JACC. Heart failure最新文献

{"title":"Risk Factors and Temporal Trends of Maternal Heart Failure","authors":"Clara Kihlborg ,&nbsp;Jonas Faxén MD, PhD ,&nbsp;Maria Sennström MD, PhD ,&nbsp;Ängla Mantel MD, PhD","doi":"10.1016/j.jchf.2025.102617","DOIUrl":"10.1016/j.jchf.2025.102617","url":null,"abstract":"<div><h3>Background</h3><div>Maternal heart failure (HF) is increasing in several countries, but trends in Sweden remain unclear. The extent to which changes in maternal risk factors contribute to this trend and the proportion of cases linked to associated cardiac conditions are not well established.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to estimate the annual incidence of maternal HF in Sweden over the last 2 decades, assess the proportion with associated cardiac disease, identify risk factors, and examine whether changes in risk factor prevalence explain temporal trends.</div></div><div><h3>Methods</h3><div>National cohort study comprising 2,078,384 deliveries to women without pre-existing cardiac disease registered in the Swedish Medical Birth Register (2000-2019). Cases of maternal HF, with and without associated cardiac disease, were identified through linkage with national patient and mortality register. Annual incidence rates were calculated, stratified by pregnancy- or postpartum-onset and cardiac disease status. Multivariable logistic regression was used to assess risk factors.</div></div><div><h3>Results</h3><div>Maternal HF increased by 66% over the study period, with an overall incidence of 0.34 cases per 1,000 deliveries (95% CI: 0.30-0.38). Associated cardiac disease was present in approximately one-half of cases. Identified risk factors included prepregnancy comorbidities and pregnancy complications. The rising incidence was partly, yet not fully, explained by changes in risk factor prevalence.</div></div><div><h3>Conclusions</h3><div>The increasing incidence of maternal HF in Sweden highlights a growing clinical concern. The high prevalence of associated cardiac disease underscores the need for heightened awareness and appropriate management of affected patients.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 10","pages":"Article 102617"},"PeriodicalIF":11.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893254","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":"Kidney Function Decline in Incident Heart Failure Is a Surrogate Marker for Kidney Failure and Mortality","authors":"Carl P. Walther MD, PhD ,&nbsp;Katherine R. Tuttle MD ,&nbsp;Sankar D. Navaneethan MD, MS, MPH","doi":"10.1016/j.jchf.2025.102622","DOIUrl":"10.1016/j.jchf.2025.102622","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 10","pages":"Article 102622"},"PeriodicalIF":11.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893256","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":"Temporal Changes in Biomarkers, Functional Status, and Quality of Life Prior to Adverse Clinical Outcomes in Heart Failure With Mildly Reduced or Preserved Ejection Fraction","authors":"Henri Lu MD ,&nbsp;Brian L. Claggett PhD ,&nbsp;Muthiah Vaduganathan MD, MPH ,&nbsp;Akshay S. Desai MD, MPH ,&nbsp;Pardeep S. Jhund MBChB, MSc, PhD ,&nbsp;Adriaan A. Voors MD, PhD ,&nbsp;Michele Senni MD ,&nbsp;Faiez Zannad MD, PhD ,&nbsp;Bertram Pitt MD ,&nbsp;Sanjiv J. Shah MD ,&nbsp;Carolyn S.P. Lam MBBS, PhD ,&nbsp;Markus F. Scheerer PhD ,&nbsp;Andrea Scalise MD ,&nbsp;Katharina Mueller ,&nbsp;Mario Berger PhD ,&nbsp;Laura Goea PhD ,&nbsp;John J.V. McMurray MD ,&nbsp;Scott D. Solomon MD","doi":"10.1016/j.jchf.2025.102590","DOIUrl":"10.1016/j.jchf.2025.102590","url":null,"abstract":"<div><h3>Background</h3><div>Mapping clinical, biomarker, and diuretic dosing trajectories before adverse clinical outcomes in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) may inform population monitoring approaches.