ESC Heart Failure最新文献

{"title":"Right ventricular global work efficiency: A reliable non-invasive estimate of right ventricular contractility","authors":"Paolo Manca,&nbsp;Vincenzo Nuzzi,&nbsp;Alessandro Lucchino,&nbsp;Gerardo Rugiano,&nbsp;Massimiliano Mulè,&nbsp;Alessandra Carvelli,&nbsp;Stefano Cannata,&nbsp;Sergio Sciacca,&nbsp;Francesca Parisi,&nbsp;Sabato Sorrentino,&nbsp;Francesco Fulvio Faletra,&nbsp;Paolo C. Colombo,&nbsp;Manlio Gianni Cipriani","doi":"10.1002/ehf2.15354","DOIUrl":"10.1002/ehf2.15354","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Right ventricular (RV) myocardial work (RVMW) recently emerged as a non-invasive alternative for the assessment of RV contractility. However, none of the prior studies assessed its variations under different haemodynamic conditions. We aimed to evaluate the variations of the components of RVMW in heart failure (HF) patients with pulmonary hypertension (PH) undergoing a reversibility test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive HF patients with reduced ejection fraction who underwent right heart catheterization and echocardiography at our institution were prospectively enrolled. Patients with PH and augmented pulmonary vascular resistance who achieved normalization of pulmonary pressures after the reversibility test using vasodilators underwent a second echocardiographic assessment under the same haemodynamic conditions. Four components of RVMW were analysed: (1) RV global work index (mmHg%); (2) RV global constructive work (mmHg%); (3) RV global wasted work (RVGWW) (mmHg%); (4) RV global work efficiency (RVGWE) (%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred two patients were enrolled (53 with PH and 49 without). Global RVMW was higher in patients with PH, due to a significantly higher RVGWW [81 (55–119) mmHg% vs. 49 (28–72) mmHg%; <i>P</i> = 0.013], while RVGWE was similar between the two groups (80 ± 10% vs. 82 ± 12%; P = 0.332). In patients with PH, 27/52 (51.9%) had combined PH, while 25/52 (48.1%) had isolated post-capillary PH. A reversibility test was performed in 26/27 (96.2%) patients with combined PH and pulmonary pressure normalization was observed in 16/26 (61.5%) subjects. In patients with PH normalization, RVGWE remained almost unchanged (from 82.8 ± 6.9% to 85.3 ± 6.6%; <i>P</i> = 0.596), while RVGWW significantly decreased [from 60 (49–90) mmHg% to 41 (31–53) mmHg%; <i>P</i> = 0.027]. Among all the echocardiographic and haemodynamic parameters adopted for assessing RV function, RVGWE was the least variable during the reversibility test (mean variation 3 ± 10%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RVGWE is comparable between HF patients with and without PH and remains stable across different haemodynamic conditions. This consistency suggests that it can be a reliable parameter for assessing RV contractility. Larger studies are needed to confirm this hypothesis and to test its prognostic significance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3719-3730"},"PeriodicalIF":3.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552697","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":"Home-operated ultrasound exam for detection of worsening heart failure (HOUSE-HF)","authors":"Stuart B. Prenner,&nbsp;Kevin Dougherty,&nbsp;Frances S. Shofer,&nbsp;Lee R. Goldberg,&nbsp;Nova Panebianco","doi":"10.1002/ehf2.15343","DOIUrl":"10.1002/ehf2.15343","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;Acute decompensated heart failure (ADHF) is associated with a high degree of morbidity and mortality. Dynamic lung ultrasound artefact called B-lines can be obtained at the bedside and directly correlate with pulmonary vascular congestion. Obtaining patient-performed lung ultrasound images in the outpatient setting is novel. We assessed the feasibility of patients recently hospitalized for ADHF to self-perform a limited lung ultrasound using a handheld ultrasound probe and upload the images to a secure cloud for physician interpretation.