ESC Heart Failure最新文献

{"title":"A prospective analysis of management and outcomes of worsening heart failure in the outpatient setting.","authors":"Joseph McCambridge, Fiyinfoluwa Fabamwo, Shadia Taha, Dermot McCaffrey, Matthew Barrett, Ciara Mahon, Kenneth McDonald","doi":"10.1002/ehf2.15400","DOIUrl":"https://doi.org/10.1002/ehf2.15400","url":null,"abstract":"<p><strong>Aims: </strong>There is growing recognition of the burden and prognostic significance of WHF treated in the outpatient setting. However, there is currently a lack of prospective real-world data in this area of HF care. This study aims to analyse the natural history of outpatient WHF.</p><p><strong>Methods and results: </strong>This is a prospective, observational study of consecutive patients treated for WHF in our ambulatory HF clinic from August 2022 to March 2024. The diagnosis of WHF was made according to two definitions. The first required meeting strict pre-specified diagnostic criteria. The second included patients not meeting these diagnostic criteria but deemed to have WHF by a senior cardiologist. All patients required escalation in diuretic therapy (oral and/or intravenous) for inclusion. Clinical endpoints included outcomes from the presenting WHF episode and over the subsequent 3 months. Of the 234 patients treated for outpatient WHF, stabilisation was achieved in 78.6% (184) with 16.2% (38) requiring HF hospitalisation. A further 3.4% (8) experienced non-HF-related admissions, 2 (0.9%) patients died without hospitalisation and 2 (0.9%) patients requested follow up in other units for geographic ease. Bailout therapies (oral metolazone and/or IV loop diuretic) were used in 45.3% (106), and adverse clinical outcomes were significantly higher in this group than among those treated with oral loop diuretic only (35.8%, 38/106 and 9.4%, 12/128 respectively; odds ratio 7.24, P < 0.001). Of those who initially stabilised, 24.5% (45/184) had recurrent outpatient WHF during the subsequent 3-month period of follow-up, and 4.9% (9/184) were hospitalised for HF.</p><p><strong>Conclusions: </strong>Outpatient WHF was successfully treated in the majority of patients in the community. However, despite initial stabilisation, there is a persistent risk of recurrent deterioration. This may reflect challenges in defining stability clinically in HF patients. Biologic markers of stability and closer follow-up may help to address this challenge and improve outlook for this at-risk group.</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":"144947492","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":"Four decades of heart-lung transplantation: Milestones and outcomes in advanced cardiorespiratory failure.","authors":"L Lily Rosenthal, Anna Maria Mühlbauer, Carola Grinninger, Nikolaus A Haas, Heinrich Netz, Robert Dalla Pozza, Jürgen Hörer, Sebastian Michel, R Schramm, D Graetz, Christian Hagl","doi":"10.1002/ehf2.15411","DOIUrl":"https://doi.org/10.1002/ehf2.15411","url":null,"abstract":"<p><strong>Aims: </strong>Heart-lung transplantation (HLTx) remains a life-saving intervention for patients with end-stage cardiopulmonary failure. We retrospectively analysed long-term HLTx outcomes at our centre to assess survival trends and evaluate the impact of evolving immunosuppressive, surgical and perioperative strategies.</p><p><strong>Methods and results: </strong>This single-centre retrospective cohort study included 80 patients who underwent HLTx between 1983-1995 (Era 1) and 1996-2010 (Era 2), with follow-up through June 2024. All patients had severe cardiorespiratory failure. The primary endpoint was all-cause mortality. Secondary endpoints included early and late post-transplant outcomes. Overall survival at 1, 5 and 10 years post-transplant was 60 ± 6%, 46 ± 6% and 35 ± 6%, respectively. Survival improved significantly between Era 1 (46 ± 10%, 18 ± 9% and 9 ± 6%) and Era 2 (66 ± 7%, 5 ± 7% and 45 ± 7%) (P < 0.001), correlating with advancements in immunosuppression, organ preservation and perioperative care. Univariable risk factors for increased mortality included Euro Collins versus Perfadex lung preservation (P < 0.001), University of Wisconsin (UW2) versus Histidine-Tryptophan-Ketoglutarate (HTK) solution cardioplegia (P < 0.001), and Epstein-Barr virus infection (P = 0.036). Heart failure: OR 4.557 (95% CI: 1.057-19.648, P = 0.042) and gastrointestinal bleeding: OR 2.739 (95% CI: 1.310-5.726, P = 0.016) were identified as risks for mortality. These factors remained significant in multivariable analysis.</p><p><strong>Conclusions: </strong>HLTx outcomes at our centre are consistent with international benchmarks. Survival has improved in Era 2, likely due to individualised immunosuppressive regimens, novel organ preservation techniques and enhanced surveillance. These results support ongoing optimisation of multidisciplinary care for complex cardiopulmonary failure.