ESC Heart Failure最新文献

{"title":"In-hospital and 1 year incremental prognostic value of drug abuse detection in acute heart failure","authors":"Charles Fauvel, Jean-Guillaume Dillinger, Thomas Bochaton, Thomas Levasseur, Amine El Ouahidi, Cyril Zakine, Antony El Hadad, Nicolas Mansencal, Nathalie Noirclerc, Marc Goralski, Christophe Thuaire, Nathan Mewton, Guillaume Schurtz, Pascal Lim, Thibaut Pommier, Léo Lemarchand, Quentin Laissac, Nicolas Lamblin, Tanissia Boukertouta, Damien Logeart, Alain Cohen-Solal, Patrick Henry, Théo Pezel, for the ADDICT-ICCU Investigators","doi":"10.1002/ehf2.15118","DOIUrl":"10.1002/ehf2.15118","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The study aims to assess the in-hospital and 1 year incremental prognostic value of recent drug abuse use, detected by a systematic urinary screening, in a consecutive cohort of patients hospitalized for acute heart failure (AHF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients admitted for AHF with a drug abuse screening using a urinary assay were included in this prospective multicentric study (39 French centres). The outcomes were (i) in-hospital major adverse cardiovascular events (MACEs) defined as all-cause death, resuscitated cardiac arrest or cardiogenic shock; and (ii) 1 year MACEs defined as cardiovascular death or hospitalization for AHF. Incremental prognostic value was assessed using the C-index, the global <i>χ</i><sup>2</sup> and likelihood-ratio (LR) test, the net reclassification improvement (NRI) and integrated discrimination improvement (IDI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 458 patients with AHF were included (mean age 68 ± 14 years, 67% male, 79% of new heart failure onset). In-hospital and 1 year MACEs occurred, respectively, in 65 (14.2%) and 129 (28.2%) patients. Drug abuse detection was independently associated with in-hospital MACEs [model 1—known comorbidities: odds ratio (OR) = 4.46, 95% confidence interval (CI) (1.88–10.3), <i>P</i> < 0.001; model 2—clinical severity: OR = 3.64, 95% CI (1.56–8.26), <i>P</i> = 0.002], even after propensity-matched population analysis [OR = 3.34, 95% CI (1.32–8.70), <i>P</i> = 0.011], with a significant incremental prognostic value over and above traditional risk factors (<i>C</i>-statistic improvement 0.04 with LR test <i>P</i> < 0.001 for both models). Patients with drug abuse detection had worse 1 year survival: HR = 1.82, 95% CI (1.13–2.92), <i>P</i> = 0.012. Drug abuse detection was independently associated with 1 year MACEs after adjustment with traditional prognosticators [OR = 2.54, 95% CI (1.28–4.98), <i>P</i> = 0.008] and propensity-matched population analysis [OR = 2.77, 95% CI (1.98–5.21), <i>P</i> = 0.001], with an incremental prognostic value as well (<i>C</i>-statistic improvement 0.02, LR test <i>P</i> < 0.001, positive NRI and IDI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Drug abuse use was independently associated with a higher occurrence of both in-hospital and 1 year MACEs with an incremental prognostic value. These results suggest a potential interest of a systematic illicit drug screening in these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 ","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2736-2748"},"PeriodicalIF":3.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208045","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 effects of early exercise on cardiovascular biomarkers in patients with congestive heart failure","authors":"Yanxiang Sun,&nbsp;Xuansheng Huang,&nbsp;Bing Hu,&nbsp;Zidi Wu,&nbsp;Yanchun Zhang,&nbsp;Yong Yuan,&nbsp;Li Feng","doi":"10.1002/ehf2.15317","DOIUrl":"10.1002/ehf2.15317","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Exercise training improves functional outcomes in chronic heart failure (HF), but the effects of early in-hospital physical activity on cardiovascular biomarkers and prognosis in acute congestive heart failure (AHF) patients remain unclear. This study investigated the short-term impact of early rehabilitation on prognostic biomarkers—high-sensitivity troponin T (hs-TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), soluble suppression of tumourigenesis-2 (sST2), galectin-3 (Gal-3) and endothelin-1 (ET-1)—and evaluated associations with clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>A total of 118 hospitalized AHF patients (35 controls and 83 exercise group) underwent biomarker measurement before and after supervised rehabilitation using non-invasive cardiac output monitoring. Serum levels of NT-proBNP, hs-TnT, sST2, Gal-3, and ET-1 were analysed. Prognosis was assessed via 12-month follow-up for all-cause mortality. Statistical analysis included ANOVA for biomarker changes and Kaplan–Meier survival analysis. Post-intervention, NT-proBNP levels increased significantly in the exercise group (2900 ± 700 pg/mL to 3500 ± 760 pg/mL, <i>P</i> = 0.012), as did ET-1 (1.9 ± 0.4 pg/mL to 2.4 ± 0.5 pg/mL, <i>P</i> = 0.018). Hs-TnT, sST2 and Gal-3 showed no significant changes (all <i>P</i> &gt; 0.05). Survival analysis demonstrated higher baseline hs-TnT [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.3–3.4] and greater NT-proBNP elevation post-exercise (ΔNT-proBNP HR 1.8, 95% CI 1.1–2.9) were independent predictors of mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early in-hospital exercise in AHF patients transiently elevates NT-proBNP and ET-1, indicative of acute haemodynamic stress, without altering myocardial injury or fibrosis markers (hs-TnT, sST2 and Gal-3). Elevated baseline hs-TnT and post-exercise NT-proBNP increases correlate with poorer survival, highlighting their prognostic value in risk assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2985-2992"},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15317","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101685","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":"Quality of life after transcatheter tricuspid valve repair: results from the Tri.FR trial","authors":"Sabina Istratoaie,&nbsp;Pascal de Groote,&nbsp;Nicole Karam,&nbsp;Jean-Noel Trochu,&nbsp;Guillaume Leurent,&nbsp;Augustin Coisne,&nbsp;Pierre-Yves Le Roux,&nbsp;Anne Ganivet,&nbsp;Anne Bernard,&nbsp;Antoinette Neylon,&nbsp;Romain Pierrard,&nbsp;Florent Le Ven,&nbsp;François Picard,&nbsp;Nicolas Piriou,&nbsp;Thierry Laperche,&nbsp;Jerome Jouan,&nbsp;Amedeo Anselmi,&nbsp;Vincent Auffret,&nbsp;Emmanuel Oger,&nbsp;Erwan Donal","doi":"10.1002/ehf2.15327","DOIUrl":"10.1002/ehf2.15327","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>In the Tri.FR trial, tricuspid transcatheter edge-to-edge repair (T-TEER) reduced severity of tricuspid regurgitation (TR) and improved the composite clinical score, driven by patient-reported outcomes. The purpose of this study was to describe the longitudinal impact of T-TEER on different dimensions and items of quality of life compared with guideline-directed medical treatment (OMT) alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>Patients were randomized to T-TEER +OMT (<i>n</i> = 152) or OMT alone (<i>n</i> = 148). Health status was assessed at baseline, 6 weeks, 6 months, and 1 year using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Minnesota Living with Heart Failure (MLHF) Questionnaire. Mixed effects linear regression analysed changes over time. Patients receiving T-TEER + OMT experienced a significant increase in KCCQ overall summary score (KCCQ-OS) at all time points: +17.0 points (95% confidence interval [CI] 13.1–21.5) at 6 weeks, +15.9 points (95% CI 11.2–20.6) at 6 months, and +18.7 points (95% CI 13.8–23.6) at 1 year. The mean between-group difference in KCCQ-OS was +10.3 points (95% CI 5.6–15.0) in favour of T-TEER + OMT, evident at 6 weeks and sustained for 1 year. Similarly, MLHF total scores improved significantly in the T-TEER group (mean between-group difference −8.61 points, 95% CI –12.6 to −4.6), including physical (−3.9, 95% CI –5.9 to −1.9) and emotional (−2.2, 95% CI –3.4 to −1.0) subscales.