{"title":"Pressure From Within and Without in Heart Failure With Preserved Ejection Fraction","authors":"Barry A. Borlaug MD , Ryan J. Tedford MD","doi":"10.1016/j.jchf.2025.102516","DOIUrl":"10.1016/j.jchf.2025.102516","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102516"},"PeriodicalIF":10.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480314","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}
Yuxing Yuan MD , Chenyang Li MM , Shiyi Lei MM , Asad Nawaz MM , Jiajin Li MD , Muhammad Junaid Akram MD , Lingjuan Liu MD , Huichao Sun MD , Bo Pan MD , Tiewei Lv MD , Xiaohua Liang MD , Jie Tian MD
{"title":"Global Burden and Disparities in Pediatric Heart Failure","authors":"Yuxing Yuan MD , Chenyang Li MM , Shiyi Lei MM , Asad Nawaz MM , Jiajin Li MD , Muhammad Junaid Akram MD , Lingjuan Liu MD , Huichao Sun MD , Bo Pan MD , Tiewei Lv MD , Xiaohua Liang MD , Jie Tian MD","doi":"10.1016/j.jchf.2025.03.032","DOIUrl":"10.1016/j.jchf.2025.03.032","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) is a major global health threat; however, the disease burden of pediatric heart failure (PHF) remains poorly understood.</div></div><div><h3>Objectives</h3><div>This study aimed to comprehensively assess the global burden of PHF using the GBD (Global Burden of Disease) 2021 study.</div></div><div><h3>Methods</h3><div>Data for PHF (0-20 years) were analyzed to estimate the prevalence, years lived with disability, and estimated annual percentage changes, stratified by age, gender, region, country, and sociodemographic index.</div></div><div><h3>Results</h3><div>In 2021, the global prevalence of PHF was 6.01 million cases (rate: 228 per 100,000). The prevalence rate increased by 8.78% from 1990 to 2021, with significant differences observed by gender, age, country and region. A positive correlation between sociodemographic index and PHF prevalence was observed (<em>P <</em> 0.001). The leading causes of PHF were congenital heart anomalies, other cardiomyopathies, rheumatic heart disease, and chronic kidney disease, with varying trends over time. The increase in years lived with disability mirrored the change in prevalence, forecasting a consistent upward trend in the disease burden of PHF by 2050.</div></div><div><h3>Conclusions</h3><div>This study underscores the growing burden of PHF and the urgent need for targeted interventions to alleviate its impact. It highlights the importance of addressing geographical disparities and factors such as gender, age, and underlying causes. To mitigate the impact of PHF on children's health, there is a need to draw lessons from successful regions, promote focused clinical and mechanistic research, and develop more effective prevention and treatment strategies.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102484"},"PeriodicalIF":10.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144469880","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}
Liviu Klein MD, MS , Marat Fudim MD, MHS , Mozziyar Etemadi MD, PhD , Robert Gordon MD , Anjan Tibrewala MD , Jaime Hernandez-Montfort MD, MPH, MSc , Patrick McCann MD , Lucas Zier MD , Kevin Shah MD , Allman Rollins MD , Darshak Karia MD , Arshed Quyyumi MD , Shweta R. Motiwala MD, MPH , Nikolaos Diakos MD, PhD , John Rommel MD , Andrew P. Ambrosy MD , Venu G. Ganti PhD , Priyanka Soni MS , Karen Larimer PhD, ACNP-BC , Andrew M. Carek PhD , Omer T. Inan PhD
{"title":"Noninvasive Pulmonary Capillary Wedge Pressure Estimation in Heart Failure Patients With the Use of Wearable Sensing and AI","authors":"Liviu Klein MD, MS , Marat Fudim MD, MHS , Mozziyar Etemadi MD, PhD , Robert Gordon MD , Anjan Tibrewala MD , Jaime Hernandez-Montfort MD, MPH, MSc , Patrick McCann MD , Lucas Zier MD , Kevin Shah MD , Allman Rollins MD , Darshak Karia MD , Arshed Quyyumi MD , Shweta R. Motiwala MD, MPH , Nikolaos Diakos MD, PhD , John Rommel MD , Andrew P. Ambrosy MD , Venu G. Ganti PhD , Priyanka Soni MS , Karen Larimer PhD, ACNP-BC , Andrew M. Carek PhD , Omer T. Inan PhD","doi":"10.1016/j.jchf.2025.102513","DOIUrl":"10.1016/j.jchf.2025.102513","url":null,"abstract":"<div><h3>Background</h3><div>Remote hemodynamics-guided management of heart failure (HF) with implantable pulmonary artery pressure sensors has been shown to reduce HF hospitalizations. The widespread clinical adoption of this procedure is constrained by its invasive nature and high cost. We present a noninvasive technology based on a wearable sensor (CardioTag; Cardiosense) and machine learning (ML) for estimating pulmonary capillary wedge pressure (PCWP) in patients with heart failure with reduced ejection fraction (HFrEF).