JACC. Heart failure最新文献

{"title":"Growth Hormone Replacement Therapy in Heart Failure With Reduced Ejection Fraction: A Randomized, Double-Blind, Placebo-Controlled Trial.","authors":"Alberto Maria Marra, Roberta D'Assante, Mariarosaria De Luca, Michele Arcopinto, Paola Gargiulo, Valeria Valente, Giulia Crisci, Carmen Rainone, Michele Modestino, Federica Giardino, Stefania Paolillo, Francesco Cacciatore, Lavinia Saldamarco, Dario Bruzzese, Donatella Scarpa, Pasquale Perrone Filardi, Giovanni Esposito, Luigi Saccà, Eduardo Bossone, Andrea Salzano, Antonio Cittadini","doi":"10.1016/j.jchf.2024.11.017","DOIUrl":"https://doi.org/10.1016/j.jchf.2024.11.017","url":null,"abstract":"<p><strong>Background: </strong>Growing evidence suggests that reduced activity of the growth hormone (GH)/insulin-like growth factor (IGF)-1 axis is common and associated with poor clinical status and outcome in heart failure (HF). In addition, preliminary results of growth hormone deficiency (GHD) correction in HF showed an improvement in quality of life, cardiac structure and function, and cardiovascular performance.</p><p><strong>Objectives: </strong>The aim of the present double-blind, randomized, placebo-controlled trial was to evaluate the cardiovascular effects of 1 year of GH replacement therapy in a cohort of patients with heart failure and reduced ejection fraction (HFrEF).</p><p><strong>Methods: </strong>Consecutive patients with HFrEF in NYHA functional class I/II/III and concomitant GHD were recruited. GHD patients were randomized to receive GH (0.012 mg/kg every second day ∼2.5 IU), or placebo, on top of background therapy. The primary endpoint was peak oxygen consumption (VO₂). Secondary endpoints included hospitalizations, end-systolic left ventricular volumes, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, health-related quality of life score, and muscle strength (handgrip).</p><p><strong>Results: </strong>A total of 318 consecutive patients were screened, with 86 (27%) fulfilling the criteria for GHD. Of these, 22 subjects refused to participate in the study. The final study groups consisted of 64 patients, 30 randomized in the active treatment group and 34 in the control group. After 1 year, 45 patients completed the study (21 in the control group and 24 in the active group). A statistically significant improvement of peak VO₂ was reached in the active group (from 12.8 ± 3.4 mL/kg/min to 15.5 ± 3.15 mL/kg/min; P < 0.01; delta peak VO₂ between groups: +3.1 vs -1.8; P < 0.01). Other cardiopulmonary exercise test parameters (ie, peak workload, VO₂ at the aerobic threshold, O₂ pulse and VE/VCO₂ slope; P < 0.05) also improved, paralleled by an increase in 6-minute walking test distance (P < 0.05) and handgrip strength (P < 0.01). GH improved right ventricular function (ie, TAPSE and TAPSE/pulmonary artery systolic pressure ratio; P < 0.01), leading to an amelioration of clinical status (NYHA functional class; P < 0.05) and health-related quality of life (Minnesota Living With Heart Failure Questionnaire; P < 0.05). A significant decrease of NT-proBNP was also found (P < 0.05).</p><p><strong>Conclusions: </strong>This randomized, double-blind, placebo-controlled trial demonstrates that GH replacement therapy in HFrEF patients with GHD improves exercise performance, and left ventricular and right ventricular structure and function, leading to an amelioration of clinical status and health-related quality of life. (Treatment of GHD Associated With CHF; NCT03775993).</p>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567154","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":"Management of Patients With Impella 5.5 Left Ventricular Assist Devices on a Cardiovascular Stepdown Unit.","authors":"Anthony P Carnicelli, Brian A Houston, Jennifer Hajj, Kaylen Dodson, Lindsey Bull, Meg Ospina, Thomas G di Salvo, Jeffrey D McMurray, Jeffrey Yourshaw, Ryan J Tedford, Lucas J Witer, Arman Kilic","doi":"10.1016/j.jchf.2025.02.002","DOIUrl":"10.1016/j.jchf.2025.02.002","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399253","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":"Left Atrial-to-Coronary Sinus Shunting in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: The ALT-FLOW Trial (Early Feasibility Study) 2-Year Results.","authors":"Francesco Fioretti, Benjamin Hibbert, Peter M Eckman, Trevor Simard, Marino Labinaz, Babak Nazer, Mark Wiley, Bhanu Gupta, Andrew J Sauer, Hirak Shah, Paul Sorajja, Andres M Pineda, Emil Missov, Lillian Aldaia, Konstantinos Koulogiannis, William A Gray, Firas Zahr, Javed Butler","doi":"10.1016/j.jchf.