ESC Heart Failure最新文献

{"title":"Progression and prognostic significance of electrocardiographic findings in patients with cardiac amyloidosis.","authors":"Alessia Argirò, Mattia Zampieri, Carlotta Mazzoni, Carlo Fumagalli, Michela Baccini, Alessandra Mattei, Alberto Cipriani, Laura De Michieli, Aldostefano Porcari, Gianfranco Sinagra, Marco Merlo, Giacomo Tini, Beatrice Musumeci, Domitilla Russo, Pier Filippo Vianello, Marco Canepa, Roberto Licordari, Gianluca di Bella, Claudio Rapezzi, Federico Perfetto, Francesco Cappelli","doi":"10.1002/ehf2.14684","DOIUrl":"https://doi.org/10.1002/ehf2.14684","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to evaluate the change of the main electrocardiographic (ECG) characteristics and their prognostic role across the main subtypes of cardiac amyloidosis [light-chain amyloidosis (AL) and hereditary (ATTRv) and wild-type transthyretin amyloidosis (ATTRwt)].</p><p><strong>Methods and results: </strong>This multicentre, retrospective study was performed in six referral centres for cardiac amyloidosis. Clinical and ECG data were collected at the first and last evaluations. Three hundred fifty-six patients were included (AL, n = 105; ATTRv, n = 50; ATTRwt, n = 201). The median age was 76 (67-81) years, and 271 (74%) were men. At baseline, patients with ATTRwt showed a higher prevalence of conduction abnormalities compared with those with AL [first-degree atrioventricular block, n = 51 (40%) vs. n = 13 (34%), P < 0.01; left bundle branch block, n = 23 (11%) vs. n = 2 (2%), P < 0.01], and patients with AL more often had low QRS voltage [n = 58 (55%); in ATTRv, n = 17 (34%); in ATTRwt, n = 67 (33%), P value < 0.01] and T wave inversion compared with those with ATTR [n = 39 (37%); in ATTRv, n = 9 (18%); in ATTRwt, n = 37 (18%)]. After a median follow-up of 15 (8-26) months, the adjusted differences in mean PR, QRS interval, total, peripheral, and precordial QRS scores were similar across subtypes of amyloidosis (P value for linear regression > 0.05). The adjusted odds ratios for the development of right bundle branch block were higher in AL compared with ATTRwt [odds ratio 4.7 (95% confidence interval 1.5-15), P < 0.05]. QRS duration at baseline remained independently associated with patient survival in the overall population even after adjustment for relevant clinical variables [hazard ratio 1.78 (95% confidence interval 1.13-2.8), P < 0.01].</p><p><strong>Conclusions: </strong>The progression of the ECG abnormalities seems similar across amyloidosis subtypes. QRS duration could be a marker of more advanced disease.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812680","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":"Lean ZSF1 rats in basic research on heart failure with preserved ejection fraction.","authors":"Petra Büttner, Antje Augstein, Mahmoud Abdellatif, André Lourenço, Adelino Leite-Moreira, Inês Falcão-Pires, Sarah Werner, Holger Thiele, Simon Sedej, Antje Schauer, Volker Adams","doi":"10.1002/ehf2.15111","DOIUrl":"https://doi.org/10.1002/ehf2.15111","url":null,"abstract":"<p><strong>Aims: </strong>ZSF1 obese rats harbouring two mutant leptin receptor alleles (Lepr^cp and Lepr^fa) develop metabolic syndrome and heart failure with preserved ejection fraction (HFpEF), making them a widely used animal model in cardiometabolic research. Studies using ZSF1 rats have contributed significantly to the elucidation of pathophysiological mechanisms underlying HFpEF and therapeutic strategies against this multi-organ syndrome. In contrast, hybrid, lean ZSF1 rats (L-ZSF1) do not develop HFpEF and generally serve as controls, disregarding the possibility that the presence of one mutant Lepr allele might affect left ventricular ejection fraction (LVEF), diastolic dysfunction and other relevant HFpEF parameters, such as N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and cardiac inflammation, which could increase during disease manifestation.</p><p><strong>Methods and results: </strong>We collected specimens and echocardiography data of male and female L-ZSF1 rats (n = 165; ZSF1-Lepr^faLepr^cp/Crl) at the age of 6-32 weeks from four independent research groups and performed genotyping as well as the genotype-phenotype analyses. The genotype distribution within L-ZSF1 was in line with the Hardy-Weinberg equilibrium. Genotypes were not associated with CD68 counts (n = 52, P = 0.886), E/e' ratio (n = 125, P > 0.250) and NT-proBNP (n = 126, P = 0.874). LVEF significantly decreased from 25 weeks of age (P = 0.021) but was independent of the genotype (P = 0.768 at <25 weeks of age and P = 0.069 at ≥25 weeks of age, n = 128).