ESC Heart Failure最新文献

{"title":"Validation of a biomarker-based mortality score for cardiogenic shock patients: Comparison with a clinical risk score.","authors":"Elina Hynninen, Heli Tolppanen, Mercedes Rivas-Lasarte, Tuukka Tarvasmäki, Veli-Pekka Harjola, Benjamin Deniau, Mari Hongisto, Ewa A Jankowska, Raija Jurkko, Toni Jäntti, Anu Kataja, Alexandre Mebazaa, Tuija Sabell, Alessandro Sionis, Johan Lassus","doi":"10.1002/ehf2.15234","DOIUrl":"https://doi.org/10.1002/ehf2.15234","url":null,"abstract":"<p><strong>Aims: </strong>Cardiogenic shock (CS) is the deadliest manifestation of acute heart failure, with persistently high mortality rates and a lack of recent therapeutic breakthroughs. Accurate risk prediction is crucial in clinical decision-making and the design of future clinical trials. We aimed to validate the CLIP score, a biomarker-based risk score comprising cystatin C, lactate, interleukin-6 and NT-proBNP, for predicting mortality in acute coronary syndrome (ACS) related CS, and to compare its predictive value with the previously published CardShock risk score.</p><p><strong>Methods and results: </strong>The study is a post hoc analysis of the CardShock Study, a prospective, observational European multicentre study on CS. The CLIP score was calculated 12 h after hospital admission, and its ability to predict 90-day mortality was assessed using are under the curve (AUC) of the receiver-operating characteristics (ROC) curve analysis. The discriminative ability of the CLIP score was compared with the CardShock risk score by comparing the AUC's. The cohort was dichotomized into low and high risk groups by the optimal cut-off value derived from the ROC analysis of the CLIP score. Kaplan-Meier curves were constructed to evaluate risk stratification when combining the CLIP and CardShock risk scores. The cohort (n = 121) comprised 77% (n = 93) men and the median age was 67 years (IQR 61-76). A total of 21% (n = 25) of the patients had non-ACS related CS. The CLIP score demonstrated appropriate predictive accuracy for 90-day mortality (AUC 0.84, 95% CI 0.77-0.91), comparable with the CardShock risk score (AUC 0.77 [95% CI 0.69-0.85]; P = 0.064 for comparison). A CLIP score cut-off of 0.28 stratified patients into high risk (65% mortality) and low risk (16% mortality) groups. In addition, incorporating the CLIP score enhanced risk stratification in all CardShock risk score categories.</p><p><strong>Conclusions: </strong>The CLIP score, calculated within 12 h of hospital admission, accurately predicted 90-day mortality in CS and complemented the CardShock risk score. The biomarker-based score has potential utility in dynamic mortality risk assessment and could inform clinical management and trial design.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079077","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":"Randomized trial to assess worsening renal function by adding dapagliflozin for acute decompensated heart failure.","authors":"Shodai Kawanami, Yasuyuki Egami, Masaru Abe, Mizuki Osuga, Hiroaki Nohara, Kohei Ukita, Akito Kawamura, Koji Yasumoto, Naotaka Okamoto, Yasuharu Matsunaga-Lee, Masamichi Yano, Masami Nishino","doi":"10.1002/ehf2.15212","DOIUrl":"https://doi.org/10.1002/ehf2.15212","url":null,"abstract":"<p><strong>Aims: </strong>Dapagliflozin (DAPA), a sodium-glucose co-transporter 2 inhibitor, has been shown to reduce cardiovascular mortality among patients with chronic heart failure. We aimed to evaluate the impact on a worsening renal function (WRF) by adding DAPA as compared to standard decongestive therapy with loop diuretics alone.</p><p><strong>Methods and results: </strong>We enrolled 114 consecutive acute decompensated heart failure (ADHF) patients with a left ventricular ejection fraction (LVEF) of less than 50%. The patients were prospectively randomized to be assigned either to DAPA group who received DAPA at a dose of 10 mg once daily within 24 h after admission or conventional therapy group (CON group) who received loop diuretics alone. All patients were adjusted by increasing or decreasing the loop diuretic by 10 mg to maintain a 1-2 mL/kg/h urine output. The primary endpoint was the incidence of WRF, which was defined as an increase in the serum creatinine of ≥0.3 mg/dL from baseline. The median age of the patients was 77 [interquartile range (IQR): 64, 85] years, 35% were female and the median LVEF was 33 [IQR: 28, 38] %. There was no significant difference in the incidence of WRF between the two groups (16.1%, n = 9 vs. 12.1%, n = 7, P value = 0.54). The total dose of loop diuretics through day 7 was lower in the DAPA group than CON group (184 ± 79.5 mg vs. 214 ± 66.5 mg, P value = 0.03).