European Journal of Heart Failure最新文献

{"title":"Interplay of serum potassium and kidney function with finerenone in heart failure with mildly reduced or preserved ejection fraction: Findings from FINEARTS-HF.","authors":"João Pedro Ferreira,Muthiah Vaduganathan,Brian L Claggett,Ian Kulac,John W Ostrominski,Akshay S Desai,Pardeep S Jhund,Carolyn S P Lam,Michele Senni,Sanjiv J Shah,Adriaan A Voors,Bertram Pitt,Katja Rohwedder,Meike Brinker,Patrick Schloemer,John J V McMurray,Scott D Solomon,Faiez Zannad","doi":"10.1002/ejhf.70052","DOIUrl":"https://doi.org/10.1002/ejhf.70052","url":null,"abstract":"AIMSFinerenone improved heart failure (HF) outcomes in patients with heart failure and mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). Clinical decision-making around initiation of mineralocorticoid receptor antagonists often relies on measures of kidney function and serum potassium (K+) levels. The aim of this study was to evaluate the efficacy and safety of finerenone across categories of serum K+ and estimated glomerular filtration rate (eGFR).METHODS AND RESULTSFour mutually exclusive categories were created: (1) K+ ≤4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2; (2) K+ >4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2; (3) K+ ≤4.5 mmol/L and eGFR <60 ml/min/1.73 m2; and (4) K+ >4.5 mmol/L and eGFR <60 ml/min/1.73 m2. Outcomes and treatment effects were compared across these categories. The primary outcome was a composite of total HF events and cardiovascular death. The median follow-up was 32 months. A total of 6001 patients were included. Compared to patients with K+ ≤4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2, those with eGFR <60 ml/min/1.73 m2, irrespective of K+ levels, had a 1.5- to 2-fold higher risk of experiencing primary outcome and fatal events across treatment groups. No significant interaction was observed on the effects of finerenone (vs. placebo) on the primary outcome across K+/eGFR categories. The respective risk ratios (RR) and 95% confidence intervals (CI) were: (1) K+ ≤4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2: RR 0.66, 95% CI 0.52-0.85; (2) K+ >4.5 mmol/L and eGFR ≥60 ml/min/1.73 m2: RR 0.92, 95% CI 0.65-1.30; (3) K+ ≤4.5 mmol/L and eGFR <60 ml/min/1.73 m2: RR 0.91, 95% CI 0.74-1.13; (4) K+ >4.5 mmol/L and eGFR <60 ml/min/1.73 m2: RR 0.92, 95% CI 0.72-1.17; p for interaction = 0.20. Patients with low eGFR and/or high K+ experienced more frequent adverse events and treatment discontinuation; still, categories of K+/eGFR did not significantly modify the relative risk of adverse events with finerenone versus placebo (p for interaction > 0.1 for all adverse events).CONCLUSIONSNo significant heterogeneity was found on the effect of finerenone to reduce primary outcome events. Still, adverse events and treatment discontinuation were more frequent among patients with low eGFR and/or high K+, suggesting. that such patients may require tailored strategies to mitigate adverse events and avoid treatment discontinuation.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"29 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145209291","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":"Global patterns of polypharmacy after acute heart failure hospitalization: Prevalence and outcomes from the REPORT-HF registry.","authors":"Wan Ting Tay,Tiew-Hwa Katherine Teng,Wouter Ouwerkerk,John G F Cleland,Sean P Collins,Christiane E Angermann,Kenneth Dickstein,Ulf Dahlstrom,Anja Schweizer,Achim Obergfell,Kai-Hang Yiu,Mathieu Ghadanfar,Mahmoud Hassanein,Qing-Wen Ren,Wen-Li Gu,Georg Ertl,Sergio V Perrone,Gerasimos Filippatos,Carolyn S P Lam,Jasper Tromp","doi":"10.1002/ejhf.70056","DOIUrl":"https://doi.org/10.1002/ejhf.70056","url":null,"abstract":"AIMSPolypharmacy, defined as the concurrent use of ≥5 medications, is prevalent among older adults with heart failure (HF). While guideline-directed HF medications provide therapeutic benefits, non-HF polypharmacy, particularly involving inappropriate medications, may lead to adverse outcomes. The international REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure (REPORT-HF), the largest available global acute HF registry, was used to examine the prevalence, clinical correlates, and 1-year outcome associations of non-HF polypharmacy.METHODS