European Journal of Heart Failure最新文献

{"title":"Correction to “Biologically active adrenomedullin as a marker for residual congestion and early rehospitalization in patients hospitalized for acute heart failure: Data from STRONG-HF”","authors":"","doi":"10.1002/ejhf.3561","DOIUrl":"10.1002/ejhf.3561","url":null,"abstract":"<p>Voordes G, Davison B, Biegus J, Edwards C, Damman K, ter Maaten J, <i>et al</i>. Biologically active adrenomedullin as a marker for residual congestion and early rehospitalization in patients hospitalized for acute heart failure: Data from STRONG-HF. <i>Eur J Heart Fail</i> 2024; <b>26</b>:1480–1492. https://doi.org/10.1002/ejhf.3336</p><p>The middle initials of Geert Voordes and Jozine ter Maaten were previously missing but have now been corrected in the published article. The names now read as follows: Geert H.D. Voordes and Jozine M. ter Maaten.</p><p>We apologize for this error.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 1","pages":"184"},"PeriodicalIF":16.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3561","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857688","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":"Guideline-directed medical therapy for heart failure in arrhythmia-induced cardiomyopathy with improved left ventricular ejection fraction","authors":"Luis Manuel Domínguez-Rodríguez,&nbsp;David Dobarro,&nbsp;Carla Iglesias-Otero,&nbsp;María G. Crespo-Leiro,&nbsp;Sergio Raposeiras-Roubín,&nbsp;Jesús Álvarez-García,&nbsp;Manuel Barreiro-Pérez,&nbsp;Isabel Muñoz-Pousa,&nbsp;Angel Sánchez-Recalde,&nbsp;Ándrés Íñiguez-Romo,&nbsp;José Luis Zamorano","doi":"10.1002/ejhf.3556","DOIUrl":"10.1002/ejhf.3556","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>No study has analyzed the impact of guideline-directed medical therapy in preventing heart failure (HF) relapse in patients with arrhythmia-induced cardiomyopathy (AiCM) following left ventricular ejection fraction (LVEF) improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>We analyzed data from a single-center cohort of 200 patients admitted for HF, LVEF &lt;50% and cardiac arrhythmia considered by cardiologists to be the precipitating cause of the episode. The primary endpoint was time-to-HF relapse, defined as the composite of readmission for HF, Emergency Department (ED) visit for HF, or significant decline in LVEF. Changes in medication were recorded and a time-varying multivariate Cox regression was performed. After a median follow-up period of 6.14 years, diagnostic confirmation was achieved in 188 out of the initial 200 patients with suspected AiCM. A total of 89 patients (47.3%) met the primary endpoint. RAS inhibitors (adjusted hazard ratio (HR) 0.50 [0.31–0.81]; <i>p</i> = 0.005) and beta-blockers (adjusted HR 0.48 [0.28–0.81]; <i>p</i> = 0.006) were associated with a lower incidence of relapse. Mineralocorticoid receptor antagonists were associated with a significantly lower incidence of ED visits for HF (adjusted HR 0.38 [0.15–0.95]; <i>p</i> = 0.038), but did not achieve statistical significance for the combined primary endpoint. Antiarrhythmic drugs did not show a significant impact on the primary endpoint.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Maintaining RAS inhibitors and beta-blockers was associated with a significantly lower incidence of relapse in the setting of AiCM with improved LVEF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 3","pages":"442-452"},"PeriodicalIF":16.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3556","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848838","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":"Prediction of new-onset atrial fibrillation in patients with hypertrophic cardiomyopathy using machine learning","authors":"Ree Lu,&nbsp;Heidi S. Lumish,&nbsp;Kohei Hasegawa,&nbsp;Mathew S. Maurer,&nbsp;Muredach P. Reilly,&nbsp;Shepard D. Weiner,&nbsp;Albree Tower-Rader,&nbsp;Michael A. Fifer,&nbsp;Yuichi J. Shimada","doi":"10.1002/ejhf.3546","DOIUrl":"10.1002/ejhf.3546","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) is the most common sustained arrhythmia among patients with hypertrophic cardiomyopathy (HCM), leading to increased symptom burden and risk of thromboembolism. The HCM-AF score was developed to predict new-onset AF in patients with HCM, though sensitivity and specificity of this conventional tool are limited. Thus, there is a need for more accurate tools to predict new-onset AF in HCM. The objective of the present study was to develop a better model to predict new-onset AF in patients with HCM using machine learning (ML).