ESC Heart Failure最新文献

{"title":"GEO combined with quantitative protein trait loci identify causative proteins in hypertrophic cardiomyopathy","authors":"Bo Li,&nbsp;Xu Zhao,&nbsp;Yan Ding,&nbsp;Yi Zhang","doi":"10.1002/ehf2.15287","DOIUrl":"10.1002/ehf2.15287","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Hypertrophic cardiomyopathy (HCM) is a rare genetic heart disease characterized by a limited patient population and scarce research and treatment resources. This study aimed to identify HCM-associated proteins by integrating cardiac tissue data from the Gene Expression Omnibus (GEO) database with the latest protein quantitative trait locus (pQTL) dataset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>We analysed data from the GEO database. The GSE36961 dataset included 106 HCM samples and 39 healthy controls. The GSE180313 dataset included 13 HCM samples and 7 healthy controls. pQTL data were obtained from the plasma of 54 000 UK Biobank participants, covering 1463 proteins. HCM genome-wide association study (GWAS) data were sourced from the FinnGen study, which included 1125 HCM cases and 411 056 controls. We analysed the GEO dataset of cardiac tissue from HCM patients to identify differentially expressed genes (DEGs). These DEGs were compared with pQTL data to identify protein phenotypes suitable for Mendelian randomization (MR) analysis. A two-sample MR analysis was performed to assess the causal association between these protein phenotypes and HCM. The robustness of the study results was further assessed through sensitivity analysis of heterogeneity and horizontal pleiotropy tests. Two proteins were identified as causally associated with HCM risk: carbonic anhydrase 3 (CA3) [inverse variance weighted (IVW): odds ratio (OR) = 1.292, 95% confidence interval (CI) = 1.021–1.636, <i>P</i> = 0.033] and serpin family E member 1 (SERPINE1) [IVW: OR = 1.313, 95% CI = 1.063–1.621, <i>P</i> = 0.011]. Both proteins were associated with increased HCM risk, with no significant heterogeneity (<i>P</i> &gt; 0.05) or evidence of horizontal pleiotropy (<i>P</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CA3 and SERPINE1 proteins may exert causal effects on HCM and may serve as characteristic markers and therapeutic targets for this condition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2827-2833"},"PeriodicalIF":3.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15287","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999258","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":"Novel three-dimensional ECG algorithm for reliable screening for cardiac amyloidosis","authors":"Amir A. Mahabadi,&nbsp;Jan Knobeloch,&nbsp;Viktoria Backmann,&nbsp;Lars Michel,&nbsp;Markus S. Anker,&nbsp;Reza Wakili,&nbsp;Christian Fach,&nbsp;Stefan D. Anker,&nbsp;Tienush Rassaf","doi":"10.1002/ehf2.15318","DOIUrl":"10.1002/ehf2.15318","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Currently, there is no established screening tool for cardiac amyloidosis, leading to a delay in diagnosis in the majority of patients. We aimed to develop and validate a non-invasive and easy to use tool that allows for screening of cardiac amyloidosis based on structured evaluation of three-dimensional electrocardiograms (ECGs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>We included patients with confirmed cardiac AL or ATTR amyloidosis and controls of patients with other cardiovascular diseases but without amyloidosis into two independent cohorts: a derivation and validation cohort. All patients received three-dimensional ECGs and vector loops were categorized based on predefined patterns by two independent cardiologists. Consecutively, an AI algorithm was trained in the derivation cohort (<i>n</i> = 66 amyloidosis cases, <i>n</i> = 89 controls). This algorithm was then applied to the validation cohort (<i>n</i> = 33 amyloidosis cases, <i>n</i> = 67 controls).</p>\u0000 \u0000 <p>Overall, 99 patients with amyloidosis and 156 controls were included (mean age: 69 ± 15 years, 79% male). In the derivation cohort, the AI algorithm reached a sensitivity of 85%, a specificity of 89%, a positive predictive value of 91%, and a negative predictive value of 87%. Applying the algorithm on the independent validation cohort, a sensitivity of 79%, specificity of 82%, a positive predictive value of 61%, and a negative predictive value of 92% was reached.