Heart Failure Reviews最新文献

{"title":"Evolving anticoagulation paradigms in left ventricular assist device (LVAD) patients: a focus on direct oral anticoagulants.","authors":"Andrew Ndakotsu, Adhvithi Pingili, Lida Koskina, Soad Al Osta, Erika Feller","doi":"10.1007/s10741-025-10537-8","DOIUrl":"https://doi.org/10.1007/s10741-025-10537-8","url":null,"abstract":"<p><p>Anticoagulation management in patients supported by left ventricular assist devices (LVADs) is essential to prevent thromboembolic events while minimizing bleeding complications. Warfarin remains the standard therapy but is constrained by a narrow therapeutic index, dietary restrictions, and the need for frequent monitoring, prompting growing interest in direct oral anticoagulants (DOACs) as alternatives. The HeartMate 3 (HM3), now the predominant LVAD in clinical practice, features improved hemocompatibility and has demonstrated reduced rates of pump thrombosis and ischemic stroke compared to earlier-generation devices. These advances raise the possibility of simplified antithrombotic regimens tailored to specific device profiles. Retrospective studies suggest that DOACs, particularly apixaban, may provide comparable thromboembolic protection and potentially lower bleeding risk than warfarin, especially when aspirin is omitted. Additionally, DOACs offer more predictable pharmacokinetics, fewer interactions, and improved patient adherence due to reduced monitoring requirements. However, current evidence remains limited by small sample sizes, short follow-up durations, and heterogeneous study designs. Many existing studies include patients with older devices such as HeartMate II and HVAD, which are no longer implanted but remain in a substantial number of living patients. These legacy devices carry distinct thrombogenic risks that complicate generalizability. This review evaluates the emerging role of DOACs in the context of modern and legacy LVAD platforms. While initial data are promising, large-scale, prospective randomized trials are needed particularly in HM3-supported patients to define the optimal anticoagulation strategy.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting inflammation in heart failure: evolving insights and future directions from randomized clinical trials.","authors":"Reina Nagasaka, Ellis Kim, Andrew P Ambrosy, Matthew J Feinstein","doi":"10.1007/s10741-025-10538-7","DOIUrl":"https://doi.org/10.1007/s10741-025-10538-7","url":null,"abstract":"<p><p>Heart failure (HF) is a leading cause of cardiovascular morbidity and mortality, with inflammation recognized as a key cause and byproduct. Despite observational studies linking elevated indices of inflammation with HF severity, as well as experimental models highlighting the centrality of inflammation to the pathogenesis of various types of HF, clinical trials of anti-inflammatory therapies in HF have produced inconsistent results. This variability may relate to the substrate included - differences in HF stage and/or clinical phenotype - as well as the mechanisms and target of therapeutics, whether aimed at preventing new-onset HF or treating established disease. This review evaluates clinical trials directly targeting inflammation in HF, with a focus on disease stage and symptomatology. Ultimately, by highlighting the importance of HF staging and the timing of therapeutics in prior inflammation-targeted interventions, we aim to inform more precise targets from a disease substrate perspective when designing trials of inflammation-modulating therapies in HF.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the complexity of nonobstructive hypertrophic cardiomyopathy.","authors":"Leopoldo Ordine, Roberto Polizzi, Grazia Canciello, Felice Borrelli, Salvatore di Napoli, Lorenzo Moscano, Brigida Napolitano, Raffaele Martorano, Alessandra Spinelli, Raffaella Lombardi, Giovanni Esposito, Maria-Angela Losi","doi":"10.1007/s10741-025-10535-w","DOIUrl":"https://doi.org/10.1007/s10741-025-10535-w","url":null,"abstract":"<p><p>Hypertrophic cardiomyopathy (HCM) is a genetic heart disorder defined by the presence of a maximal wall thickness of at least 15 mm with two main forms: obstructive (oHCM) and nonobstructive (nHCM). While oHCM is characterized by left ventricular (LV) outflow tract obstruction (LVOTO), nHCM lacks this feature and shows significant variability in its hemodynamic and anatomical traits. In nHCM, LV hypertrophy (LVH) presents diverse morphologies, including apical hypertrophy and reverse septal curvature, the latter potentially causing mid-ventricular obstruction and near-complete LV emptying. Apical hypertrophy is associated with the risk of LV aneurysms, potentially leading to arrhythmias and thromboembolism. These findings challenge the belief that nHCM is a more benign phenotype than oHCM and highlight the necessity for improved diagnostic and therapeutic strategies. Symptoms in nHCM, such