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>In this prospective, multicentre cohort study, we enrolled 1069 patients with HCM without a prior history of AF. We built a ML model (logistic regression with Lasso regularization) using clinical variables. We developed the ML model using the cohort from one institution (training set) and applied it to an independent cohort from a separate institution (test set). We used the HCM-AF score as a reference model. We compared the area under the receiver-operating characteristic curve (AUC) between the ML model and the reference model using the DeLong's test. Median follow-up time was 2.1 years, with 128 (12%) patients developing new-onset AF. Using the ML model developed in the training set to predict new-onset AF, the AUC in the test set was 0.84 (95% confidence interval [CI] 0.77–0.91). The ML model outperformed the reference model (AUC 0.64; 95% CI 0.54–0.73; DeLong's <i>p</i> &lt; 0.001). The ML model had higher sensitivity (0.82; 95% CI 0.65–0.93) than that of the reference model (0.67; 95% CI 0.52–0.88). The ML model also had higher specificity (0.76; 95% CI 0.71–0.81) than that of the reference model (0.57; 95% CI 0.41–0.70). Among the most important clinical variables included in the ML-based model were left atrial volume and diameter, left ventricular outflow tract gradient with exercise stress and at rest, late gadolinium enhancement on cardiac magnetic resonance imaging, peak heart rate during exercise stress, age at diagnosis, positive genotype, diabetes mellitus, and end-stage renal disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our ML model showed superior performance compared to the conventional HCM-AF score for the prediction of new-onset AF in patients with HCM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 2","pages":"275-284"},"PeriodicalIF":16.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142849115","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":"Mortality after high-risk myocardial infarction over the last 20 years: Insights from the VALIANT and PARADISE-MI trials","authors":"Alberto Foà,&nbsp;Maria A. Pabon,&nbsp;Eugene Braunwald,&nbsp;Karola Jering,&nbsp;Muthiah Vaduganathan,&nbsp;Brian L. Claggett,&nbsp;Lars Køber,&nbsp;Eldrin F. Lewis,&nbsp;Christopher B. Granger,&nbsp;Peter van der Meer,&nbsp;Jean L. Rouleau,&nbsp;Aldo P. Maggioni,&nbsp;John J.V. McMurray,&nbsp;Scott D. Solomon,&nbsp;Marc A. Pfeffer","doi":"10.1002/ejhf.3557","DOIUrl":"10.1002/ejhf.3557","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The temporal changes in clinical profiles and outcomes of high-risk myocardial infarction survivors enrolled in clinical trials are poorly described. This study compares mortality rates, baseline characteristics, and the prognostic impact of therapies among participants of the VALIANT and PARADISE-MI trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>Exclusively VALIANT participants who matched the inclusion criteria of the PARADISE-MI trial were included in the analysis. Risk of death was compared between trials using Cox regression models. The impact of baseline characteristics and therapies on mortality was estimated by the magnitude reduction of β coefficients using Cox proportional hazards regression models. A total of 9617 VALIANT participants matched the inclusion criteria of the PARADISE-MI trial (<i>n</i> = 5661). All-cause mortality in PARADISE-MI was less than half that in VALIANT (4.2 vs 9.9 per 100 patient-years; hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.37–0.46). This difference was reduced after adjustment for clinical variables but remained substantial (adjusted HR 0.68, 95% CI 0.58–0.80). The most important mediator of this reduction related to covariate adjustment was the use of percutaneous coronary intervention (PCI), accounting for almost half of the attenuation observed. Similar results were found for cardiovascular (CV) death, while no between-trial significant differences were found in the non-CV mortality risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cardiovascular mortality following high-risk myocardial infarction has significantly declined over time, while the risk for non-CV death has remained unchanged. This improvement is partially attributable to advancements in CV care, particularly the use of PCI. Continued efforts to implement guidelines and standardize the quality of care are needed to sustain this positive trend.