</div></div><div><h3>Objectives</h3><div>We assessed temporal patterns of 2 biomarkers (N-terminal pro-B-type natriuretic peptide [NT-proBNP] and estimated glomerular filtration rate [eGFR]), physician assigned functional status (NYHA functional class), a patient-reported outcome (Kansas City Cardiomyopathy Questionnaire Total Symptom Score [KCCQ-TSS]), and diuretic dosing leading up to a clinical event.</div></div><div><h3>Methods</h3><div>FINEARTS-HF was a double-blind, randomized clinical trial testing finerenone vs placebo in 6,001 patients with symptomatic HF and a left ventricular ejection fraction of ≥40%. Key variables including NT-proBNP, eGFR, NYHA functional class, KCCQ-TSS, and diuretic dosing (expressed as furosemide equivalents) were serially assessed until the occurrence of cardiovascular death, first HF event, or the end of the follow-up period. Each variable was plotted relative to the number of months before an event or the end of follow-up. Patients who experienced a clinical event were compared with a control population who remained alive and free of hospitalization during follow-up.</div></div><div><h3>Results</h3><div>Over a median 2.7-year follow-up period, 1,343 cardiovascular deaths or first HF events occurred. At baseline, the participants who experienced a clinical event had higher NT-proBNP values, lower eGFR, higher NYHA functional class, lower KCCQ-TSS, and higher diuretic doses compared with the control population. The eGFR declined by about 5 mL/min/1.73 m² (from a mean of ∼57 to ∼52 mL/min/1.73 m²), and the NT-proBNP level increased by approximately 70% to 80%, in the 12 to 18 months leading up to an event; these markers remained relatively stable in the control group. NYHA functional class showed a sharp deterioration in the 6 to 9 months before an event, and KCCQ-TSS declined by approximately 6 points (from a mean of ∼68 to ∼62) during this period, reflecting worsening functional class and patient-reported symptoms, respectively. Finally, diuretic doses increased in the 6 months preceding the event, from ∼50 to ∼60 mg/day of furosemide equivalents.</div></div><div><h3>Conclusions</h3><div>In a large HFmrEF/HFpEF trial population, clinically meaningful changes in readily available biomarkers, functional status, and patient-reported health status were observed in the months leading up to a clinical event. Monitoring these parameters may help identify patients at high risk for near-term adverse clinical events. (Finerenone Trial to Investigate the Efficacy and Safety Superior to Placebo in Patients With Heart Failure [FINEARTS-HF]; <span><span>NCT04435626</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 10","pages":"Article 102590"},"PeriodicalIF":11.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895078","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":"What Causes Inflammation in Heart Failure and Preserved Ejection Fraction?: Potential Role of Eicosanoid Adipokines.","authors":"Milton Packer","doi":"10.1016/j.jchf.2025.102638","DOIUrl":"https://doi.org/10.1016/j.jchf.2025.102638","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":"102638"},"PeriodicalIF":11.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954589","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":"Capturing Totality of Treatment Effects","authors":"Stephanie Armbruster MSc ,&nbsp;Zachary R. McCaw PhD ,&nbsp;Karola Jering MD ,&nbsp;Brian L. Claggett PhD ,&nbsp;Muthiah Vaduganathan MD, MPH ,&nbsp;Scott Solomon MD, PhD ,&nbsp;Marc A. Pfeffer MD, PhD ,&nbsp;Lee-Jen Wei PhD","doi":"10.1016/j.jchf.2025.102605","DOIUrl":"10.1016/j.jchf.2025.102605","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 10","pages":"Article 102605"},"PeriodicalIF":11.