JACC. Heart failure最新文献

{"title":"The Antifibrotic Effects of Eplerenone in Hypertrophic Cardiomyopathy","authors":"Stavroula Papapostolou MBBS ,&nbsp;Leah Iles MBBS, PhD ,&nbsp;Jessica O’Brien MBBS ,&nbsp;Sarah J. Gutman MBBS, PhD ,&nbsp;Andris Ellims MBBS, PhD ,&nbsp;James Hare MBBS, PhD ,&nbsp;Dion Stub MBBS, PhD ,&nbsp;Stuart Moir MBBS, PhD ,&nbsp;Andrew J. Taylor MBBS, PhD","doi":"10.1016/j.jchf.2025.01.021","DOIUrl":"10.1016/j.jchf.2025.01.021","url":null,"abstract":"<div><h3>Background</h3><div>Fibrosis plays a central role in hypertrophic cardiomyopathy (HCM), contributing to symptoms via impaired systolic and diastolic function and ventricular arrhythmias.</div></div><div><h3>Objectives</h3><div>The aim of this study was to determine if eplerenone has an antifibrotic effect in nonobstructive HCM (resting left ventricular outflow tract gradient &lt;30 mm Hg).</div></div><div><h3>Methods</h3><div>This was a randomized, double-blind, placebo-controlled trial of eplerenone in 61 patients with nonobstructive HCM over 12 months. The primary endpoint was native T1 time on cardiac magnetic resonance as an index of diffuse fibrosis. Secondary endpoints included changes in diastolic function.</div></div><div><h3>Results</h3><div>Thirty patients were randomized to 50 mg eplerenone and 31 to placebo. There was a reduction in native T1 time within the eplerenone group (1,315 ± 134 ms at baseline vs 1,259 ± 92 ms at 12 months; <em>P =</em> 0.041), with no significant change in the placebo group (1,234 ± 28 ms at baseline vs 1,238 ± 70 ms at 12 months; <em>P =</em> 0.854). This represents a 3.7% ± 9% reduction in native T1 with eplerenone compared with a 1.1% ± 9% increase with placebo (<em>P =</em> 0.07). There was no significant change in functional status or markers of diastolic function (such as E/e′ ratio or mitral E/A ratio).</div></div><div><h3>Conclusions</h3><div>In patients with nonobstructive HCM, there was a reduction in myocardial T1 time with eplerenone, consistent with a reduction in diffuse myocardial fibrosis. Larger and longer trials are needed to confirm this finding and explore whether it translates into improved exercise capacity or a reduction in mortality over time. (Anti-fibrotic role of eplerenone on diffuse myocardial fibrosis and diastolic function in patients with hypertrophic cardiomyopathy; <span><span>ACTRN12613000065796</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 7","pages":"Article 102415"},"PeriodicalIF":10.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Cardiac Arrhythmias Identified by Insertable Cardiac Monitors in Patients With Symptomatic Heart Failure","authors":"Rami Kahwash MD ,&nbsp;Javed Butler MD, MPH, MBA ,&nbsp;Muhammad Shahzeb Khan MD, MSc ,&nbsp;Prasad Chalasani MD ,&nbsp;Barry Bertolet MD ,&nbsp;Laura Gravelin MD ,&nbsp;Cameron Lambert MD ,&nbsp;Shantanu Sarkar PhD ,&nbsp;Brian Van Dorn MS ,&nbsp;Aimee Laechelt BS ,&nbsp;Jennifer Wehking RN, CHFN ,&nbsp;Nirav Patel MS ,&nbsp;Bart Gerritse PhD ,&nbsp;Verla Laager MA ,&nbsp;Michael R. Zile MD","doi":"10.1016/j.jchf.2025.102527","DOIUrl":"10.1016/j.jchf.2025.102527","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac bradyarrhythmias and tachyarrhythmias in chronic heart failure (CHF) patients are associated with increased morbidity and mortality. Insertable cardiac monitors provide a continuous, ambulatory, accurate monitoring strategy for patients with CHF who are not candidates for cardiac implantable electronic devices.</div></div><div><h3>Objectives</h3><div>This study aims to assess the occurrence of cardiac arrhythmias (CAs) in patients with CHF across the ejection fraction (EF) spectrum and not indicated for cardiac implantable electronic devices.