</p>\u0000 </section>\u0000 </div>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 3","pages":"589-597"},"PeriodicalIF":16.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142849113","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":"Association between body mass index and clinical outcomes in patients with acute myocardial infarction and reduced systolic function: Analysis of PARADISE-MI trial data","authors":"Offer Amir,&nbsp;Gabby Elbaz-Greener,&nbsp;Shemy Carasso,&nbsp;Brian Claggett,&nbsp;Olga Barbarash,&nbsp;Azfar Zaman,&nbsp;Christina Christersson,&nbsp;Songsak Kiatchoosakun,&nbsp;John Anonuevo,&nbsp;Grzegorz Opolski,&nbsp;Mody F. Vaghaiwalla,&nbsp;Peter van der Meer,&nbsp;Yinong Zhou,&nbsp;Douglas L. Mann,&nbsp;Lars Kober,&nbsp;Gabriel Steg,&nbsp;Karola Jering,&nbsp;Ian Kulac,&nbsp;Carmine G. De Pasquale,&nbsp;John J.V. McMurray,&nbsp;Marc A. Pfeffer,&nbsp;for the PARADISE-MI Investigators and Committees","doi":"10.1002/ejhf.3542","DOIUrl":"10.1002/ejhf.3542","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The relationship between body mass index (BMI) and clinical outcomes in patients with cardiovascular disease, including acute heart failure (AHF) and acute myocardial infarction (AMI), remains debated. This study investigates the association between BMI and clinical outcomes within the PARADISE-MI cohort, while also evaluating the impact of angiotensin receptor–neprilysin inhibitor (ARNI) versus angiotensin-converting enzyme inhibitor (ACE-I) treatment on this relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>The analysis included 5589 patients from the PARADISE-MI study with available baseline BMI data. The cohort comprised patients with AMI and pulmonary congestion and/or left ventricular ejection fraction ≤40%. Patients were categorized into six World Health Organization BMI subgroups. The primary outcome of interest was the composite endpoint of cardiovascular death, heart failure (HF)-associated hospitalization, and outpatient symptomatic HF episodes. The mean baseline BMI of the cohort was 28.1 ± 5.0 kg/m². The lowest rate of the primary composite endpoint (6.2/100 patient-years) was observed in overweight patients (BMI 25–29.9 kg/m²), while the highest rates were found in the lowest and highest BMI subgroups (8.4/100 patient-years for BMI &lt;18.5 kg/m² and 9.7/100 patient-years for BMI &gt;40 kg/m²). There was no significant interaction between BMI and the treatment effect of ARNI versus ACE-I on the primary composite outcome (<i>p</i> = 0.73). Additionally, no significant differences in the incidence of adverse events or serious adverse events were noted across the BMI subgroups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In AMI with AHF patients, the relationship between BMI and the primary composite outcome is non-linear, with the lowest event rates observed in overweight individuals. Outcomes and safety profiles for ARNI and ACE-I treatments were similar across BMI subgroups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 3","pages":"558-565"},"PeriodicalIF":16.