AND RESULTSMedication counts were classified as no polypharmacy (<5), polypharmacy (5-9), and hyper-polypharmacy (≥10). Potentially harmful medications were identified using the 2016 American Heart Association scientific statement. Multivariable regression models examined correlates of polypharmacy and 1-year mortality. Among 18 030 patients (66 ± 14 years, 39% women), 39% had polypharmacy and 9% had hyper-polypharmacy (63% and 25%, respectively, if including HF medications). Non-HF polypharmacy was more common in older white patients from high-income countries, with preserved ejection fraction and high comorbidity burden. Patients with greater non-HF medication use were less likely to receive guideline-directed HF medications and more likely to take medications that can worsen HF. Crude hazard ratios (HRs) for 1-year mortality were 1.16 (95% confidence interval [CI] 1.08-1.25) for polypharmacy and 1.46 (95% CI 1.31-1.63) for hyper-polypharmacy versus no polypharmacy. After adjustment, hyper-polypharmacy remained associated with increased mortality (HR 1.16, 95% CI 1.01-1.33).CONCLUSIONSNon-HF polypharmacy in HF is common worldwide, particularly in high-income regions. Its association with reduced use of guideline-directed HF medications and higher usage of medications causing or worsening HF, as well as elevated 1-year mortality, underscores the importance of addressing polypharmacy in HF.CLINICAL TRIAL REGISTRATIONClinicalTrials.gov NCT02595814.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"5 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194881","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's new in heart failure? August 2025","authors":"Alberto Aimo,&nbsp;Pau Codina,&nbsp;Matthew M.Y. Lee,&nbsp;Daniela Tomasoni,&nbsp;Michael Böhm","doi":"10.1002/ejhf.70020","DOIUrl":"10.1002/ejhf.70020","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 8","pages":"1375-1378"},"PeriodicalIF":10.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190532","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":"Blood pressure, safety and clinical efficacy of vericiguat in chronic heart failure with reduced ejection fraction: Insights from the VICTOR trial.","authors":"Robert J Mentz,Javed Butler,Ciaran J McMullan,Daniel M Wojdyla,Kevin J Anstrom,Irina Barash,Marc P Bonaca,Maria Borentain,Stefano Corda,Justin A Ezekowitz,Davis Gates,Carolyn S P Lam,Eldrin F Lewis,JoAnn Lindenfeld,Christopher M O'Connor,Piotr Ponikowski,Yogesh N V Reddy,Giuseppe M C Rosano,Clara Saldarriaga,Michele Senni,Pedro Pinto Teixeira,James Udelson,Alessia Urbinati,Vanja Vlajnic,Adriaan A Voors,Aiwen Xing,Faiez Zannad, ","doi":"10.1002/ejhf.70033","DOIUrl":"https://doi.org/10.1002/ejhf.70033","url":null,"abstract":"AIMSThe efficacy and safety of vericiguat in patients with chronic heart failure with reduced ejection fraction (HFrEF) on contemporary heart failure (HF) therapies and without recent worsening was investigated in the VICTOR trial, yet some subgroups may be more susceptible to symptomatic hypotension.METHODS AND RESULTSAmong VICTOR trial participants that received at least one dose of study drug or placebo, we describe the systolic blood pressure (SBP) trajectories over time (mean change from baseline), symptomatic hypotension events and efficacy of vericiguat in potentially vulnerable patient subgroups: lower baseline blood pressure (SBP ≤110 mmHg), older patients (>75 years) and those taking angiotensin receptor-neprilysin inhibitors (ARNI) or sodium-glucose co-transporter 2 inhibitors (SGLT2i) at baseline. The efficacy outcomes of cardiovascular death and HF hospitalization and cardiovascular death alone across baseline SBP were examined using Cox proportional hazards models. Overall SBP trajectories showed a small initial decline from baseline in vericiguat-treated patients compared with placebo (placebo-corrected differences of -1.17 [-1.84, -0.50], p = 0.0007) that was relatively stable throughout follow-up. This trajectory was similar in those >75 years (vs. younger) as well as those receiving ARNI or SGLT2i (as compared with those not receiving these) or those with SBP ≤110 mmHg at baseline (compared with >110 mmHg). Symptomatic hypotension occurred in 11.3% of vericiguat-treated patients compared with 9.2% of placebo-treated patients