ESC Heart Failure最新文献

{"title":"Clinical impact of tricuspid regurgitation in patients with acute myocardial infarction","authors":"Shun Nishino,&nbsp;Chiharu Nishino,&nbsp;Michikazu Nakai,&nbsp;Kensaku Nishihira,&nbsp;Nehiro Kuriyama,&nbsp;Yoshisato Shibata","doi":"10.1002/ehf2.15375","DOIUrl":"10.1002/ehf2.15375","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The clinical impact of tricuspid regurgitation (TR) in patients after acute myocardial infarction (AMI) is largely unknown. The aim of this study was to clarify the prevalence and prognostic impact of TR in post-AMI patients treated with appropriate primary percutaneous coronary intervention (PCI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>Three hundred fifty-one consecutive patients with first-onset AMI who underwent successful primary PCI from July 2014 to December 2018 were retrospectively examined. Standard two- and three-dimensional echocardiography were performed at discharge. Based on the presence or absence of mild or greater TR, patients were divided into TR (+) and TR (−) groups, respectively. The primary outcome was the incidence of major adverse cardiac events (MACE), defined as the composite of death, re-hospitalization for congestive heart failure and recurrent MI. Seventy-eight (22.2%) patients had mild or greater TR. Kaplan–Meier analysis showed that the cumulative 6-year incidence of MACE was significantly higher in the TR (+) group (hazard ratio, 2.56 [95% confidence interval, 1.48–4.44]; <i>P</i> &lt; 0.001). In the analysis of the severity of TR, the prognosis of patients with mild TR was significantly worse than that of patients without TR (<i>P</i> = 0.026). Multivariable analysis identified the left anterior descending coronary artery as the culprit vessel, left atrial dilation (&gt;34 mL/m²), reduced left ventricular ejection fraction (&lt;50%) and the presence of significant (≥mild) ischaemic mitral regurgitation as independent predictors of mild or greater residual TR after primary PCI for AMI at discharge. Following adjustment for significant clinical parameters, mild or greater TR at discharge was still associated with a significant hazard ratio for the occurrence of MACE (1.87, [95% confidence interval, 1.01–3.48]; <i>P</i> = 0.048).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The presence of mild or greater TR at discharge may serve as a poor prognostic marker in patients with first-onset AMI. In addition to traditional clinical risk factors, it is important to pay more attention to TR and to manage it appropriately.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3461-3474"},"PeriodicalIF":3.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15375","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636512","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":"Immuno-haemostatic dysregulation in heart failure with preserved ejection fraction","authors":"Giorgia D'Italia,&nbsp;Daniëlle M. Coenen,&nbsp;Titus P. Lemmens,&nbsp;Lloyd Brandts,&nbsp;Simone J. H. Wielders,&nbsp;Magdolna Nagy,&nbsp;Sanne G. J. Mourmans,&nbsp;Anouk Achten,&nbsp;Ahmad Al-Abadi,&nbsp;Jerremy Weerts,&nbsp;Arantxa Barandiaran Aizpurua,&nbsp;Vanessa van Empel,&nbsp;Blanche Schroen,&nbsp;Judith M. E. M. Cosemans","doi":"10.1002/ehf2.15361","DOIUrl":"10.1002/ehf2.15361","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 with preserved ejection fraction (HFpEF) is a complex condition with partially unclear pathophysiology, in which systemic inflammation is a central contributor to changes in cardiac structure and function. The contribution of non-traditional immune effectors—such as platelets and coagulation—remains underexplored in HFpEF. We characterized platelet function, as well as coagulation and neutrophil activation, in patients with HFpEF.&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;The in vivo activation of platelets, neutrophils, endothelial cells and coagulation was measured in plasma from patients with HFpEF (&lt;i&gt;n&lt;/i&gt; = 103), age- and sex-matched controls (&lt;i&gt;n&lt;/i&gt; = 40) and pooled plasma from a healthy reference cohort. Flow cytometric and microfluidic assays were performed to investigate platelet function ex vivo.