&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;This was a prospective observational convenience sample. Patients were enrolled from an urban academic tertiary care centre and were eligible if they had chronic left-sided heart failure regardless of ejection fraction. While hospitalized, patients were educated for 20 min on a six-lung-zone image protocol, how to use the cloud archival system and given a handheld ultrasound transducer and smart tablet. A brief instructional video was also available to patients on the smart tablet throughout the study (https://www.dropbox.com/scl/fi/bii7ovdcv21ps7yxyqsy1/120-21080-00-Rev-01-BNI-041-UPENN-IN-APP-TRAINING-VIDEO.mp4?rlkey=f5vu55xbnugdoz6jzyb8lv872&amp;st=56es4qif&amp;dl=0). Patients were asked to upload images three times weekly, for 3 weeks, for a total of nine studies. All images were reviewed and a B-line score was calculated for each lung zone, and a total B-line score for the entire exam. Additionally, patients completed a survey to assess the patient-centred experience.&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;A total of 15 patients were enrolled, all of whom completed seven or more studies (10 patients completed all 9). Median patient age was 63 years (range: 28 –86 years), the majority were male (73%), white (60%) and average body mass index was 33 kg/m&lt;sup&gt;2&lt;/sup&gt;. Of them,33.3% had an ejection fraction &gt;50%, average hospital length of stay was 6.3 days. Of the 792 potential images, 788 were obtained (99.5%). Of these, a total of 637 scans were interpretable (80.8%). The right upper apical lung zone (zone 1R) was most often adequate for interpretation (96.2%), where left lower mid-axillary (zone 3L) was least often interpretable (69.5%). The average number of B-lines per six-image scan was three (with a range of 0–13). Patient survey data identified zone 3L as the most challenging to obtain with overall high satisfaction with the study educational materials.&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 pilot stud","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3372-3380"},"PeriodicalIF":3.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15343","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552696","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":"Prognostic utility of advanced lung cancer inflammation index in heart failure with preserved ejection fraction","authors":"Daisuke Sakamoto,&nbsp;Yuki Matsuoka,&nbsp;Masahiro Seo,&nbsp;Takahisa Yamada,&nbsp;Daisaku Nakatani,&nbsp;Katsuki Okada,&nbsp;Akihiro Sunaga,&nbsp;Hirota Kida,&nbsp;Taiki Sato,&nbsp;Tetsuhisa Kitamura,&nbsp;Shunsuke Tamaki,&nbsp;Masamichi Yano,&nbsp;Takaharu Hayashi,&nbsp;Akito Nakagawa,&nbsp;Yusuke Nakagawa,&nbsp;Yoshio Yasumura,&nbsp;Shungo Hikoso,&nbsp;Yohei Sotomi,&nbsp;Yasushi Sakata,&nbsp;the OCVC-Heart Failure Investigators","doi":"10.1002/ehf2.15313","DOIUrl":"10.1002/ehf2.15313","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Malnutrition and inflammation are associated with poor outcomes with heart failure (HF). As a marker integrating inflammation and nutritional status, the advanced lung cancer inflammation index (ALI), calculated by body mass index × serum albumin level / neutrophil-to-lymphocyte ratio, has been developed for the prognosis of several diseases including HF. The aim of this study is to investigate the prognostic value of ALI in elderly multimorbid HF patients with HF with preserved ejection fraction (HFpEF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study utilized data from the Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with preserved Ejection Fraction (PURSUIT-HFpEF). Patients with acute decompensated HF and left ventricular ejection fraction ≥50% were included. ALI levels were calculated from discharge data. The primary endpoint was all-cause death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1238 patients [83 (77, 87) years, 555 (45%) male] were enrolled, with 1121 analysed for prognostic value of ALI. In the multivariable Cox model, ALI was significantly associated with the primary endpoint [adjusted hazard ratio (HR) for log-transformed ALI: 0.50, 95% confidence interval (CI): 0.34–0.75, <i>P</i> = 0.001]. ALI appears to enhance the prognostic value of the MAGGIC risk score [net reclassification improvement (NRI) = 46% (95% CI: 28%–65%), <i>P</i> &lt; 0.001; integrated discrimination improvement (IDI) = 4.6% (95% CI: 2.8%–6.5%), <i>P</i> &lt; 0.001], the geriatric nutritional risk index [NRI = 16% (95% CI: −3% to 35%), <i>P</i> = 0.103; IDI = 2.0% (95% CI: 0.8%–3.1%), <i>P</i> &lt; 0.001] and C-reactive protein [NRI = 39% (95% CI: 20%–58%), <i>P</i> &lt; 0.001; IDI = 4.8% (95% CI: 2.9%–6.6%), <i>P</i> &lt; 0.001].