with an adjusted hazard ratio of 1.24 (95% confidence interval 1.06-1.46), which was similar across age, SBP, SGLT2i and ARNI groups (all interaction p >0.05). The treatment effect of vericiguat compared with placebo on the efficacy outcomes was similar across the spectrum of baseline SBP (both interaction p >0.15).CONCLUSIONSVericiguat showed a slight adjusted decrease in SBP and resulted in more symptomatic hypotension compared with placebo but was overall well-tolerated in a broad population with HFrEF on contemporary therapy even among those predisposed to hypotension. Treatment effects on efficacy outcomes were consistent regardless of baseline SBP.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"20 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182607","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":"Acute heart failure care - a consensus series of an international experts' group.","authors":"Gad Cotter,Jan Biegus,Marat Fudim,Òscar Miró,Andrew P Ambrosy,Matteo Pagnesi,Ovidiu Chioncel,Beth Davison,Yonathan Freund,Edimar A Bocchi,Javed Butler,Anastase Dzudie,Sivadasanpillai Harikrishnan,Ivna C G V Lima,Robert J Mentz,Siti E Nauli,Mauro Riccardi,Naoki Sato,Gianluigi Savarese,Karen Sliwa,Yuhui Zhang,Jingmin Zhou,Alexandre Mebazaa,Sean Collins","doi":"10.1002/ejhf.70057","DOIUrl":"https://doi.org/10.1002/ejhf.70057","url":null,"abstract":"The care of patients hospitalized for acute heart failure (AHF) has been largely unchanged from the early 1960s until a few years ago, consisting mainly of oxygen and diuretics supplemented sometimes by other vasoactive drugs. These treatments, although effective in the short term in controlling congestion, do not prevent early readmissions and death, occurring in over 30% of patients in the 6 months after an AHF hospitalization. In the last years, studies showed that AHF diagnosis can be improved, early diuretic care can be optimized, and early intensive therapy with combined drug regimens can reduce the rate of adverse outcomes. However, unlike acute coronary syndromes, where guidelines have existed since 1996, there are no separate detailed guidelines for AHF. In a series of four papers (International Expert Opinion Series on AHF Management) an international expert group highlights important aspects of AHF care where the evidence base to inform clinical practice is lacking. These papers focus on (1) diagnosis and treatment during prehospital and in the emergency department, (2) management during the first days of admission, (3) care before and after AHF discharge, and (4) hospitalized AHF management in patients presenting with cardiogenic shock, significant valvular disease, or end-stage renal disease. These papers are not intended to serve as guidelines, but rather to suggest a framework for future recommendations for the diagnosis and treatment of AHF. In the current summary paper, we highlight the main considerations and key recommendations in each of the parts of AHF care.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"96 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182677","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 major cardiovascular events in patients with metabolic dysfunction-associated steatotic liver disease in the general population.","authors":"Yvonne Huber,Lea Hofmann,Jürgen H Prochaska,Thomas Koeck,Julian Chalabi,Norbert Pfeiffer,Manfred Beutel,Konstantin Strauch,Karl J Lackner,Oliver Tüscher,Thomas Münzel,Matthias M Weber,Julia Weinmann-Menke,Philipp Wild,Peter R Galle,Jörn M Schattenberg","doi":"10.1002/ejhf.70053","DOIUrl":"https://doi.org/10.1002/ejhf.70053","url":null,"abstract":"AIMSMajor adverse cardiovascular events (MACE) related to cardiovascular disease are a major cause of death in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We explored the impact of MASLD on incident MACE and overall mortality in the general population in Germany.METHODS AND RESULTSA total of 14 575 patients were included for the analysis. Elevated liver enzymes were present in 21.7% and MASLD, defined with a positive fatty liver index (FLI) in the absence of relevant alcohol use, was detected in 37% of participants. MACE were defined as a three-item composite endpoint of acute myocardial infarction (AMI), stroke and cardiovascular mortality (3-point