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947651","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":"Phenotype characterization of heart failure with preserved ejection fraction in medical device and surgical trials.","authors":"Kurdo Araz, Francesco Fioretti, Sara Ladak, Mohammed Obaidan, Javed Butler, Aamir Hameed","doi":"10.1002/ehf2.15401","DOIUrl":"https://doi.org/10.1002/ehf2.15401","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure with preserved ejection fraction (HFpEF) prevalence is nearing 50% of all heart failure cases and is often associated with advanced age, obesity, atrial fibrillation and hypertension, and medical approaches are limited. This review aims to determine the potential of medical devices or surgical interventions in treating HFpEF and to propose specific phenotypes of HFpEF.</p><p><strong>Methods and results: </strong>A systematic review was conducted using various clinical trial databases and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines followed by descriptive analysis and methodology quality assessment. Inclusion criteria included a medical device or surgical intervention involving HFpEF patients defined by a left ventricular ejection fraction (LVEF) ≥50% and signs of diastolic dysfunction. Twenty-four novel trials were identified involving n = 1752 participants: 17 medical device trials [3 interatrial shunt device trials (n = 1069), 1 atrial flow regulator trial (n = 41), 3 vagal nerve stimulation trials (n = 112), 1 baroreflex activation therapy trial (n = 21), 1 cardiac contractility modulator trial (n = 47), 6 cardiac resynchronization therapy trials (n = 178) and 2 functional electrical stimulation therapy trials (n = 89)] and 7 surgical intervention trials [1 renal denervation trial (n = 25), 3 greater splanchnic nerve ablation trials (n = 111), 2 catheter ablation trials (n = 55) and 1 pericardiotomy procedure trial (n = 4)]. One trial completed phase 3 trials, 20 trials completed phase 1 trials with further trials, and 5 trials completed phase 1 trials without further trials.</p><p><strong>Conclusions: </strong>Overall, 16 out of 24 trials have at least demonstrated safety and feasibility. However, despite many trials of a medical device or surgical procedure showing proof of concept to treat HFpEF phenotypes, they do not provide sufficient evidence of long-term benefit. More robust and phenotype-based clinical trials are needed to ensure evidence-based solutions are developed in HFpEF.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947281","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":"Digital implementation strategy to increase SGLT2 inhibitor uptake in heart failure: Study design of EMAIL-HF.","authors":"Mariam Elmegaard, Lars Køber, Mads Kristian Ersbøll, Theis Lange, Christian Ditlev Tuxen, Mette Rauhe Mouridsen, Trine Kiilerich Lauridsen, Jens Jakob Thune, Peter Godsk Jørgensen, Morten Lamberts, Nadia Paarup Dridi, Peter Bonfils, Morten Petersen, Nis Ottesen Stride, Anders Barasa, Jesper Jensen, Caroline Garred, Emil Fosbøl, Emil Wolsk, John McMurray, Mark Petrie, Morten Schou","doi":"10.1002/ehf2.15398","DOIUrl":"https://doi.org/10.1002/ehf2.15398","url":null,"abstract":"<p><strong>Aims: </strong>The EMAIL-HF trial aims to evaluate whether a digital guideline implementation strategy can increase and accelerate initiation of sodium-glucose co-transporter 2 (SGLT2) inhibitors in patients with heart failure (HF).</p><p><strong>Methods and results: </strong>EMAIL-HF is a pragmatic, registry-based, randomized controlled trial including patients with a diagnosis of HF within the last 10 years, residing in the Capital Region of Denmark and the municipality of Roskilde (~2 million inhabitants). A total of 5996 eligible patients not already treated with SGLT2 inhibitors were identified from nationwide health registries and randomized 1:1 to either receive a digital letter providing information on SGLT2 inhibitors with an invitation for evaluation (intervention group: 2979 patients), or to usual care without the letter (control group: 3017 patients). The median age was 73 years (intervention) vs. 74 years (control), with 67.4% and 66.5% males, respectively. The primary outcome is the proportion of patients initiating SGLT2 inhibitor therapy within 6 months after randomization. The secondary outcome is a composite of time to first HF hospitalization or all-cause mortality. Additional exploratory outcomes include adherence, clinical events, healthcare utilization and subgroup analyses. Full baseline characteristics and clinical outcomes will be reported after completion of event accrual.