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Compared with matched controls, patients with HFpEF exhibited reduced platelet reactivity, characterized by alterations in platelet integrin activation and granule release, and an overall decrease in thrombus activation, contraction and fibrin formation. In vivo platelet activation markers β-TG and CXCL4 were increased in plasma from patients with HFpEF and matched controls compared with the healthy reference cohort (β-TG: 923.01 and 822.25 vs. 335.06 ng/mL; CXCL4: 660.16 and 603.63 vs. 458.34 ng/mL). Linear regression analyses showed an association between platelet aberrant activation and function and the presence of HFpEF, independent of comorbidities or medications [e.g., thrombus characteristics (size, contraction, height): &lt;i&gt;P&lt;/i&gt; values&lt;sub&gt;Fully adjusted model&lt;/sub&gt; = &lt;0.001; &lt;0.001; &lt;0.001]. Patients with HFpEF showed higher levels of the neutrophil activation markers MPO and S100A8/A9 compared with matched controls (MPO: &lt;i&gt;P&lt;/i&gt; value = 0.0152; S100A8/A9: &lt;i&gt;P&lt;/i&gt; value = 0.0041). Levels of endothelial markers ICAM-1 and VCAM-1 were unaltered between groups. Coagulation was found elevated in patients with HFpEF, particularly in patients not on anticoagulant (AC) medications, showing increased plasma levels of plasma kallikrein, factor XI, factor IX, thrombin and D-dimer (kallikrein: &lt;i&gt;P&lt;/i&gt; value = 0.0415; AC excluded: FXIa:C1inh: &lt;i&gt;P&lt;/i&gt; value = 0.0110; FIXa:AT: &lt;i&gt;P&lt;/i&gt; value = 0.0095; T:AT: 4.46 vs. reference 4 μg/L; D-dimer: 0.65 vs. reference 0.5 mg/L).&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;Patients with HFpEF present with dysfunctional platelets, a procoagulant state and neutrophil activation. The associatio","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3444-3460"},"PeriodicalIF":3.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15361","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607857","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":"Two-year outcomes of a cardiac microcurrent device in chronic heart failure: A first-in-human pilot study","authors":"Dragana B. Kosevic,&nbsp;Una Radak,&nbsp;Petar Vukovic,&nbsp;Jan D. Schmitto,&nbsp;Kersten Brandes,&nbsp;Peter Goettel,&nbsp;Hans-Dirk Duengen,&nbsp;Elvis Tahirovic,&nbsp;Marija Zdravkovic,&nbsp;Johannes Mueller,&nbsp;Faouzi Kallel,&nbsp;Marat Fudim,&nbsp;Stefan D. Anker,&nbsp;Jesus Eduardo Rame,&nbsp;Miodrag Peric","doi":"10.1002/ehf2.15369","DOIUrl":"10.1002/ehf2.15369","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>In heart failure patients, altered myocardial electrical fields linked to oedema may impair left ventricular function. While short-term use of implanted microcurrent generators (C-MIC) has shown promise, long-term effects remain unclear. This study assessed the safety and efficacy of C-MIC use beyond the initial 6 month pilot period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients from the initial C-MIC pilot study who were alive at 6 months were screened for 2 year follow-up. The primary endpoint included rates of all-cause, cardiac- and device-related mortality, all-cause, cardiac and device related hospitalizations, along with adverse events, device malfunctions and exchanges. Secondary endpoints evaluated device performance via left ventricular ejection fraction (LVEF), 6 min walk distance, New York Heart Association (NYHA) class and SF-36 quality-of-life scores and the need for prolonged therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 10 patients enrolled in the initial study, 7 were enrolled in follow-up (mean age 52.4 ± 7.6 years, NYHA Class III and mean LVEF 31.7 ± 3.7%). No device-related adverse events occurred. One non-cardiac, non-device related death was reported at 18 months. Improvement in LVEF of 11.60% [95% confidence interval (CI): 5.64–17.56, <i>P</i> &lt; 0.001] from baseline to 6 months was maintained at 2 years post-C-MIC deactivation, with a sustained increase of 12.56% from baseline (95% CI: 4.67–20.45, <i>P</i> = 