MACE) and extended MACE (eMACE) including MACE criteria, incident atrial fibrillation and pulmonary embolism. In the group with a positive FLI (≥60) a higher rate of male sex and a higher age as well as a higher prevalence of metabolic and cardiovascular risk factors compared to the group with a negative FLI (<30) were present. At 5 years of follow-up, 475 patients (3.7%) developed 3-point MACE and 577 (4.9%) developed eMACE. In the subgroup with MASLD, the incidence of eMACE was higher (7.1% vs. 3.7%; p < 0.0001). Using Cox regression analysis with a stepwise adjustment strategy, we were able to show an independent prediction of MACE and eMACE by hepatic steatosis under consideration of various confounders. The presence of MASLD was associated with an increased risk of developing MACE by 62.3% (p < 0.0001) and eMACE by 44.0% (p < 0.0001). Importantly, MASLD was associated with an increased risk for all-cause mortality (hazard ratio 1.55; p < 0.0001).CONCLUSIONSMetabolic dysfunction-associated steatotic liver disease is an independent risk factor for MACE and is associated with a significantly increased risk of all-cause mortality. In the management of patients with cardiovascular risk, identification of MASLD can potentially refine their disease trajectory.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"1 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140317","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":"Future development of arrhythmogenic risk scores in patients with heart failure and inherited dilated cardiomyopathy. A scientific statement of the Heart Failure Association of the ESC.","authors":"Marta Gigli,Job A J Verdonschot,Pablo Garcia-Pavia,Davide Stolfo,Lorenzo Monserrat,Sanjay Prasad,Andrea Mazzanti,Folkert W Asselbergs,Barbara Bauce,Philippe Charron,Dana Dawson,Brian P Halliday,Luisa Mestroni,Petar Seferovic,Upasana Tayal,Maria Teresa Tome Esteban,Peter Van Tintelen,Stephane Heymans,Antonis Pantazis,Marco Metra,Gianfranco Sinagra","doi":"10.1002/ejhf.70042","DOIUrl":"https://doi.org/10.1002/ejhf.70042","url":null,"abstract":"The risk of sudden cardiac death (SCD) in the general population of patients with dilated cardiomyopathy (DCM) has progressively declined with the implementation of novel medical strategies. However, still cases occur in young individuals and the challenge of risk stratification remains unsolved. Traditional criteria, including left ventricular ejection fraction, have demonstrated their profound weakness to identify subjects at high risk of SCD in this specific context. The increasing availability of genetic information has allowed identification of certain genotypes with a high arrhythmic risk that deserve a more individualized approach. Recent European guidelines recognized the contribution of genetic information in clinical decision-making. Gene-specific risk stratification tools have been developed, and in some cases externally validated, which can support clinicians in the decisions on SCD primary prevention interventions. However, they are generally based on basic variables, whereas the growing amount of knowledge on novel methods for risk prediction, and in particular the solid data on the predictive value of cardiac magnetic resonance tissue characterization (i.e. late gadolinium enhancement) are not incorporated in available scores, and more in general, are not systematically part of the clinical work-up. In this scientific statement, we summarized the current state of the art concerning the risk stratification of SCD in DCM, with particular emphasis on genetic forms, highlight the weaknesses of the available strategies and the potential actions needed for improving them. Available risk stratification tools are discussed, and methodologies that should be incorporated in future prognostication models are summarized. Lastly, a point-by-point summary of the key prerequisites for developing the future arrhythmogenic risk scores in patients with DCM is provided.