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Compared with OMT alone, T-TEER resulted in substantial, multidimensional, and sustained improvements in patient-reported quality of life. These findings reinforce the value of T-TEER in managing severe symptomatic TR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"3053-3061"},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15327","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093207","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 phenotyping of cardiogenic shock at a glance: A rapid, costless, streamlined approach","authors":"Miloud Cherbi,&nbsp;Hamid Merdji,&nbsp;Eric Bonnefoy,&nbsp;François Roubille,&nbsp;Clément Delmas,&nbsp;for the FRENSHOCK Investigators","doi":"10.1002/ehf2.15336","DOIUrl":"10.1002/ehf2.15336","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Cardiogenic shock (CS) is a heterogeneous syndrome in which recent guidelines have proposed clinical phenotyping based on the presence of hypoperfusion and/or congestion signs and symptoms. However, the impact of this clinical phenotype on outcomes remains poorly characterized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>FRENSHOCK is a prospective registry including 772 CS patients from 49 centres. Patients were categorized into multiple phenotypic groups based on three clinically assessed bedside criteria at admission: congestion, hypotension and skin mottling. The primary endpoint was 30-day all-cause mortality. Among 475 CS patients included, 69.7% were male, with a median age of 67.0 (59.0–78.0) years. Most patients presented with SCAI stage C (37.1%) or D (51.2%). At admission, 424 patients (89.3%) presented with congestion (50.7% on both sides, 39.2% left-sided, 10.1% right-sided), 343 (72.2%) with hypotension and 180 (37.9%) with mottling. At 30 days, 113 patients (23.8%) had died, spanning from 8.8% for patients with isolated hypotension (without congestion/mottling) to 26.5% for patients with hypotension and congestion, and 32.3% for patients with hypotension, congestion and mottling. The corresponding ORs for 30-day all-cause mortality remained significant even after adjustment for potential confounders, with 1.19 [(1.02–1.39), <i>P</i> = 0.03] for hypotension and congestion and 1.26 [(1.08–1.48), <i>P</i> &lt; 0.01] for hypotension, congestion and mottling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A simple clinical bedside evaluation of the CS phenotype based on hypotension, congestion and mottling allows for quick and costless stratification of 30-day mortality risk and can be used to guide the level of monitoring intensity and/or patient management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"3183-3186"},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15336","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101558","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":"SGLT2 inhibitor with and without ALDosterone AntagonIst for heart failure with preserved ejection fraction: Design paper","authors":"João Pedro Ferreira,&nbsp;Francisco Vasques-Nóvoa,&nbsp;Francisca Saraiva,&nbsp;Ana C. Oliveira,&nbsp;Jorge Almeida,&nbsp;Ana Beatriz Batista,&nbsp;Arsénio Barbosa,&nbsp;Ana Filipa Ferreira,&nbsp;Cátia Costa,&nbsp;Diogo Santos-Ferreira,&nbsp;Fernando Friões,&nbsp;Cândida Goncalves,&nbsp;João Tiago Guimarães,&nbsp;Marta Leite,&nbsp;Pedro Marques,&nbsp;Joana Mascarenhas,&nbsp;Maria Inês Matos,&nbsp;Catarina Pereira,&nbsp;Pedro Rodrigues,&nbsp;Abhinav Sharma,&nbsp;Gualter Silva,&nbsp;Inês Pereira-Sousa,&nbsp;Carla Sousa,&nbsp;Faiez Zannad,&nbsp;Joana Pimenta,&nbsp;Ricardo Fontes-Carvalho,&nbsp;Adelino Leite-Moreira","doi":"10.1002/ehf2.15294","DOIUrl":"10.1002/ehf2.15294","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Sodium glucose co-transporter 2 inhibitors (SGLT2i) and mineralocorticoid receptor antagonists (MRA) reduce heart failure (HF) events in patients with heart failure and mildly reduced or preserved ejection fraction (HFmr/pEF). The randomized comparison of SGLT2i/MRA combination versus SGLT2i or MRA alone requires further testing in HFmr/pEF.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To compare the efficacy (NT-proBNP change as primary outcome) and safety (potassium, creatinine, and blood pressure changes) of dapagliflozin/spironolactone combination versus dapagliflozin alone (primary comparison) and spironolactone alone (exploratory comparison).