European Journal of Heart Failure最新文献

{"title":"Silencers versus stabilizers in amyloid cardiomyopathy. Are we asking the wrong questions?","authors":"Rodney H. Falk, Sarah A.M. Cuddy, Osnat Itzhaki Ben Zadok","doi":"10.1002/ejhf.3614","DOIUrl":"10.1002/ejhf.3614","url":null,"abstract":"<p>Transthyretin (TTR) is a small tetrameric molecule with a half-life of 2–2.5 days.<span><sup>1</sup></span> TTR cardiomyopathy is an increasingly recognized cause of progressive heart failure in the elderly and is associated with amyloid production derived from the breakdown of either wild-type TTR or, less commonly, mutant TTR. Two therapeutic mechanisms have been utilized to treat TTR cardiomyopathy, tetramer stabilization and tetramer silencing. The former is designed to lessen amyloidogenic monomers formed from TTR breakdown, which in turn can form dimers, oligomers and eventually amyloid fibrils, and the latter to significantly reduce hepatic TTR production, thereby markedly reducing the amount of breakdown products. The initial therapeutic mechanism to be addressed was TTR stabilization and in both of the two pivotal stabilizer trials of tafamidis and acoramidis respectively, treatment significantly reduced combined morbidity/mortality compared to placebo<span><sup>2, 3</sup></span>. However, while both trials showed that therapy produced a significant blunting of N-terminal pro-B-type natriuretic peptide (NT-proBNP) rise and lesser deterioration of 6-min walk over time compared to placebo, neither showed an improvement in these parameters compared to baseline. In addition, some patients with congestive heart failure progressed to death despite treatment with active drug.</p><p>Failure to prevent disease progression in some patients, particularly those entering the trial as New York Heart Association (NYHA) class III, led to the postulate that TTR stabilizers may be suboptimal for producing complete cessation of amyloid production and raised the question whether a silencer, by significantly reducing TTR production, might be a more effective treatment. The possibility that this might be the case was underscored by the relative efficacy of TTR silencers compared to stabilizers in TTR familial amyloid polyneuropathy (FAP), a disease due exclusively to mutant TTR. While no direct comparison of stabilizers and silencers has been performed in this condition, post-hoc comparison of tafamidis and silencer efficacy suggests that silencers are superior in significantly slowing the relatively rapid progression of polyneuropathy associated with FAP.<span><sup>4</sup></span> In addition, one study of the TTR silencer patisiran examining its efficacy in FAP showed a subtle improvement in longitudinal ventricular contraction in the subgroup with cardiomyopathy,<span><sup>5</sup></span> and vutrisiran therapy in FAP showed a trend to similar results,<span><sup>6</sup></span> raising the possibility that silencers might be associated with improvement of cardiac function.</p><p>The recently-published HELIOS-B trial of vutrisiran, a small-interfering RNA for the treatment of TTR cardiac amyloidosis, was the first such silencer trial to be completed and confirmed the benefit of lowering TTR in cardiac amyloidosis.<span><sup>7</sup></span> Treated patients","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 4","pages":"623-627"},"PeriodicalIF":16.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3614","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412584","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":"Outpatient diuretic intensification across the cardiovascular‐kidney‐metabolic spectrum","authors":"Pedro Marques, João Pedro Ferreira","doi":"10.1002/ejhf.3611","DOIUrl":"https://doi.org/10.1002/ejhf.3611","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"33 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401236","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":"Heart failure guideline implementation in developing countries: A testimony from Syria","authors":"Amr Abdin, Mohammad Bashar Izzat, Ahmad Rasheed Alsaadi, Asim Katbeh, Yassin Bani Marjeh, Suleman Aktaa","doi":"10.1002/ejhf.3625","DOIUrl":"10.1002/ejhf.3625","url":null,"abstract":"<p>The European Society of Cardiology (ESC) develops clinical practice guidelines for a number of cardiovascular diseases including heart failure (HF) to provide evidence-based, up-to-date recommendations designed to be applicable in daily practice.