as fatigue and dyspnea, are often attributed to diastolic dysfunction, whereas symptoms like angina are attributed to microvascular dysfunction. However, current treatment options remain limited, as traditional heart failure therapies frequently fail to provide substantial benefits. Given its heterogeneity, a more personalized treatment approach is warranted, including optimizing comorbidities, assessing coronary microvascular dysfunction, and considering alternative pharmacologic strategies. Emerging therapies, such as myosin inhibitors mavacamten and aficamten, target sarcomeric hypercontractility and show promise in early trials, but their clinical impact on nHCM is still under investigation. Gene therapies also hold potential, though their applicability to nHCM is limited by the high rate of mutation-negative cases and the potential irreversibility of advanced disease states. This review critically analyzes the pathophysiological mechanisms of nHCM, evaluates current and emerging therapeutic strategies, and provides guidance on contemporary management approaches for this complex and often underrecognized condition.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The application of neighborhood area deprivation index to improve health equity across the spectrum of heart failure: a review.","authors":"Tracy T Makuvire, Jose L Lopez, Zara Latif, Damla Mergen, Christy N Taylor, Ersilia M DeFilippis, Nasrien E Ibrahim","doi":"10.1007/s10741-025-10492-4","DOIUrl":"10.1007/s10741-025-10492-4","url":null,"abstract":"<p><p>Neighborhood environments play a key role in the development of individual risk factors for heart failure (HF) and impact health outcomes across the spectrum of HF. The area deprivation index (ADI) is an important composite measure of neighborhood depravity that has been associated with poor cardiovascular outcomes. The objective of our review is to discuss how neighborhood deprivation, with an emphasis on ADI, influences the spectrum of HF among patients and to propose solutions for ADI applications to improve the implementation of equitable care across the HF spectrum. MEDLINE/Pubmed was systematically searched to identify observational studies published between 2016 and 2024, examining the impact of ADI on HF risk, management, and outcomes. The search involved crossing two sets of terms included in article titles and abstracts: (1) social deprivation, area deprivation index, and neighborhood deprivation; (2) cardiovascular disease risk, heart failure, heart failure medications, and heart failure outcomes. Additional references were identified through searching relevant author reference lists and review articles. Key findings suggest that (1) the prevalence of HF risk is increased in individuals residing in neighborhoods with higher ADI; (2) HF patients living in more deprived neighborhoods have increased odds of being hospitalized for HF; (3) after HF admission, the relationship between ADI and risk for readmissions varies by race; and (4) there is an excess 30-day mortality of HF associated with race and neighborhood deprivation. The ADI is an important value to consider in patients with HF, given its association with clinical outcomes. Therefore, we suggest practical ways to incorporate ADI into the management of patients with HF to improve equitable outcomes.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":" ","pages":"589-604"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epicardial adipose tissue: a new link between type 2 diabetes and heart failure-a comprehensive review.","authors":"Si-Jia Zhang, Si-Wei Wang, Shi-Yu Liu, Ping Li, De-Lian Huang, Xi-Xi Zeng, Tian Lan, Ye-Ping Ruan, Hai-Jiao Shi, Xin Zhang","doi":"10.1007/s10741-024-10478-8","DOIUrl":"10.1007/s10741-024-10478-8","url":null,"abstract":"<p><p>Diabetic cardiomyopathy is a unique cardiomyopathy that is common in diabetic patients, and it is also a diabetic complication for which no effective treatment is currently available. Moreover, relevant studies have revealed that a link exists between type 2 diabetes and heart failure and that abnormal thickening of EAT is inextricably linked to the development of diabetic heart failure. Numerous clinical studies have demonstrated that EAT is implicated in the pathophysiologic process of diabetic myocardial disease. In this overview, we will introduce the physiology, pathophysiology of the disease and potential therapeutic strategies, knowledge gaps, and future directions of the role of epicardial adipose tissue in type 2 diabetes mellitus and heart failure to promote the development of novel therapeutic approaches to improve the prognosis of patients with diabetic cardiomyopathy.