ESC Heart Failure最新文献

{"title":"Impact of mitral valve transcatheter edge-to-edge repair on haemodynamic parameters in cardiogenic shock.","authors":"Michal Droppa, Dominik Rath, Philippa Jaeger, Ioannis Toskas, Monika Zdanyte, Andreas Goldschmied, Jürgen Schreieck, Meinrad Gawaz, Tobias Geisler","doi":"10.1002/ehf2.15306","DOIUrl":"https://doi.org/10.1002/ehf2.15306","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter edge-to-edge repair (TEER) has been shown to be an effective treatment option for patients experiencing cardiogenic shock (CS) with concomitant high-grade mitral valve regurgitation. However, haemodynamic changes following M-TEER have not been thoroughly investigated. Afterload mismatch, leading to the deterioration of haemodynamics subsequent to mitral regurgitation correction, could potentially occur and adversely impact prognosis. Our objective was to analyse the effect of TEER on haemodynamic and echocardiographic parameters in patients with CS.</p><p><strong>Methods and results: </strong>We conducted a retrospective study of patients undergoing TEER for mitral valve regurgitation in the setting of CS. Haemodynamic and echocardiographic parameters before and after TEER were systematically analysed. A total of 25 patients underwent TEER in the context of CS. All patients were successfully treated with at least of one grade reduction in mitral regurgitation. The median left atrial mean pressure decreased from 23 mmHg (IQR 17-30) to 16 mmHg (IQR 11-20, P < 0.01), and the V-wave decreased from 36 mmHg (IQR 27-44) to 21 mmHg (IQR 14-25, P < 0.01) following the procedure. The stroke volume index and cardiac index increased from 25 mL/m² (IQR 18-29) to 34 mL/m² (IQR 25-44, P < 0.01) and from 1.90 L/min/m² (IQR 1.41-2.30) to 2.50 L/min/m² (IQR 1.99-2.86, P < 0.01), respectively. We did not observe any worsening of the ejection fraction after the procedure. Ten patients (40%) died during their hospital stay.</p><p><strong>Conclusions: </strong>Our study demonstrates that TEER leads to favourable haemodynamic changes in patients with CS. We observed a significant reduction in left atrial pressure, V-wave, and an elevation in cardiac index. Importantly, we did not observe any deterioration in left ventricular function following the procedure. This supports the concept of haemodynamic stabilization with TEER in patients with CS and high-grade mitral regurgitation.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976323","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":"Clinical characteristics and long-term outcomes in patients with apical hypertrophic cardiomyopathy.","authors":"Meng Guo, Chuanfen Liu, Jingjing Ye, Jian Liu","doi":"10.1002/ehf2.15298","DOIUrl":"https://doi.org/10.1002/ehf2.15298","url":null,"abstract":"<p><strong>Aims: </strong>As a special type of hypertrophic cardiomyopathy (HCM), apical HCM (ApHCM) has different clinical characteristics while its nature history and prognosis are not well recognized. We aimed to describe the characteristics and outcomes of ApHCM and identify predictors of adverse outcomes.</p><p><strong>Methods: </strong>In this single-centre retrospective study, we included 479 patients with HCM and divided them into ApHCM and non-ApHCM groups. Clinical, electrocardiographic, echocardiographic and survival data were compared between the groups. The primary outcome was major adverse cardiac events in hospital and during follow-up. A two-sided P-value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 109 ApHCM patients and 370 non-ApHCM patients were analysed and 379 patients completed the follow-up among them. The age of enrolled patients was 61.0 (50.0-69.0) years, and 289 (60.3%) were male. Compared with non-ApHCM patients, ApHCM patients were older at diagnosis [55.0 (45.0-64.0) vs. 50.0 (40.0-61.0) years, P = 0.006] and had less positive family history for HCM [3 (2.8%) vs. 34 (9.2%), P = 0.027], more electrocardiographic abnormalities [101 (92.7%) vs. 287 (77.6%), P < 0.001], lower brain natriuretic peptide level [135.5 (60.8-272.8) vs. 422.5 (182.8-888.2) pg/mL, P < 0.001] and better left ventricular ejection fraction (LVEF) [69.00 (64.00-73.87) vs. 67.00 (60.24-73.45) %, P = 0.048] at baseline. During a median follow-up of 5.59 (2.33-10.30) years, the primary outcome occurred less frequently in ApHCM patients [11.4% vs 27.2%; hazard ratio (HR)_adj 0.360 (95% confidence interval, CI: 0.187-0.696), P = 0.002; log rank P = 0.001]. Specifically, ApHCM was characterized by fewer all-cause death (HR_adj 0.545, 95% CI: 0.305-0.975; P = 0.041) and fatal ventricular arrhythmia or appropriate implantable cardioverter defibrillator intervention (HR_adj 0.099, 95% CI: 0.013-0.724; P = 0.023). LVEF (HR_adj 0.861, 95% CI: 0.763-0.971; P = 0.015) and age (HR_adj 1.247, 95% CI: 1.095-1.419; P = 0.001) were identified as independent predictors of the composite outcome in ApHCM.