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886541","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":"Contemporary Antibody-Mediated Rejection in Heart Transplantation","authors":"Aditya Mehta MD ,&nbsp;Ersilia M. DeFilippis MD ,&nbsp;Josef Stehlik MD, MPH ,&nbsp;Annette M. Jackson PhD ,&nbsp;Jon A. Kobashigawa MD ,&nbsp;Palak Shah MD, MS","doi":"10.1016/j.jchf.2025.102614","DOIUrl":"10.1016/j.jchf.2025.102614","url":null,"abstract":"<div><div>Heart transplantation remains the definitive therapy for patients with advanced heart failure. Acute and chronic rejection affect both short- and long-term outcomes. Antibody-mediated rejection (AMR) remains a leading cause of graft failure and mortality. The reported incidence of AMR varies widely, on the basis of patient characteristics, variability in the interpretation of endomyocardial biopsy, and differences in clinical thresholds at which to treat AMR. There has been increased recognition of the role of human leukocyte antigen donor-specific antibodies and molecular diagnostics, such as donor-derived cell-free DNA or intragraft gene expression, in supporting the diagnosis of AMR beyond histopathology alone. Furthermore, therapeutic management of patients with AMR previously focused on quelling inflammation, removing or neutralizing pathological antibodies, and blocking antibody-producing cells. Novel therapies now also target complement-mediated injury, costimulatory blockade, and specific cytokine-mediated inflammatory pathways. This position statement highlights contemporary diagnostic and therapeutic approaches for AMR after heart transplantation.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 10","pages":"Article 102614"},"PeriodicalIF":11.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886635","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":"Disease Penetrance in Genotype-Positive But Clinically Unaffected Relatives From Families With Dilated Cardiomyopathy","authors":"Douglas E. Cannie PhD ,&nbsp;Athanasios Bakalakos MD ,&nbsp;Petros Syrris PhD ,&nbsp;Alexandros Protonotarios PhD ,&nbsp;Massimiliano Lorenzini PhD ,&nbsp;Oliver Guttmann MD ,&nbsp;Constantinos O’Mahony PhD ,&nbsp;Konstantinos Savvatis PhD ,&nbsp;Neha Sekhri PhD ,&nbsp;Saidi Mohiddin MBChB, MD ,&nbsp;Luis R. Lopes PhD ,&nbsp;Perry M. Elliott MD","doi":"10.1016/j.jchf.2025.102588","DOIUrl":"10.1016/j.jchf.2025.102588","url":null,"abstract":"<div><h3>Background</h3><div>Serial clinical assessment of genotype-positive relatives from families with dilated cardiomyopathy (DCM) is recommended, but there are limited data to guide screening intervals.</div></div><div><h3>Objectives</h3><div>This study sought to understand the influence of age, sex, and genotype on disease expression.</div></div><div><h3>Methods</h3><div>Families with a DCM phenotype and a likely pathogenic or pathogenic variant in DCM-related genes were identified. Consecutive genotype-positive relatives who were clinically unaffected at baseline assessment were retrospectively recruited. The incidence rates of disease penetrance during follow-up observation were stratified by age, sex, and genotype. A primary composite endpoint of heart failure and malignant ventricular arrhythmia was evaluated.</div></div><div><h3>Results</h3><div>A total of 130 relatives (59 male [45%], median age: 31.4 years [Q1-Q3: 25.1-47.6 years]) from 74 families were included. The incidence rate of phenotype development during 80 months of follow-up was 11.6 per 100 person-years (Q1-Q3: 9.0-14.3 per 100 person-years). A phenotype developed in more men than women (16.1 vs 8.9 per 100 person-years, respectively; log-rank <em>P</em> value = 0.007). <em>LMNA</em> variant carriers had the highest incidence rate of disease penetrance at 17.7 per 100 person-years (Q1-Q3: 9.8-25.7 per 100 person-years). Baseline LVEF was strongly associated with disease penetrance. Four relatives (3.1%) had the primary composite endpoint; 3 (9.4%) relatives with an implantable cardiac defibrillator received an appropriate shock.</div></div><div><h3>Conclusions</h3><div>Rates of disease penetrance are high in genotype-positive relatives and particularly high in men and <em>LMNA</em> variant carriers. Baseline LVEF is strongly associated with disease penetrance. These findings emphasize the importance of regular evaluation of this cohort and underline the potential for tailored screening intervals.