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":" ","pages":"477-491"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart failure outpatient clinics resources in Italy: a viewpoint of Italian Society of Cardiology organization.","authors":"Alberto Palazzuoli, Piergiuseppe Agostoni, Savina Nodari, Stefania Paolillo, Pasquale Perrone Filardi","doi":"10.1007/s10741-024-10480-0","DOIUrl":"10.1007/s10741-024-10480-0","url":null,"abstract":"<p><p>The current paper reports the model organization, level of health care, and type of medical and research activities related to the existing heart failure centers of the Italian Society of Cardiology. Of note, we conduced an internal survey among the members of heart failure working group and related hospital and territorial sites about the quality of care and assistance levels according to the local hospital resources and type of diagnostic therapeutic and management resources. Thirty-two hospital ambulatorial structures have been identified, the centers were equally distributed within the national ground, with similar concentration between north and south regions of the Italian country. We distinguished three different levels of organization: (1) basal territorial clinics in which patients with suspected or already diagnosed heart failure (HF) are initially identified and screened; (2) intermediate clinics in which HF patients can be routinary followed by HF specialists supported by a dedicated staff including imaging and arrythmologist experts, and interventional cardiologist; (3) advanced clinics composed by all the technical and staff resources capable of guarantying repetitive invasive assessment, continuous invasive monitoring, dedicated telemedicine structures focused on more advanced HF management integrated by heart transplantation or mechanical assistance programs. Different type of assistance is supported by a relevant number of research activity primarily conducted by the Italian Society of Cardiology or spontaneous studies arranged by HF specialist members. The number of HF centers has increased over the past few decades in proportion to the progressive rise in HF diagnoses and associated hospitalization. The expansion of ambulatory structures has been facilitated by an increasing socioeconomic and research influence. The quality of HF services in Italy could be raised by improving the network and connections between HF specialists, general practitioners (GPs), caregivers, and other specialists frequently working in this field.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":" ","pages":"505-513"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947711","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":"Initiation and sequencing of guideline-directed medical therapy for heart failure across the ejection fraction spectrum.","authors":"Izza Shahid, Muhammad Shahzeb Khan, Javed Butler, Gregg C Fonarow, Stephen J Greene","doi":"10.1007/s10741-025-10481-7","DOIUrl":"10.1007/s10741-025-10481-7","url":null,"abstract":"<p><p>Strong evidence supports the importance of rapid sequence or simultaneous initiation of quadruple guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) for substantially reducing risk of mortality and hospitalization. Barring absolute contraindications for each individual medication, employing the strategy of rapid sequence, simultaneous, and/or in-hospital initiation at the time of HF diagnosis best ensures patients with HFrEF have the opportunity to benefit from proven medications and achieve large absolute risk reductions for adverse clinical outcomes. However, despite guideline recommendations supporting this approach, implementation in clinical practice remains persistently low, with less than one-fifth of eligible patients being prescribed the quadruple GDMT regimen. Additionally, for heart failure with mildly reduced or preserved ejection fraction (HFpEF), sodium-glucose co-transporter 2 inhibitors (SGLT2i) and non-steroidal mineralocorticoid receptor antagonists (MRA) constitute foundational therapy for all eligible patients with significant clinical benefits within just weeks of medication initiation. Nonetheless, the burden of symptoms, functional limitations, and hospitalizations remains substantial for many of these patients, even with SGLT2i and non-steroidal MRA therapy. Additional evidence supports consideration of adjunctive therapies for HF with EF > 40% that can be tailored to the patient phenotype, including glucagon-like peptide-1 receptor agonists (GLP-1 RA) for patients with obesity, as well as angiotensin receptor-neprilysin inhibitors (ARNI) for patients with EF below normal. This article reviews the evidence-based sequencing of GDMT for HF across the spectrum of EF, emphasizing the rationale and benefits of early up-front initiation of quadruple medical therapy for HFrEF, rapid initiation of SGLT2i for HF regardless of EF, and prompt phenotype-specific tailored approach to adjunctive therapies for HF with EF > 40%.