</p><p><strong>Conclusions: </strong>Patients with ApHCM may have better prognosis. LVEF and age were independent predictors of long-term outcomes in ApHCM.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multicentre registry of hospitalized patients with acute and chronic heart failure: Study design of the H²-registry.","authors":"Johannes Leiner, Sebastian König, Anne Nitsche, Sven Hohenstein, Jana Nagel, Melchior Seyfarth, Henning Baberg, Alexander Lauten, Hans Neuser, Alexander Staudt, Jürgen Tebbenjohanns, René Andrié, Michael Niehaus, Markus W Ferrari, Ralf Kuhlen, Andreas Bollmann","doi":"10.1002/ehf2.15266","DOIUrl":"https://doi.org/10.1002/ehf2.15266","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure (HF) is a highly prevalent condition affecting 1-3% of the adult population in Europe. Despite landmark improvements in HF care over the last two decades, hospitalization and mortality rates remain relatively high. Gathering real-world data on HF populations is crucial, especially in the light of newly emerging therapeutic approaches. The Helios Heart (H²)-registry was established to provide up-to-date, real-world data on a contemporary cohort of hospitalized HF patients in Germany using a standardized set of outcome measures with a focus on patient-reported outcomes (PROs). This manuscript describes the registry's design and presents an interim analysis of baseline characteristics and 1-year outcomes.</p><p><strong>Methods and results: </strong>The H²-registry is a prospective, investigator-initiated, multicentre observational registry in Germany that started in 2021 and is actively enrolling patients. Inpatients ≥18 years of age with a present diagnosis of chronic or acute HF are recruited in secondary and tertiary hospitals throughout Germany. Routine follow-up (FU) is conducted every 6 months. Data collection is based on a set of variables following recommendations of the International Consortium of Health Outcome Measurements (ICHOM) covering data on demographics, medical history, HF characteristics, medication, procedures, and patients' perceived health status via the collection of standardized PROs. Until 31 December 2023, a total of 2361 patients were enrolled in 10 study centres. Mean age in this cohort is 72 years, 36.9% are female, and median left ventricular ejection fraction is 45%. An analysis of 6-month and 12-month outcomes in a cohort of 1593 patients with complete FU data revealed all-cause mortality rates of 9.0% and 16.2% at 6 and 12 months, while HF-related rehospitalizations occurred in 24.4% and 43.5% at 6 and 12 months.</p><p><strong>Conclusions: </strong>The H²-registry is currently the largest ongoing prospective registry of HF patients in Germany. It is foreseeable that the H²-registry will significantly contribute to the collection of real-world data and provide a comprehensive and unique perspective on the current characteristics, treatment strategies, and resulting outcomes of HF patients in Germany.</p><p><strong>Trial registration number: </strong>NCT04844944.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978957","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":"Length of stay and prior heart failure admission in frailty and heart failure: A systematic review and meta-analysis.","authors":"Konstantinos Prokopidis, Amy Nortcliffe, Chukwuma Okoye, Massimo Venturelli, Gregory Y H Lip, Masoud Isanejad","doi":"10.1002/ehf2.15300","DOIUrl":"https://doi.org/10.1002/ehf2.15300","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to compare the differences in length of stay (LoS) and prior hospitalization due to heart failure (HHF) in patients with HF and frailty versus without frailty.</p><p><strong>Methods and results: </strong>From inception until August 2024, PubMed, Scopus, Web of Science and Cochrane Library were searched. To examine the association related to LoS and HHF in patients with HF, a meta-analysis using a random-effects model was conducted (CRD42024570604). Our main analysis demonstrated a significantly increased LoS in patients with frailty versus those without frailty [n = 10; mean difference (MD): 3.67; 95% CI: 2.26-5.08, I² = 93%, P < 0.01]. Likewise, patients with frailty had significantly increased odds of HHF [n = 17; odds ratio (OR): 1.76; 95% CI: 1.50-2.07, I² = 81%, P < 0.01]. Risk of bias assessment of the included studies was overall fair, while Egger's test showed publication bias regarding studies that examined LoS (P = 0.02).