</div></div><div><h3>Methods</h3><div>Patients with recent heart failure events enrolled in LINQ-HF (Reveal LINQ Heart Failure) and Phase 1 ALLEVIATE-HF (Algorithm Using LINQ Sensors for Evaluation and Treatment of Heart Failure) studies were implanted with an insertable cardiac monitor. All CAs were adjudicated first using an artificial intelligence model, then manually verified, and grouped into 3 categories: atrial fibrillation (AF), ventricular tachycardia (VT) or fibrillation (VF), and bradycardia/pauses.</div></div><div><h3>Results</h3><div>In total, 163 patients (mean age 67.2 ± 11.2 years, 62.6% male, 49.1% EF ≥50%, 83.4% Class III, 55.2% history of AF) were followed for 17.2 ± 9.8 months. Occurrence of AF was 59.7% at 2 years, 53.1% in heart failure with reduced ejection fraction (HFrEF) &lt;50%, and 64.6% in heart failure with preserved ejection fraction (HFpEF) ≥50%. Incidence of AF in patients without prior AF was 23.8%, 23.9% in HFrEF, and 27.6% in HFpEF. Incidence of bradycardia or pause was 37.2% overall, (37.5% in HFrEF and 39.8% in HFpEF; 30.3% during daytime vs 19.4% during nighttime). Incidence of VT/VF was 14.3% overall, 19.8% in HFrEF, and 10.4%, in HFpEF.</div></div><div><h3>Conclusions</h3><div>In CHF patients undergoing ambulatory, continuous, accurate arrhythmia monitoring, the incidence of AF and bradycardia/pause events was high and similar in HFpEF vs HFrEF patients. VT/VF was lower in HFpEF than HFrEF, but clinically important.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102527"},"PeriodicalIF":10.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interaction Between Aldosterone and Mineralocorticoid Receptor Antagonist","authors":"Masatake Kobayashi MD, PhD ,&nbsp;Bertram Pitt MD, PhD ,&nbsp;João Pedro Ferreira MD, PhD ,&nbsp;Kevin Duarte PhD ,&nbsp;Faiez Zannad MD, PhD ,&nbsp;Nicolas Girerd MD, PhD","doi":"10.1016/j.jchf.2025.02.025","DOIUrl":"10.1016/j.jchf.2025.02.025","url":null,"abstract":"<div><h3>Background</h3><div>Mineralocorticoid receptor antagonists (MRAs) block the activation of mineralocorticoid receptors by aldosterone, thereby mitigating cardiovascular risks. However, data on whether impact of aldosterone on outcomes differs with MRA use remain limited.</div></div><div><h3>Objectives</h3><div>The study aims to explore the associations between baseline aldosterone, its changes and outcomes, and their interaction with eplerenone.</div></div><div><h3>Methods</h3><div>In a subset of the EPHESUS (Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study) trial, associations between baseline serum aldosterone concentrations, their changes from baseline to month 1, and outcomes were separately assessed in the eplerenone and placebo groups. The primary outcome was a composite of cardiovascular death or heart failure (HF) hospitalization.</div></div><div><h3>Results</h3><div>Among 453 patients (mean age: 62 ± 11 years; 75% male), baseline median serum aldosterone was 5.6 ng/dL (Q1-Q3: 3.1-9.2 ng/dL). Higher baseline serum aldosterone was associated with primary outcome in the placebo group (HR per 1 ng/dL: 1.04 ng/dL [95% CI: 1.02-1.07 ng/dL]; <em>P =</em> 0.002), but not in the eplerenone group (HR per 1 ng/dL: 0.99 ng/dL [95% CI: 0.93-1.05 ng/dL]; <em>P =</em> 0.64; <em>P</em> for interaction = 0.048), and these associations persisted after covariate adjustment (ie, prior HF history and renal function). At month 1, eplerenone increased serum aldosterone more than placebo (<em>P &lt;</em> 0.001). High serum aldosterone changes (≥ median value) were associated with increased risk of primary outcome in the placebo group but not in the eplerenone group (HR: 3.48 [95% CI: 1.35-8.99]; <em>P =</em> 0.01 in placebo; HR: 0.81 [95% CI: 0.36-1.82]; <em>P =</em> 0.60 in eplerenone; <em>P</em> for interaction = 0.046), and these associations persisted after covariate adjustment.