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Low ALI levels were significantly associated with poor prognosis in elderly multimorbid HFpEF patients. ALI might complement existing risk indices for prognostic assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3361-3371"},"PeriodicalIF":3.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539624","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 impact of follow-up endomyocardial biopsy in myocarditis during or after immune-suppressive therapy","authors":"Anna Baritussio,&nbsp;Andrea Silvio Giordani,&nbsp;Stefania Rizzo,&nbsp;Cristina Vicenzetto,&nbsp;Monica De Gaspari,&nbsp;Elisa Carturan,&nbsp;Giuseppe Toscano,&nbsp;Federico Scognamiglio,&nbsp;Giuseppe Tarantini,&nbsp;Sabino Iliceto,&nbsp;Cristina Basso,&nbsp;Renzo Marcolongo,&nbsp;Alida Linda Patrizia Caforio","doi":"10.1002/ehf2.15349","DOIUrl":"10.1002/ehf2.15349","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>While the diagnostic role of endomyocardial biopsy (EMB) in myocarditis is unquestioned, little is known about its indications and clinical value during long-term follow-up. We aim to report our experience on the clinical relevance of repeating EMB in a cohort of biopsy-proven myocarditis patients treated with immune-suppressive therapy (IMT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>We retrospectively included 92 patients with virus-negative EMB-proven myocarditis treated with IMT, of whom 22 [73% male, 37 years, interquartile range (IQR) 33–48] received at least one, uneventful, follow-up EMB, 3.5 years (IQR 2.5–5.3) after the first one. Follow-up EMB was performed because of clinical worsening (<i>n</i> = 12) or suspected myocarditis relapse (<i>n</i> = 7) and to assess IMT response (<i>n</i> = 3). Patients receiving follow-up EMB more likely had abnormal troponin levels (<i>P</i> = 0.048) and a trend towards lower prevalence of anti-heart auto-antibodies positivity at diagnosis (<i>P</i> = 0.05) and showed worse imaging findings at follow-up. Active or borderline myocarditis on follow-up EMB was found in 12 patients, leading to a change in IMT regimen in 10 (83%); among patients with evidence of healed myocarditis, 2 had a change in IMT regimen, 2 underwent heart transplant evaluation check list, 2 had mitral valve treatment, 1 received ventricular tachycardia ablation and 1 primary prevention implantable cardioverter-defibrillator implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>One-fourth of EMB-proven myocarditis patients had a clinical indication to repeat EMB at least once during long-term follow-up. Follow-up EMB was safe in all cases; it showed active or borderline myocarditis in 55% of patients and lead to a change in management in the majority of patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3707-3718"},"PeriodicalIF":3.7,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526938","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":"Improvements in medical therapy and prognosis for patients with HFrEF following the 2021 ESC HF guidelines","authors":"Kristian Berge,&nbsp;Henrik Schirmer,&nbsp;Tarjei Øvrebotten,&nbsp;Hamza Nahoui,&nbsp;Lars Gullestad,&nbsp;Charlotte Björk Ingul,&nbsp;Torstein Hole,&nbsp;Rune Mo,&nbsp;Kristina Larsby,&nbsp;Tone M. Norekvål,&nbsp;Torbjørn Omland,&nbsp;Stein Ørn,&nbsp;Peder L. Myhre","doi":"10.1002/ehf2.15337","DOIUrl":"10.1002/ehf2.15337","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The guideline-directed medical therapy (GDMT) sequencing strategy for patients with heart failure (HF) and reduced ejection fraction (HFrEF) underwent a paradigm shift with the 2021 ESC HF guidelines, from stepwise escalation to rapid simultaneous initiation of quadruple therapy. We aimed to assess the temporal trends in the use of GDMT and prognosis for patients with HFrEF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>Through the Norwegian HF Registry, we obtained data on patients treated at HF outpatient clinics with left ventricular ejection fraction ≤40% from 2016 through 2023 (<i>n</i> = 13 992), including GDMT, HF hospitalisations and mortality. Since 2016, &gt;90% of patients have been treated with beta-blockers and renin-angiotensin-system-inhibitors, with angiotensin receptor-neprilysin inhibitors (ARNI) utilisation increasing from 4% in 2016 to 54% in 2023. Mineralocorticoid-receptor-antagonists (MRA) utilisation was at 36% in 2016, increased by 3% per year to 54% in 2021, and thereafter increased by 12% per year to 78% in 2023. Sodium-glucose cotransporter-2-inhibitors (SGLT2i) utilisation increased rapidly from 3% in 2020 to 85% in 2023. The utilisation of ≥50% of target dose followed similar trends. From 2016 to 2021, the crude 6-month mortality rate remained at 2.7%, followed by a decline of approximately 0.5% per year to 1.8% in 2023. HF hospitalisations declined steadily from 12.9% in 2016 to 8.2% in 2021, with a further decline to 6.8% in 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The utilisation of GDMT in Norwegian HF clinics has increased markedly since 2016, with a fourfold acceleration in MRA and a substantial increase in SGLT2i use following the 2021 ESC HF guidelines. HF hospitalisations have consistently declined, while mortality rates first declined after 2021.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3343-3352"},"PeriodicalIF":3.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15337","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505219","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":"Heart transplantation outcomes with donation after circulatory death in patients with left ventricular assist device","authors":"Aris Karatasakis,&nbsp;Edwin Grajeda Silvestri,&nbsp;Gatha G. Nair,&nbsp;Benjamin Zuniga,&nbsp;Song Li,&nbsp;Claudius Mahr,&nbsp;Richard K. Cheng,&nbsp;April S. Stempien-Otero,&nbsp;Ioannis Dimarakis,&nbsp;Maziar Khorsandi,&nbsp;Jay D. Pal,&nbsp;Jorge R. Kizer,&nbsp;Marc A. Simon,&nbsp;Claudio A. Bravo","doi":"10.1002/ehf2.15357","DOIUrl":"10.1002/ehf2.15357","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Donation after circulatory death (DCD) has emerged as a strategy to increase the donor pool for heart transplantation (HT). Left ventricular assist device (LVAD) patients represent a discrete and unique population. We sought to explore the early outcomes of DCD-HT compared with donation after brain death (DBD) HT in LVAD patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>We obtained data from the United Network of Organ Sharing database. The main cohort consisted of adults listed for HT between 17 October 2018 and 3 July 2024, with LVAD implanted before or after listing. The primary outcome was survival within the first year post-HT. There were 3336 patients with LVAD underwent HT during the study period (median age 55 years (interquartile range 45–62), 24% women, 29% Black, 89% DBD). The short-term post-HT mortality in LVAD patients who underwent DCD HT was not significantly different from DBD (adjusted hazard ratio [aHR] 1.00, 95% CI 0.70–1.42, <i>P</i> value &gt; 0.9). The likelihood of transplantation within 1 year was higher at centres performing DCD (aHR 1.44, 95% CI 1.39–1.49, <i>P</i> &lt; 0.001). Despite the longer donor-recipient distance in DCD-HT, in-hospital outcomes (stroke and acute kidney injury requiring dialysis) were not different from DBD-HT. A higher incidence of primary graft dysfunction (adjusted risk ratio [aRR] 3.8, 95% CI 2.5–5.7, <i>P</i> &lt; 0.001), and treated rejection was observed with DCD-HT (aRR 1.48, 95% CI 1.14–1.93, <i>P</i> = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In LVAD patients who received DCD HT, early post-transplant survival, stroke, acute kidney injury and length of stay were not significantly different from those who underwent DBD HT. There were increased rates of primary graft dysfunction and treated rejection among LVAD patients who underwent DCD HT. Patients in a DCD centre were significantly more likely to be transplanted earlier.