0.002). Similarly, the 6 min walk distance improved by 206.35 m at 6 months (95% CI: 161.32–251.39, <i>P</i> &lt; 0.0001) and remained at 191 m above baseline at 2 years (95% CI: 131.83–250.99, <i>P</i> &lt; 0.0001). Improvements in NYHA functional class and SF-36 quality-of-life scores observed at 6 months were also preserved throughout the 2 year follow-up. One patient required C-MIC reactivation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Long-term use of the C-MIC device appears safe with sustained improvements in NYHA class, LVEF, 6 min walk distance and quality of life, supporting the long-term therapeutic potential of microcurrent therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3264-3275"},"PeriodicalIF":3.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599769","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":"Atrial-secondary tricuspid regurgitation: a better prognosis in early stage heart failure, but not in late stage","authors":"Corentin Bourg,&nbsp;K. Charlotte Lee Frost,&nbsp;Augustin Coisne,&nbsp;Elizabeth Curtis,&nbsp;Guillaume L'official,&nbsp;Yoan Lavie-Badie,&nbsp;Léo Lemarchand,&nbsp;Julien Dreyfus,&nbsp;Emmanuel Oger,&nbsp;Erwan Donal","doi":"10.1002/ehf2.15370","DOIUrl":"10.1002/ehf2.15370","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Although the classification of secondary tricuspid regurgitation (STR) by atrial or ventricular aetiology (A-STR or V-STR) carries prognostic importance, the confounding effects of New York Heart Association (NYHA) class have not yet been elucidated. We aimed to correlate STR and NYHA classification with patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied 281 patients with severe STR who presented to 16 French hospitals between 2017 and 2019. Patients were separated into A-STR and V-STR categories using echocardiographic criteria (A-STR = tricuspid tenting height ≤10 mm, right mid-ventricular diameter ≤38 mm, and LVEF ≥ 50%). We tracked time to cardiovascular disease-related hospitalization or death, whichever came first.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the patients 91/281 (32.7%) had A-STR, 164/281 (58.4%) had mixed/V-STR, and 25/281 (8.9%) could not be classified. Baseline age, labs, comorbidities and NYHA category (Class I–II = mildly symptomatic, Class III–IV = very symptomatic) did not differ between groups (<i>P</i> &gt; 0.05). Although there were no differences in event-free survival among groups (70.7% vs. 65.9%, <i>P</i> = 0.59), this was confounded by NYHA class (<i>P</i> = 0.0104). Thus, among mildly symptomatic patients, estimated 5 year event-free survival was 76.4% in the A-STR group and 53.2% in the mixed/V-STR group (<i>P</i> &lt; 0.05). Among very symptomatic patients, there was no difference in estimated event-free survival (39.4% vs. 17.2%, <i>P</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Though A-STR carries a more favourable prognosis in mildly symptomatic patients, this distinction is irrelevant in patients with advanced disease. Thus, the value of tricuspid valve intervention may become ‘too little, too late’ if A-STR is not promptly addressed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3435-3443"},"PeriodicalIF":3.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15370","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical endpoints in pragmatic heart failure trials: From data collection to clinical endpoint classification","authors":"Veraprapas Kittipibul,&nbsp;Harriette G.C. Van Spall,&nbsp;William Schuyler Jones,&nbsp;Marat Fudim,&nbsp;Robert J. Mentz,&nbsp;Kevin Anstrom,&nbsp;Bertram Pitt,&nbsp;Patrice Desvigne-Nickens,&nbsp;Jerome L. Fleg,&nbsp;Camilla Hage,&nbsp;Stefan James,&nbsp;Claes Held,&nbsp;Lars Lund,&nbsp;Adam DeVore","doi":"10.1002/ehf2.15366","DOIUrl":"10.1002/ehf2.15366","url":null,"abstract":"<p>Clinical endpoint classification (CEC)—that is, evaluation of clinical events using pre-defined criteria—is commonly conducted in clinical trial operations to ensure systematic and consistent assessment of endpoints needed to assess the intervention's safety and efficacy. This is particularly relevant for heart failure (HF) trials given the subjective decision-making around hospitalizations and variation in how worsening HF events are managed (both in hospital and in ambulatory settings). Several CEC strategies have been adopted to address the growing need for pragmatic clinical trials that enhance generalizability and minimize research burden on trial sites and patients. This review summarizes common CEC strategies including the traditional approach, investigator-reported endpoints, CEC using real-world data and CEC utilizing large language models. We summarize CEC strategies used in recent HF pragmatic trials and present challenges and considerations for CEC in HF pragmatic trials from the selection of clinical endpoints and data collection to CEC.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3250-3263"},"PeriodicalIF":3.7,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15366","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599768","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":"Nutritional risk, frailty and functional status in elderly heart failure patients","authors":"Magdalena Lisiak,&nbsp;Maria Jędrzejczyk,&nbsp;Marta Wleklik,&nbsp;Katarzyna Lomper,&nbsp;Michał Czapla,&nbsp;Izabella Uchmanowicz","doi":"10.1002/ehf2.15351","DOIUrl":"10.1002/ehf2.15351","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Heart failure (HF) in elderly patients is frequently associated with frailty, malnutrition and reduced functional status. This study assessed the associations between nutritional risk, functional capacity, frailty and length of hospital stay (LOHS) in elderly patients hospitalized with HF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>A cross-sectional study of 200 patients aged 60–91 years (mean age 72.3 ± 6.6; 70.5% male) hospitalized for HF. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), functional capacity with Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales, and frailty using Fried's criteria. BMI, central obesity, comorbidities and LOHS were also recorded. Frailty was present in 65% of participants; 36.5% were malnourished or at nutritional risk. Well-nourished patients had significantly higher IADL scores (<i>P</i> = 0.002). Mean LOHS was longer in frail compared with pre-frail patients (6.18 ± 2.37 vs. 5.41 ± 1.60 days; <i>P</i> = 0.016). In multivariable logistic regression, frailty independently predicted increased LOHS (OR = 4.063, 95% CI: 1.36–12.1; <i>P</i> = 0.012). BMI, central obesity and comorbidity burden were not associated with functional status or LOHS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Frailty was independently associated with increased LOHS in elderly HF patients. Poor nutritional status was significantly linked to reduced instrumental functional capacity. Routine frailty and nutritional screening may help identify patients who could benefit from early interventions aimed at improving functional outcomes and reducing hospitalization time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3426-3434"},"PeriodicalIF":3.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15351","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567268","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 left ventricular ejection time in MYBPC3 variant carriers with overt or subclinical hypertrophic cardiomyopathy","authors":"Isabell Yan,&nbsp;Zoe Möhring,&nbsp;Daniel Reichart,&nbsp;Fanny Kortüm,&nbsp;Julia Münch,&nbsp;Rixa Woitschach,&nbsp;Paulus Kirchhof,&nbsp;Lucie Carrier,&nbsp;Carolyn Y. Ho,&nbsp;Thomas Eschenhagen,&nbsp;Monica Patten","doi":"10.1002/ehf2.15346","DOIUrl":"10.1002/ehf2.15346","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;Hypertrophic cardiomyopathy (HCM) is an inherited cardiomyopathy often caused by pathogenic variants in &lt;i&gt;MYBPC3&lt;/i&gt; and &lt;i&gt;MYH7&lt;/i&gt;, encoding myosin-binding protein C3 and myosin heavy chain 7, respectively. These variants can cause increased actin–myosin crossbridge cycling, resulting in ventricular hypercontractility, but mice lacking &lt;i&gt;Mybpc3&lt;/i&gt; exhibited reduced left ventricular ejection time (LVET) as a sign of systolic dysfunction. In this study, we tested whether LVET is specifically altered in patients carrying &lt;i&gt;MYBPC3&lt;/i&gt; variants by retrospective echocardiographic analysis in two genotype-defined HCM cohorts.