&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;SOGALDI-PEF (SOdium-Glucose cotransporter 2 inhibitor, ALDosterone AntagonIst, or both for heart failure with preserved ejection fraction; NCT05676684), a proof-of-concept investigator-initiated two-centre randomized cross-over trial comparing three arms (dapagliflozin, spironolactone, or both) for three periods of 12 weeks each intercalated by a wash-out period of 4 weeks. After two independent trials demonstrating efficacy of SGLT2i in HFmr/pEF, a mid-trial protocol amendment dropped the spironolactone alone sequence and reduced the wash-out period to 1 week. A sample size of 108 patients was estimated to provide 80% power, at a 0.05 alfa level, to detect a 0.15 &lt;i&gt;Log&lt;/i&gt;NT-proBNP difference between the spironolactone/dapagliflozin combination and dapagliflozin alone sequence.&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;SOGALDI-PEF included 108 patients with a median age of 76 years, 57% women, 42% with atrial fibrillation, 46% with type 2 diabetes, 33% having an eGFR below 60 mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt;, and 93% having an ejection fraction ≥ 50%. The median serum potassium was 4.3 mmol/L, and the median NT-proBNP was 764 pg/mL. Most patients were treated with renin–angiotensin blockers (68%), beta-blockers (70%) and loop diuretics (69%). Compared to other HFmr/pEF trials, SOGALDI-PEF patients were older, were more frequently women, had a high prevalence of atrial fibrillation, and had more often a preserved ejection fraction.&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;SOGALDI-PEF will be the first trial in HFmr/pEF to test the combination of dapagliflozin/spironolactone vs dapagliflozin alone in a randomized manner. SOGALDI-PEF will provide information on the potential efficacy and safety of concomitant administ","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"3134-3144"},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101673","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":"METAB-HTX: prospective, longitudinal cohort study evaluating cardiac and systemic metabolism after heart transplantation","authors":"Amin Polzin,&nbsp;Daniel Scheiber,&nbsp;Fabian Voss,&nbsp;Jean Haurand,&nbsp;Elric Zweck,&nbsp;Daniel Oehler,&nbsp;Oliver Maier,&nbsp;Mareike Cramer,&nbsp;Maximilian Spieker,&nbsp;Constanze Moos,&nbsp;Ursala Tokhi,&nbsp;David Naguib,&nbsp;Philipp Mourikis,&nbsp;Marcel Benkhoff,&nbsp;Robert Wagner,&nbsp;Michael Roden,&nbsp;Heinz-Peter Schultheiss,&nbsp;Sascha Dietrich,&nbsp;Hug Aubin,&nbsp;Udo Boeken,&nbsp;Artur Lichtenberg,&nbsp;Malte Kelm","doi":"10.1002/ehf2.15330","DOIUrl":"10.1002/ehf2.15330","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;Heart transplantation (HTX) is the treatment of choice for advanced heart failure. Still, long-term survival needs to be improved. Recent studies showed that obesity and type 2 diabetes (T2D) as well as impaired renal and liver function are associated with mortality post-HTX. There are many open questions including (i) optimal metabolic surveillance post-transplant, (ii) association of metabolic deterioration and cardiac function, (iii) association with hepatic and renal deterioration, and (iv) optimal timing and choice of treatment. The METAB-HTX trial will address these open questions, hypothesizing that metabolic deterioration post-HTX is associated with impaired cardiac function and survival.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods and results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;METAB-HTX is a prospective, longitudinal cohort study, enrolling 400 patients post-HTX in a period of 5 years. Time-series, deep cardiac, and metabolic phenotyping will be conducted. Cardiac function will be analysed by echocardiography as well as serial cardiac magnetic resonance imaging and spectroscopy (cMRI/MRS). Coronary angiography will be conducted to assess both macrovascular and microvascular coronary allograft vasculopathy (CAV). To evaluate allograft rejection, endomyocardial biopsies will be taken. Metabolic alterations will be investigated by (i) glucometabolic phenotyping including serial oral glucose tolerance tests, homeostasis model assessment, T2D endotyping, and muscle biopsies in selected cases; (ii) lipid disorders will be evaluated by classical lipid measurements in combination with evaluation of HDL function, plasma membrane lipid composition, fluidity analyses of circulating cells and MRI/MRS for adipose tissue distribution, and ectopic fat analysis. Kidney and liver function and structural alterations will be evaluated. Complex analyses will be conducted to evaluate (i) myocardial substrate