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 10","pages":"Article 102588"},"PeriodicalIF":11.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886538","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":"Clinical Presentation, Biomarker Trajectories, and Outcomes in Women and Men Hospitalized for Acute Heart Failure","authors":"Alice Ravera MD ,&nbsp;Hailun Qin MD ,&nbsp;Jozine M. ter Maaten MD PhD ,&nbsp;Bernadet T. Santema MD, PhD ,&nbsp;Marianna Adamo MD, PhD ,&nbsp;Piotr Ponikowski MD, PhD ,&nbsp;Gad Cotter MD ,&nbsp;Beth A. Davison PhD ,&nbsp;G. Michael Felker MD ,&nbsp;Gerasimos S. Filippatos MD ,&nbsp;Peter S. Pang MD ,&nbsp;Barry H. Greenberg MD ,&nbsp;Claudio Gimpelewicz MD ,&nbsp;Thomas Severin MD ,&nbsp;John R. Teerkink MD ,&nbsp;Adriaan A. Voors MD, PhD ,&nbsp;Marco Metra MD","doi":"10.1016/j.jchf.2025.102524","DOIUrl":"10.1016/j.jchf.2025.102524","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have shown important but sometimes heterogeneous differences between women and men with heart failure (HF).</div></div><div><h3>Objectives</h3><div>This study aims to investigate sex differences in the phenotype and journey of men and women in a large contemporary acute heart failure (AHF) cohort.</div></div><div><h3>Methods</h3><div>The authors analyzed 6,545 AHF patients (40% women) enrolled in RELAX-AHF-2 (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF).</div></div><div><h3>Results</h3><div>Women were older (78 vs 72 years; <em>P &lt;</em> 0.001) and had higher ejection fraction (45% vs 35%; <em>P &lt;</em> 0.001). During hospitalization, women received lower diuretic doses (furosemide equivalent through day 5: 200 vs 240 mg intravenous; <em>P &lt;</em> 0.001) and achieved lower weight loss (relative; <em>P =</em> 0.026), with slightly lower diuretic response (−0.33 vs −0.36 kg/40 mg furosemide at day 5; <em>P =</em> 0.011) and similar sign and symptom improvement by day 5 compared with men (all adjusted <em>P</em> &gt; 0.05). More women experienced worsening renal function by day 5 (WRF; adjusted HR: 1.24 [95% CI: 1.06-1.46]; <em>P =</em> 0.009). Women experiencing WRF had increased risk of 180-day cardiovascular death and rehospitalizations for HF or renal failure (RF) and of rehospitalizations for HF/RF compared with men and women without WRF (adjusted <em>P</em> for interaction: <em>P</em> &lt; 0.001). Incidence of other outcomes was similar in women and men (all <em>P &gt;</em> 0.2).</div></div><div><h3>Conclusions</h3><div>During an AHF hospitalization, women received lower doses of loop diuretic agents and achieved less weight loss with slightly lower diuretic response compared with men, despite similar symptom relief and postdischarge outcomes. Early incident WRF was more frequent in women and was associated with worse 180-day outcomes. (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF [RELAX-AHF-2]; <span><span>NCT01870778</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 10","pages":"Article 102524"},"PeriodicalIF":11.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886539","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":"All That Glitters Is Not Gold","authors":"Sukrit Narula MD, PhD ,&nbsp;Andrew Y. Chang MD, PhD","doi":"10.1016/j.jchf.2025.102629","DOIUrl":"10.1016/j.jchf.2025.102629","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 10","pages":"Article 102629"},"PeriodicalIF":11.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886540","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":"Background Therapy for HF Clinical Trials","authors":"Mona Fiuzat PharmD ,&nbsp;Javed Butler MD, MPH, MBA ,&nbsp;Norman Stockbridge MD, PhD ,&nbsp;JoAnn Lindenfeld MD ,&nbsp;Isabella Cavagna BS ,&nbsp;Christopher O’Connor MD ,&nbsp;Milton Packer MD","doi":"10.1016/j.jchf.2025.102596","DOIUrl":"10.1016/j.jchf.2025.102596","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 10","pages":"Article 102596"},"PeriodicalIF":11.8,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863996","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}