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3542","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142841768","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":"Observational study for multiparametric assessment of cardiac congestion in outpatient worsening heart failure (EVOLUTION)","authors":"Gad Cotter,&nbsp;Beth Davison,&nbsp;Philip Janiak,&nbsp;Christopher Edwards,&nbsp;Maria Novosadova,&nbsp;Koji Takagi,&nbsp;Marie-Laure Ozoux,&nbsp;Francesca Lawson,&nbsp;Hamlet Hayrapetyan,&nbsp;Hamayak Sisakian,&nbsp;Victor R. Ter-Grigoryan,&nbsp;Katell Peoc'h,&nbsp;Alexandre Raynor,&nbsp;Paul Bruzeau,&nbsp;Alexis Nguyen,&nbsp;Alexandre Mebazaa","doi":"10.1002/ejhf.3555","DOIUrl":"10.1002/ejhf.3555","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We sought to characterize the clinical course of patients following worsening heart failure (WHF) treated in an outpatient setting and to identify factors associated with a poor response to standard of care with loop diuretics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>Between September 2022 and March 2023, 44 eligible patients (mean age 66.3 years, 84% male) with ejection fraction &lt;50% and with WHF symptoms in the preceding week treated in an outpatient setting were enrolled. Patients were assessed weekly over 4 weeks following the WHF episode. At week 4, responses to fluid expansion and furosemide administration were assessed in 39 patients to unmask persistent subclinical congestion. Patients were on stable doses of guideline-directed medical therapy (GDMT) with a mean daily furosemide dose of 47.4 mg. Patient-reported and physician-assessed symptoms and quality of life improved over the 4 weeks. At 1 h following 1 L Ringer solution infused over 2 h, the median (interquartile range) urine volume and urine sodium excreted over 3 h were 300 (200.0–500.0) ml and 39.6 (12.4–63.0) mEq, respectively. Receiver-operating characteristic curves suggest that cystatin C &gt;1.2 ng/ml, N-terminal pro-B-type natriuretic peptide (NT-proBNP) &gt;1500 pg/ml, and high-sensitivity troponin T &gt;20 pg/ml represent good predictors of non-response to a fluid challenge (diuresis, natriuresis, and rales) following an outpatient WHF, with having all three markers associated with the worst response.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with high levels of troponin, or NT-proBNP, or cystatin C who develop WHF despite being treated with a loop diuretic, need novel therapies for WHF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 2","pages":"325-336"},"PeriodicalIF":16.9,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3555","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142849114","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":"Effect of sacubitril/valsartan in heart failure with preserved ejection fraction across the age spectrum in PARAGON-HF","authors":"Xiaowen Wang,&nbsp;Orly Vardeny,&nbsp;Brian Claggett,&nbsp;Muthiah Vaduganathan,&nbsp;Sheila M. Hegde,&nbsp;Hicham Skali,&nbsp;Maria A. Pabon,&nbsp;Alberto Foà,&nbsp;Safia Chatur,&nbsp;Annamaria Kosztin,&nbsp;Eileen O'Meara,&nbsp;Jean Rouleau,&nbsp;Margaret Redfield,&nbsp;Carolyn S.P. Lam,&nbsp;Michael Zile,&nbsp;Milton Packer,&nbsp;Amil M. Shah,&nbsp;Maja Cikes,&nbsp;Mauro Gori,&nbsp;Bela Merkely,&nbsp;Marc A. Pfeffer,&nbsp;John J.V. McMurray,&nbsp;Scott D. Solomon","doi":"10.1002/ejhf.3535","DOIUrl":"10.1002/ejhf.3535","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate clinical outcomes, echocardiographic features, and the efficacy and safety of sacubitril/valsartan compared to valsartan across age groups in the PARAGON-HF trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>A total of 4796 participants ≥50 years of age with chronic heart failure (HF) and left ventricular ejection fraction (LVEF) ≥45% were divided into three age groups: &lt;65 years (<i>n</i> = 825), 65–74 years (<i>n</i> = 1772), and ≥75 years (<i>n</i> = 2199). Echocardiograms of 1097 patients were analysed in a standardized fashion at a core imaging laboratory. The primary composite outcome was total HF hospitalizations and cardiovascular (CV) death. Older patients were more likely to experience primary composite outcomes (compared to patients &lt;65 years, adjusted rate ratio [aRR] for ≥75 years: 1.39, 95% confidence interval [CI] 1.21–1.61), total HF hospitalization (aRR 1.27, 95% CI 1.09–1.49), and CV death (adjusted hazard ratio [aHR] 2.04, 95% CI 1.44–2.87). Age did not modify the effect of sacubitril/valsartan compared to valsartan on primary composite endpoint (<i>p</i>_interaction = 0.79) in the overall population or in those with LVEF ≤57%. Older adults randomized to sacubitril/valsartan were more likely to develop hypotension compared to those