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.jchf.2025.02.003","url":null,"abstract":"<p><strong>Background: </strong>The ALT-FLOW trial EFS (Early Feasibility Study) evaluated safety, hemodynamics and outcomes for the APTURE system in patients with HF and mildly reduced or preserved ejection fraction.</p><p><strong>Objectives: </strong>In this study, the authors sought to examine the 2-year health status, functional capacity, and outcomes of ALT-FLOW EFS.</p><p><strong>Methods: </strong>Device safety, performance, patency, hemodynamics, echocardiographic parameters, and outcomes were assessed in patients with LVEF >40% (n = 95); NYHA functional class, Kansas City Cardiomyopathy Questionnaire (KCCQ) Clinical Summary Score (CSS), Total Symptom Score (TSS), and Overall Summary Score (OSS), 6-minute walk distance, and the ratio of pulmonary capillary wedge pressure at peak exercise to workload normalized to body weight (PCWL) were evaluated.</p><p><strong>Results: </strong>Major adverse cardiac, cerebral, and renal events and reintervention through 30 days occurred in 2.8% of patients. All implanted shunts were patent for up to 5 years. The mean PCWL decreased from 131 ± 74 mm Hg/W/kg at baseline to 76 ± 57 mm Hg/W/kg after 6 months (P < 0.0001). After 2 years, NYHA functional class improvement was reported in 51/62 patients (82.3%). Mean KCCQ CSS, TSS, and OSS at baseline were 45 ± 17, 46 ± 19, and 38 ± 18 points, respectively, and improved at 2 years by 25 ± 20, 26 ± 23, and 31 ± 23 points, respectively. The reduction in PCWL and improvement in NYHA functional class and KCCQ scores were consistent in patients with or without pulmonary vascular disease. No detrimental changes in right or left ventricular function were observed.</p><p><strong>Conclusions: </strong>In patients with HF and LVEF >40%, the APTURE shunt confirmed an acceptable safety profile with improvements in HF symptoms, quality of life, and functional capacity without negatively affecting right and left heart function after 2 years, regardless of pulmonary vascular disease. (Exploratory Study of the Edwards APTURE Transcatheter Shunt System [ALT-FLOW Canada]; NCT04000607; Early Feasibility Study-Edwards APTURE Transcatheter Shunt System [ALT-FLOW US]; NCT03523416).</p>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523571","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":"Ultrafiltration for Management of Decompensated Heart Failure: A Reappraisal of AVOID-HF.","authors":"Sean P Pinney, Maria V DeVita, Bjorn Redfors, Lak N Kotinkaduwa, Megan Cotts, Jennifer Cowger, Maria Rosa Costanzo","doi":"10.1016/j.jchf.2024.11.018","DOIUrl":"https://doi.org/10.1016/j.jchf.2024.11.018","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476492","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":"Ventricular Reconstruction","authors":"Frederick G.P. Welt MD,&nbsp;James C. Fang MD","doi":"10.1016/j.jchf.2024.12.001","DOIUrl":"10.1016/j.jchf.2024.12.001","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 2","pages":"Pages 309-311"},"PeriodicalIF":10.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143180872","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":"24-Month Outcomes of Endovascular Baroreflex Amplification With the MobiusHD Device in Heart Failure With Reduced Ejection Fraction","authors":"Kerstin Piayda MD, MSc ,&nbsp;Stefan Bertog MD ,&nbsp;Kolja Sievert MD ,&nbsp;Horst Sievert MD ,&nbsp;Tamaz Shaburishvili MD ,&nbsp;Irakli Gogorishvili MD ,&nbsp;Martin Rothman MD ,&nbsp;James L. Januzzi Jr. MD ,&nbsp;JoAnn Lindenfeld MD ,&nbsp;Gregg W. Stone MD","doi":"10.1016/j.jchf.2024.11.005","DOIUrl":"10.1016/j.jchf.2024.11.005","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 2","pages":"Pages 386-388"},"PeriodicalIF":10.