JACC. Heart failure最新文献

{"title":"Interleukin-6 in Heart Failure With Reduced Ejection Fraction and the Effect of Dapagliflozin: An Exploratory Analysis of the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure Trial.","authors":"Kieran F Docherty, Kirsty McDowell, Paul Welsh, Mark C Petrie, Inder Anand, David D Berg, Rudolf A de Boer, Lars Køber, Mikhail N Kosiborod, Felipe A Martinez, Eileen O'Meara, David A Morrow, Piotr Ponikowski, Marc S Sabatine, Naveed Sattar, Morten Schou, Ann Hammarstedt, Mikaela Sjöstrand, Anna Maria Langkilde, Pardeep S Jhund, Scott D Solomon, John J V McMurray","doi":"10.1016/j.jchf.2024.12.012","DOIUrl":"https://doi.org/10.1016/j.jchf.2024.12.012","url":null,"abstract":"<p><strong>Background: </strong>Inflammation may play an important pathophysiological role in the development and progression of heart failure (HF). Interleukin (IL)-6 is a circulating cytokine and is the main regulator of the release of C-reactive protein (CRP).</p><p><strong>Objectives: </strong>The authors examined the association between IL-6 and high-sensitivity (hs)-CRP and outcomes in patients with HFrEF in the DAPA-HF trial and their relationship with the effect of dapagliflozin.</p><p><strong>Methods: </strong>Inclusion criteria included: 1) NYHA functional class II-IV; 2) left ventricular ejection fraction ≤40%; 3) elevated N-terminal pro-B-type natriuretic peptide; and 4) estimated glomerular filtration rate ≥30 mL/min/1.73 m². The primary outcome was a composite of a worsening HF event or cardiovascular death. IL-6 and hs-CRP were measured at baseline and 12 months (Roche Diagnostics). The associations between IL-6 and hs-CRP and outcomes were adjusted for known prognostic variables, including NT-proBNP.</p><p><strong>Results: </strong>Among 2,940 patients, median IL-6 and hs-CRP at baseline were 6.01 pg/mL (Q1-Q3: 4.18-9.28 pg/mL) and 2.05 mg/L (Q1-Q3: 0.83-4.9 mg/L), respectively. Baseline IL-6 tertiles (T) were: T1 ≤4.72 pg/mL; T2 4.73-7.89 pg/mL; and T3 ≥7.90 pg/mL. The adjusted risks of the primary outcome relative to T1 were as follows: T2 = HR 1.34 (95% CI: 1.04-1.73) and T3 = HR 1.80 (95% CI: 1.41-2.31). A rise in IL-6 between baseline and 12 months was associated with worse outcomes. The beneficial effect of dapagliflozin on the primary outcome was consistent regardless of IL-6 concentration (continuous interaction P = 0.57), with similar results for hs-CRP. Dapagliflozin did not reduce IL-6 or hs-CRP at 12 months.</p><p><strong>Conclusions: </strong>In DAPA-HF, elevated IL-6 and hs-CRP levels were each associated with the risk of worsening HF or cardiovascular death. Dapagliflozin reduced the risk of adverse outcomes regardless of baseline IL-6 or hs-CRP. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure [DAPA-HF]; NCT03036124).</p>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633881","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":"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":"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":"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":"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":"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":"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":"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}

{"title":"The Clinical Trajectory of NYHA Functional Class I Patients With Obstructive Hypertrophic Cardiomyopathy","authors":"Monica Ahluwalia MD ,&nbsp;Jiankang Liu PhD ,&nbsp;Iacopo Olivotto MD ,&nbsp;Victoria Parikh MD ,&nbsp;Euan A. Ashley MRCP, DPhil ,&nbsp;Michelle Michels MD, PhD ,&nbsp;Jodie Ingles MPH, PhD ,&nbsp;Rachel Lampert MD ,&nbsp;John C. Stendahl MD, PhD ,&nbsp;Steven D. Colan MD ,&nbsp;Dominic Abrams MD ,&nbsp;Alexandre C. Pereira MD, PhD ,&nbsp;Joseph W. Rossano MD ,&nbsp;Thomas D. Ryan MD, PhD ,&nbsp;Anjali T. Owens MD ,&nbsp;James S. Ware PhD, MRCP ,&nbsp;Sara Saberi MD, MS ,&nbsp;Adam S. Helms MD ,&nbsp;Sharlene Day MD ,&nbsp;Brian Claggett PhD ,&nbsp;Neal K. Lakdawala MD","doi":"10.1016/j.jchf.2024.09.008","DOIUrl":"10.1016/j.jchf.2024.09.008","url":null,"abstract":"<div><h3>Background</h3><div>An improved understanding of the natural history in NYHA functional class I patients with obstructive hypertrophic cardiomyopathy (oHCM) is needed.</div></div><div><h3>Objectives</h3><div>Using a multicenter registry (SHaRe [Sarcomeric Human Cardiomyopathy Registry]), this study described the natural history in patients with oHCM who were classified as NYHA functional class I at the initial visit compared with patients classified as NYHA functional class II and reported baseline characteristics associated with incident clinical events.</div></div><div><h3>Methods</h3><div>Incident events assessed included a composite of NYHA functional class III to IV symptoms, left ventricular ejection fraction &lt;50%, atrial fibrillation, stroke, ventricular arrhythmias, septal reduction therapy, ventricular assist device or transplantation, or death. Factors associated with incident events were determined using Kaplan-Meier, Cox proportional hazards, and restricted cubic spline models.</div></div><div><h3>Results</h3><div>Of 7,964 patients with HCM in SHaRe, 1,239 patients with oHCM met inclusion criteria; 598 were in NYHA functional class I at the initial visit (age 48 ± 17 years; 31.1% female; peak gradient, 75 ± 40 mm Hg). At 5-year follow-up, the composite event rate of NYHA functional class I patients was 28% compared with 44% (<em>P &lt;</em> 0.001) in 641 NYHA functional class II patients with oHCM (age 54 ± 16 years; 46.5% female; peak gradient, 83 ± 39 mm Hg). Left atrial (LA) diameter ≥45 mm (HR: 1.56 [95% CI: 1.14-2.12]; <em>P =</em> 0.005), female sex (HR: 1.61 [95% CI: 1.16-2.24]; <em>P =</em> 0.003), and older age (HR: 1.21 per 10 years [95% CI: 1.09-1.34]; <em>P &lt;</em> 0.001), but not the magnitude of left ventricular outflow tract obstruction, were associated with a higher risk of the composite outcome in NYHA functional class I patients.</div></div><div><h3>Conclusions</h3><div>Although NYHA functional class I patients with oHCM fared better than NYHA functional class II patients, more than one-fourth experienced adverse events over 5-year follow-up, especially if they were older, female, and/or had LA enlargement. Strategies to reduce the rate of clinical outcomes in NYHA functional class I patients warrant further study.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 2","pages":"Pages 332-343"},"PeriodicalIF":10.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620762","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}