</div></div><div><h3>Objectives</h3><div>The authors developed and evaluated (against right heart catheterization [RHC]) an ML model to estimate PCWP with the use of electrocardiography, seismocardiography, and photoplethysmography signals from CardioTag.</div></div><div><h3>Methods</h3><div>A multicenter prospective study was performed, and 310 patients with HFrEF (EF ≤40%) were recruited in both inpatient and outpatient settings. A blinded core laboratory adjudicated the RHC PCWP tracings to yield criterion-standard PCWP labels against which the model was trained and tested. The data were separated into 2 sets: a training set for model training and fine-tuning, and a held-out testing set unseen until final evaluation.</div></div><div><h3>Results</h3><div>The patients were 61± 13 years of age, 38% female, 44% White, and 39% African American, and had a PCWP of 18.1 ± 9.45 mm Hg. The model estimated PCWP values in the held-out test set with error of 1.04 ± 5.57 mm Hg (limits of agreement of −9.9 to 11.9 mm Hg), with consistent performance across sex, race, ethnicity, and body mass index.</div></div><div><h3>Conclusions</h3><div>The CardioTag and its ML algorithm estimate PCWP with accuracy approaching implantable hemodynamic sensors, potentially offering a more accessible and cost-effective option for hemodynamics-guided management in HFrEF patients.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102513"},"PeriodicalIF":10.3,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337489","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}
Sara Saberi MD, MS , Theodore P. Abraham MD , Lubna Choudhury MD, MRCPI , Roberto Barriales-Villa MD, PhD , Perry M. Elliott MBBS, MD , Michael E. Nassif MD, MS , Artur Oreziak MD, PhD , Anjali T. Owens MD , Albree Tower-Rader MD , Florian Rader MD , Pablo Garcia-Pavia MD, PhD , Iacopo Olivotto MD , Caroline J. Coats MD, PhD , Michael A. Fifer MD , Mark V. Sherrid MD , Scott D. Solomon MD , Hugh Watkins MD, PhD , Stephen B. Heitner MD , Daniel L. Jacoby MD , Stuart Kupfer MD , Ahmad Masri MD MS
{"title":"Aficamten Treatment for Symptomatic Obstructive Hypertrophic Cardiomyopathy","authors":"Sara Saberi MD, MS , Theodore P. Abraham MD , Lubna Choudhury MD, MRCPI , Roberto Barriales-Villa MD, PhD , Perry M. Elliott MBBS, MD , Michael E. Nassif MD, MS , Artur Oreziak MD, PhD , Anjali T. Owens MD , Albree Tower-Rader MD , Florian Rader MD , Pablo Garcia-Pavia MD, PhD , Iacopo Olivotto MD , Caroline J. Coats MD, PhD , Michael A. Fifer MD , Mark V. Sherrid MD , Scott D. Solomon MD , Hugh Watkins MD, PhD , Stephen B. Heitner MD , Daniel L. Jacoby MD , Stuart Kupfer MD , Ahmad Masri MD MS","doi":"10.1016/j.jchf.2025.03.040","DOIUrl":"10.1016/j.jchf.2025.03.040","url":null,"abstract":"<div><h3>Background</h3><div>Long-term safety and efficacy data for aficamten in symptomatic obstructive hypertrophic cardiomyopathy are needed.</div></div><div><h3>Objectives</h3><div>This study aims to evaluate 48-week experience from the ongoing FOREST-HCM (A Follow-Up, Open-Label, Research Evaluation of Sustained Treatment With Aficamten [CK-3773274] in Hypertrophic Cardiomyopathy) study.</div></div><div><h3>Methods</h3><div>Obstructive hypertrophic cardiomyopathy participants in an aficamten study (REDWOOD-HCM [Dose-finding Study to Evaluate the Safety, Tolerability, PK, and PD of CK-3773274 in Adults With HCM; <span><span>NCT04219826</span><svg><path></path></svg></span>]; SEQUOIA-HCM [Aficamten vs Placebo in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy; <span><span>NCT05186818</span><svg><path></path></svg></span>]) could enroll in this phase 2/3, open-label, extension study. Participants received aficamten 5 mg once daily titrated ≤20 mg based on site-read echocardiographic assessments of Valsalva left ventricular outflow tract gradient and left ventricular ejection fraction.