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3333-3342"},"PeriodicalIF":3.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15357","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505218","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":"Pulmonary congestion relief by adding dapagliflozin to intravenous loop diuretic in acute heart failure patients","authors":"Daniela Mocan,&nbsp;Maria Puschita,&nbsp;Diana Lungeanu,&nbsp;Adina Pop-Moldovan,&nbsp;Luminita Pilat,&nbsp;Dan Darabantiu,&nbsp;Radu Jipa,&nbsp;Radu Ioan Lala","doi":"10.1002/ehf2.15356","DOIUrl":"10.1002/ehf2.15356","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We aim to assess the efficacy of congestion relief and safety associated with adding SGLT2i (viz., dapagliflozin 10 mg) to intravenous loop diuretics within 24 h of hospital presentation in patients with acute heart failure (AHF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>A single-centre open-label clinical research study enrolled 98 patients admitted with an episode of AHF who were randomized into two groups: (a) receiving SGLT2i once daily in addition to structured intravenous furosemide therapy; (b) receiving structured intravenous furosemide therapy alone. In-hospital congestion relief was evaluated by body weight change, EVEREST score, lung ultrasound B-lines, inferior vena cava ultrasound measurement, NT-proBNP and CD146. Safety was assessed by changes in renal function and serum electrolyte abnormalities. Secondary endpoints included diuresis and natriuresis, hospital care indices and echocardiographic changes in cardiac function at 1-month. ANCOVA analysis was performed to adjust for imbalance between the two groups regarding chronic kidney disease status and baseline values. The analysis followed an intention-to-treat approach. The mean age ± standard deviation in the SGLT2i and control group was 63.63 ± 10.95 years and 65.31 ± 10.82 years, respectively, with 40/49 and 42/49 males. No death occurred in hospital; 1/49 and 2/49 deaths at 30 days were recorded. The adjusted mean change ± standard error (SE) in body weight was −4.90 ± 0.93 kg versus −4.28 ± 0.81 kg in the SGLT2i and control group, respectively. The adjusted mean change ± SE in B-lines at discharge and at 1 month was −19.93 ± 0.87 versus −18.64 ± 0.79 (<i>P</i> = 0.227) and −19.65 ± 1.54 versus −14.82 ± 1.43 (<i>P</i> = 0.012), respectively. The proportion of worsening renal function was 15/49 and 6/47 (<i>P</i> = 0.048) in the respective treatment groups (SGLT2i and control). The adjusted mean ± SE of 24-h urinary Na was 248.03 ± 23.69 mmol/day versus 173.83 ± 20.76 mmol/day (<i>P</i> = 0.009). One-month changes in ultrasound parameters were significantly improved in the SGLT2i group, with median (inter-quartile range) values of left ventricular ejection fraction and end-diastolic volume equal to 5% (0.35% to 11.5%) versus 0 (−1% to +5%) and −6.5 mL (−27.5 to +3) versus 4 mL (−11.5 to +10), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early initiation of SGLT2i administration in addition to intravenous loop diuretics in patients with AHF would optimize congestion relief and improve clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3320-3332"},"PeriodicalIF":3.