</p><p><strong>Conclusions: </strong>In conclusion, validation of the genotype distribution in L-ZSF1 rats revealed no associations between the genotype and HFpEF-relevant measures, namely, NT-proBNP, CD68 count, LVEF or E/e'.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812502","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":"Investigation of left ventricular ejection fraction in a Swiss heart failure population: Insights into mortality and sex differences.","authors":"Rubén Fuentes Artiles, Renald Meçani, Taulant Muka, Lukas Hunziker, Lukas Capék","doi":"10.1002/ehf2.15174","DOIUrl":"https://doi.org/10.1002/ehf2.15174","url":null,"abstract":"<p><strong>Aims: </strong>Understanding heart failure (HF) characteristics is essential to improve patient outcomes. Categorizing HF beyond left ventricular ejection fraction (LVEF) is challenging due to heterogeneous clinical presentation and aetiologies. Despite global studies on HF, the role of LVEF on mortality remains controversial. We explored the association of LVEF with mortality, considering sex differences and comorbidities in a cohort from the largest tertiary cardiovascular centre in Switzerland.</p><p><strong>Methods: </strong>HF patients admitted to the University Hospital of Bern from January 2015 to December 2019 were evaluated. LVEF was used to classify patients into HF with preserved ejection fraction (HFpEF), HF with mid-range ejection fraction (HFmrEF) and HF with reduced preserved ejection fraction (HFrEF) categories. Cox proportional hazard models and time-stratified analyses adjusted for potential confounders were employed.</p><p><strong>Results: </strong>A total of 5824 HF patients were included, and 2912 died over a median follow-up time of 3.39 years. Mortality rates across LVEF categories showed no significant differences, while overall, women showed significantly higher mortality; 30 day mortality was lower in the HFpEF category [hazard ratio (HR) 0.67, 95% confidence interval (CI): 0.52-0.88, P = 0.003], with persistent effects upon stratification in males (HR 0.59, 95% CI: 0.42-0.81, P < 0.001) and non-diabetics (HR 0.62, 95% CI: 0.44-0.87, P = 0.005). An isolated reduction in HFpEF mortality was observed in females after 1 year (HR 0.72, 95% CI: 0.53-0.98, P = 0.035).</p><p><strong>Conclusions: </strong>The prognostic role of LVEF on all-cause mortality remains unclear, while differences in mortality rate distribution between women and men mirror established HF pathophysiological sex differences. Future HF studies should focus on HF aetiology and include measures beyond LVEF for comprehensive characterization.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805802","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":"Duration of sodium zirconium cyclosilicate treatment and continuation of RAASi therapy after a hyperkalaemia episode.","authors":"Charles V Pollack, David Arroyo, Eiichiro Kanda, Ignacio José Sánchez Lázaro, Eva Lesén, Stefan Franzén, Christen M Gray, Anna Lipińska, Toyoaki Murohara, Anjay Rastogi","doi":"10.1002/ehf2.15171","DOIUrl":"https://doi.org/10.1002/ehf2.15171","url":null,"abstract":"<p><strong>Aims: </strong>Renin-angiotensin-aldosterone system inhibitors (RAASi) are foundational in the management of heart failure (HF) and chronic kidney disease (CKD) but increase the risk of hyperkalaemia. To facilitate continuation of RAASi therapy, guidelines suggest managing hyperkalaemia using newer potassium binders such as sodium zirconium cyclosilicate (SZC). This observational study describes the likelihood of continued RAASi therapy by duration of SZC treatment.</p><p><strong>Methods: </strong>The study population included non-dialysis-dependent adults diagnosed with HF and/or CKD who initiated outpatient SZC treatment while receiving RAASi therapy. Patients were identified using healthcare registers and claims data from the United States, Japan and Spain. SZC treatment duration was described using the Kaplan-Meier method. Hernán's clone-censor-weight (CCW) approach, using principles of trial emulation, was applied to evaluate the likelihood of continued RAASi therapy at specific time points by distinct SZC treatment durations, using a weighted Kaplan-Meier method and Z-tests.