</div></div><div><h3>Conclusions</h3><div>In patients with left ventricular systolic dysfunction and/or HF after myocardial infarction, higher baseline or rising aldosterone levels were associated with increased risk of HF events. However, eplerenone mitigated aldosterone-associated risks.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102479"},"PeriodicalIF":10.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant Surgical Procedures and Aspirin Avoidance With Left Ventricular Assist Device Therapy","authors":"Francis D. Pagani MD, PhD ,&nbsp;Ivan Netuka MD, PhD ,&nbsp;Ulrich P. Jorde MD ,&nbsp;Jason N. Katz MD, MHS ,&nbsp;Finn Gustafsson MD, PhD ,&nbsp;Jean M. Connors MD ,&nbsp;Nir Uriel MD, MSc ,&nbsp;Edward G. Soltesz MD ,&nbsp;Peter Ivak MD, PhD ,&nbsp;Aditya Bansal MD ,&nbsp;Abbas Bitar MD ,&nbsp;J. David Vega MD ,&nbsp;Daniel Goldstein MD ,&nbsp;Matthew Danter MD ,&nbsp;Yuriy Pya MD, DMSc ,&nbsp;Ashwin Ravichandran MD ,&nbsp;Jennifer Conway MD ,&nbsp;Eric D. Adler MD ,&nbsp;Eugene S. Chung MD ,&nbsp;Jonathan Grinstein MD ,&nbsp;Mandeep R. Mehra MD, MSc","doi":"10.1016/j.jchf.2025.01.017","DOIUrl":"10.1016/j.jchf.2025.01.017","url":null,"abstract":"<div><h3>Background</h3><div>ARIES-HM3 (Antiplatelet Removal and Hemocompatibility Events With the HeartMate 3 Pump) demonstrated that aspirin avoidance with a fully magnetically levitated HeartMate 3 (HM3) left ventricular assist device (LVAD) reduces bleeding complications and does not increase thromboembolism. Whether a concomitant surgical procedure modifies the observed safety and benefits remains uncertain.</div></div><div><h3>Objectives</h3><div>This prespecified analysis of ARIES-HM3 studied clinical outcomes when concomitant surgical procedures are performed during LVAD implantation with excluding aspirin but maintaining a vitamin K antagonist.</div></div><div><h3>Methods</h3><div>Among 628 patients randomized to receive either placebo or aspirin with a vitamin K antagonist, 589 (296 placebo and 293 aspirin) contributed to the primary endpoint analysis. Sub-categorization with receiving a concomitant surgical procedure (valvular procedure/coronary artery bypass grafting or nonvalvular procedure) was done and the composite primary endpoint of survival free from major nonsurgical (&gt;14 days postimplant) hemocompatibility-related adverse events at 12 months was assessed.</div></div><div><h3>Results</h3><div>There were 155 (52%) and 145 (49%) concomitant procedures in placebo and aspirin arms, respectively. The percentage of subjects achieving primary endpoint success was higher with the placebo group in patients with a concomitant procedure, and no interaction was observed on primary outcomes between those with and without concomitant surgical procedures (<em>P</em>_int = 0.231, 0.298, and 0.735 for any procedure, valvular/coronary artery bypass grafting, and nonvalvular procedures, respectively). There was a similar reduction in nonsurgical major hemorrhagic events with placebo compared with aspirin, observed in patients with or without any concomitant procedure: 0.64 (95% CI: 0.44-0.94) and 0.66 (95% CI: 0.46-0.93).</div></div><div><h3>Conclusions</h3><div>Our findings support the safety and efficacy of aspirin avoidance from the antithrombotic regimen in HM3 LVAD patients undergoing concomitant surgical procedures. (Antiplatelet Removal and Hemocompatibility Events With the HeartMate 3 Pump [ARIES-HM3]; <span><span>NCT04069156</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 7","pages":"Article 102411"},"PeriodicalIF":10.