&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;LVET was measured by echocardiography and adjusted for heart rate [LVET index (LVETI)] in 166 patients. Variant carriers were stratified for the presence (LVH+) or absence of left ventricular hypertrophy with septal thickness of ≥13 mm (LVH−). Multivariate analysis of variance (MANOVA) was used to identify differences in LVETI between variant carriers and controls with LVETI as the dependent variable, adjusted for sex, age, left ventricular ejection fraction (LVEF), interventricular septal diameter in diastole (IVSd), diastolic dysfunction, left ventricular outflow tract (LVOT) gradient at rest and medication history as confounders.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In a total of 166 patients carrying &lt;i&gt;MYBPC3&lt;/i&gt; or &lt;i&gt;MYH7&lt;/i&gt; pathogenic variants (38 ± 3 years, 45% female), we compared the discovery cohort (40 &lt;i&gt;MYBPC3&lt;/i&gt; and 31 &lt;i&gt;MYH7&lt;/i&gt;) and the validation cohort (‘Valsartan in Attenuating Disease Evolution in Early Sarcomeric HCM’; 54 &lt;i&gt;MYBPC3&lt;/i&gt; and 41 &lt;i&gt;MYH7&lt;/i&gt;) with 44 healthy controls. LVETI was lower in &lt;i&gt;MYBPC3&lt;/i&gt; and higher in &lt;i&gt;MYH7&lt;/i&gt; LVH+ patients than in controls in the discovery, validation and pooled cohorts (pooled: &lt;i&gt;MYBPC3&lt;/i&gt; 381 ± 19 ms vs. &lt;i&gt;MYH7&lt;/i&gt; 437 ± 38 ms, &lt;i&gt;P&lt;/i&gt; &lt; 0.001; &lt;i&gt;MYBPC3&lt;/i&gt; vs. controls 411 ± 15 ms, &lt;i&gt;P&lt;/i&gt; &lt; 0.001; and &lt;i&gt;MYH7&lt;/i&gt; vs. controls, &lt;i&gt;P&lt;/i&gt; &lt; 0.001). Similar findings were seen in LVH− (pooled: &lt;i&gt;MYBPC3&lt;/i&gt; 380 ± 16 ms vs. &lt;i&gt;MYH7&lt;/i&gt; 437 ± 39 ms, &lt;i&gt;P&lt;/i&gt; &lt; 0.001; &lt;i&gt;MYBPC3&lt;/i&gt; vs. controls, &lt;i&gt;P&lt;/i&gt; &lt; 0.001). While &lt;i&gt;MYH7&lt;/i&gt; variants were all missense as expected, 87% of the &lt;i&gt;MYBPC3&lt;/i&gt; variants were truncating (including nonsense variants, out-of-frame deletion and splice site variants) and 13% were non-truncating (missense and in-frame deletion). LVETI did not differ between the groups and was significantly lower than the control in both.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Con","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3416-3425"},"PeriodicalIF":3.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15346","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559545","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":"Cardiogenic shock requiring VA-ECMO therapy in scorpionism-induced myocarditis","authors":"Alba I. Violino,&nbsp;María Alicia Lozano,&nbsp;Rocio Garcia Moralez,&nbsp;Juan P. Ricarte-Bratti,&nbsp;Julieta Lozita,&nbsp;Elizabeth Y. Ravinovich","doi":"10.1002/ehf2.15368","DOIUrl":"10.1002/ehf2.15368","url":null,"abstract":"&lt;p&gt;It is estimated that approximately 1.2 million scorpion stings occur globally each year. However, the true incidence is likely underestimated due to underreporting, particularly in endemic regions with limited access to healthcare systems. While the vast majority of stings result in only local symptoms, approximately 5% of patients develop systemic manifestations, and up to 1% progress to life-threatening complications such as acute heart failure, arrhythmias and cardiogenic shock.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Scorpion envenomation represents a significant public health issue in tropical and subtropical regions, including parts of Latin America. This case occurred in Córdoba, Argentina, a temperate region in the central part of the country characterized by hot summers and mild winters. The city of Córdoba, where the patient was treated, is a large urban centre surrounded by hilly terrain and natural scorpion habitats. &lt;i&gt;Tityus trivittatus&lt;/i&gt;, the most medically relevant scorpion species in Argentina, is endemic to the area, with increasing reports of envenomation during the warm season.