ESC Heart Failure最新文献

{"title":"Comparison of supine and sitting pulmonary pressures in ambulatory heart failure patients using the novel Cordella pulmonary pressure system","authors":"Husam M. Salah,&nbsp;Tamas Alexy,&nbsp;Ryan J. Tedford,&nbsp;Nicholas J. Hiivala,&nbsp;Max M. Owens,&nbsp;Liviu Klein,&nbsp;Marat Fudim","doi":"10.1002/ehf2.15374","DOIUrl":"10.1002/ehf2.15374","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of this study is to examine the relationship between supine and seated pulmonary artery pressure (PAP) measurements using the CordellaTM HF management system (Cordella) in patients with heart failure (HF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method and results</h3>\u0000 \u0000 <p>Paired supine and seated PAP readings from the SIRONA 2 and PROACTIVE-HF trials were included. A total of 504 NYHA class III HF patients contributed 40 115 paired measurements. Mean supine mean PAP (mPAP) was 29.1 ± 11.6 mmHg compared with a mean seated mPAP of 22.1 ± 12.2 mmHg (supine-seated difference 7.1 ± 6.5 mmHg, correlation = 0.85; <i>P</i> &lt; 0.001); mean supine sPAP was 44.4 ± 16.6 mmHg compared to a mean seated sPAP 35.4 ± 17.8 mmHg (supine-seated difference 9.0 ± 8.5 mmHg, correlation = 0.88; <i>P</i> &lt; 0.001); and mean supine dPAP was 19.1 ± 9.5 mmHg compared to a mean seated dPAP of 13.9 ± 9.5 mmHg (supine-seated difference 5.2 ± 5.6 mmHg, correlation = 0.82; <i>P</i> &lt; 0.001). Quartile analysis demonstrated that supine-seated differences were larger at lower mPAP levels and narrowed at higher pressures (<i>P</i> &lt; 0.001). Seated mPAP trends showed modest increases prior to heart failure hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study presents the largest paired comparison of supine and sitting PAP and demonstrates a high degree of correlation between seated and supine measures of PAP. Supine-seated differences may reflect venous capacitance and preload reserve, providing novel physiologic insights into HF phenotyping. Seated PAP measurements are a valid and reliable alternative to supine measurements for HF patients with PAP sensors. Given patient preference for seated measurements and their closer reflection of daily physiologic status, incorporating seated PAP into routine monitoring may enhance adherence and optimize remote HF management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3399-3404"},"PeriodicalIF":3.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15374","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947486","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":"Socioeconomic determinants of vaccination against pneumococcus in 763 945 patients with heart failure","authors":"F. Roubille,&nbsp;B. Wyplosz,&nbsp;J. Fernandes,&nbsp;B. Grenier,&nbsp;F. Raguideau,&nbsp;E. Blanc,&nbsp;G. Goussiaume","doi":"10.1002/ehf2.15381","DOIUrl":"10.1002/ehf2.15381","url":null,"abstract":"<p>Respiratory infections are the leading cause of acute decompensation, hospitalization and higher mortality in heart failure (HF) patients. Despite recommendations, vaccination coverage against pneumococcus and influenza remains alarmingly low (3% and 50% in 2018, respectively). This study aimed to identify factors associated with vaccination among HF patients using data from the Nationwide Health Claims Database for 2020, in France. The patients were followed during the entire year 2020. At least one dose of PCV13 was considered as a proxy for vaccination. The model used was a multivarable logistic regression.</p><p>Among 763 945 HF patients (mean age 76.7 years, 54.2% male), the mean annual visits were 7.0 with a general practitioner, 1.68 with a specialist and 70.0 with a nurse. Despite frequent healthcare contacts, vaccination coverage was only 12.6% for pneumococcus (PCV13) and 63.1% for influenza.</p><p>In multivariable analyses, at least one dose of the PCV13 was less often received when patients were (1) older (odd ratio (OR): 0.71 [0.67; 0.74], <i>P</i> &lt; 0.0001 and 0.48 [0.46; 0.51], <i>P</i> &lt; 0.0001) in patients 76–85 and older than 85 years old, respectively, (2) women (OR: 0.916 [0.903; 0.929], <i>P</i> &lt; 0.0001) or 3/when they presented social deprivation (for the quintile Q5 of deprivation index, OR was 0.893 [0.872; 0.914], <i>P</i> &lt; 0.0001). Pneumoccocus vaccination was associated with influenza vaccination or with better access to health services.</p><p>We need to consider factors, such as age, sex and social deprivation, to adapt public health initiatives supporting a significantly and sustainably increase pneumococcal vaccination coverage in frail HF patients.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3750-3754"},"PeriodicalIF":3.