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognosis After >50% Decline in eGFR in Heart Failure Patients","authors":"Deewa Zahir Anjum MD ,&nbsp;Mariam Elmegaard MD ,&nbsp;Caroline Hartwell Garred MD ,&nbsp;Nina Nouhravesh MD ,&nbsp;Emil Fosbol MD, PhD ,&nbsp;Pardeep S. Jhund MBChB, MSc, PhD ,&nbsp;John J.V. McMurray MD ,&nbsp;Mark C. Petrie MD ,&nbsp;Lars Køber MD, DMSc ,&nbsp;Morten Schou MD, PhD","doi":"10.1016/j.jchf.2025.02.027","DOIUrl":"10.1016/j.jchf.2025.02.027","url":null,"abstract":"<div><h3>Background</h3><div>A 50% decline in estimated glomerular filtration rate (eGFR) has been introduced as a new kidney endpoint in heart failure (HF) trials. However, its prognostic significance beyond the initial 6 months following HF diagnosis, during which patients often undergo medical therapy optimization, remains uncertain—particularly for patients without diabetes.</div></div><div><h3>Objectives</h3><div>This study aims to determine the long-term prognostic implications of eGFR decline focusing on risks for all-cause mortality and end-stage kidney disease (ESKD).</div></div><div><h3>Methods</h3><div>The authors conducted a nationwide cohort study of all new-onset patients diagnosed with HF between 2014 and 2021. eGFR trajectory was assessed from months 6 to 12 post-diagnosis categorizing patients into 3 groups: stable eGFR (&lt;25% decline), 25%-50% decline, and &gt;50% decline. Only patients who survived the first year post-diagnosis were included in the landmark analysis with the primary outcomes of all-cause mortality and ESKD.</div></div><div><h3>Results</h3><div>Among 45,385 patients with HF (median age: 73.6, 63.8% male), 82.5% had stable eGFR, 14.2% had a 25%-50% decline, and 3.3% had &gt;50% decline at 1 year. In patients without diabetes, eGFR decline &gt;25% was associated with increased 5-year mortality, with absolute risks of 33.2%, 53.8%, and 63.0% for stable eGFR, 25%-50% decline, and &gt;50% decline, respectively. In patients with diabetes, absolute mortality risk was generally higher but followed the same trend (42.8%, 58.6%, and 65.6% for stable eGFR, 25%-50% decline, and &gt;50% decline, respectively). The risk of developing ESKD also increased with eGFR decline. In patients without diabetes, absolute risks were 3.3%, 7.9%, and 11.5% for stable eGFR, 25%-50% decline, and &gt;50% decline, respectively, whereas the absolute risk of ESKD was notably higher in patients with diabetes (7.4%, 15.6%, and 21.1% for stable eGFR, 25%-50% decline, and &gt;50% decline, respectively).</div></div><div><h3>Conclusions</h3><div>In this large real-world study, a &gt;50% eGFR decline was associated with increased mortality and ESKD risk irrespective of diabetes status, underscoring its clinical relevance.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102481"},"PeriodicalIF":10.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote Hemodynamic Monitoring for Heart Failure","authors":"Evan P. Kransdorf MD, PhD ,&nbsp;Hal A. Skopicki MD, PhD","doi":"10.1016/j.jchf.2025.04.014","DOIUrl":"10.1016/j.jchf.2025.04.014","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102507"},"PeriodicalIF":10.3,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Wall Motion Abnormalities in Brain-Dead Heart Donors","authors":"Francis D. Pagani MD, PhD","doi":"10.1016/j.jchf.2025.05.001","DOIUrl":"10.1016/j.jchf.2025.05.001","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102505"},"PeriodicalIF":10.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linking Chronic Kidney Disease to Incident Heart Failure and Adverse Cardiac Remodeling Through the Plasma Proteome","authors":"Leo F. Buckley PharmD, MPH ,&nbsp;Pranav Dorbala MS ,&nbsp;Victoria Lamberson PhD ,&nbsp;Brian L. Claggett PhD ,&nbsp;Yue Ren MS ,&nbsp;Morgan E. Grams MD, PhD ,&nbsp;Josef Coresh MD, PhD ,&nbsp;Kunihiro Matsushita MD, PhD ,&nbsp;Ryan T. Demmer PhD ,&nbsp;Ruth F. Dubin MD ,&nbsp;Rajat Deo MD, MTR ,&nbsp;Peter Ganz MD ,&nbsp;Christie M. Ballantyne MD ,&nbsp;Ron C. Hoogeveen PhD ,&nbsp;Bing Yu PhD ,&nbsp;Amil M. Shah MD, MPH","doi":"10.1016/j.jchf.2025.102512","DOIUrl":"10.1016/j.jchf.2025.102512","url":null,"abstract":"<div><h3>Background</h3><div>Investigation of circulating plasma proteins may reveal insights into molecular pathways that contribute to the development of heart failure (HF) among people with chronic kidney disease.