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"13 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133958","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 implementation of guideline-directed medical and device therapies in heart failure: Insights from the Central/Eastern Europe Quality of Care Centres Survey.","authors":"Petar M Seferović,Marija Polovina,Jan Krejči,Bela Merkely,Mariya Tokmakova,Martin Huelssmann,Vladimir Miloradović,Svetlana Apostolović,Elizabeta Srbinovska-Kostovska,Slavica Radovanović,Anastazija Stojšić-Milosavljević,Aleksandra Milovančev,Marija Zdravković,Duška Glavaš,Tamara Preradović-Kovačević,Eva Goncalvesova,Michal Laufer-Perl,Nataša Marković-Nikolić,Zumreta Kušljugić,Larisa Hudić-Dizdarević,Dan Gaita,Ginta Kamzola,Robert Sepp,Dragan Simić,Arsen Ristić,Milika Ašanin,Gordana Krljanac,Petar Otašević,Dejana Stanisavljević,Davor Miličić,Magdy Abdelhamid,Gianluigi Savarese, ","doi":"10.1002/ejhf.70031","DOIUrl":"https://doi.org/10.1002/ejhf.70031","url":null,"abstract":"AIMSThe Central/Eastern Europe (CEE) Quality of Care Centres (QCC) Survey evaluated the implementation of guideline-directed medical therapies (GDMT) and device use at discharge after heart failure (HF) hospitalization in CEE, where GDMT underutilization remains a concern.METHODS AND RESULTSBetween March 2024 and January 2025, 2251 patients (mean age 70.0 years, 60.4% male) were enrolled at discharge from 21 centres across 12 CEE countries. The patient population included HF with reduced ejection fraction (HFrEF) (55.5%), HF with mildly reduced ejection fraction (15.3%) and HF with preserved ejection fraction (27.9%). In the total population, from admission to discharge there was a increase in the use of angiotensin receptor-neprilysin inhibitor (ARNI) (17.1% to 34.3%), beta-blockers (69.4% to 92.4%), mineralocorticoid receptor antagonists (MRA) (44.0% to 82.1%) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) (30.8% to 79.9%), with a reduction in angiotensin-converting enzyme inhibitor (ACEI) use (all p < 0.05). Similar trends were observed across HF phenotypes, including HFrEF (increased use of ARNI, 26.3% to 55.1%, beta-blockers, 69.8% to 95.3%, MRA 49.5% to 89.0%, and SGLT2I 36.2% to 79.8%, and lower ACEI use, all p < 0.05). At discharge, 53.5% of patients received quadruple therapy (63.9% with HFrEF), while ≥50% target doses of titratable drugs were achieved in 18.8% (17.8% in HFrEF). Predictors of GDMT underuse included older age, lower education, living alone, non-ischaemic HF, higher ejection fraction, chronic kidney disease, hypotension, hyperkalaemia, prolonged hospitalization, and residual oedema. Among eligible HFrEF patients, 21.3% were discharged with, or referred for implantable cardioverter-defibrillator, and 17.4% for cardiac resynchronization therapy.CONCLUSIONSThe CEE-QCC Survey highlights substantial in-hospital GDMT implementation and up-titration, though device use remains limited. Targeted strategies are needed to enhance guideline implementation and ensure optimal HF care across the CEE region.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"93 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133960","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":"Deep phenotyping of heart failure with preserved ejection fraction through multi-omics integration.","authors":"Jakob Versnjak,Titus Kuehne,Pauline Fahjen,Nina Jovanovic,Ulrike Löber,Gabriele G Schiattarella,Nicola Wilck,Holger Gerhardt,Dominik N Müller,Frank Edelmann,Philipp Mertins,Roland Eils,Michael Gotthardt,Sofia K Forslund,Benjamin Wild,Marcus Kelm","doi":"10.1002/ejhf.70041","DOIUrl":"https://doi.org/10.1002/ejhf.70041","url":null,"abstract":"AIMSHeart failure with preserved ejection fraction (HFpEF) has become the predominant form of heart failure and a leading cause of global cardiovascular morbidity and mortality. Due to its heterogeneous nature, HFpEF presents substantial challenges in diagnosis and management. Given the limited treatment options and lifestyle-associated comorbidities, early identification is crucial for establishing effective preventive strategies. Here, we introduce and validate a machine learning-based multi-omics approach that integrates clinical and molecular data to detect and characterize HFpEF.METHODS AND RESULTSA supervised classifier was trained on a stratified subset of UK Biobank participants (n = 401 917) to identify phenotypic profiles associated with subsequent symptom-defined HFpEF during longitudinal follow-up. Model performance was validated in a non-overlapping hold-out subset from all 22 UK Biobank assessment centres (n = 