utilization and energy metabolism by cardiac and circulating cell respirometry, (ii) impact of genetic (including immunogenetic) and transcriptomic factors by third- and fourth generation sequencing (short- and long-read sequencing), (iii) circulating signatures of future neoplasia by single-cell sequencing of circulating leucocytes, and (iv) evaluation of thromboinflammation in association with heart transplant events. The primary endpoint will be the incidence of heart transplant events, defined as worsening of systolic or diastolic left ventricular function, CAV, allograft rejection, worsening of kidney function, metabolic liver disease, infections, neoplasia, deterioration of glucose and lipid metabolism. Secondary outcomes include hospitalizations related to primary endpoints, re-HTX or ventricular assist device, cardiovascular mortality, and all-cau","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"3152-3162"},"PeriodicalIF":3.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15330","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076816","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":"Investigating the efficacy of mineralocorticoid receptor antagonists for cardiovascular outcomes in different diseases","authors":"Jiao Wang,&nbsp;Meijuan Zheng,&nbsp;Yuchun Yang,&nbsp;Lei Zhang,&nbsp;Muhuyati Wulasihan","doi":"10.1002/ehf2.15329","DOIUrl":"10.1002/ehf2.15329","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;Mineralocorticoid receptor antagonists (MRAs) are crucial in managing cardiovascular diseases, with different MRAs demonstrating varying efficacy across diverse disease contexts. This research aims to compare the cardiovascular protective effects of different MRAs across various disease conditions.&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;Evidence from eligible randomized controlled trials (RCTs), cohort studies, or real-world registry studies that investigated hazard ratio (HR) with 95% confidence intervals (CIs) of major adverse cardiovascular events (MACE) following MRA treatment were searched in four literature databases. Surface under the cumulative ranking curve values were calculated. Sensitivity analyses were conducted to assess the robustness of the findings.&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;Data from a total of 21 investigations involving 61 076 participants were included. The control groups comprised placebo arms in RCTs and non-MRA users in observational studies. In heart failure (HF) patients, finerenone showed highest efficacy with HR 0.68 (95% CI 0.47–0.95) versus control, followed by spironolactone (HR 0.72, 95% CI 0.55–0.89) and eplerenone (HR 0.81, 95% CI 0.64–1.10). For non-HF populations, spironolactone showed the most protective effect (HR 0.40, 95% CI 0.15–1.10), followed by eplerenone (HR 0.58, 95% CI 0.25–1.30) and finerenone (HR 0.89, 95% CI 0.50–1.60). In diabetes mellitus population, spironolactone maintained advantage (HR 0.57, 95% CI 0.13–2.43) in contrast to finerenone (HR 0.74, 95% CI 0.41–1.25) and eplerenone (HR 0.78, 95% CI 0.40–1.62). Sensitivity analyses which excluded observational studies and included only RCTs showed consistent results for these disease populations. But the chronic kidney disease/end-stage renal disease population exhibited different patterns: eplerenone showed optimal efficacy in primary analysis (HR 0.62, 95% CI 0.32–1.20) followed by spironolactone (HR 0.79, 95% CI 0.49–1.06) and finerenone (HR 0.87, 95% CI 0.55–1.35). Sensitivity analysis revealed better result for spironolactone in this population (HR 0.40, 0.15–1.10) followed by eplerenone (HR 0.62, 0.27–1.40) and finerenone (HR 0.87, 0.49–1.50).&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;MRAs exhibit varying cardiovascular protective effects depending on the disease context. These findings support tailored treatment strategies based on specific disease conditions to optimize patient outcomes. Further research with larger and more diverse datasets is needed to validate these resu","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"3062-3072"},"PeriodicalIF":3.