our goal is to determine if DNA methylation changes in circulating CD4⁺ T lymphocytes, which are strongly involved in left ventricle remodelling, can help in differentiating IsHF and NIsHF causes among patients with HFrEF and if DNA methylation levels associate with key clinical features.</p><p><strong>Methods and results: </strong>We performed a post hoc network-oriented analysis of the original PRESMET clinical trial dataset (NCT05475028). Integrating epigenomic data obtained with the high-resolution reduced representation bisulfite sequencing (RRBS) platform and the left-ventricle interactome (protein-protein interaction map) we identified six differentially methylated CpG positions (DMPs), which were able to distinguish IsHF (n = 8) versus NIsHF (n = 4) patients with an area under the curve (AUC) > 0.8. Network-oriented DMPs were significantly hypomethylated in IsHF versus NIsHF and annotated to six genes, namely, cytoskeleton-associated protein 4 (CKAP4), carnitine palmitoyltransferase 1A (CPT1A), eukaryotic translation initiation factor 2 subunit beta (EIF2S2), spectrin beta (SPTB), synaptotagmin 6 (SYT6) and RAB11 family interacting protein 1 (RAB11FIP1) (P < 0.05). We found that the CD4⁺ T cell hypomethylation of EIF2S2 gene significantly correlated with VO₂ max (ρ = 0.73, P = 0.04), hypomethylation of RAB11FIP1 significantly correlated with MECKI score (ρ = -0.85, P = 0.001), whereas SPTB significantly correlated with VO₂ max (ρ = 0.73, P = 0.04), left ventricle mass index (ρ = -0.91, P = 0.005) and left ventricular ejection fraction (ρ = 0.83, P = 0.01) in IsHF patients.</p><p><strong>Conclusions: </strong>We demonstrate that circulating CD4⁺ T cell-specific methylation levels of network-oriented CKAP4, CPT1A, EIF2S2, SPTB, SYT6 and RAB11FIP1 genes can distinguish between IsHF and NIsHF. In particular, hypomethylation of EIF2S2, SPTB and RAB11FIP1 genes is significantly correlated with key clinical features in isHF patients, highlighting its potential to enhance personalized prognosis for HFrEF patients.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947539","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":"Predicting acute decompensated heart failure using circadian markers from heart rate time series.","authors":"Valerie A A van Es, Mayke M C J van Leunen, Ignace L J de Lathauwer, Cindy C A G Verstappen, René A Tio, Ruud F Spee, Lu Yuan, Monica Betta, Giacomo Handjaras, Hareld M C Kemps","doi":"10.1002/ehf2.15395","DOIUrl":"https://doi.org/10.1002/ehf2.15395","url":null,"abstract":"<p><strong>Aims: </strong>Hospital admissions for acute decompensated heart failure (ADHF) are linked to high readmission rates, emphasizing the need for early intervention. Dysregulation of the circadian rhythm that regulates key physiological processes, such as heart rate (HR), blood pressure and sleep-wake cycles, may precede weight gain and clinical symptoms of worsening heart failure (HF) by weeks, providing a window for timely intervention. This study aims to develop a predictive algorithm for early and accurate ADHF detection.</p><p><strong>Methods and results: </strong>Sixty-five patients discharged after ADHF hospitalization monitored HR with a wrist-worn device for 6 months after reaching stable HF. Circadian parameters (mesor, amplitude and acrophase) were extracted via cosinor analysis and used to train a long short-term memory neural network. The algorithm analysed 21-day periods before an HF event, defined as unplanned outpatient visits for congestion episode, increased diuretics, ADHF hospitalization or sudden cardiac death. Circadian changes appeared in the 21 days preceding HF events, with elevated mesor (70.6 vs. 73.6 b.p.m.; P < 0.001), reduced amplitude (8.3 vs. 4.9 b.p.m.; P = 0.046) and acrophase shifts (11.3 vs. 12.2 h; P = 0.706). The classification algorithm showed 74% sensitivity, 73% specificity and a 74% AUC (P < 0.001). Amplitude was the strongest predictor, contributing 62% to the algorithm's feature importance.</p><p><strong>Conclusions: </strong>Circadian metrics from a wrist-worn device showed progressive alterations over the 3 weeks preceding ADHF, offering potential early detection of HF decompensation with moderate prediction performance. Future research should refine these metrics and results in larger, diverse populations, using various sensor types and explore early interventions.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947346","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}