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We here describe a novel screening tool, which allows for reliable detection of cardiac amyloidosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2993-3002"},"PeriodicalIF":3.2,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15318","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974215","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":"Prescription of guideline-directed medical therapy in heart failure: impact on mortality and readmission","authors":"Martin Möckel,&nbsp;Samipa Pudasaini,&nbsp;Kristina Feldmann,&nbsp;Henning Thomas Baberg,&nbsp;Benny Levenson,&nbsp;Jürgen Malzahn,&nbsp;Thomas Mansky,&nbsp;Guido Michels,&nbsp;Christian Günster,&nbsp;Elke Jeschke","doi":"10.1002/ehf2.15280","DOIUrl":"10.1002/ehf2.15280","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The 2021 European heart failure (HF) guidelines recommend the combination of four drugs as a standard therapy (angiotensin-converting enzyme inhibitor [ACEI]/angiotensin receptor blocker [ARB]/angiotensin receptor-neprilysin inhibitor [ARNI]; beta-blocker (BB); mineralocorticoid receptor antagonist [MRA]; sodium-glucose co-transporter 2 inhibitor [SGLT2i]) in patients with heart failure and reduced ejection fraction (HFrEF). We investigated if the use of this combined treatment (as opposed to the outdated two-drug ACEI/ARB and BB therapy) yields a favourable outcome regarding mortality and readmission and evaluated whether an increase in adoption of the newly endorsed therapy can already be observed in clinical routine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>We included anonymous data from all patients who were insured at Germany’s largest health insurer (Allgemeine Ortskrankenkasse [AOK]) and had a claims record for hospitalization (2019–2021) with the main diagnosis of HF. Mortality and readmission within 91–365 days following the index stay were analysed, and the impact of medication on outcome was compared. 315 342 cases of hospitalization due to HF were included (median 80 years [IQR 72–86], 53.7% female). HF drug prescription rates were as follows: ACEI 46.3%, ARB 31.8%, ARNI 12.1%, BB 80.9%, MRA 35.6%, SGLT2i 7.3%. Treatment combinations were prescribed in 35.9% (two-drug) and 3.7% (four-drug). Total mortality was 18.0%, all-cause readmission 32.0%, and HF readmission 16.0%. Mortality risk was significantly lower (adjusted HR = 0.92 [95% CI 0.86–0.97]) with the four- versus two-drug treatment. Kaplan–Meier survival was 88.2% for the four-drug therapy [95% CI: 87.6%–88.8%] and 83.1% for the two-drug therapy [95% CI: 82.9%–83.3%]). Similar benefits were visible for the readmission rates due to all causes (HR = 0.76 [0.73–0.80]) and readmission due to HF (HR = 0.90 [0.85–0.95]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study suggests that the newly recommended four-drug therapy may lead to lower mortality and readmission rates compared to the outdated two-drug therapy. However, the overall adoption of the four-drug therapy remains limited.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2791-2802"},"PeriodicalIF":3.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968533","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":"Role for inflammatory markers in predicting right ventricular failure in mechanical assist device recipients","authors":"Abdul-Fatawu Osman,&nbsp;Shane S. Scott,&nbsp;Ebubechukwu O. Ezeh,&nbsp;Evans Osuji,&nbsp;Israel O. Ailemen,&nbsp;Mohamed H. Derbala,&nbsp;Salil Kumar,&nbsp;Asvin M. Ganapathi,&nbsp;Daniel B. Sims,&nbsp;Ashrith Guha,&nbsp;Bryan A. Whitson,&nbsp;Sakima A. Smith","doi":"10.1002/ehf2.15160","DOIUrl":"10.1002/ehf2.15160","url":null,"abstract":"<p>Right ventricular failure (RVF) is a common complication following left ventricular assist device (LVAD) implantation and increases patient morbidity and mortality. Due to the complex and limited understanding of RVF pathophysiology, efforts to prognosticate RVF after LVAD have been challenging. To fill the gaps, current efforts have been focused on identifying molecular drivers and physiological mechanisms of right ventricular dysfunction in this population. Recent work suggests that pro-inflammatory and oxidative stress pathways contribute to the development and progression of RVF post-LVAD, and elevation of inflammatory indices have been correlated with poor prognosis. Current prediction models are limited and performed only modestly in validation studies and do not include immunologic and molecular parameters, which could enhance pre-operative risk stratification towards reducing post-operative burden of RVF post-LVAD. In this review, we identified and summarized clinically relevant molecular and inflammatory markers of RVF and RVF following LVAD placement. Correlating these markers with current haemodynamic and echocardiographic parameters provides an avenue to reduce RVF after LVAD.