</p><p><strong>Conclusions: </strong>Patients with frailty have longer LoS and more frequent HHF, underscoring the need for early, targeted interventions to manage frailty that may be attributed primarily to ageing and comorbidity-related status.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978977","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":"Dapagliflozin effect on functional mitral regurgitation and myocardial remodelling: The DEFORM trial.","authors":"Zhuoshan Huang, Rui Fan, Shaozhao Zhang, Junlin Zhong, Yiquan Huang, Peihan Xie, Shanshan Yin, Xiaomin Ye, Xinghao Xu, Rihua Huang, Zhenyu Xiong, Yue Guo, Menghui Liu, Yifen Lin, Suhua Li, Xiaoxian Qian, Jinlai Liu, Xiaodong Zhuang, Xinxue Liao","doi":"10.1002/ehf2.15296","DOIUrl":"https://doi.org/10.1002/ehf2.15296","url":null,"abstract":"<p><strong>Aims: </strong>Functional mitral regurgitation (FMR) is associated with adverse outcomes in patients with heart failure, and current guideline-directed medical therapy (GDMT) offers limited efficacy in managing FMR. This study aims to evaluate the therapeutic impact of the sodium-glucose cotransporter 2 inhibitor (SGLT2i) dapagliflozin in patients with moderate or severe FMR.</p><p><strong>Methods and results: </strong>In this randomized controlled trial, 104 patients with moderate or severe FMR were assigned in a 1:1 ratio to receive either dapagliflozin 10 mg once daily or no additional treatment alongside current GDMT for FMR, with a follow-up period of 3 months. The primary endpoint was the change in effective regurgitant orifice area (EROA) of mitral regurgitation (MR). Secondary endpoints included changes in regurgitant volume (RV), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular mass (LVM), left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), E/e' ratio, and left atrial volume index (LAVI). The incidence of hospitalization for heart failure or cardiovascular death was also compared between the groups. As a result, dapagliflozin significantly reduced the EROA of FMR (-0.074 ± 0.099 vs. -0.030 ± 0.058 cm² for dapagliflozin vs. control, P = 0.008). It also significantly decreased RV (-9.08 ± 15.27 vs. -2.98 ± 9.28 mL, P = 0.017), E/e' ratio (-5.88 ± 7.41 vs. -1.98 ± 7.63, P = 0.011), and LAVI (-2.50 ± 4.75 vs. -0.43 ± 3.14 mL/m², P = 0.011) while improving LVEF (6.57 ± 10.10 vs. 1.92 ± 9.57%, P = 0.017). No significant differences were observed in changes in LVEDV, LVESV, LVM, and LVMI between groups (P > 0.05). Hospitalization for heart failure occurred in 9.6% of the dapagliflozin group and 15.3% of the control group (hazard ratio, 0.60; 95% CI, 0.20-1.83; P = 0.368). Cardiovascular death occurred in 1.9% of the dapagliflozin group compared to 3.8% of the control group (hazard ratio, 0.49; 95% CI, 0.04-5.41; P = 0.561) during the 3-month follow-up.</p><p><strong>Conclusions: </strong>Dapagliflozin demonstrates the potential to further reduce the degree of MR and enhance myocardial remodelling in patients with FMR when used in addition to current GDMT. These findings suggest the importance of SGLT2i in heart failure patients with FMR as an additive positive effect on echocardiographic parameter and possibly outcome.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978963","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":"Identification of hub genes for the diagnosis associated with heart failure using multiple cell death patterns.","authors":"Hua-Jing Yuan, Hui Yu, Yi-Ding Yu, Xiu-Juan Liu, Wen-Wen Liu, Yi-Tao Xue, Yan Li","doi":"10.1002/ehf2.15299","DOIUrl":"https://doi.org/10.1002/ehf2.15299","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure (HF) is an important public health problem worldwide, and programmed cell death (PCD) plays a crucial role in its pathologic process. This study aims to identify the hub genes associated with HF through PCD in order to better understand the pathogenesis of HF and improve its diagnosis and treatment.</p><p><strong>Methods and results: </strong>The gene expression dataset of HF was obtained from the GEO database. Bioinformatics and machine learning algorithms were utilized to screen the HF key genes and PCD-related HF hub genes, and an HF diagnostic model was constructed on this. Functional enrichment analysis clarified the gene ontology and signalling pathways of HF. The immune infiltration analysis of HF was performed to explore the expression levels of immune cells in each hub gene. Through bioinformatics analysis, 95 HF key genes were obtained. Functional enrichment analysis showed that they were mainly involved in inflammation, immunomodulation and other mechanisms. DHRS11 and LRKK2 were identified as PCD-associated HF hub genes by machine learning algorithms. The hub genes were confirmed as significant biomarkers of HF in the training and validation datasets, and their constructed nomogram had effective diagnostic value. Immune infiltration analysis showed significant immune imbalance of T-cell populations, monocytes and macrophages M2 in HF.