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005571","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":"Growth Differentiation Factor–15 Is Associated With Congestion-Related Anorexia and Weight Loss in Advanced Heart Failure","authors":"Luca Monzo MD, PhD ,&nbsp;Petr Jarolim MD, PhD ,&nbsp;Barry A. Borlaug MD ,&nbsp;Jan Benes MD, PhD ,&nbsp;Ivana Jurcova MD ,&nbsp;Dominik Jenca MD ,&nbsp;Katerina Kroupova MD ,&nbsp;Peter Wohlfahrt MD, PhD ,&nbsp;Martin Kotrc MD ,&nbsp;Vojtech Melenovsky MD, PhD","doi":"10.1016/j.jchf.2024.10.023","DOIUrl":"10.1016/j.jchf.2024.10.023","url":null,"abstract":"<div><h3>Background</h3><div>Growth differentiation factor (GDF)-15 is a pleiotropic cytokine that is associated with appetite-suppressing effects and weight loss in patients with malignancy.</div></div><div><h3>Objectives</h3><div>This study aims to investigate the relationships between GDF-15 levels, anorexia, cachexia, and clinical outcomes in patients with advanced heart failure with reduced ejection fraction (HFrEF).</div></div><div><h3>Methods</h3><div>In this observational, retrospective analysis, a total of 344 patients with advanced HFrEF (age 58 ± 10 years, 85% male, 67% NYHA functional class III), underwent clinical and echocardiographic examination, body composition evaluation by skinfolds and dual-energy x-ray absorptiometry, circulating metabolite assessment, Minnesota Living with Heart Failure Questionnaire, and right heart catheterization.</div></div><div><h3>Results</h3><div>The median GDF-15 level was 1,503 ng/L (Q1-Q3: 955-2,332 ng/L) (reference range: &lt;1,200 ng/L). Higher GDF-15 levels were associated with more prevalent anorexia and cachexia. Patients with higher GDF-15 had increased circulating free fatty acids and beta-hydroxybutyrate, lower albumin, cholesterol, and insulin/glucagon ratio, consistent with a catabolic state. Patients with higher GDF-15 had worse congestion and more severe right ventricular dysfunction. In multivariable Cox analysis, elevated GDF-15 was independently associated with risk of the combined endpoint of death, urgent transplantation, or left ventricular assist device implantation, even after adjusting for coexisting anorexia and cachexia (T3 vs T1 HR: 2.31 [95% CI: 1.47-3.66]; <em>P &lt;</em> 0.001).</div></div><div><h3>Conclusions</h3><div>In patients with advanced HFrEF, elevated circulating GDF-15 levels are associated with a higher prevalence of anorexia and cachexia, right ventricular dysfunction, and congestion, as well as an independently increased risk of adverse events. Further studies are warranted to determine whether therapies altering GDF-15 signaling pathways can affect metabolic status and clinical outcomes in advanced HFrEF.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 2","pages":"Pages 315-329"},"PeriodicalIF":10.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Heart Failure","authors":"Johan E. Larsson MD, PhD ,&nbsp;Maria Generosa Crespo-Leiro MD, PhD ,&nbsp;Finn Gustafsson MD, PhD","doi":"10.1016/j.jchf.2024.10.026","DOIUrl":"10.1016/j.jchf.2024.10.026","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 2","pages":"Pages 248-252"},"PeriodicalIF":10.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143179806","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":"Upgrading Right Ventricular Pacing to Cardiac Resynchronization in HFrEF Patients Improves Symptoms and Functional Outcomes","authors":"Eperke Merkel MD ,&nbsp;Robert Hatala MD, PhD ,&nbsp;Mátyás Szigeti PhD ,&nbsp;Walter Schwertner MD ,&nbsp;Bálint Lakatos MD, PhD ,&nbsp;Anett Behon MD ,&nbsp;Kinga Goscinska-Bis MD ,&nbsp;Goran Milasinovic MD ,&nbsp;Roland Papp MD ,&nbsp;Mihály Ruppert MD, PhD ,&nbsp;László Sághy MD, PhD ,&nbsp;Marcell Clemens MD, PhD ,&nbsp;Scott D. Solomon MD ,&nbsp;Valentina Kutyifa MD, PhD ,&nbsp;Attila Kovács MD, PhD ,&nbsp;Annamária Kosztin MD, PhD ,&nbsp;Béla Merkely MD, PhD","doi":"10.1016/j.jchf.2024.09.011","DOIUrl":"10.1016/j.jchf.2024.09.011","url":null,"abstract":"<div><h3>Background</h3><div>In the BUDAPEST (Biventricular Upgrade on left ventricular reverse remodeling and clinical outcomes in patients with left ventricular Dysfunction and intermittent or permanent APical/SepTal right ventricular pacing)-CRT Upgrade randomized trial, the authors have demonstrated improved mortality and morbidity after cardiac resynchronization therapy (CRT) upgrade in patients with heart failure with reduced ejection fraction (HFrEF) with high right ventricular (RV) pacing burden.