</p><p><strong>Conclusions: </strong>EMAIL-HF will determine whether a population-wide digital strategy can increase and accelerate guideline-based initiation of SGLT2 inhibitors in patients with chronic HF. This trial may offer a scalable model to improve implementation of novel therapies in routine clinical practice.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947582","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":"Haemodynamic consequences of acute pulmonary embolism predict risk of CTPA-related acute kidney injury.","authors":"Anna M Imiela, Michał Machowski, Bartosz Karolak, Olaf Wasilewski, Małgorzata Landowska, Aleksandra Żuk-Łapan, Aleksandra Piech, Tomasz Cader, Małgorzata Wiśniewska, Bogdan Stelmach, Piotr Pruszczyk","doi":"10.1002/ehf2.15392","DOIUrl":"https://doi.org/10.1002/ehf2.15392","url":null,"abstract":"<p><strong>Introduction: </strong>Computed tomography pulmonary angiography (CTPA) is an important study in the diagnosis of acute pulmonary embolism (APE). There are limited data on acute kidney injury (AKI) after CTPA in APE patients. The aim was to evaluate frequency and predictors of AKI in patients with the first APE episode.</p><p><strong>Patients and methods: </strong>Single-centre, retrospective analysis of APE patients, without haemodynamic instability. Blood tests, including plasma creatinine concentration and clinical evaluation were performed before CTPA and after 48 and 72 h. Transthoracic echocardiography was performed to evaluate right ventricular (RV) function.</p><p><strong>Results: </strong>A total of 411 patients with APE were enrolled. AKI defined by creatine increase ≥0.3 mg% within 72 h following CTPA was found in 46 pts (11.2%). Patients with AKI (+) when compared with AKI (-) were characterized by higher sPESI score; more pronounced RV dysfunction; higher plasma concentration of N terminal pro brain natriuretic peptide (NT-proBNP) and more often suffered from pre-existing chronic kidney disease (CKD) and diabetes mellitus (DM2). The multivariate logistic regression model showed that only: BOVA score {odds ratio (OR) 1.431 [95% confidence interval (CI), 1.110; 1.845], P value = 0.006}; NT-proBNP > 3314 pg/mL [OR 3.765 (95% CI, 1.572; 9.016), P value = 0.003], while not CKD or sPESI were independent risks factors for AKI. Among subjects with BOVA ≥ 3 points and NT-proBNP ≥ 3314 pg/mL, almost 32% developed AKI, and among patients with BOVA < 3 points and NT-proBNP < 3314 pg/mL, only 5% of patients developed AKI.</p><p><strong>Conclusions: </strong>AKI present in 11% of all PE patients diagnosed with CTPA is associated with embolism severity, measured by BOVA score, and RV dysfunction as defined by higher NT-proBNP, while not to pre-existing CKD or DM2.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946492","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":"Epicardial, visceral and subcutaneous adipose tissue in heart failure with preserved ejection fraction","authors":"Michelle Lobeek,&nbsp;Lea P. A. Timmann,&nbsp;Dirk J. van Veldhuisen,&nbsp;Just Dronkers,&nbsp;Riemer H. J. A. Slart,&nbsp;Michiel Rienstra,&nbsp;Alain R. Viddeleer,&nbsp;Thomas M. Gorter","doi":"10.1002/ehf2.15396","DOIUrl":"10.1002/ehf2.15396","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Obesity is common in patients with heart failure with preserved ejection fraction (HFpEF), and adipose tissue (AT) plays a key role in its pathophysiology. We examined the distribution and association of visceral AT (VAT), subcutaneous AT (SAT) and epicardial AT (EAT) in HFpEF using multimodality imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Heart failure patients with left ventricular ejection fraction &gt;40% were prospectively enrolled. All patients underwent cardiac magnetic resonance (CMR) imaging and total body computed tomography (CT). EAT was measured on CMR, and VAT, SAT and waist circumference (WC) were measured on CT. Linear regression analysis was used to assess associations between EAT and other AT depots.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 68 patients were included. Mean age was 73 ± 8 years; 34 (50%) were women. Twenty-six patients (38%) were obese, while 60 (91%) had increased WC and 58 (85%) had increased VAT. Body mass index (BMI) and WC were comparable between men and women, but men had more EAT (217 vs. 180 mL, <i>P</i> &lt; 0.001) and VAT (306 vs. 196 cm², <i>P</i> &lt; 0.001), but less SAT (177 vs. 276 cm², <i>P</i> &lt; 0.001), as compared with women. After adjusting for age, gender and BMI, VAT was only associated with EAT, albeit modest (<i>β</i> = 0.40, <i>P</i> &lt; 0.001, <i>R</i>² = 0.40), but not with SAT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The distribution of various AT depots is markedly different between men and women with HFpEF. Men have more VAT and EAT, but less SAT. The observed variation in AT depots may potentially contribute to gender-related differences in cardiovascular risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3353-3360"},"PeriodicalIF":3.