100 446; 6726 HFpEF cases; 7394 with multi-omics data). The classifier demonstrated robust discriminatory performance, with a receiver operating characteristic area under the curve (ROC AUC) of 0.931 (95% confidence interval [CI] 0.930-0.931), a sensitivity of 0.857 (95% CI 0.855-0.860) and a specificity of 0.847 (95% CI 0.846-0.847). It identified individuals who subsequently developed HFpEF an average of 6.3 ± 3.9 years before symptom onset in asymptomatic individuals. Similarity network fusion (SNF) identified distinct subgroups, including a high-risk cluster characterized by elevated mortality and dysregulated inflammatory pathways, which was distinguishable with high accuracy (ROC AUC 0.988; 95% CI 0.985-0.990).CONCLUSIONSWe identified HFpEF phenotypes at an early stage, often several years before the onset of clinical symptoms, when the disease trajectory may still be amenable to modification. The molecular characterization provides novel insights into the underlying disease complexity and enables more refined risk stratification.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"1 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103418","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":"Effect of glucagon-like peptide-1 receptor agonists on heart failure outcomes and cardiovascular death across varying cardiovascular-kidney-metabolic comorbidity.","authors":"Tariq Jamal Siddiqi,Muhammad Shahzeb Khan,Saad Ahmed Waqas,Harriette G C Van Spall,Michael D Shapiro,Gregg C Fonarow,James L Januzzi,Aasim M Afzal,Ambarish Pandey,Javed Butler,Stephen J Greene","doi":"10.1002/ejhf.70048","DOIUrl":"https://doi.org/10.1002/ejhf.70048","url":null,"abstract":"AIMSEffects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on heart failure hospitalization (HFH) and cardiovascular (CV) death among patients with varying overlap of cardiovascular-kidney-metabolic (CKM) comorbidity are not well characterized. This study aimed to assess effects GLP-1RAs on HFH and CV death across populations with varying type and number of CKM comorbidity.METHODS AND RESULTSOnline databases were queried through November 2024 for primary and secondary analyses of clinical outcome trials of GLP-1RAs in patients with heart failure (HF), type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), obesity, and combinations of these diseases. Primary outcome was a composite HFH or CV death. Secondary outcomes were first HFH and CV death. Hazard ratios (HRs), risk ratios (RRs), and their 95% confidence intervals (CI) were derived using random-effects models. Fifteen trials (n = 87 549) were included. Compared with placebo, GLP-1RAs reduced the relative risk of composite HFH/CV death in HF (HR 0.81, 95% CI 0.69-0.96), T2DM (HR 0.85, 95% CI 0.78-0.93), and obesity (HR 0.70, 95% CI 0.58-0.86), with a non-significant risk reduction in CKD (HR 0.79, 95% CI 0.61-1.01). GLP-1RAs reduced the risk of HFH in T2DM (HR 0.89, 95% CI 0.80-0.99) and obesity (HR 0.63, 95% CI 0.45-0.87), with a non-significant risk reduction among patients with HF (HR 0.85, 95% CI 0.69-1.04) and CKD (HR 0.82, 95% CI 0.64-1.06). GLP-1RAs also significantly reduced CV death in HF (HR 0.88, 95% CI 0.77-0.99), T2DM (HR 0.85, 95% CI 0.78-0.93), and in obesity (HR 0.83, 95% CI 0.73-0.93), with a non-significant risk reduction in CKD (HR 0.80, 95% CI 0.60-1.08). Effects were consistent across subgroups, except for HF with reduced ejection fraction (HFrEF), where GLP-1RAs showed a non-significant risk increase in HFH (HR 1.17, 95% CI 0.93-1.47) but significantly reduced CV death (HR 0.67, 95% CI 0.50-0.90). GLP-1RAs were not associated with increased risk for serious adverse events (RR 0.94, 95% CI 0.89-1.00).CONCLUSIONSGlucagon-like peptide-1 receptor agonists reduce HFH and CV death across CKM conditions, with generally consistent effects in varying combinations of these diseases. The potential exception is among patients with HFrEF, where a reduction in risk of CV death, but a numeric increase in HFH, was observed. Definitive CV outcome trials are needed to definitively determine effects of GLP-1RAs in patients with established HFrEF.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"22 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103417","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}