<span><sup>1, 2</sup></span> These guidelines serve as a vital tool for healthcare professionals, offering guidance on patient management based on clinically reviewed contemporary evidence. However, observational studies highlight a gap and geographic variations in the implementation of guideline recommendations,<span><sup>3, 4</sup></span> resulting in missed opportunities to reduce morbidity, mortality, and healthcare utilization associated with HF.<span><sup>5</sup></span></p><p>The implementation of clinical practice guidelines in clinical practice is a complex and challenging process influenced by multiple factors. Numerous barriers and enablers have been identified.<span><sup>6</sup></span> First, barriers related to the guidelines themselves include their complexity, limited accessibility, and poor applicability to real-world practice. Second, barriers associated with healthcare providers include a lack of knowledge and skills, as well as language barriers in multi-ethnic countries. Additionally, patient-related factors, such as limited awareness, poor adherence, and financial constraints, play a significant role. Finally, institutional and resource-related challenges, such as time constraints, suboptimal healthcare networks, inadequate interprofessional communication pathways, and insufficient incentives or reimbursement, further complicate effective implementation.</p><p>In many low- and middle-income countries (LMICs), which account for approximately 50% of global cardiovascular mortality,<span><sup>7</sup></span> the magnitude of the ‘evidence–practice’ gap in HF care is less appreciated and likely more substantial compared with developed countries (<i>Figure</i> 1). Many developing countries lack a structured approach for HF care, with missed or delayed follow-up and limited access to HF specialists and advanced HF therapies.<span><sup>8, 9</sup></span> Understanding the healthcare systems and challenges in these regions is therefore critical. Unfortunately, research from LMICs remains sparse. For example, between 2008 and 2017, 80% of cardiovascular publications originated from high-income countries, while only 0.2% came from LMICs. Syria, for instance, contributed approximately 5% of all publications from LMICs, which equates to just 10 cardiovascular disease publications over a decade.<span><sup>7, 10</sup></span></p><p>The Syrian crisis had a profound impact on the Syrian healthcare system, resulting in the undertreatment of many cardiovascular conditions, including HF.<span><sup>8, 11</sup></span> During the war years, Syria's healthcare infrastructure suffered extensive damage, leading to severe shortages of medical equipment, pharmacotherapies, and skilled healthcare professionals wh","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 4","pages":"614-616"},"PeriodicalIF":16.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3625","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412582","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":"Salt repletion and diuretic response: The role of serum chloride. A post‐hoc analysis of the SALT‐HF trial on furosemide and hypertonic saline solution administration in ambulatory patients with worsening heart failure","authors":"Julio Núñez, Gema Miñana, Rafael de la Espriella, Isabel Zegrí‐Reiriz, Josep Comín‐Colet, Jorge Rubio Gracia, Jose Luis Morales‐Rull, Pau Llàcer, Pablo Diez‐Villanueva, Javier de Juan Bagudá, Carolina Ortiz Cortés, Josebe Goirigolzarri‐Artaza, Jose Manuel García‐Pinilla, Elvira Barrios, Susana del Prado Díaz, Santiago Jiménez‐Marrero, Maria Alejandra Restrepo‐Córdoba, Jeffrey Testani, Marta Cobo Marcos","doi":"10.1002/ejhf.3597","DOIUrl":"https://doi.org/10.1002/ejhf.3597","url":null,"abstract":"AimsThe efficacy of combining hypertonic saline solution (HSS) with loop diuretics in worsening heart failure (WHF) remains uncertain. Hypochloraemia has been associated with reduced diuretic efficacy. Some authors propose that chloride repletion may enhance natriuretic and diuretic responses. This post‐hoc analysis of the SALT‐HF trial evaluated the effect of single‐dose administration of HSS plus intravenous (IV) furosemide versus IV furosemide, stratified by baseline serum chloride.Methods and resultsThe analysis included 148 ambulatory patients with WHF from the double‐blind, randomized SALT‐HF trial. Participants received either an IV single dose of HSS plus furosemide or IV furosemide. The