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":" ","pages":"515-523"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positron emission tomography in cardiac amyloidosis: current evidence and future directions.","authors":"Alberto Aimo, Yu Fu Ferrari Chen, Vincenzo Castiglione, Claudio Passino, Dario Genovesi, Assuero Giorgetti, Michele Emdin, Giuseppe Vergaro","doi":"10.1007/s10741-025-10493-3","DOIUrl":"10.1007/s10741-025-10493-3","url":null,"abstract":"<p><p>The increasing recognition of cardiac amyloidosis (CA) as a cause of heart failure, coupled with advancements in therapeutic options, has underscored the need for early detection. Positron emission tomography (PET) imaging emerged as a promising non-invasive tool for diagnosing and managing CA. This review provides a comprehensive analysis of current PET imaging techniques, focusing on radiotracers, including [¹¹C]Pittsburgh Compound B, [¹⁸F]Flutemetamol, [¹⁸F]Florbetapir, [¹⁸F]Florbetaben, [¹⁸F]-sodium fluoride, and [¹²⁴I]Evuzamitide. PET imaging's ability to differentiating CA subtypes and quantify amyloid burden contributes defining prognosis and aids in monitoring treatment response. However, standardizing imaging protocols and establishing definitive diagnostic thresholds remain challenging. As PET imaging continues to evolve, it promises to improve patient outcomes by facilitating earlier diagnosis, more accurate subtype differentiation, and better treatment monitoring in CA.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":" ","pages":"605-618"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382316","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":"SERCA2a dysfunction in the pathophysiology of heart failure with preserved ejection fraction: a direct role is yet to be established.","authors":"Adam Kia Shooshtarian, Kevin O'Gallagher, Ajay M Shah, Min Zhang","doi":"10.1007/s10741-025-10487-1","DOIUrl":"10.1007/s10741-025-10487-1","url":null,"abstract":"<p><p>With rising incidence, mortality and limited therapeutic options, heart failure with preserved ejection fraction (HFpEF) remains one of the most important topics in cardiovascular medicine today. Characterised by left ventricular diastolic dysfunction partially due to impaired Ca²⁺ homeostasis, one ion channel in particular, SarcoEndoplasmic Reticulum Ca²⁺-ATPase (SERCA2a), may play a significant role in its pathophysiology. A better understanding of the complex mechanisms interplaying to contribute to SERCA2a dysfunction will help develop treatments targeting it and thus address the growing clinical challenge HFpEF poses. This review examines the conflicting evidence present for changes in SERCA2a expression and activity in HFpEF, explores potential underlying mechanisms, and finally evaluates the drug and gene therapy trials targeting SERCA2a in heart failure. Recent positive results from trials involving widely used anti-diabetic agents such as sodium-glucose co-transporter protein 2 inhibitors (SGLT2i) and glucagon-like peptide-1 (GLP-1) agonists offer advancement in HFpEF management. The potential interplay between these agents and SERCA2a regulation presents a novel angle that could open new avenues for modulating diastolic function; however, the mechanistic research in this emerging field is limited. Overall, the direct role of SERCA2a dysfunction in HFpEF remains undetermined, highlighting the need for well-designed pre-clinical studies and robust clinical trials.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":" ","pages":"545-564"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11991975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023140","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":"Closing the GDMT gap: insights from PHARM-HF A&F on the role of pharmacists in heart failure care.","authors":"Jimmy Zheng","doi":"10.1007/s10741-025-10496-0","DOIUrl":"10.1007/s10741-025-10496-0","url":null,"abstract":"<p><p>This focused review examines the results of the PHARM-HF A&F Study, a randomized trial evaluating audit and feedback interventions to optimize heart failure medication management among primary care pharmacists in the Veterans Affairs (VA) healthcare system. Despite strong evidence that quadruple guideline-directed medical therapy (GDMT) can reduce mortality by ~ 70% in patients with heart failure with reduced ejection fraction (HFrEF), implementation remains suboptimal, particularly in rural areas. While both trial arms showed improvements in heart failure medication management during the study period, audit and feedback led to modest increases in medication encounters and mineralocorticoid receptor antagonist initiation compared to education alone. This review explores these results in the context of broader efforts to improve heart failure care quality through pharmacist-led interventions in primary care settings.</p>","PeriodicalId":12950,"journal":{"name":"Heart Failure Reviews","volume":" ","pages":"633-636"},"PeriodicalIF":4.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}