</p><p><strong>Results: </strong>The study included 7980 patients, from the United States (n = 4849), Japan (n = 2759) and Spain (n = 372). Across the three countries, mean patient age was 73.1-75.0 years, 53.2%-66.4% of patients were male, 39.0%-75.0% had HF and 76.9%-95.3% had CKD. Between Days 30 and 120, the percentage of patients remaining on SZC treatment decreased from 36.5% to 12.8% in the United States, from 63.8% to 33.7% in Japan, and from 81.9% to 65.0% in Spain. In the United States, patients who continued SZC treatment beyond 30 days had a higher likelihood of continuing RAASi therapy for up to 90 days (P < 0.001), and continuing SZC treatment beyond 60 days was superior for continuing RAASi therapy for up to 6 months (P < 0.001), versus earlier SZC discontinuation. At 120 days, the likelihood of remaining on RAASi therapy was 69%-70% for SZC treatment durations exceeding 60 days, versus 59% for shorter durations (1-30 days) (P < 0.001). Similar patterns were observed in Japan. At 120 days, the likelihood of remaining on RAASi therapy was 86%-87% for SZC treatment durations exceeding 90 days, versus 82% for shorter SZC treatment durations (1-30 days) (P < 0.05). The CCW analyses were not deemed feasible in the Spanish dataset due to the smaller initial sample size and few patients having a relatively short SZC treatment duration.</p><p><strong>Conclusions: </strong>Patients with longer SZC treatment experience sustained protection against RAASi discontinuation, and the risk of RAASi discontinuation resumes once SZC is discontinued.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805564","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":"Incidence of atrial fibrillation in patients with an insertable cardiac monitor and symptomatic heart failure.","authors":"Muhammad Shahzeb Khan, Michael R Zile, Rami Kahwash, Shantanu Sarkar, Brian Van Dorn, Jodi Koehler, Noreli Franco, Bart Gerritse, Javed Butler","doi":"10.1002/ehf2.15180","DOIUrl":"https://doi.org/10.1002/ehf2.15180","url":null,"abstract":"<p><strong>Aims: </strong>We aim to evaluate the incidence of atrial fibrillation (AF) in a large real-world cohort of patients implanted with an insertable cardiac monitor (ICM) who had a clinical history of symptomatic heart failure (HF) with reduced or preserved left ventricular ejection fraction (LVEF).</p><p><strong>Methods: </strong>Patients with an ICM and a history of HF events were identified from the Optum® de-identified Electronic Health Record dataset merged with an ICM device dataset collected during 2007-2021. All ICM-detected AF episodes that were available with ≥30-s of ECG at onset were adjudicated using artificial intelligence (AI model). Episodes with AI model probability of AF ≥ 0.9 were analysed. The Kaplan-Meier incidence of AF as a function of episode duration, history of AF, and LVEF were assessed.</p><p><strong>Results: </strong>A total of 1020 patients with ICM were identified of whom 911 had ≥180 days of follow-up and were included. According to the AI model, 358 patients had 8407 episodes of true AF. Incidence of AF at 42 months was 45.6% (44.1% vs. 46.8% in reduced vs. preserved LVEF). Incidence of new-onset AF was 23.2% (23.3% vs. 22.2% in reduced vs. preserved LVEF) in patients with no clinical history of AF. Patients with new-onset AF had a higher HF event rate compared with patients who had no clinical history of AF and did not develop AF during follow-up [OR = 2.73 (1.47-5.09); P = 0.002]. Patients with preserved LVEF had more longer duration paroxysmal AF compared with those with reduced LVEF (44.5% vs. 33.9%, P = 0.02).</p><p><strong>Conclusions: </strong>AF was observed in almost half of patients with ICM and symptomatic HF. One-fourth of the patients had new onset AF and a higher rate of HF events compared with patients without AF. AF incidence was similar in patients with preserved and reduced LVEF.