</p><p><strong>Conclusions: </strong>This randomized prospective trial revealed the addition of DAPA within 24 h after admission reduced the diuretic dose without WRF.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064442","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":"Real-world comparative effectiveness of sacubitril/valsartan versus RAS inhibition alone in patients with de novo heart failure.","authors":"Ankeet S Bhatt, Muthiah Vaduganathan, Barada P Jena, Sylwia Suminska, Carlos Eid, Heike Schwende, Michele Senni","doi":"10.1002/ehf2.15183","DOIUrl":"https://doi.org/10.1002/ehf2.15183","url":null,"abstract":"<p><strong>Aims: </strong>Large-scale, real-world data on early initiation of sacubitril/valsartan in patients newly diagnosed (de novo) with HF with reduced ejection fraction (HFrEF) are limited. We examined the effectiveness of sacubitril/valsartan versus angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) on all-cause and cause-specific hospitalizations among patients with de novo HFrEF from the Optum® dataset in the United States.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients with de novo HFrEF (diagnosed ≤30 days) with left ventricular ejection fraction (LVEF) ≤40% who were first prescribed with sacubitril/valsartan or ACEi/ARB from 1 January 2016 to 31 March 2020. The primary endpoint (all-cause hospitalization) and secondary endpoints were analysed in propensity score-matched cohorts.</p><p><strong>Results: </strong>A cohort of 3290 patients with de novo HFrEF who were prescribed with sacubitril/valsartan and a propensity-matched cohort of 6580 patients who were prescribed with ACEi/ARB were analysed. Overall, the mean (SD) age of patients was 63 (14) years, 34% were women, and baseline characteristics were balanced across treatment groups. Hypertension (67%), diabetes (33%) and chronic kidney disease (28%) were highly prevalent comorbidities. Patients in the sacubitril/valsartan cohort when compared with the ACEi/ARB cohort had lower annual rates of all-cause hospitalizations [incidence rate ratio (IRR): 0.81, 95% confidence interval (CI): 0.75-0.89, P < 0.001], cardiovascular (CV) hospitalizations (IRR: 0.80, 95% CI: 0.73-0.87, P < 0.001) and HF hospitalizations (IRR: 0.86, 95% CI: 0.78-0.95, P = 0.002).</p><p><strong>Conclusions: </strong>Among patients with de novo HFrEF, sacubitril/valsartan (compared with that of ACEi/ARB) was associated with fewer all-cause, CV and HF hospitalizations. These findings are consistent with clinical trial evidence suggesting potential benefits of early initiation of sacubitril/valsartan in patients with HFrEF, including those soon after diagnosis.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064478","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":"Health-related quality of life across heart failure categories: associations with clinical characteristics and outcomes.","authors":"Camilla Settergren, Lina Benson, Ulf Dahlström, Tonje Thorvaldsen, Gianluigi Savarese, Lars H Lund, Bahira Shahim","doi":"10.1002/ehf2.15206","DOIUrl":"https://doi.org/10.1002/ehf2.15206","url":null,"abstract":"<p><strong>Aims: </strong>The study aims to examine characteristics and outcomes associated with health-related quality of life (HRQoL) in patients with heart failure (HF) with preserved, mildly reduced and reduced ejection fraction (EF) (HFpEF, HFmrEF and HFrEF).