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495333","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":"Analysis of outcomes in patients with HeartMate 3 with and without right ventricular assist device support","authors":"Vinh Q. Chau,&nbsp;Laura Coyle,&nbsp;Rachel Pedersen,&nbsp;Colleen Gallagher,&nbsp;Nicole Graney,&nbsp;Lisa Kukla,&nbsp;Robin Paliga,&nbsp;Gregory P. Macaluso,&nbsp;Sunil Pauwaa,&nbsp;William G. Cotts,&nbsp;Patroklos S. Pappas,&nbsp;Antone J. Tatooles,&nbsp;Nikhil Narang","doi":"10.1002/ehf2.15353","DOIUrl":"10.1002/ehf2.15353","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Following HeartMate 3 (HM3) LVAD implantation, acute right heart failure necessitating temporary right ventricular assist device (tRVAD) support has not been extensively described. We examined clinical outcomes in patients with HM3 LVAD stratified by the need for tRVAD support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>This was a single-centre, retrospective study of patients who underwent primary HM3 implantation from 2018 to 2022. Patients were placed on tRVAD (concomitant or delayed) support due to clinical deterioration. The primary outcome was 1-year all-cause mortality following HM3 implantation using competing risk analysis with heart transplantation acting as the competing event. A matched cohort analysis was also performed to evaluate the primary outcome of patients with and without tRVAD support. Secondary outcomes included an analysis of risk of LVAD-related adverse events stratified by the presence of tRVAD. Of the 192 patients (median age 60 [49–68] years, 74% male, 37% white), 51 (26%) required tRVAD support. Compared with those with HM3 alone, the tRVAD group had a higher percentage of INTERMACS profile 1 or 2 (49% vs. 27%, <i>P</i> = 0.0005) and had higher rates of pre-operative VA-ECMO (28% vs. 5%, <i>P</i> &lt; 0.0001). The tRVAD group had a higher 1-year all-cause mortality (33% vs. 3%, adjusted HR [95%CI]: 32.4 [9.51–110], <i>P</i> &lt; 0.0001) compared with the HM3 alone group. In-hospital mortality for patients with tRVAD was 26% compared with 1% in patients with HM3 alone (<i>P</i> &lt; 0.0001). In the matched cohort analysis, significantly higher risk of both stroke (HR [95% CI]: 5.75 [1.55–21.3], <i>P</i> = 0.009) and dialysis (HR [95% CI]: 13.4 (3.96–45.5), <i>P</i> &lt; 0.0001) was observed in the tRVAD cohort. Compared with concomitant tRVAD support, the delayed tRVAD group did not have a significantly higher risk of adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this large single-centre experience, patients undergoing HM3 LVAD requiring tRVAD support had significantly higher risks of adverse clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3306-3319"},"PeriodicalIF":3.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15353","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483616","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 applications of urinary sodium in heart failure from prognostic marker to clinical tool","authors":"Jeroen Dauw","doi":"10.1002/ehf2.15350","DOIUrl":"10.1002/ehf2.15350","url":null,"abstract":"&lt;p&gt;Sodium plays a central role in the pathophysiology of heart failure, where its retention drives congestion and volume overload.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Urinary sodium (UNa) provides direct insight into renal sodium handling and reflects the combined influence of neurohormonal activation, renal perfusion and tubular function; all of which are central to the syndrome. Although UNa has only recently entered clinical heart failure care, it is gaining recognition as a prognostic marker, as shown in the current analysis, and is increasingly considered for therapeutic and monitoring applications.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this issue, a post-hoc analysis of the Efficacy of Saline Hypertonic Therapy in Ambulatory Patients with HF (SALT-HF) trial examines the association between early natriuretic response and 30-day clinical outcomes in ambulatory patients with worsening heart failure.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; SALT-HF was a randomized trial investigating the effect of adding hypertonic saline to intravenous loop diuretics in this population.&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt; The authors evaluated UNa and urine output collected over 3 h following intravenous loop diuretic administration and observed that low UNa, but not low urine volume, was independently associated with higher risk of adverse outcomes, including death, hospitalization, or need for repeat IV diuretics. These results reinforce the idea that natriuresis may reflect more meaningful decongestion than diuresis alone, in terms of both alignment with underlying pathophysiology and its association with outcomes.