</div></div><div><h3>Objectives</h3><div>The authors aimed to identify circulating kidney function–related plasma proteins that are associated with the risk of incident HF.</div></div><div><h3>Methods</h3><div>The authors studied participants of the ongoing longitudinal Atherosclerosis Risk In Communities study. Relative plasma concentrations of 4,697 unique proteins were measured with the use of an aptamer assay (Somalogic). Each protein was tested for associations with estimated glomerular filtration rate (eGFR), log-transformed urine albumin-to-creatinine ratio (UACR), and incident HF by means of multivariable linear and Cox regression models. Protein-HF associations were validated externally in the CRIC (Chronic Renal Insufficiency Cohort) study. Two-sample mendelian randomization was used to test for potential causal associations.</div></div><div><h3>Results</h3><div>In fully adjusted models, 44 plasma proteins were associated with either eGFR or UACR and incident HF at two separate ARIC study visits, of which 29 were validated externally in CRIC. Most plasma proteins were associated with HF with preserved ejection fraction, but not reduced ejection fraction. A cluster within these 44 plasma proteins were associated with larger left ventricular end-diastolic volume index and left ventricular diastolic dysfunction. Mendelian randomization suggests that Golgi membrane protein 1 is causally associated with HF and eGFR.</div></div><div><h3>Conclusions</h3><div>This study identified 44 eGFR- and UACR-related plasma proteins that are associated with incident HF independently from demographics, risk factors, and kidney function. These results may inform future therapeutic and biomarker development for the prevention and treatment of incident HF.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102512"},"PeriodicalIF":10.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart-Lung Interactions in HFpEF","authors":"Michael G. Leahy PhD ,&nbsp;Denis J. Wakeham PhD ,&nbsp;James P. MacNamara MD ,&nbsp;Tiffany Brazile MD ,&nbsp;Abidan Abulimiti MD, PhD ,&nbsp;Christopher M. Hearon Jr. PhD ,&nbsp;Mitchel Samels MSc ,&nbsp;Andrew R. Tomlinson MD ,&nbsp;Bryce N. Balmain PhD ,&nbsp;Tony G. Babb PhD ,&nbsp;Benjamin D. Levine MD ,&nbsp;Satyam Sarma MD","doi":"10.1016/j.jchf.2025.102523","DOIUrl":"10.1016/j.jchf.2025.102523","url":null,"abstract":"<div><h3>Background</h3><div>Patients with heart failure with preserved ejection fraction (HFpEF) are characterized by an exaggerated rise in pulmonary capillary wedge pressure (PCWP) with exercise compared with healthy similar-aged adults. Due to the multisystemic effects of the disease, patients with HFpEF often experience expiratory flow limitation (EFL), thereby perpetuating dynamic hyperinflation (DH) and ventilation at a higher percentage of total lung volume. How lung mechanics and operational lung volume affect central hemodynamics in patients with HFpEF is not fully understood.</div></div><div><h3>Objectives</h3><div>The authors sought to characterize the association and correlation of DH and EFL on PCWP in adults with HFpEF during exercise.</div></div><div><h3>Methods</h3><div>A total of 55 patients with HFpEF (71 ± 7 years of age, 70% female) were studied at rest and during 20-W and peak exercise on an upright semirecumbent cycle ergometer. Right atrial and mean pulmonary artery (mPAP) pressures as well as PCWP (via right heart catheterization), oxygen uptake (indirect calorimetry), cardiac output (direct Fick), and ventilation (flow-volume parameters) were measured at each timepoint. DH was defined as an increase in end-expiratory lung volume of ≥150 mL from rest as determined by repeated inspiratory capacity maneuvers.