</p><p><strong>Conclusions: </strong>In this study, DHRS11 and LRKK2 were identified as hub genes. HF diagnostic model construction and immune infiltration analyses were performed, which provided new ideas for the molecular mechanisms of HF development and treatment.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978880","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":"Immune Checkpoint Inhibitors and Cardiovascular Adverse Events.","authors":"Maria Luisa De Perna, Elia Rigamonti, Raffaele Zannoni, Vittoria Espeli, Giorgio Moschovitis","doi":"10.1002/ehf2.15281","DOIUrl":"https://doi.org/10.1002/ehf2.15281","url":null,"abstract":"&lt;p&gt;&lt;p&gt;In the last years, we assisted to a tremendous increase in therapeutic options for the management of cancers, with immunotherapy at the forefront of this innovation. Immune checkpoint inhibitors (ICIs) have been developed to enhance the activity of the immune system against cancer cells (1) and the number of approvals for ICIs has rapidly increased. ICIs have also been associated with disinhibited cytotoxic T cells that damage healthy tissue in multiple organs, causing immune-related adverse events (AEs). Cardiovascular AEs (CVAe) are increasingly reported: myocarditis, Takotsubo syndrome, pericarditis and pericardial effusion, worsening of atherosclerosis, acute coronary syndromes, non-inflammatory heart failure, and ischaemic stroke. They are classified into five grades, based on presenting symptoms, level of cardiac biomarkers, and imaging. Even though myocarditis occurs more frequently than previously thought, clinically relevant myocarditis is a rare irAE compared to other irAE (0.5-1.2%). The clinical manifestations range from mild symptoms such as to chest pain, heart failure, and cardiogenic shock. The prognosis is severe, with mortality rates ranging from 25% to 50%. It is frequently associated with the concomitant use of combination of checkpoint inhibitors. The treatment strategies are tripartite: (i) holding ICI to prevent further toxicity, (ii) immunosuppression to alleviate inflammatory changes, and (iii) supportive therapy to address cardiac complications. Glucocorticoids represent the first-line treatment. In hemodynamically unstable patients, treatment with high-dose steroids should be initiated (intravenous methylprednisolone 1000 or 1250 mg oral methylprednisolone during 4 days). ICI-associated pericarditis can be accompanied by no/mild pericardial effusion up to cardiac tamponade. The treatment is made of nonsteroidal anti-inflammatory drugs and colchicine, corticosteroids if needed, and pericardiocentesis for the large effusions. ICIs could be continued for Grade 1 pericarditis, while temporary suspension of ICI is warranted for more severe cases. There is significant potential for accelerated atherosclerosis with ICIs as a long-term effect, but atherosclerosis-related CVAEs are not frequent, especially during treatment; increasing evidence associates ICIs with progression of atherosclerosis and increased atherosclerotic cardiovascular disease. ICIs can lead to arrhythmias: atrial fibrillation, supraventricular and ventricular tachycardias. Non-inflammatory heart failure syndrome have been observed in ICI-treated patients. Immune checkpoint inhibitors seem to be involved in the development of right ventricular dysfunction and pulmonary arterial hypertension. It is of the outmost importance to improve the collaboration among the different medical figures, such as cardiologists, oncologists, endocrinologists, and immunologists, both in clinical practice and in basic science research, to better recognize these adverse even","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959389","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":"Pantethine therapy dramatically rescues end-stage failing heart in a patient with deficiency of coenzyme A biosynthesis.","authors":"Violette Goetz, Bruno Lefort, Magalie Barth, Naïg Gueguen, Céline Bris, Emmanuelle Blanchard, Isabelle Benz-de Bretagne, Hélène Blasco, Marine Tardieu, François Labarthe","doi":"10.1002/ehf2.15283","DOIUrl":"https://doi.org/10.1002/ehf2.15283","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802661","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":"Correction to “Understanding the variability in red cell and plasma volume combinations can help guide management in heart failure”","authors":"","doi":"10.1002/ehf2.15291","DOIUrl":"10.1002/ehf2.15291","url":null,"abstract":"<p>\u0000 <span>Miller, WL</span>, <span>Fudim, M</span>, <span>Kittipibul, V</span>, <span>Yaranov, DM</span>, <span>Carry, BA</span>, <span>Silver, MA</span>. <span>Understanding the variability in red cell and plasma volume combinations can help guide management in heart failure</span>. <i>ESC Heart Failure.