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2608-2620"},"PeriodicalIF":3.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15160","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975613","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":"Delays in diagnosis and treatment of ATTR cardiac amyloidosis: A real-world data analysis","authors":"Julia Vogel,&nbsp;Sophia Jura,&nbsp;Stephan Settelmeier,&nbsp;Florian Buehning,&nbsp;Tobias Lerchner,&nbsp;Alexander Carpinteiro,&nbsp;Tienush Rassaf,&nbsp;Lars Michel","doi":"10.1002/ehf2.15311","DOIUrl":"10.1002/ehf2.15311","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Background</h3>\u0000 \u0000 <p>Cardiac amyloidosis leads to functional cardiac impairment and heart failure. Transthyretin amyloid cardiomyopathy (ATTR-CM) is the most common form. After initial suspicion, diagnosis involves imaging techniques, biopsy and genetic tests, prompting transthyretin stabilizer therapy to slow disease progression. The study aims to assess delays in diagnosis in ATTR-CM patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with ATTR-CM receiving transthyretin stabilizer therapy at the West German Amyloidosis Center (01/2018–12/2023) were included. Clinical, laboratory, and imaging data were analysed. Diagnostic timelines were compared across two periods (2018–2020 and 2021–2023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After screening 254 patients, 154 were included in the analysis. ATTRwt was the most common form (96.8%). The median age was 80 (76–83) years, 87% were male and 46.6% were NYHA class ≥III. Time to diagnosis decreased from 398 to 277 days in the second period (<i>P</i> &lt; 0.001). The median duration from diagnosis to stabilizer therapy was 84 (44–160) days, reducing from 111 (55–237) days in the first period to 57 (36–102) days in the second period (<i>P</i> &lt; 0.001). Patients diagnosed in the first period had lower LVEF (<i>P</i> &lt; 0.001) and more advanced NAC stages (<i>P</i> = 0.004). More women were diagnosed in the second period (<i>P</i> = 0.010).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ATTR-CM is associated with diagnostic delays from initial suspicion to therapy initiation. While diagnostic and treatment timelines have improved, enhanced awareness, supraregional networks, specialized centres and focused education are essential to improve diagnosis and outcomes. Increasing awareness has led to patients being diagnosed at earlier disease stages, underscoring the potential to positively impact patient prognosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2969-2975"},"PeriodicalIF":3.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978847","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":"Lower NT-proBNP plasma concentrations in Pacific peoples with heart failure","authors":"Andree G. Pearson,&nbsp;John F. Pearson,&nbsp;Lynley K. Lewis,&nbsp;Allamanda Fa'atoese,&nbsp;Katrina K. Poppe,&nbsp;Chris Pemberton,&nbsp;Gerry Devlin,&nbsp;Mayanna Lund,&nbsp;A. Mark Richards,&nbsp;Richard Troughton,&nbsp;Robert N. Doughty","doi":"10.1002/ehf2.15314","DOIUrl":"10.1002/ehf2.15314","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Plasma concentrations of the heart failure (HF) biomarker N-terminal B-type natriuretic peptide (NT-proBNP) vary by ethnicity. We investigated whether NT-proBNP concentrations differed in HF between Pacific peoples, Māori (the Indigenous people), and New Zealand (NZ) Europeans, in patients with HF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Plasma NT-proBNP was measured in patients with HF participating in two prospective NZ based multicentre studies [PEOPLE: <i>n</i> = 836, 30% female, median age 71, interquartile interval (IQI) 60, 80; IMPERATIVE-HF: <i>n</i> = 413, 30% female, median age 66, IQI 55, 76]. Regression analyses were used to understand predictors of NT-proBNP taking into account age, sex, body mass index (BMI), estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF) and presence of atrial fibrillation (AF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median NT-proBNP concentrations were significantly lower in both Pacific (930 pg/mL; <i>P</i> &lt; 0.001, IQI 409–1,473; <i>n</i> = 127) and Māori (1,387 pg/mL, IQI 685–2,393; <i>P</i> &lt; 0.001; <i>n</i> = 221) compared with NZ Europeans (2,055 pg/mL, IQI 973–3,865; <i>n</i> = 901) in unadjusted comparisons. NT-proBNP was independently associated with ethnicity, age, sex, BMI, eGFR, LVEF and presence of AF. The significant differences in plasma NT-proBNP between Pacific peoples, but not Māori, and NZ Europeans remained after adjusting for these clinical and demographic factors. The effect of age on NT-proBNP concentrations differed significantly between Pacific peoples and NZ Europeans, but not between Māori and NZ European (<i>P</i>_interaction = 0.0109). For each decade of life over 60 years, plasma NT-proBNP in patients with HF was on average, 67% lower in a Pacific person than that of an aged-matched NZ European.