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Cardiovascular complications are among the most severe and life-threatening effects of systemic scorpion envenomation. In a systematic review of over 700 reported cases of scorpion-related myocarditis, pulmonary oedema occurred in approximately 60.7% of cases, and hypotension or cardiogenic shock in 45.8%. Sinus tachycardia was the most common ECG abnormality (82%), followed by ST-T changes (64.6%), with less frequent findings such as ventricular arrhythmias and atrioventricular blocks. Echocardiographic evaluations often reveal global or regional hypokinesia, ventricular dilation and reduced left ventricular ejection fraction (EF)—frequently below 40%. Right ventricular dysfunction and functional mitral or tricuspid regurgitation may also be observed. Despite the severity of these manifestations, many patients—particularly children—exhibit rapid and complete recovery with timely supportive care.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Although the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been documented in paediatric patients with severe envenomation, no previous cases have been reported in adults.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; We present what is, to our knowledge, the first documented case of successful VA-ECMO support in an adult patient with cardiogenic shock secondary to &lt;i&gt;Tityus trivittatus&lt;/i&gt; envenomation, underscoring the importance of early recognition and aggressive intervention in such critical scenarios.&lt;/p&gt;&lt;p&gt;A 21 year-old female with no significant past medical history presented to the emergency department with acute onset of sharp pain in the right foot, radiating proximally along the lower limb, accompanied by sudden-onset vomiting. On admission, she was haemodynamically stable with normal vital signs. According to the patient and her family, the symptoms began approximately 4 h following a","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3780-3784"},"PeriodicalIF":3.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15368","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559544","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":"An unusual presentation of pheochromocytoma accompanied by catecholamine-induced cardiomyopathy","authors":"Hugh O.J. Roberts,&nbsp;Alexandru Munteanu,&nbsp;Jonas E. Mertens","doi":"10.1002/ehf2.15328","DOIUrl":"10.1002/ehf2.15328","url":null,"abstract":"&lt;p&gt;Pheochromocytomas are catecholamine-secreting tumours arising from chromaffin cells in the adrenal medulla. They are rare, with an annual incidence in Europe of 0.2 per 100 000 people.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Diagnosis is challenging due to their rarity and non-specific symptoms. Half are discovered incidentally on computed tomography (CT) or magnetic resonance imaging (MRI). These tumours are histologically indistinguishable from extra-adrenal catecholamine-secreting neoplasms, commonly referred to as paragangliomas. The majority of catecholamine-secreting tumours occur sporadically; however, approximately 40% are associated with hereditary syndromes. Familial cases are more likely to present with bilateral pheochromocytomas or multifocal paragangliomas. All known familial syndromes associated with these tumours follow an autosomal dominant pattern of inheritance, including Von Hippel–Lindau (VHL) syndrome, multiple endocrine neoplasia type 2 (MEN2) and neurofibromatosis type 1 (NF1). The prevalence of pheochromocytoma in individuals with these syndromes is approximately 10%–20% for VHL, 50% for MEN2 and 2%–3% for NF1. Symptoms typically include at least two of the ‘classic triad’: headache, sweating and tachycardia.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Hypertension is the most frequent symptom, although 10% of patients are normotensive.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Rarely, pheochromocytoma is associated with cardiomyopathy attributed to catecholamine excess (catecholamine-induced cardiomyopathy, CICM) that is similar to stress-induced cardiomyopathy (also known as takotsubo syndrome, TTS).