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15329","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076811","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":"Association between NT-proBNP changes and clinical outcomes in paediatric patients with heart failure: Insights from PANORAMA-HF and PARADIGM-HF","authors":"Robert Shaddy,&nbsp;Jianjian Gong,&nbsp;Tania Garito,&nbsp;Susan Solar-Yohay,&nbsp;Sijia Zhang,&nbsp;Margaret F. Prescott,&nbsp;Damien Bonnet,&nbsp;Paul F. Kantor,&nbsp;Michael Burch,&nbsp;Chad Mao,&nbsp;Antoinette Cilliers,&nbsp;Charles Canter,&nbsp;Yuk Law,&nbsp;Giorgia Grutter,&nbsp;Jou Kou Wang,&nbsp;Aamir Jeewa,&nbsp;Joseph Rossano,&nbsp;PANORAMA-HF investigators","doi":"10.1002/ehf2.15326","DOIUrl":"10.1002/ehf2.15326","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The PANORAMA-HF trial demonstrated significant N-terminal pro-B-type natriuretic peptide (NT-proBNP) reductions in paediatric patients with left ventricular systolic dysfunction with sacubitril/valsartan or enalapril treatment over 52 weeks. This post hoc analysis aims to correlate changes in NT-proBNP levels with clinical outcomes in PANORAMA-HF patients receiving either sacubitril/valsartan or enalapril. Additionally, NT-proBNP reductions in the paediatric population were compared with a subset of adult heart failure with reduced ejection fraction (HFrEF) patients from the PARADIGM-HF trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>This post hoc analysis utilized data from Part 2 of the PANORAMA-HF trial. Associations between baseline NT-proBNP levels, changes post-baseline and the risk of HF clinical events in paediatric patients on sacubitril/valsartan or enalapril were assessed. The paediatric HF population from PANORAMA-HF was categorized into age groups (AG): AG1 (aged 6 to &lt;18 years), AG2a (aged 2 to &lt;6 years) and AG3a (aged 1 month to &lt;2 years). The Cox proportional hazard model evaluated the relationship between NT-proBNP and clinical outcomes. Analysis of 361 paediatric patients (sacubitril/valsartan, <i>n</i> = 179; enalapril, <i>n</i> = 182) demonstrated overall higher baseline NT-proBNP levels in younger AGs. At Week 52, both treatment groups exhibited reduced NT-proBNP levels across all AGs. Reductions were comparable between sacubitril/valsartan and enalapril, with a numerically greater reduction observed in adult patients versus children. Strong associations between NT-proBNP levels and HF clinical outcomes were observed in paediatric populations in PANORAMA-HF and in adult DCM patients with HFrEF in PARADIGM-HF. Doubling of NT-proBNP levels was associated with a ≥1.7-fold increased risk of HF clinical events, while halving of the levels correlated with a 52% reduction in the risk of clinical events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the first prospective, randomized large-scale study to demonstrate a strong correlation between NT-proBNP levels and risks of HF clinical events in paediatric patients with HF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"3042-3052"},"PeriodicalIF":3.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987121","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":"Real-world use of guideline-directed therapy for heart failure: Insights from the Danish Heart Failure Registry","authors":"Inge Schjødt,&nbsp;Jan B. Valentin,&nbsp;Søren P. Johnsen,&nbsp;Rikke E. Mols,&nbsp;Kenneth Egstrup,&nbsp;Brian B. Løgstrup","doi":"10.1002/ehf2.15320","DOIUrl":"10.1002/ehf2.15320","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;We aimed to assess real-world implementation of guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (HFrEF) and its association with mortality and hospitalization.&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;We analysed 46 816 incident HFrEF patients from the Danish Heart Failure Registry (2008–2022). We examined the utilization of GDMT—renin–angiotensin system inhibitors (RASi), beta-blockers, mineralocorticoid receptor antagonists (MRAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i)—at 4, 8 and 12 weeks of follow-up according to the European Society of Cardiology guidelines within the intervals 2008–2011, 2012–2015, 2016–2020 and 2021–2022. Using Cox regression, we assessed the associations between GDMTs [none (reference), 1–2 GDMTs, and 3–4 GDMTs] initiated at 4, 8 and 12 weeks and 1 and 3 year mortality (all-cause and cardiovascular) and hospitalization (all-cause and 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;Between 2008–2011 and 2021–2022, RASi utilization at 4 weeks of follow-up was 93.2% and 93.7%, respectively, and at 12 weeks of follow-up, 97.2% and 97.8%, respectively. Beta-blocker use was 81.1% and 78.2% at 4 weeks and 89.6% and 90.4% at 12 weeks of follow-up while MRA utilization was 27.2% and 34.6% at 4 weeks and 32.6% and 52.2% at 12 weeks of follow-up. The SGLT2i use at 4 weeks increased from 0.0% to 21.3%, and at 12 weeks of follow-up from 3.2% to 35.8% between 2016–2020 and 2021–2022. The initiation of GDMTs at 4 weeks of follow-up was associated with lower adjusted hazard ratios (HRs) [95% confidence intervals (CI)] for 1 year all-cause mortality [1–2 GDMTs: 0.73 (95% CI: 0.61–0.86), 3–4 GDMTs: 0.65 (95% CI: 0.55–0.78)], 3 year all-cause mortality [1–2 GDMTs: 0.75 (95% CI: 0.66–0.86); 3–4 GDMTs: 0.67 (95% CI: 0.59–0.76)] and 3 year cardiovascular mortality [1–2 GDMTs: 0.74 (95% CI: 0.62–0.89); 3–4 GDMTs: 0.72 (95% CI: 0.59–0.87)]. Lower adjusted HRs were also observed for 1 year all-cause hospitalization [1–2 GDMTs: 0.80 (95% CI: 0.75–0.86); 3–4 GDMTs: 0.78 (95% CI: 0.73–0.84)] and 3 year all-cause hospitalization [1–2 GDMTs: 0.77 (95% CI: 0.72–0.83); 3–4 GDMTs: 0.77 (95% CI: 0.71–0.82)].&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;We demonstrated high use of RASi and beta-blockers and rising use of MRA and SGLT2i, reflecting rapid adaption to guidelines changes in incident HFrEF patients. Early GDMT initiation was associated with lower 1 and 3 year mortality and all-cause hospitalization. Upfront treatment with GDMT, according","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"3003-3017"},"PeriodicalIF":3.2,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15320","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996893","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":"Heritability and causality of QRS duration and chronic heart failure risk","authors":"Zequn Zheng,&nbsp;Xinhan Li,&nbsp;Yongfei Song","doi":"10.1002/ehf2.15321","DOIUrl":"10.1002/ehf2.15321","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Observational studies report conflicting results on the relationship between QRS duration and chronic heart failure (CHF), presenting challenges in establishing a causal link. This study investigates the heritability of QRS duration and CHF and their causal relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>Genome-wide association studies (GWAS) cohort for QRS duration included 10 815 samples from the IEU Open GWAS project, while exome-wide association studies (EWAS) data were sourced from the CHARGE Exome-Chip EKG consortium, involving 77 898 European individuals. The CHF GWAS dataset comprised 486 160 samples from the EMBL-EBI GWAS catalogue. Heritability estimates were determined using linkage disequilibrium score regression (LDSC). Mendelian randomization (MR) and sensitivity analyses assessed the causality. Heritability estimates for QRS duration were 16.3% from GWAS and 18.5% from EWAS. CHF exhibited minimal genetic influence with a heritability estimate of 0.8%. Six variants from the GWAS and 27 variants from the EWAS, including those in ion channel-related genes, like CASQ2, SCN5A and SCN10A, were identified as instrumental variables. MR analysis indicated that shorter QRS duration is causally associated with an increased CHF risk [QRS GWAS: (IVW (MRE): OR 0.84, 95% CI 0.78–0.91, <i>P</i> = 2.26E-05); QRS EWAS: (IVW (MRE): OR 0.98, 95% CI 0.96–0.99, <i>P</i> = 6.57E-05)]. Sensitivity analyses confirmed the robustness of these findings [corrected GWAS: Egger_intercept = 0.002, <i>P</i> = 0.94; corrected EWAS: Egger_intercept = 0.007, <i>P</i> = 0.38].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study establishes a causal relationship between shorter QRS duration and increased CHF risk, highlighting the importance of genetic factors in cardiac electrical conduction. Identifying QRS duration as a genetic marker for CHF risk can enhance early diagnosis and personalized treatment strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"3018-3027"},"PeriodicalIF":3.2,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963235","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}