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In HF, Pacific and Māori people had significantly lower median plasma concentrations of NT-proBNP than NZ Europeans. This difference remained after adjusting for clinical and demographic factors in patients with Pacific ethnicity. Pacific peoples also had a significantly lower rate of increase of NT-proBNP with age compared with NZ Europeans and Māori.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2976-2984"},"PeriodicalIF":3.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996889","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":"Acoustic features are independently associated with heart failure and pulmonary hypertension","authors":"Jaskanwal Deep S. Sara,&nbsp;Keiko Ishikawa,&nbsp;Yan Li,&nbsp;D.M. Anisuzzaman,&nbsp;Lilach O. Lerman,&nbsp;Amir Lerman,&nbsp;Diana Orbelo","doi":"10.1002/ehf2.15309","DOIUrl":"10.1002/ehf2.15309","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Acoustic analysis of speech has discriminated decompensated acute heart failure (HF). Speech rate (SR) and cepstral peak prominence (CPP) variation are among features previously evaluated. However, the association between SR and CPP and chronic stable HF with and without pulmonary hypertension (PH) as well as PH alone have not been previously studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients evaluated for HF and/or PH in the outpatient setting recorded a standardized text read out loud from which a sentence was extracted and analysed to extract pre-specified acoustic features including SR and CPP calculated for voiced speech (CPP-V) and in all speech (CPP-All). Patients were grouped depending on the presence or absence of disease (HF and/or PH) and symptoms. Linear regression models were fitted to determine the association between each acoustic feature and disease status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 2153 patients were included: age 65.32 ± 17.18 years; male <i>n</i> = 1246 (57.9%); 879 had HF (40.8%), 542 had PH (25.2%) and 777 had no disease and no symptoms (36.1%). After adjustment for age and sex, SR was significantly lower in patients with PH only [estimated coefficient, 95% confidence interval (CI): −0.14, −0.21 to −0.06, <i>P</i> = 0.0006], HF only (−0.11, −0.17 to −0.05, <i>P</i> = 0.0002) and HF with PH (−0.17, −0.24 to −0.10, <i>P</i> &lt; 0.0001) compared with no disease. CPP-V differed in patients with PH only (0.37, 0.16–0.57, <i>P</i> = 0.0004) and CPP-All differed significantly compared with patients without disease (0.23, 0.08–0.38, P = 0.0025).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SR is significantly slower in patients with HF alone, PH alone and HF and PH combined compared with patients without disease. CPP also differs significantly in patients with PH compared with controls. These findings suggest that acoustic analysis may be useful in discriminating chronic stable HF and PH, offering promise for the development of non-invasive screening methods for HF and PH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2946-2957"},"PeriodicalIF":3.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991650","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":"Furosemide-hydration matching with RenalGuard® in decompensated heart failure: an alternative way to use diuretics and saline","authors":"Massimo Mapelli,&nbsp;Filippo Maria Rubbo,&nbsp;Jeness Campodonico,&nbsp;Nicola Cosentino,&nbsp;Giancarlo Marenzi,&nbsp;Valentina Mantegazza,&nbsp;Filippo Trombara,&nbsp;Mateusz Sokolski,&nbsp;Piotr Ponikowski,&nbsp;Piergiuseppe Agostoni","doi":"10.1002/ehf2.15316","DOIUrl":"10.1002/ehf2.15316","url":null,"abstract":"&lt;p&gt;The vast majority of acute heart failure (HF) episodes are characterized by progressive worsening symptoms and signs of congestion with volume overload. The aim of therapy in those cases is the relief of congestion through achieving a state of euvolaemia, mainly through the use of diuretic therapy.