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15396","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144872069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of echocardiography and echocardiographic findings in patients hospitalized for acute heart failure","authors":"Koravich Lorlowhakarn,&nbsp;Thanaporn Ratchataswan,&nbsp;Thiratest Leesutipornchai,&nbsp;Aunchalee Jaroenlapnopparat,&nbsp;Palapun Waitayangkoon,&nbsp;Supanee Sinphurmsukskul,&nbsp;Sarawut Siwamogsatham,&nbsp;Sarinya Puwanant,&nbsp;Smonporn Boonyaratavej Songmuang,&nbsp;Aekarach Ariyachaipanich","doi":"10.1002/ehf2.15268","DOIUrl":"10.1002/ehf2.15268","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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%, <i>P</i> = 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; <i>P</i> &lt; 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%, <i>P</i> = 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 (<i>P</i> &lt; 0.05 for all).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3678-3687"},"PeriodicalIF":3.7,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15268","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":"OA","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,&nbsp;Nhat Minh Giang,&nbsp;Duc Tan Vo,&nbsp;Tri Huynh Quang Ho,&nbsp;Chau Ngoc-Hoa","doi":"10.1002/ehf2.15399","DOIUrl":"10.1002/ehf2.15399","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We prospectively enrolled 443 chemotherapy-naïve women with breast cancer and cardiovascular risk factors, scheduled to receive anthracycline (<i>n</i> = 333) or trastuzumab (<i>n</i> = 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 &lt; 50%, irrespective of symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 &gt; 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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3667-3677"},"PeriodicalIF":3.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15399","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":"OA","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,&nbsp;Ivan Petrović,&nbsp;Aleksandra Ilić,&nbsp;Dragana Dabović,&nbsp;Aleksandra Milovančev,&nbsp;Goran Remer,&nbsp;Vladimir Vuković,&nbsp;Dimitrije Zdravković,&nbsp;Maja Stefanović,&nbsp;Snežana Stojšić,&nbsp;Ana Balenović,&nbsp;Goran Lončar,&nbsp;Snežana Tadić,&nbsp;Milana Jaraković,&nbsp;Snežana Bjelić,&nbsp;Snežana Čemerlić,&nbsp;Marija Bjelobrk,&nbsp;Tatjana Miljković,&nbsp;Andrej Preveden,&nbsp;Milovan Petrović,&nbsp;Srdjan Maletin,&nbsp;Tanja Popov,&nbsp;Vanja Drljević Todić,&nbsp;Mirko Todić,&nbsp;Aleksandra Vulin,&nbsp;Milenko Čanković,&nbsp;Dragica Andrić,&nbsp;Dragoslava Živkov Šaponja,&nbsp;Aleksandar Redžek,&nbsp;Anastazija Stojšić Milosavljević","doi":"10.1002/ehf2.15397","DOIUrl":"10.1002/ehf2.15397","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3655-3666"},"PeriodicalIF":3.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15397","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":"OA","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,&nbsp;Muzi Maseko,&nbsp;Nqoba Tsabedze","doi":"10.1002/ehf2.15394","DOIUrl":"10.1002/ehf2.15394","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The mean age of the patients was 54.94 ± 15.83 years, of whom 207 (51%) were female (&lt;i&gt;P&lt;/i&gt; = 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 (&lt;i&gt;P&lt;/i&gt; &lt; 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 (&lt;i&gt;P&lt;/i&gt; = 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; &lt;i&gt;P&lt;/i&gt; = 0.009], elevated neutrophil–lymphocyte ratio (OR: 1.15; 95% CI: 1.03–1.29; &lt;i&gt;P&lt;/i&gt; = 0.012), elevated serum potassium (OR: 3.41; 95% CI: 1.23–9.43; &lt;i&gt;P&lt;/i&gt; = 0.018), moderate aortic regurgitation (AR) (OR: 12.80; 95% CI: 1.12–101.29; &lt;i&gt;P&lt;/i&gt; = 0.016) and severe AR (OR: 34.49; 95% CI: 3.77–353.47; &lt;i&gt;P&lt;/i&gt; = 0.002) were observed. Low diastolic blood pressure was associated with a reduced mortality risk (OR: 0.94; 95% CI: 0.89–0.99; &lt;i&gt;P&lt;/i&gt; = 0.045).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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 s","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3643-3654"},"PeriodicalIF":3.7,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15394","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}