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799195","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":"Long-term outcomes of apixaban as main anticoagulant in patients with HeartMate 3 left ventricular assist devices.","authors":"Jennifer Jdaidani, Mahmoud Shadi, Nnedi Asogwa, Jennifer Winik, Dora Rossi, Christina Saikus, Maria D Avila, Geurys R Rojas-Marte","doi":"10.1002/ehf2.15182","DOIUrl":"https://doi.org/10.1002/ehf2.15182","url":null,"abstract":"<p><strong>Aims: </strong>HeartMate 3 (HM3) left ventricular assist devices (LVADs) offer improved haemocompatibility-related outcomes for end-stage heart failure patients, facilitating the exploration of alternative anticoagulation therapies beyond warfarin. This study presents a long-term evaluation of thrombotic and bleeding outcomes in HM3 LVAD patients transitioned from warfarin to apixaban.</p><p><strong>Methods: </strong>We retrospectively identified HM3 LVAD patients at our single centre who transitioned from warfarin to apixaban. Baseline characteristics were described at discharge from implant hospitalization and at the last follow-up on each anticoagulation regimen. We reported survival, thrombo-embolic events (including LVAD pump thrombosis, stroke, arterial thrombo-embolic events and pump exchange) and bleeding events on both warfarin and apixaban.</p><p><strong>Results: </strong>Eight patients were identified between May 2018 and June 2022 who transitioned from warfarin to apixaban 5 mg twice daily. Patients were followed for a mean of 1233 days after LVAD implantation and 789 days after transition to apixaban. All patients were transitioned due to difficulty maintaining a therapeutic international normalized ratio (INR), including five patients who experienced bleeding complications on warfarin. No patients encountered LVAD pump thrombosis, stroke events, arterial thrombo-embolic event, pump exchange or death. While on warfarin, five patients had eight bleeding events: one major [requiring 2 units of packed red blood cells (pRBCs)] and seven minors (five gastrointestinal bleeds, one episode of haematuria and one episode of haemoptysis). After switching to apixaban, one patient with angioectasia had a major gastrointestinal bleed requiring two pRBCs and endoscopic clipping.</p><p><strong>Conclusions: </strong>Apixaban demonstrated safe and favourable long-term outcomes in a cohort of HM3 LVAD patients over a mean follow-up of more than 2 years. To our knowledge, our report provides the longest follow-up duration for this patient population to date. Larger prospective studies are needed before this can be adopted as the standard of care.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799579","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":"SPARCL1 and NT-proBNP as biomarkers of right ventricular-to-pulmonary artery uncoupling in pulmonary hypertension.","authors":"Oliver Dörr, Stanislav Keranov, Paulina van Wickern, Holger Nef, Christian Hamm, Pascal Bauer, Christian Troidl, Samuel Sossalla, Sandra Voss, Christoph Liebetrau, Manuel J Richter, Henning Gall, Werner Seeger, Ardeschir Ghofrani, Athiththan Yogeswaran, Khodr Tello","doi":"10.1002/ehf2.15159","DOIUrl":"https://doi.org/10.1002/ehf2.15159","url":null,"abstract":"<p><strong>Aims: </strong>SPARCL1 was recently identified as a biomarker of right ventricular (RV) maladaptation in patients with pulmonary hypertension (PH), and N-terminal pro-brain natriuretic protein (NT-proBNP) is an established biomarker of RV failure in PH. The present study investigated whether NT-proBNP and SPARCL1 concentrations are associated with load-independent parameters of RV function and RV-to-pulmonary artery (RV-PA) coupling as measured using invasive pressure-volume (PV) loops in the RV.</p><p><strong>Methods: </strong>SPARCL1 and NT-proBNP were measured in the plasma of patients with idiopathic pulmonary artery hypertension (IPAH, n = 73). Participants without LV or RV abnormalities served as controls (n = 28). All patients underwent echocardiography and right heart catheterization with invasive PV loop measurements.</p><p><strong>Results: </strong>Our cohort had more females with IPAH than the control group (64% vs. 35%; P = 0.01) and was older [69 (interquartile range, IQR 57-76) vs. 51 (IQR 35-62) years; P < 0.001]. SPARCL1 and NT-proBNP levels were significantly higher in patients with IPAH as compared with controls (P < 0.0001). Patients with IPAH and maladaptive RV remodelling had higher SPARCL1 and NT-proBNP concentrations than those with adaptive RV remodelling (P < 0.01). Both SPARCL1 and NT-proBNP were good predictors of maladaptive RV remodelling in receiver operating characteristic analysis [area under the curve (AUC) (AUC_SPARCL1 = 0.75, AUC_NT-proBNP = 0.72, P = 0.36 for AUC_SPARCL1 vs. AUC_NT-proBNP]. The combined predictive value of SPARCL1 and NT-proBNP (AUC 0.78, P < 0.001) for maladaptive RV was numerically higher than that of either SPARCL1 or NT-proBNP alone (P = 0.16 for AUC_{SPARCL1 + NT-proBNP} vs. AUC_NT-proBNP and P = 0.18 for AUC_{SPARCL1 + NT-proBNP} vs. AUC_SPARC1). SPARCL1 showed numerically a tendency for a better predictive power than NT-proBNP for parameters of early maladaptive RV remodelling such as RV ejection fraction < 50% (AUC_SPARCL1 = 0.77, AUC_NT-proBNP = 0.67, P = 0.06 for AUC_SPARCL1 vs. AUC_NT-proBNP), RV end-diastolic diameter > 42 mm (AUC_SPARCL1 = 0.72, AUC_NT-proBNP = 0.65, P = 0.19 for AUC_SPARCL1 vs. AUC_NT-proBNP) and RV end-systolic volume index RVESVI > 31 mL/m² (AUC_SPARCL1 = 0.78, AUC_NT-proBNP = 0.71, PP = 0.10 for AUC_SPARCL1 vs. AUC_NT-proBNP).</p><p><strong>Conclusions: </strong>SPARCL1 and NT-proBNP are good predictors of maladaptive RV remodelling and RV-PA uncoupling in IPAH patients. SPARCL1 may be a better predictor of early maladaptive RV remodelling than NT-proBNP.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799607","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":"MELD score predicts outcomes in patients with advanced heart failure: A longitudinal evaluation.","authors":"Francesco Curcio, Cristiano Amarelli, Rosaria Chiappetti, Irene Mattucci, Veronica Flocco, Mahmoud Issa Rammal, Ciro Abete, Francesca Mazzella, Ciro Maiello, Pasquale Abete, Francesco Cacciatore","doi":"10.1002/ehf2.15002","DOIUrl":"https://doi.org/10.1002/ehf2.15002","url":null,"abstract":"<p><strong>Aims: </strong>Advanced heart failure (AHF) is characterized by recurrent episodes of haemodynamic instability and frequent hospitalizations, leading to a progressive decline in quality of life and high mortality rates. The objectives of this study were to evaluate the effect of the model for end-stage liver disease (MELD) score and its variations in predicting adverse outcomes [death, urgent heart transplant, and left ventricular assist device (LVAD) implant] among patients with AHF to assess the clinical associations of the MELD score in this population and to compare the efficacy of this tool with other prognostic scores in AHF.</p><p><strong>Methods and results: </strong>In this longitudinal prospective study, 162 patients with advanced heart failure (AHF) were enrolled; all patients included in the study were receiving the maximum tolerated medical therapy according to guidelines. The MELD score was measured at baseline and every 6 months during follow-up. All patients underwent echocardiographic assessment and cardiopulmonary testing, which included the evaluation of maximal oxygen uptake (VO2max) and the minute ventilation/carbon dioxide production (VE/VCO2) slope. The mean age of the study group was 57.7 ± 11.6 years. There were 26 deaths, 5 urgent transplants, and 1 LVAD implantation during a follow-up period of 31.4 ± 15.6 months. The mean New York Heart Association (NYHA) class was 2.8 ± 0.5, ejection fraction (EF) was 26.3 ± 6.5%, the mean VO2max was 11.7 ± 3.5 mL/kg/min. Multiple regression analysis revealed a positive correlation between the MELD score and NT-proBNP (β = 0.215; P = 0.041) and furosemide dosage (β = 0.187; P = 0.040). Conversely, a negative correlation was observed between the MELD score and TAPSE (β = -0.204; P = 0.047). Multivariate Cox regression on combined outcome shows a HR of 1.094 (95% CI 1.003-1.196) for unit increase in MELD considered as a continuous variable. The predictive role is independent by the effect of covariates considered in the analysis such as age, sex, NYHA class, EF, TAPSE, PASP, VO2max, NT-proBNP, MELD score worsening, and NT-proBNP increase. Changes in MELD score percentage, considered as a dichotomous variable (≤100% and >100%), were found to be predictors of mortality, urgent heart transplant and LVAD implant. Receiver operating characteristic (ROC) curves showed an area under the curve (AUC) of 0.887 for MELD score and composite outcome of death, urgent transplant, and need for LVAD. The predictive performance of MELD was even superior compared with MELD-Na, MELD-XI, MAGGIC risk score, and MECKI.</p><p><strong>Conclusions: </strong>The MELD score and its longitudinal changes are effective predictors of adverse outcomes in AHF.