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The appropriate use of diuretics however remains challenging, especially when worsening renal function, diuretic resistance and electrolyte disturbances occur. In particular, in the presence of particularly low renal function values accompanied by anasarca, the presence of resistance to diuretic therapy is one of the main factors that can lead to hospitalization with the need for intravenous diuretic therapy. RenalGuard&lt;sup&gt;®&lt;/sup&gt; (PLC Medical Systems, USA) is a system for the prevention of Contrast-Associated Acute Kidney Injury (CA-AKI), engineered to ensure adequate hydration while providing contrast medium clearance; the system delivers intravenous fluids matched to urine output with a combination of hydration with normal saline at an initial dose bolus plus a low dose of furosemide (priming) and continuous monitoring for a urine output flow of &gt;150–300 mL/h, in the attempt to prevent conditions of either hyperlaemia or hypovolaemia.&lt;span&gt;&lt;sup&gt;2-4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this case report, our team employed RenalGuard&lt;sup&gt;®&lt;/sup&gt; in a patient with acute decompensated HF, setting a net negative fluid balance in order to achieve a reduction in congestion and fluid retention.&lt;/p&gt;&lt;p&gt;A 41-year-old man was admitted in September 2022 to the HF Unit at the Monzino Cardiology Center, Milan, with signs and symptoms of worsening HF: worsening dyspnoea in New York Heart Association (NYHA) class IV, with bendopnoea, orthopnoea, massive ankle swelling leading to a weight gain of +11 kg in the last 3 weeks despite an increase in the home dose of loop diuretic to furosemide 150 mg/day.&lt;/p&gt;&lt;p&gt;At the age of 17, the patient was found to have T-wave inversion in the right precordial leads and mild dilation of the right ventricle (RV) at electrocardiogram (ECG) and echocardiography, respectively, in the absence of a family history of cardiomyopathy or sudden cardiac death; no further examinations were performed at that time. In 2004, based on his clinical history, ECG, and echocardiographic findings, the patient was diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC). In 2015, at the age of 38, a cardiac magnetic resonance imaging (CMR) revealed severe RV dilation and dysfunction, as well as mild left ventricular (LV) dysfunction with an ejection fraction (EF) of 46%. Biventricular late gadolinium enhancement was observed (subepicardial, nonischaemic pattern) with sings consistent with fibro-fatty replacement. In June 2016, the patient was admitted to the emergency department with ventricular tachycardia that rapidly degenerated into ventricular fibrillation. Cardiopulmonary resuscitation was immediately initiated, and rap","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"3200-3208"},"PeriodicalIF":3.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957398","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":"Multiomics insight into the role of glucagon-like peptide-1 receptor agonists in heart failure","authors":"Yuhang Tao,&nbsp;Qi Liu,&nbsp;Yuxing Wang,&nbsp;Yingchao Gong,&nbsp;Mingying Xu,&nbsp;Ruhong Jiang,&nbsp;Kai Zhang","doi":"10.1002/ehf2.15310","DOIUrl":"10.1002/ehf2.15310","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;Cardiovascular diseases, such as atrial fibrillation, coronary artery disease, heart failure (HF) and ischaemic stroke, are leading causes of death globally and exert major global health burden. Recent studies suggest that glucagon-like peptide-1 receptor agonists (GLP1Ra), a novel class of antidiabetic drugs, may not only help manage blood glucose but also reduce the risks of cardiovascular diseases. However, the mechanisms through which GLP1Ra protects against cardiovascular diseases, remain incompletely understood.&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;Genome-wide association study dates were used to investigate the impact of GLP1Ra on cardiovascular diseases, including atrial fibrillation (1,202,168 European and 28,612 East Asian), coronary artery disease (501,756 European and 183,134 East Asian), heart failure (HF) (1,350,497 European and 203,040 East Asian) and ischaemic stroke (689,168 European and 192,383 East Asian). Genetic instruments were selected from the GLP1R gene region, and two-sample Mendelian randomization (MR) analyses were conducted to assess the causal effects of GLP1Ra on cardiovascular diseases in European and East Asian populations. Summary-data-based MR analyses were performed for further validation using expression quantitative trait loci data. Mediation analysis evaluates the role of circulating inflammatory proteins and metabolites in mediating the effects of GLP1Ra. Meantime, we performed a series of sensitivity analyses to confirm the robustness of the results. The result demonstrated significant causal association