&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Twenty-nine percent of pheochromocytomas are malignant, but the commonest causes of mortality are complications related to high circulating levels of catecholamines, including stroke, acute renal failure, ischaemic heart disease, arrhythmias, heart failure and pulmonary oedema.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; Definitive management is by resection, requiring careful surgical technique and anaesthesia management to avoid inducing catecholamine release and subsequent uncontrolled hypertension. Principles of management of paragangliomas are the same, but anatomical location can make resection challenging. The most typical paraganglioma sites are the carotid body, jugular bulb, middle ear and vagus nerve, and lower cranial nerve deficits are frequent complications of surgery.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Genetic testing is recommended for all individuals diagnosed with catecholamine-secreting tumours and is typically performed following resection and histopathological confirmation. In cases where a hereditary syndrome is identified, genetic evaluation is also indicated for first-degree relatives to facilitate early detection and management.&lt;/p&gt;&lt;p&gt;A 39-year-old female patient presented to the emergency department with intractable vomiting and a 2-year history of recurrent shaking episodes with palpitations, tingling in her limbs and hot flushes. Migraine assoc","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3776-3779"},"PeriodicalIF":3.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559543","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":"Angiotensin receptor-neprilysin inhibitors in concurrent heart failure with reduced ejection fraction and kidney failure","authors":"Mi-Hyang Jung,&nbsp;Dong-Hyuk Cho,&nbsp;Jimi Choi,&nbsp;Mi-Na Kim,&nbsp;Chan Joo Lee,&nbsp;Jung-Woo Son,&nbsp;Yaeni Kim,&nbsp;Jong-Chan Youn,&nbsp;Byung-Su Yoo","doi":"10.1002/ehf2.15359","DOIUrl":"10.1002/ehf2.15359","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Angiotensin receptor-neprilysin inhibitor (ARNI) therapy has demonstrated improved outcomes in heart failure with reduced ejection fraction (HFrEF). However, its benefits in patients with concomitant kidney failure undergoing replacement therapy remain uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>Using the National Health Insurance Service database, we identified individuals with HFrEF and kidney failure receiving replacement therapy who were prescribed either ARNI or renin-angiotensin system (RAS) blockers between 2017 and 2021. After applying inverse probability of treatment weighting, we compared 2104 patients on ARNI with 2191 on RAS blockers. The primary endpoint was a composite of all-cause mortality and any hospitalization. Secondary endpoints included all-cause mortality, any hospitalization and cardiovascular mortality. During a median follow-up of 19.1 months, ARNI use was associated with a significantly lower risk of the primary endpoint (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.75–0.97) compared with RAS blockers. ARNI also showed a reduced risk of all-cause mortality (HR 0.68, 95% CI 0.54–0.86), any hospitalization (HR 0.86, 95% CI 0.75–0.98) and cardiovascular mortality (HR 0.68, 95% CI 0.52–0.89). Subgroup analyses demonstrated consistent associations across age, sex, comorbidities and medications. Good adherence to ARNI was linked to a lower risk of the primary outcome, whereas non-adherence showed no benefit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among HFrEF patients with kidney failure receiving replacement therapy, ARNI use was associated with lower risks of all-cause mortality, any hospitalization and cardiovascular mortality compared with RAS blockers, particularly in those with good adherence to therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3405-3415"},"PeriodicalIF":3.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15359","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552695","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}