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791302","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":"Implementation of guideline-recommended medical therapy for patients with heart failure in Europe.","authors":"Maurizio Volterrani, Petar Seferovic, Gianluigi Savarese, Ilaria Spoletini, Egidio Imbalzano, Antoni Bayes-Genis, Ewa Jankowska, Michele Senni, Marco Metra, Ovidiu Chioncel, Andrew J S Coats, Giuseppe M C Rosano","doi":"10.1002/ehf2.15105","DOIUrl":"https://doi.org/10.1002/ehf2.15105","url":null,"abstract":"<p><p>Physicians' adherence to guideline-recommended heart failure (HF) treatment remains suboptimal, especially regarding the target doses. In particular, there is evidence that non-cardiologists are less compliant with HF guideline recommendations. This is likely to have a detrimental impact on patients' survival, readmissions and quality of life. Thus, the present document aims to address the reasons underlying low implementation and under-dosing of guideline-directed medical therapy in HF and to update a guidance for the initiation and rapid titration of HF drugs. In particular, aim of this document is to provide practical indications for drug implementation, to be applied not only by cardiologists but also by GPs and internal medicine doctors.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779575","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":"Mitral valve transcatheter edge-to-edge repair in the elderly-A safe and effective therapy.","authors":"Dominik Felbel, Michael Paukovitsch, Matthias Gröger, Sinisa Markovic, Leonhard Schneider, Wolfgang Rottbauer, Mirjam Keßler","doi":"10.1002/ehf2.15177","DOIUrl":"https://doi.org/10.1002/ehf2.15177","url":null,"abstract":"<p><strong>Aims: </strong>Prevalence of mitral regurgitation (MR) and comorbidity burden rise with age. Mitral valve transcatheter edge-to-edge repair (M-TEER) is increasingly performed in elderly patients, but only limited data are available for this specific subgroup. In this study, outcomes of octogenarians and nonagenarians undergoing M-TEER were analysed using a large real-world dataset.</p><p><strong>Methods: </strong>This retrospective study included consecutive patients undergoing M-TEER at the Ulm University Heart Center between January 2010 and December 2021. The cohort was divided into an elderly group and a younger group based on the cohorts' median age. Group differences regarding 1 and 3 year mortality and heart failure hospitalization rates were assessed using Kaplan-Meier survival analysis and Cox proportional hazard models.</p><p><strong>Results: </strong>A total of 1118 patients [median age 79 (inter-quartile range 74-83) years; 42% female] were included and divided into 513 elderly (≥80 years) and 605 younger (<80 years) patients. Primary MR was more frequent in the elderly group (56% vs. 27%, P < 0.001). Pre-procedural and post-procedural MR grades were comparable between groups (pre-procedural MR grade 4: 69% in the elderly group vs. 71% in the younger group, P = 0.67; post-procedural MR grade 1: 60% in the elderly group vs. 58% in the younger group, P = 0.77) as well as in-hospital mortality rates (0.2% vs. 0.3%, P = 0.66). Three-year heart failure hospitalization rates did not differ significantly between both groups (30.7% in the older age cohort vs. 36.0% in the younger cohort, P = 0.191). While 1 year all-cause mortality rates were comparable (18% vs. 16.4%, P = 0.577), 3 year all-cause mortality was significantly higher in the elderly [43.1% vs. 33.0%; hazard ratio (HR) 1.29 (95% confidence interval 1.02-1.65), P = 0.035]. Pre-procedural N-terminal pro-brain natriuretic peptide (NT-proBNP) ≥3402 pg/mL [HR 2.29 (95% CI 1.34-3.90), P = 0.002], pre-interventional MR grade [HR 1.79 (95% CI 1.01-3.17), P = 0.045] and European System for Cardiac Operative Risk Evaluation (EuroSCORE) II [HR 1.06 (95% CI 1.03-1.08), P < 0.001] were identified as independent predictors of 3 year mortality in the elderly.</p><p><strong>Conclusions: </strong>M-TEER displays a safe and effective treatment option for elderly patients with symptomatic MR, offering symptom relief and comparable 1 year outcomes to younger patients. Elderly patients with elevated EuroSCORE II and advanced heart failure might benefit from additional care to further reduce 3 year mortality.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767561","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}