between GLP1Ra and HF in European populations (odds ratio: 0.60, 95% CI 0.51–0.72, &lt;i&gt;P&lt;/i&gt; = 2.76 × 10&lt;sup&gt;−8&lt;/sup&gt;), and this result was confirmed by SMR analyses. No significant associations were found for atrial fibrillation, coronary artery disease, ischaemic stroke in European populations or all cardiovascular diseases in East Asian populations. GLP1Ra was found to influence 27 circulating inflammatory proteins and 146 circulating metabolites. Among them, 4 inflammatory proteins and 17 metabolites are associated with HF. Mediation analysis indicated that the protective effect of GLP1Ra on HF was mediated by circulating fibroblast growth factor 5 (FGF5) and N-acetylglycine (NAC), with a mediated proportion of 4.37% and 8% of the total effect, respectively.&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;This study provides multiomics insight into the role of GLP1Ra in cardiovascular diseases, especially in HF and the underlying pathway. The results suggest that GLP1Ra may exert anti-HF effects by reducing the concentration of circulating FGF5 and ","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"2958-2968"},"PeriodicalIF":3.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998627","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":"EVOLUTION-HF DEallEF: A non-interventional study of patients with heart failure initiated on dapagliflozin: study design","authors":"Matthias Paul,&nbsp;Ralph Bosch,&nbsp;Behrus Subin,&nbsp;Angelika Guth,&nbsp;Marlena Mueller,&nbsp;Mareike Seelinger,&nbsp;Stephanie Riemann,&nbsp;Birgit Assmus","doi":"10.1002/ehf2.15312","DOIUrl":"10.1002/ehf2.15312","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 failure (HF) is one of today's leading public health issues worldwide. The sodium-glucose cotransporter 2 inhibitor (SGLT2i) dapagliflozin recently received a label expansion. It is now approved for treatment of HF across the entire spectrum of ejection fraction (EF) in Germany. However, real-world data are limited. EVOLUTION-HF DE&lt;sub&gt;allEF&lt;/sub&gt; aims to complement existing data in Germany under the multinational umbrella EVOLUTION-HF study protocol.&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;EVOLUTION-HF DE&lt;sub&gt;allEF&lt;/sub&gt; (NCT06336330) is a non-interventional, prospective, longitudinal cohort study. It is planned to enrol a total of 1000 (700 evaluable) patients with HF in Germany. Distribution is planned as 40% patients with preserved (HFpEF), 20% with mildly reduced (HFmrEF), and 40% with reduced EF (HFrEF). Patients &lt;i&gt;≥&lt;/i&gt;18 years of age, who started dapagliflozin treatment 14–90 days prior to enrolment according to the local product label, are eligible to participate. Among reasons for exclusion are previous SGLT2i treatment (including dapagliflozin), type 1 diabetes, and hypersensitivity to dapagliflozin or its excipients. Data on medical history, HF status and medication before dapagliflozin treatment will be collected retrospectively at baseline. Follow-up data will concern clinical symptoms, healthcare utilization, HF and concomitant medication, as well as dapagliflozin usage. These data will be extracted from real-world data sources like patient charts, discharge letters, and electronic medical records. They will be collected prospectively every 3 months for up to 12 months. In addition, patient-reported outcomes (PROs) on health-related quality of life (HRQoL), medication adherence, work productivity, and patient's needs, expectations, and satisfaction with medical care will be collected using standardized and unstandardized questionnaires. Primary objectives include demographic and clinical characterization of patients and the assessment of treatment patterns of dapagliflozin, other HF medications, and glucose-lowering medications. Secondary objectives are to describe HRQoL, medication adherence, and work productivity. Exploratory objectives are to describe depression, healthcare utilization, and patient's needs, expectations, and satisfaction with medical care. EVOLUTION-HF DE&lt;sub&gt;allEF&lt;/sub&gt; has included its first patient in April 2024 and is currently open for enrolment.&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;EVOLUTION-HF DE&lt;sub&gt;allEF&lt;/sub&gt; will deliver relevant insights into real-world dapagliflozin treatment for HF focusing on clinical and patient perspective in Germany.&lt;/p&gt;","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 4","pages":"3145-3151"},"PeriodicalIF":3.2,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003989","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}