</div></div><div><h3>Results</h3><div>PCWP was greater in those with DH at 20-W exercise (DH 24 ± 6 mm Hg vs typical 18 ± 6; <em>P =</em> 0.033) and peak exercise (DH 44 ± 9 vs typical 31 ± 6 mm Hg; <em>P =</em> 0.002). The degree of dynamic inflation was modestly, but significantly associated with a greater PCWP at 20-W (<em>r</em>² = 0.196; <em>P =</em> 0.001) and peak (<em>r</em>² = 0.204; <em>P &lt;</em> 0.001) exercise, as was mPAP (both <em>P &lt;</em> 0.001).</div></div><div><h3>Conclusions</h3><div>Patients with HFpEF that dynamically hyperinflate during exercise have greater PCWP as measured with reference to atmospheric pressure. The severity of hyperinflation scaled proportionally to higher exercise PCWP. Our findings suggest that the augmented exercise PCWP in patients with HFpEF may not be entirely attributed to ventricular stiffness, but also a consequence of increased intrathoracic pressure from dysfunctional ventilatory mechanics. (Mechanisms of Exercise Intolerance in Heart Failure With Preserved Ejection Fraction; <span><span>NCT04068844</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102523"},"PeriodicalIF":10.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of Left Ventricular Regional Wall Motion Abnormalities After Brain Death and Their Clinical Significance","authors":"Alex J. Chang MD ,&nbsp;Brian J. Wayda MD ,&nbsp;Shiqi Zhang MS ,&nbsp;Yingjie Weng MHS ,&nbsp;Kiran K. Khush MD, MAS ,&nbsp;Jonathan G. Zaroff MD","doi":"10.1016/j.jchf.2025.102511","DOIUrl":"10.1016/j.jchf.2025.102511","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular dysfunction is common in potential heart donors after brain death, but specific regional wall motion abnormality (RWMA) patterns in this population have not been well described.</div></div><div><h3>Objectives</h3><div>This study aims to define and characterize RWMA patterns in potential heart donors after brain death by using a machine learning algorithm.</div></div><div><h3>Methods</h3><div>The Donor Heart Study enrolled 4,333 potential heart donors after brain death. All had a transthoracic echocardiogram (TTE) including RWMA assessment, with each segment analyzed for WMS (Wall Motion Score). Those with any RWMA (ie, any WMS &gt;1) were classified using <em>k</em>-means clustering, and each cluster’s associations with donor clinical characteristics, heart use, and recipient survival were assessed.</div></div><div><h3>Results</h3><div>The final analytical cohort included 913 initial TTEs. We identified 4 unique RWMA phenotypes: focal basal septal (FBS) (n = 500), basal and midventricular (n = 311), apical (n = 66), and global hypokinesis (n = 36). These phenotypes exhibited similar donor characteristics but differed in troponin, N-terminal pro–B-type natriuretic peptide levels (both lowest in FBS), and left ventricular ejection fraction (LVEF) (highest in FBS). On subsequent TTEs (performed in 314 donors with any RWMA), all phenotypes demonstrated significant improvement in LVEF. The FBS phenotype had the highest donor heart acceptance for transplantation (68%). Of the hearts accepted for transplantation, there were no significant differences by RWMA phenotype in recipient survival.</div></div><div><h3>Conclusions</h3><div>Left ventricular dysfunction after brain death exhibits distinct RWMA phenotypes, which differ in terms of selected biomarkers and LVEF, but not in recipient survival of the hearts accepted for transplantation.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102511"},"PeriodicalIF":10.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}