</p><p><strong>Methods and results: </strong>Data on HRQoL were collected in the Swedish Heart Failure Registry (SwedeHF; 2000-2021) using the EuroQoL 5-dimensional visual analogue scale (EQ 5D-vas). Baseline EQ 5D-vas scores were categorized as 'best' (76-100), 'good' (51-75), 'bad' (26-50) and 'worst' (0-25). Independent associations between patients' characteristics and EQ 5D-vas, as well as between EQ 5D-vas and outcomes were assessed. Of 40 809 patients (median age 74 years; 32% female), 29% were in the 'best', 41% in the 'good', 25% in the 'bad' and 5% in the 'worst' EQ 5D-vas categories, similarly distributed across all EF categories. Higher New York Heart Association (NYHA) class was strongly associated with lower EQ 5D-vas regardless of EF categories, followed by chronic obstructive pulmonary disease, smoking, body mass index, higher heart rate, anaemia, previous stroke, ischaemic heart disease, use of diuretics and living alone, whereas higher income, male sex, outpatient status and higher systolic blood pressure were inversely associated with lower EQ 5D-vas categories. Patients in the 'worst' EQ 5D-vas category as compared with the 'best' had the highest risk of all-cause death [adjusted hazard ratios 1.97, 95% confidence interval (CI) 1.64-2.37 in HFrEF, 1.77, 95% CI 1.30-2.40 in HFmrEF and 1.43 95% CI 1.02-2.00 in HFpEF].</p><p><strong>Conclusions: </strong>Most patients were in the two highest EQ 5D-vas categories. Higher NYHA class had the strongest association with lower EQ 5D-vas categories, across all EF categories. Patients in the worst EQ 5D-vas category were at the highest risk of mortality.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052049","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":"Nephrological perspectives on the underutilization of SGLT2is in heart failure and chronic kidney disease","authors":"Özant Helvacı,&nbsp;Ömer Faruk Akçay,&nbsp;Emre Yaşar,&nbsp;Ülver Derici,&nbsp;Galip Güz","doi":"10.1002/ehf2.15230","DOIUrl":"10.1002/ehf2.15230","url":null,"abstract":"&lt;p&gt;We read with great interest the study by Kocabaş and colleagues, which brings attention to the suboptimal use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in heart failure (HF), particularly in patients with chronic kidney disease (CKD), where these drugs should be regarded as cornerstone therapies.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The RED-HEART study involving 1923 patients highlights that SGLT2is are disproportionately prescribed to patients with more severe disease. This feature is evidenced by the higher proportion of New York Heart Association Class IV cases and the increased concomitant use of angiotensin receptor-neprilysin inhibitors (ARNis), mineralocorticoid receptor antagonists (MRAs), and diuretics. This prescribing pattern underscores a concerning trend: SGLT2is are often perceived as add-on therapies for advanced cases rather than essential treatments in HF management. As the authors note, clinical inertia likely contributes to this suboptimal integration of SGLT2is into standard care, limiting their potential to significantly improve outcomes.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;HF and CKD are intricately intertwined, as the two conditions frequently coexist and share overlapping risk factors, pathophysiological mechanisms, and therapeutic targets. This interconnectedness underscores the importance of therapies like SGLT2is, which provide both cardiovascular and renal benefits.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The findings of the RED-HEART study present an opportunity to explore these renal aspects in greater depth.&lt;/p&gt;&lt;p&gt;The study does not clarify key methodological details, such as which estimated glomerular filtration rate (eGFR) formula was used (e.g., Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease) or the specific cut-off values applied to define CKD. These details are crucial for interpreting the characteristics and outcomes of the CKD subgroup within this cohort.&lt;/p&gt;&lt;p&gt;Although GFR staging and albuminuria are central to CKD assessment, neither appears to have been explicitly reported.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Albuminuria, in particular, is a marker not only of CKD severity but also of significant prognostic value in HF.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Including these metrics would provide a more nuanced understanding of the interplay between HF and CKD in the study population.&lt;/p&gt;&lt;p&gt;The cohort's median eGFR around 70 mL/min suggests that patients with stage 3B and 4 (combined eGFR between 15 and 45 mL/min) were likely excluded. Furthermore, the CKD prevalence of 28% in the cohort is notably lower than the 40%–50% typically reported in HF trials.