</i> <span>2025 Feb</span>; <span>12</span>(<span>1</span>): <span>142</span>–<span>9</span>.</p><p>The second to the last author, Brendan A. Carry, is incorrectly spelled. The author's name correctly spelled is Brendan J. Carry.</p><p>We apologize for this error.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 3","pages":"2396"},"PeriodicalIF":3.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15291","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802659","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":"Multicentre comparison of various microaxial pump devices as a bridge to durable assist device implantation.","authors":"Marta L Medina, Daniel Lewin, Hendrik Treede, Sebastian V Rojas, Alexander Bernhardt, Michael Billion, Anna L Meyer, Ivan Netuka, Janajade Kooij, Marina Pieri, Antonio Loforte, Mauro Rinaldi, Mariusz K Szymanski, Adriaan O Kraajieveld, Christian J H Moeller, Payam Akhyari, Khalil Jawad, Bastian Schmack, Gloria Färber, Assad Haneya, Daniel Zimpfer, Gaik Nersesian, Ilija Djordjevic, Diyar Saeed, Finn Gustafsson, Anna M Scandroglio, Bart Meyns, Steffen Hofmann, Jan Belohlavek, Jan Gummert, Pia Lanmueller, Evgenij V Potapov, Mehmet Oezkur","doi":"10.1002/ehf2.15282","DOIUrl":"https://doi.org/10.1002/ehf2.15282","url":null,"abstract":"<p><strong>Aims: </strong>Patients with acute decompensated advanced heart failure requiring left ventricular assist device (LVAD) implantation often experience progressive cardiac function deterioration, negatively impacting surgical outcomes. This study aimed to assess the efficacy of different microaxial flow pump (mAFP) support devices (Impella®) in achieving optimal left ventricular unloading for preconditioning and facilitating definitive treatment in this high-risk patient cohort.</p><p><strong>Methods and results: </strong>A retrospective analysis was conducted across 19 high-volume European centres. The study population included patients transitioning from temporary to durable circulatory support over a 7.5-year period, with a median follow-up of 1 year. Patients were categorized based on mAFP support capacity: those receiving high-flow support (>5 L/min, '5+') and those with lower-flow support (3.5 L/min, 'CP'). Patients who were initially treated with CP but subsequently upgraded to 5+ support were classified in the 5+ group. Demographic and clinical characteristics, mobilization, right heart function, and organ dysfunction outcomes were analysed. A total of 339 patients received preoperative mAFP support prior to LVAD implantation. The 5+ group comprised 247 patients (73%), including 38 patients who were upgraded from CP, while the CP group included 92 patients (27%). Baseline demographic and clinical characteristics were comparable between groups, except for mobilization status, which showed significant differences (P < 0.001). Patients in the 5+ group achieved higher rates of full and partial mobilization compared to the CP group. Extracorporeal life support (ECLS) was more frequently required in the CP group than in the 5+ group (40.5% vs. 33.8%; P < 0.001). Additionally, right ventricular assist device (RVAD) implantation was significantly more common in the CP group (29.2% vs. 18.2%; P = 0.026). Patients in the 5+ group demonstrated greater reductions in both vasoactive inotropic scores (P = 0.006) and inotropic scores (P = 0.008). Furthermore, liver dysfunction (P = 0.016), renal failure (P = 0.041), and the need for dialysis (P = 0.013) were significantly more prevalent in the CP group. There were no significant differences between the two groups in terms of LVAD operative duration (P = 0.637) or cardiopulmonary bypass time (P = 0.408).</p><p><strong>Conclusions: </strong>High-flow mAFP devices (+5) provided superior haemodynamic support, enhanced left ventricular unloading, and reduced dependence on catecholamines compared to lower-flow CP devices. These improvements were associated with lower rates of right ventricular failure, renal dysfunction, and liver injury. However, no statistically significant difference was observed between mAFP groups regarding 30-day mortality rates.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779382","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}