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947317","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":"The pulmonary artery pulsatility index in patients with severe aortic stenosis undergoing valve replacement","authors":"Laura A. Rechsteiner,&nbsp;Lukas Weber,&nbsp;Philipp K. Haager,&nbsp;Johannes Rigger,&nbsp;Joannis Chronis,&nbsp;Peter Ammann,&nbsp;Roman Brenner,&nbsp;Martin O. Schmiady,&nbsp;Hans Rickli,&nbsp;Micha T. Maeder","doi":"10.1002/ehf2.15378","DOIUrl":"10.1002/ehf2.15378","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>The pulmonary artery pulsatility index (PAPi), that is, the pulmonary artery pulse pressure (PAPP) divided by the mean right atrial pressure (mRAP), is an increasingly used invasive index of right ventricular function. We sought to assess the prognostic impact of the PAPi in unselected patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied consecutive patients with severe AS (<i>n</i> = 487, 74 ± 10 years, 58% males) undergoing right heart catheterization prior to AVR with post-AVR follow-up of several years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean PAPi was 4.7 ± 3.3, and the mean values in the four PAPi quartiles were 2.1 ± 0.5, 3.2 ± 0.3, 4.5 ± 0.5 and 8.9 ± 4.2. Patients in the lowest PAPi quartile had similar AS severity, symptoms, B-type natriuretic peptide and surgical risk compared with patients in higher quartiles. The lowest PAPi quartile had the lowest PAPP and the highest mRAP and only a slightly reduced stroke volume index (SVI) but the highest pulmonary artery capacitance (PAC). After a median post-AVR follow-up of 45 months mortality did not differ across PAPi quartiles (log rank <i>P</i> = 0.50), which was independent of the AVR mode. However, all contributors of the PAPi equation, that is, higher PAPP, lower PAC (i.e., stroke volume divided by PAPP), lower SVI and higher mRAP were associated with increased mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In unselected patients with severe AS, the PAPi did not predict post-AVR mortality. This may be explained by the fact that the low PAPP in those with low PAPi was mainly a reflection of a high PAC rather than a low SVI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3483-3493"},"PeriodicalIF":3.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15378","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658763","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":"Efficacy of ambulatory intravenous diuresis for chronic heart failure patients: Insights from the DEA-HF trial","authors":"Amit Gruber,&nbsp;Aharon (Ronnie) Abbo,&nbsp;Ina Volis,&nbsp;Doron Aronson,&nbsp;Nicolas Girerd,&nbsp;Søren Lund Kristensen,&nbsp;Robert Zukermann,&nbsp;Natalia Alberkant,&nbsp;Elena Sitnitsky,&nbsp;Anton Kruger,&nbsp;Polina Khasis,&nbsp;Evgeny Bravo,&nbsp;Boaz Elad,&nbsp;Ludmila Helmer Levin,&nbsp;Oren Caspi","doi":"10.1002/ehf2.15358","DOIUrl":"10.1002/ehf2.15358","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Oral diuretic treatment has limited efficacy in managing chronic heart failure (HF) patients. Novel strategies are needed to manage patients with refractory congestion despite optimal HF therapy and high-dose oral diuretic treatment. In the present study, we prospectively quantified the efficacy and safety of an ambulatory, weekly, high-dose parenteral diuresis strategy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>Data from the prospective, randomized, cross-over controlled study for comparisons of diuresis efficacy in HF patients (DEA-HF) were analysed. Chronic HF patients with congestion despite guideline-directed medical therapy were enrolled to receive three high-intensity diuretic regimens, once a week, in a randomized order: intravenous (IV) furosemide 250 mg; IV furosemide 250 mg + oral metolazone 5 mg; and IV furosemide 250 mg + IV acetazolamide 500 mg. The primary outcome compared the total sodium excretion following each diuretic regimen. Here, all regimens were pooled to assess the effect of weekly intensive diuresis approach on congestion parameters. The study population included 42 patients, 40% females, with a mean age of 72 ± 9 years. Following three consecutive weekly treatments, the mean body weight was decreased from 85.5 kg [95% confidence interval (CI): 79.7–91.2] to 83.1 kg (95% CI: 77.4–88.9. <i>P</i> = 0.0005), accompanied by a significant decrease in congestion score, N-terminal-pro-brain natriuretic peptide levels and lung ultrasound B-line count. Serum creatinine mildly but significantly increased from 1.81 mg/dL (95% CI: 1.62–2.01) to 2.01 mg/dL (95% CI: 1.81–2.21. <i>P</i> &lt; 0.001), and no hospitalizations due to acute kidney injury occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with congestion-refractory HF, an ambulatory strategy utilizing high-intensity weekly IV diuretic therapy achieved effective decongestion without major safety concerns. This escalated strategy may improve clinical outcomes and prevent hospitalizations of chronic HF patients who require diuresis intensification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3285-3295"},"PeriodicalIF":3.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636513","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 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}