</div></div><div><h3>Results</h3><div>From May 2021 to October 2023, 213 participants enrolled; 46 participants with 48 weeks of follow-up were evaluated (mean age: 59.7 years; female: n = 26 [56.5%]). There were rapid, substantial, and sustained reductions in mean resting (−40 ± 34 mm Hg) and Valsalva peak left ventricular outflow tract gradient (−53 ± 39 mm Hg) from baseline to week 48. A total of 82% experienced ≥1 NYHA functional class improvement; 31% experienced a 20-point improvement in Kansas City Cardiomyopathy Questionnaire–Clinical Summary score. There were substantial reductions (mean change) in maximum left ventricular wall thickness (−1.2 ± 1.6 mm; <em>P <</em> 0.0001), left atrial volume index (−3.5 ± 6.6 mL/m<sup>2</sup>; <em>P =</em> 0.0008), lateral E/e′ (−2.2 ± 6.1; <em>P =</em> 0.02), and cardiac biomarkers (<em>P ≤</em> 0.0031). Aficamten was well tolerated with 2 (4.3%) asymptomatic and transient instances of left ventricular ejection fraction <50% (range: 47%-49%), neither resulting in drug discontinuation, and no new-onset atrial fibrillation.</div></div><div><h3>Conclusions</h3><div>Aficamten treatment over 48 weeks was well tolerated and associated with substantial and durable relief of obstruction and symptom burden, lower cardiac biomarker levels, and cardiac phenotypic changes, which may indicate favorable cardiac remodeling. (A Follow-Up, Open-Label, Research Evaluation of Sustained Treatment With Aficamten [CK-3773274] in Hypertrophic Cardiomyopathy [FOREST-HCM]; <span><span>NCT04848506</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 8","pages":"Article 102496"},"PeriodicalIF":10.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314254","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":"Timing of Cardiac Resynchronization Therapy Following Stable Medical Therapy in Patients With Heart Failure.","authors":"Alessandro Villaschi,Christian Basile,Lina Benson,Paolo Gatti,William T Abraham,Michael Böhm,Biykem Bozkurt,Javed Butler,Gianluigi Condorelli,Cecilia Linde,Marco Metra,Wilfried Mullens,Peter Mol,Shelley Zieroth,Raffaele Scorza,Lars H Lund,Fredrik Gadler,Gianluigi Savarese","doi":"10.1016/j.jchf.2025.102515","DOIUrl":"https://doi.org/10.1016/j.jchf.2025.102515","url":null,"abstract":"BACKGROUNDGuidelines' recommendations for cardiac resynchronization therapy (CRT) implantation in selected patients with heart failure (HF) exist. However, data on the best timing for CRT implantation after the achievement of stable medical therapy (SMT) and its association with outcomes are currently lacking.OBJECTIVESThe aim of this study was to investigate the timing of CRT implantation after the achievement of SMT, associated patient profiles, and clinical outcomes in a real-world HF population.METHODSPatients with HF treated with SMT derived from the Swedish ICD and Pacemaker Registry who received CRT between 2007 and 2020 were included in the study. Patient characteristics associated with a shorter or longer time to CRT implantation were assessed using multivariable logistic regression, and associations between the time from SMT to CRT implantation and clinical outcomes (mortality and morbidity) were analyzed using multivariable Cox regression.RESULTSOf the 9,409 patients, 43.8% received CRT at <3 months of achieving SMT, 34.9% between 3 and 9 months, and 21.3% after 9 months. The time from SMT to CRT implantation decreased significantly over the study period. Independent determinants of shorter time to implantation included recent HF hospitalization, previous implantation of a defibrillator, and greater use of guideline-directed medical therapy, whereas a history of HF >6 months and ischemic heart disease were associated with a longer time. After adjustments, there was a 9% lower risk of cardiovascular death with a shorter time from SMT to CRT implantation of <3 months vs 3-9 months (P = 0.045). A delayed time of >9 months vs 3-9 months was associated with a 13% higher risk of cardiovascular death/HF hospitalization, a 12% higher risk of cardiovascular death (P = 0.040), and an 11% higher risk of first HF hospitalization (P = 0.013).CONCLUSIONSTime from the achievement of SMT to CRT implantation decreased over the study period. Delayed CRT implantation beyond 3 months was associated with higher cardiovascular mortality compared with earlier implantation after GDMT optimization.","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 9 1","pages":"102515"},"PeriodicalIF":13.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337473","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}
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