receiving valsartan (<i>p</i>_interaction = 0.026). Older patients had smaller left ventricular chamber sizes, higher LVEF, and were more likely to have abnormal measures of diastolic function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Older patients with HF with preserved ejection fraction had higher event rates than younger patients, more adverse events overall, and more hypotension when treated with sacubitril/valsartan; however, the treatment benefits of sacubitril/valsartan were retained in older patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 1","pages":"96-106"},"PeriodicalIF":16.9,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825152","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 risk of death according to left ventricular ejection fraction and right ventricular dilatation in 17 321 adults with heart failure from 40 high-, middle- and low-income countries – A Global Congestive Heart Failure (G-CHF) study","authors":"Darryl P. Leong, Philip G. Joseph, Hisham Dokainish, Stefan Störk, John V.V. McMurray, Lisa M. Mielniczuk, Sanjib Kumar Sharma, Andrés Orlandini, Kamilu M. Karaye, Antoni Bayes-Genis, Tara McCready, Alex Grinvalds, Kumar Balasubramanian, Kelley R. Branch, Kristian Kragholm, Salim Yusuf","doi":"10.1002/ejhf.3550","DOIUrl":"https://doi.org/10.1002/ejhf.3550","url":null,"abstract":"The aim of this study was to describe the prognostic importance of left ventricular ejection fraction (LVEF) versus right ventricular (RV) dilatation and dysfunction in patients with heart failure (HF) from countries of different income levels.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"51 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825132","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":"Empagliflozin to prevent worsening of left ventricular volumes and systolic function after myocardial infarction (EMPRESS-MI)","authors":"Jaclyn Carberry,&nbsp;Mark C. Petrie,&nbsp;Matthew M.Y. Lee,&nbsp;Bethany Stanley,&nbsp;Katriona J.M. Brooksbank,&nbsp;Ross T. Campbell,&nbsp;Richard Good,&nbsp;Pardeep S. Jhund,&nbsp;Peter Kellman,&nbsp;Ninian N. Lang,&nbsp;M. Mitchell Lindsay,&nbsp;Kenneth Mangion,&nbsp;Roy S. Gardner,&nbsp;Patrick B. Mark,&nbsp;Barbara Meyer,&nbsp;Joanne O'Donnell,&nbsp;Vanessa Orchard,&nbsp;Aadil Shaukat,&nbsp;Stuart Watkins,&nbsp;Alex McConnachie,&nbsp;John J.V. McMurray,&nbsp;Paul Welsh,&nbsp;Naveed Sattar,&nbsp;Colin Berry,&nbsp;Kieran F. Docherty","doi":"10.1002/ejhf.3560","DOIUrl":"10.1002/ejhf.3560","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Patients with a reduced left ventricular ejection fraction (LVEF) following an acute myocardial infarction (MI) are considered to be at risk of progressive adverse cardiac remodelling which can lead to the development of heart failure and death. The early addition of a sodium–glucose cotransporter 2 (SGLT2) inhibitor to standard treatment may delay or prevent progressive adverse remodelling in these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>We performed a randomized, double-blind, placebo-controlled, multicentre trial using cardiovascular magnetic resonance imaging (MRI), in patients with left ventricular systolic dysfunction following MI. Eligible patients were those ≥12 h and ≤14 days following acute MI, with an LVEF &lt;45% by MRI. Patients were randomized to empagliflozin 10 mg once a day or matching placebo. The primary outcome was the change in left ventricular end-systolic volume indexed to body surface area (LVESVI) from baseline to 24 weeks. Secondary outcomes included measures of left ventricular and atrial volumes, left ventricular mass, LVEF, and high-sensitivity troponin I (hs-TnI) and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentrations. From October 2022 to January 2024, 105 eligible patients were randomized. The mean age was 63 ± 11 years and 90 (87%) were male. The mean LVEF was 34.8 ± 6.0%. In the placebo group, LVESVI decreased by 7.8 ± 16.3 ml/m², left ventricular end-diastolic volume index (LVEDVI) did not change (−0.3 ± 18.7 ml/m²) and LVEF increased by 8.5 ± 7.4% at 24 weeks from baseline. Empagliflozin did not affect the change in LVESVI from baseline to 24 weeks (between-group difference = 0.3 ml/m², 95% confidence interval −5.2 to 5.8; <i>p</i> = 0.92). Compared with placebo, empagliflozin also had no effect on LVEDVI, LVEF, left atrial volume index, left ventricular mass index, NT-proBNP, or hs-TnI, but did increase haematocrit and reduced uric acid and weight.