&lt;/p&gt;&lt;p&gt;However, several considerations temper the interpretation of these findings. Most importantly, 30-day outcomes are influenced by multiple factors beyond the initial response to therapy. The impact of treatment adjustments, outpatient follow-up and changes in disease trajectory likely play a significant role and were not fully captured. Furthermore, the inclusion of hypertonic saline in half of the population may have influenced natriuretic response, and no subgroup analysis according to treatment arm was performed. Finally, although three-hour urine collections are pragmatic, they may not reflect the full duration of loop diuretic action, which typically peaks between 4 and 6 h.&lt;/p&gt;&lt;p&gt;From a mechanistic perspective, these findings support the concept that sodium retention is the primary driver of congestion in heart failure, with fluid accumulation occurring as a secondary consequence. This underlines the relevance of targeting natriuresis rather than fluid loss. In a subanalysis of the Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF) study, patients with low urinary sodium excretion had worse outcomes even when achieving a negative fluid balance,&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; suggesting that UNa more directly reflects the pathophysiological processes underlying congestion and may be the best target for decongestion.&lt;/p&gt;&lt;p&gt;Although the SALT-HF analysis w","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3209-3211"},"PeriodicalIF":3.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483617","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":"Response to ‘Simple jugular venous assessment: a new approach to heart failure’","authors":"Geert H. D. Voordes,&nbsp;Adriaan A. Voors,&nbsp;Jozine M. Ter Maaten,&nbsp;Kevin Damman","doi":"10.1002/ehf2.15355","DOIUrl":"10.1002/ehf2.15355","url":null,"abstract":"<p>We thank Dr. Kawasaki for his interest in our paper. We agree that the assessment of jugular venous pressure (JVP) is essential in basic cardiological evaluation and should be performed as a regular clinical assessment.</p><p>While it might be a crude method to assess elevated central venous pressures (CVP), its assessment is non-invasive and non-time consuming and provides a lot of information in different clinical settings. In the emergency department, assessment of the jugular vein adds information on the differential diagnosis for patients with arrhythmia, shock and/or dyspnoea.<span>^{1, 2}</span> Furthermore, clinical assessment of jugular venous pressure is essential in guiding diuretic treatment in patients with heart failure as a high JVP indicates persistent elevated RAP and a need for more diuresis, while a normal JVP implies a euvolaemic state.<span>¹</span> Lastly, heart failure patients with persistent elevated JVP have a higher risk for short-term rehospitalization, possibly due to residual congestion.<span>³</span> As assessment of the JVP provides a lot of information, basically for free, we believe it is the cardiovascular physician's best friend.</p><p>GHDV has nothing to disclose. The employer of AAV received consultancy fees and/or research support from Adrenomed, AnaCardio, AstraZeneca, Bayer AG, BMS, Boehringer Ingelheim, Corteria, Eli Lilly, Merck, Moderna, Novartis, Novo Nordisk, Roche Diagnostics and Salubris Bio. KD reports speaker and consultancy fees from Boehringer Ingelheim, AstraZeneca, Abbott, FIRE1 and Echosense. JMtM reports speaker and/or consultancy fees from Novartis, Bayer, Boehringer Ingelheim, Johnson &amp; Johnson, Moderna, Roche and Novo Nordisk and receives grants from the Dutch Heart Foundation and Netherlands Organisation for Scientific Research (NWO) outside the submitted work.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3764-3765"},"PeriodicalIF":3.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474380","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}