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; This discrepancy likely reflects differences between real-world data and clinical trial populations.&lt;/p&gt;&lt;p&gt;It is well-established that as CKD progresses, HF with preserved ejection fraction (HFpEF) becomes more prevalent compared to HF with reduced ejection fraction (HFrEF).&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; In practice, distinguish","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 2","pages":"1490-1491"},"PeriodicalIF":3.2,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15230","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046058","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 of baseline eGFR and incident heart failure on patients receiving intensive blood pressure treatment.","authors":"Li Haonan, He Qiaorui, Zhu Wenqing, Zhang Yanjun, Pingcuo Wangjia, Yu Shikai, Deji Zhuoga, Zhang Yi, Zhao Yifan","doi":"10.1002/ehf2.15232","DOIUrl":"https://doi.org/10.1002/ehf2.15232","url":null,"abstract":"<p><strong>Aims: </strong>We aim to elucidate the association of baseline eGFR and incident heart failure on patients receiving intensive BP treatment.</p><p><strong>Methods and results: </strong>A post hoc analysis was conducted on the SPRINT database. Multivariab le Cox regression and interaction restricted cubic spline (RCS) analysis were performed to investigate the interaction between baseline eGFR and intensive BP control on heart failure prevention. The primary endpoint focused on incident heart failure. The study cohort comprised 8369 adults with a mean [SD] age of 68 [59-77] years, including 2940 women (35.1%). Over a median [IQR] follow-up period of 3.9 [2.0-5.0] years, 183 heart failure events were recorded. A significant interaction was observed between baseline eGFR and treatment groups in terms of heart failure prevention (Interaction P = 0.012). The risk of heart failure showed a sharp slope until eGFR = 75 mL/min/1.73 m² and then became flat by an interaction RCS. Intensive BP treatment did not exhibit a preventive effect on heart failure (HR (95% CI) = 1.03 (0.82-1.52)) when baseline eGFR was 75 mL/min/1.73 m² or lower. Conversely, when baseline eGFR was higher than 75 mL/min/1.73 m², a reduced risk of heart failure was observed (HR (95% CI) = 0.65 (0.41-0.98)). Intensive BP control did not increase the incident long-term dialysis regardless of baseline eGFR but was associated with a higher risk of eGFR reduction.</p><p><strong>Conclusions: </strong>Among nondiabetic hypertensive patients, baseline eGFR serves as a crucial indicator for assessing the risk reduction potential of intensive BP control in heart failure prevention, with 75 mL/min/1.73 m² appearing as a suitable cut-off value.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046057","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":"Temporal profiling of M-TEER-related complications.","authors":"Jafer Haschemi, Hanna Schrameck, Jean Marc Haurand, Daniel Oehler, Maximilian Spieker, Fabian Voss, Malte Kelm, Amin Polzin, Patrick Horn","doi":"10.1002/ehf2.15220","DOIUrl":"https://doi.org/10.1002/ehf2.15220","url":null,"abstract":"<p><strong>Aims: </strong>Transcatheter edge-to-edge repair of the mitral valve (M-TEER) is known for its low complication rates. However, the optimal level and duration of post-procedural care remain unclear. This study aimed to identify the specific timeframe of post-procedural complications following M-TEER.</p><p><strong>Methods and results: </strong>We conducted a retrospective analysis of 865 patients who underwent M-TEER at the University Hospital Düsseldorf between August 2010 and August 2023. Our analysis focused on a comprehensive examination of all acute post-procedural complications (1-100 h), considering the time point of occurrence or diagnosis. The complication analysed included cardiogenic shock, pericardial tamponade, stroke, cardiac arrhythmias, bleeding, acute kidney injury, myocardial infarction, peripheral vascular ischaemia and in-hospital mortality.</p><p><strong>Results: </strong>The median age was 80 (74, 84) years, and the EuroScore II was high (6.5 [4.0, 12.0] %). Functional mitral regurgitation (MR) was more common than degenerative or mixed MR (69% vs. 20%. respectively; 11%). Technical success rate was 97.2%. Overall, acute post-procedural complications occurred in 87 patients (10.1%). Most complications (75.9%) occurred within the first 4 h post-procedure. 