endpoints were 3‐h urinary sodium excretion and diuresis, 7‐day congestion score, and 30‐day adverse events according to chloride levels. Multivariable linear and logistic regression models assessed the relationship between the intervention and the endpoints. The mean baseline serum chloride level was 100 ± 4 mmol/L. Sixteen patients (10.8%) were identified as hypochloraemic (serum chloride &lt;96 mmol/L), balanced between treatment groups. Patients with hypochloraemia showed a lower natriuretic response (<jats:italic>p</jats:italic> &lt; 0.05). Interaction analysis revealed a between‐treatment differential natriuretic effect based on the chloride levels (<jats:italic>p</jats:italic><jats:sub>interaction</jats:sub> = 0.008). HSS plus furosemide increased natriuresis compared to furosemide at lower chloride levels. No differential between‐treatment effect was found for 3‐h diuresis. Similar heterogeneous results were found for the 7‐day clinical congestion score and 30‐day heart failure events, with a benefit with HSS in patients with lower chloride levels.ConclusionIn ambulatory patients with WHF and hypochloraemia, adding HSS to furosemide may improve short‐term natriuretic response and outcomes. These findings suggest that chloride supplementation may help overcome diuretic resistance in these patients.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"78 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143393116","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 can be done to improve the outcomes for cardiogenic shock patients with circulatory support devices?","authors":"Naoki Sato","doi":"10.1002/ejhf.3603","DOIUrl":"10.1002/ejhf.3603","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 5","pages":"842-843"},"PeriodicalIF":16.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401237","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":"Failure to improve cardiac remodelling and outcomes post-myocardial infarction: Insights from EMPRESS-MI","authors":"Francesco Fioretti,&nbsp;Gregg W. Stone,&nbsp;Javed Butler","doi":"10.1002/ejhf.3602","DOIUrl":"10.1002/ejhf.3602","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 5","pages":"800-803"},"PeriodicalIF":16.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401606","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's anti-inflammatory spectrum in type 2 diabetes mellitus: Piecing together the puzzle","authors":"Sophie Van Linthout,&nbsp;Frank Spillmann,&nbsp;Subodh Verma","doi":"10.1002/ejhf.3604","DOIUrl":"10.1002/ejhf.3604","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 5","pages":"857-859"},"PeriodicalIF":16.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401605","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":"Rescuing patients with post-myocardial infarction mitral regurgitation with transcatheter edge-to-edge repair: A salvation for all mechanisms of mitral regurgitation","authors":"Ali Vazir,&nbsp;Robert D Smith,&nbsp;Stephan Baldus","doi":"10.1002/ejhf.3605","DOIUrl":"10.1002/ejhf.3605","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 5","pages":"922-923"},"PeriodicalIF":16.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401239","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":"Comorbidity trajectories before and after the diagnosis of heart failure: A UK Biobank cohort study","authors":"Hugo MacGowan, Oliver I. Brown, Michael Drozd, Andrew M.N. Walker, Marilena Giannoudi, Sam Straw, Maria F. Paton, John Gierula, Melanie McGinlay, Kathryn J. Griffin, Klaus K. Witte, Mark T. Kearney, Richard M. Cubbon","doi":"10.1002/ejhf.3601","DOIUrl":"https://doi.org/10.1002/ejhf.3601","url":null,"abstract":"Heart failure (HF) is frequently associated with multiple comorbidities. We aimed to define their trajectory of accrual to identify opportunities for disease prevention.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"19 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143393565","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":"Man versus machine in advanced heart failure: Can artificial intelligence beat clinicians?","authors":"Lucas Bacmeister,&nbsp;Pau Codina,&nbsp;Dirk Westermann","doi":"10.1002/ejhf.3609","DOIUrl":"10.1002/ejhf.3609","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 4","pages":"737-738"},"PeriodicalIF":16.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143393115","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}