</div></div><div><h3>Objectives</h3><div>This substudy sought to examine the impact of CRT upgrade on symptoms, functional outcome, and exercise capacity.</div></div><div><h3>Methods</h3><div>In the BUDAPEST-CRT Upgrade trial, 360 HFrEF patients with pacemaker or implantable cardioverter-defibrillator (ICD) and ≥20% RV pacing burden were randomly assigned (3:2) to cardiac resynchronization therapy with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). The prespecified tertiary endpoints were changes in quality of life (QoL) (EQ-5D-3L), NYHA functional class, 6-minute walk test, and N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels.</div></div><div><h3>Results</h3><div>Up to 12 months, NYHA functional class improved in the CRT-D upgrade arm compared with ICD only (adjusted OR: 0.50 [95% CI: 0.32-0.80]; <em>P =</em> 0.003). A remarkable decrease was observed in NT-proBNP levels in the CRT-D arm (adjusted difference: −1,257 pg/mL [95% CI: −2,287 to −228 pg/mL]; <em>P =</em> 0.017). The progression of age-related worsening of QoL was moderated by CRT-D upgrade (EQ-5D-3L difference by each year: 0.015 [95% CI: 0.005-0.025]; <em>P</em> interaction = 0.003). However, exercise tolerance (6-minute walk test) remained unchanged in both groups.</div></div><div><h3>Conclusions</h3><div>HFrEF patients with pacemaker/ICD and ≥20% RV pacing burden receiving CRT upgrade showed a substantial improvement in NYHA functional class and decrease in natriuretic peptide levels, as compared with ICD alone. Moreover, CRT-D upgrade could moderate the progression of worsening of QoL attributed to ageing in this vulnerable, elderly patient population. (Biventricular Upgrade on left ventricular reverse remodeling and clinical outcomes in patients with left ventricular Dysfunction and intermittent or permanent APical/SepTal right ventricular pacing [BUDAPEST]-CRT Upgrade trial; <span><span>NCT02270840</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 2","pages":"Pages 265-273"},"PeriodicalIF":10.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768942","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":"Beyond Guideline-Directed Medical Therapy","authors":"Onyedika J. Ilonze MD, MPH ,&nbsp;Daniel E. Forman MD ,&nbsp;Lisa LeMond MD ,&nbsp;Jonathan Myers PhD ,&nbsp;Scott Hummel MD ,&nbsp;Amanda R. Vest MBBS MPH ,&nbsp;Ersilia M. DeFilippis MD ,&nbsp;Eiad Habib MBBS ,&nbsp;Sarah J. Goodlin MD","doi":"10.1016/j.jchf.2024.08.018","DOIUrl":"10.1016/j.jchf.2024.08.018","url":null,"abstract":"<div><div>Heart failure (HF) is a leading cause of cardiovascular morbidity, mortality, and health care expenditure. Guideline-directed medical therapy and device-based therapy in HF are well established. However, the role of nonpharmacologic modalities to improve HF care remains underappreciated, is underused, and requires multimodal approaches to care. Diet, exercise and cardiac rehabilitation, sleep-disordered breathing, mood disorders, and substance use disorders are potential targets to reduce morbidity and improve function of patients with HF. Addressing these factors may improve symptoms and quality of life, reduce hospitalizations, and improve mortality in heart failure. This state-of-the-art review discusses dietary interventions, exercise programs, and the management of sleep-disordered breathing, mood disorders, and substance use in individuals with heart failure. The authors review the latest data and provide optimal lifestyle recommendations and recommended prescriptions for nonpharmacologic therapies.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 2","pages":"Pages 185-199"},"PeriodicalIF":10.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500653","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}