12.6% of the complications occurred during the period between 4 and 24 h post-procedure, and 11.5% of the complications happened between 24 and 100 h post-procedure. Life-threatening complications were observed only within the first 4 h post-procedure.</p><p><strong>Conclusions: </strong>The majority of post-procedural complications after M-TEER occur within the first 4 h, with pericardial tamponade and major bleeding occurring only during this period. These findings provide valuable insight for physicians in determining the optimal surveillance and monitoring duration after M-TEER within clinical settings.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac myosin binding protein C correlate with cardiac troponin I during an exercise training program in patients with HFrEF.","authors":"E Riveland, A Ushakova, T Valborgland, T Karlsen, H Dalen, E Prescott, T Omland, A Linke, M Halle, M Marber, Ø Ellingsen, A I Larsen","doi":"10.1002/ehf2.15222","DOIUrl":"https://doi.org/10.1002/ehf2.15222","url":null,"abstract":"<p><strong>Background: </strong>Cardiac myosin binding protein C (cMyC) is an emerging new biomarker of myocardial injury rising earlier and cleared faster than cardiac troponins. It has discriminatory power similar to high-sensitive troponins in diagnosing myocardial infarction in patients presenting with chest pain. It is also associated with outcome in patients with acute heart failure. It is currently unclear how it relates to cardiac troponins in patients with chronic heart failure undergoing exercise training.</p><p><strong>Methods and results: </strong>This is a post hoc analysis of symptomatic heart failure patients in the multicentre randomized SMARTEX trial. Patients were randomized to one of three arms: high-intensity interval training, moderate continuous training and recommendation of regular exercise serving as control group (CG) for 12 weeks. As the training load in the two intervention arms was similar, these patients were merged and constituted the intervention group (IG). Clinical data and measurements were obtained at baseline and at 12 weeks. In 205 patients, serum was available for cMyC testing and in 196 patients, serum was available for hs-cTni testing. Due to non-normal distribution, cMyC and hs-cTnI measurements were log-transformed. A Bland-Altman plot was employed to evaluate the agreement of cMyC with hs-cTnI measurements. Lastly, a linear regression model was applied. No significant differences were observed in the change of cMyC levels between the groups throughout the intervention period (∆ cMyC IG: -0.5 [IQR: -3.4; 2.1] vs. ∆ cMyC CG: -0.7 [IQR: -2.7; 2.6]). The change in log hs-cTnI was significantly correlated with the change in log cMyC during the 12-week intervention period, with a Pearson correlation coefficient of R = 0.52 (95% CI 0.37-0.66, P < 0.001). For every 10% increase in cMyC levels, hs-cTnI levels rose by approximately 5%.</p><p><strong>Conclusions: </strong>Changes in levels of the novel biomarker cMyC were significantly associated with hs-cTnI serum levels in patients with symptomatic chronic HFrEF during a structured 12-week exercise training programme. This may indicate that cMyC has a role as a future marker of subclinical myocardial damage.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022633","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":"State of precision medicine for heart failure with preserved ejection fraction in a new therapeutic age.","authors":"Roy Rasalam, Andrew Sindone, Gary Deed, Ralph G Audehm, John J Atherton","doi":"10.1002/ehf2.15205","DOIUrl":"https://doi.org/10.1002/ehf2.15205","url":null,"abstract":"<p><p>Heart failure with preserved ejection fraction (HFpEF) is defined by heart failure (HF) with a left ventricular ejection fraction (LVEF) of at least 50%. HFpEF has a complex and heterogeneous pathophysiology with multiple co-morbidities contributing to its presentation. Establishing the diagnosis of HFpEF can be challenging. Two algorithms, the 'Heavy, 2 or more Hypertensive drugs, atrial Fibrillation, Pulmonary hypertension, Elderly age >60, elevated Filling pressures' (H₂FPEF) and the 'Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, Final aetiology' (HFA-PEFF), can