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with left ventricular systolic dysfunction after an acute MI receiving contemporary standard of care, treatment with empagliflozin had no effect on cardiac volumes or LVEF compared with placebo. Progressive adverse cardiac remodelling did not occur in the majority of patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 3","pages":"566-576"},"PeriodicalIF":16.9,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3560","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825134","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":"Tailoring medical therapy for heart failure with preserved ejection fraction","authors":"Riccardo M. Inciardi,&nbsp;Mauro Riccardi,&nbsp;Gianluigi Savarese,&nbsp;Marco Metra,&nbsp;Muthiah Vaduganathan,&nbsp;Scott D. Solomon","doi":"10.1002/ejhf.3558","DOIUrl":"10.1002/ejhf.3558","url":null,"abstract":"<p>Heart failure with preserved ejection fraction (HFpEF) accounts for half of the hospitalization for heart failure (HF) worldwide, and the prevalence is expected to increase along with population aging and increasing burden of cardio-kidney-metabolic disorders.<span>¹</span> Treatment options for chronic HFpEF have expanded in recent years.<span>²</span> Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are now guideline-recommended as a first-line treatment in patients with mildly reduced and preserved ejection fraction. In a meta-analysis of the EMPEROR-Preserved and DELIVER trials, SGLT2i reduced cardiovascular (CV) death or first hospitalization for HF by 20% with consistent reductions in both components (12% risk reduction in CV death and 26% risk reduction in first hospitalization for HF), among HF patients with left ventricular ejection fraction (LVEF) &gt;40%.<span>³</span> In the PARAGON-HF trial, treatment with sacubitril/valsartan led to a marginal reduction of total hospitalizations for HF and CV death compared to valsartan in patients with HF and LVEF ≥45%, with a more pronounced benefit observed in those with an LVEF below normal.<span>⁴</span> Based on the results of this trial, sacubitril/valsartan received indications for use in patients with HF with mildly reduced ejection fraction (HFmrEF) and selected patients with HFpEF with an LVEF below normal in the United States. Lastly, in the FINEARTS-HF trial, the non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone showed a 16% relative risk reduction of worsening HF events and death from CV causes compared to placebo among patients with HF and LVEF ≥40%.<span>⁵</span></p><p>These advances in HFpEF pharmacotherapy, along with the substantial residual risk of this population, highlight the need for an accelerated optimization of foundational medical therapy.</p><p>The rising prevalence worldwide, the burden on the healthcare system and costs related to hospitalization represent critical challenges in the management of HFpEF. Novel therapeutic options advocate a transformative change in the care of chronic HFpEF patients encompassing recognition of multiple treatments, along with the management of comorbidities according to specific HFpEF phenotype. An upfront combination of foundational therapies, potentially enhancing tolerance and persistence of each other, should represent the bedrock of HFpEF treatment by targeting multiple pathophysiological drivers. A simultaneous or rapid sequence initiation of SGLTi and the non-steroidal MRA finerenone may be considered along with tailored therapies including incretin-based therapies and ARNI (<i>Figure</i> 1), based on clinical phenotype and settings, to optimally improve health status and clinical outcomes of patients with HFpEF.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 2","pages":"190-193"},"PeriodicalIF":16.9,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3558","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825135","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}