help to determine the likelihood of HFpEF in individuals with symptoms of HF. Phenotype clusters defined largely by the total number and types of co-morbidities may delineate groups of patients with HFpEF with different management needs. It is important to recognize alternative diagnoses or HFpEF mimics such as infiltrative cardiomyopathies, coronary artery disease, lung disease, anxiety, depression, anaemia, severe obesity, and physical deconditioning, among others. Treatment with sodium-glucose co-transporter 2 inhibitors (dapagliflozin and empagliflozin) is recommended for all patients with HFpEF unless contraindicated. Future research should consider alternative approaches to guide the initial diagnosis and treatment of HFpEF, including phenotype clustering models and artificial intelligence, and consider whether LVEF is the most useful distinguishing feature for categorizing HF. Ongoing clinical trials are evaluating novel pharmacological and device-based approaches to address the pathophysiological consequences of HFpEF.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022639","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":"Association between the Tpeak-Tend interval on admission and coronary microvascular dysfunction in Takotsubo syndrome.","authors":"Kyohei Onishi, Masafumi Ueno, Nobuhiro Yamada, Kazuyoshi Kakehi, Kosuke Fujita, Koichiro Matsumura, Gaku Nakazawa","doi":"10.1002/ehf2.15214","DOIUrl":"https://doi.org/10.1002/ehf2.15214","url":null,"abstract":"<p><strong>Aims: </strong>The Tpeak-Tend interval on electrocardiogram may be a predictor of worse outcomes in Takotsubo syndrome (TTS), but the mechanisms have not been fully determined. This study aimed to investigate the relationships between the corrected Tpeak-Tend (cTp-e) interval and coronary microvascular-dysfunction (CMD) assessed by the angiography-derived index of microvascular resistance (Angio-IMR) and the in-hospital prognosis in patients with TTS.</p><p><strong>Methods and results: </strong>We retrospectively evaluated 111 consecutive patients admitted for TTS who underwent coronary angiography at Kindai University Hospital from October 2009 to July 2023. The Tpeak-Tend interval was defined as the time interval between the peak and the end of the T wave in electrocardiogram lead V5 on admission. Angio-IMR was assessed from aortic pressure, quantitative flow ratio (QFR), vessel length and hyperemic velocity using the formula described in validation studies. QFR, vessel length and hyperemic velocity was derived from coronary angiography and QAngio XA 3D software package. The degree of CMD was assessed by the maximum Angio-IMR value in each of the three coronary arteries. The primary endpoint was the relationship between the grade of a prolonged cTp-e interval on admission and Angio-IMR. The secondary endpoint was the relationship between the grade of a prolonged cTp-e interval on admission and in-hospital adverse cardiovascular events (composite of acute heart failure, cardiogenic shock, life-threatening arrhythmia, thrombotic events, stroke and all-cause death). The median age was 77.5 [71.0-83.0] years, and most patients were women (82.0%). The median cTp-e interval was 114.5 [91.2-147.0] ms. The patients were categorized according to the tertiles of the cTp-e interval (T1: 52.4-96.9 ms; T2: 100.1-129.1 ms; T3: 131.7-309.8 ms). There was a stepwise increment in the values of maximum Angio-IMR in each of the three coronary arteries in tertiles of the cTp-e interval (T1 vs. T2 vs. T3: 16.1 [14.7-19.3] vs. 21.8 [16.0-31.1] vs. 29.0 [27.2-31.9], P < 0.001). In-hospital adverse cardiovascular events occurred in 53 of 111 patients (47.7%). There was a stepwise increment in the incidence of in-hospital adverse cardiovascular events in tertiles of the cTp-e interval (T1 vs. T2 vs. T3: 27.1% vs. 54.1% vs. 62.2%, P = 0.007). The multivariable analysis showed that prolonged cTp-e interval (OR: 1.30; 95% CI: 1.12-1.56; P < 0.001) was independent predictors of in-hospital adverse cardiovascular events.</p><p><strong>Conclusions: </strong>The Tpeak-Tend interval on admission reflected CMD and predicts in-hospital adverse cardiovascular events in patients with TTS.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022631","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}