European Journal of Heart Failure最新文献

{"title":"Considerations on biological age-related therapeutic intensity. Less numbers, more biology","authors":"Bernhard Haring, Michael Böhm","doi":"10.1002/ejhf.3533","DOIUrl":"10.1002/ejhf.3533","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 1","pages":"107-109"},"PeriodicalIF":16.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724347","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":"Discontinuation and reinitiation of mineralocorticoid receptor antagonists in patients with heart failure and reduced ejection fraction.","authors":"Laura Landucci, Ulrika Ljung Faxén, Lina Benson, Ulf Dahlström, Juan J Carrero, Gianluigi Savarese, Lars H Lund","doi":"10.1002/ejhf.3523","DOIUrl":"https://doi.org/10.1002/ejhf.3523","url":null,"abstract":"<p><strong>Aims: </strong>Mineralocorticoid receptor antagonists (MRA) improve outcomes in heart failure with reduced ejection fraction (HFrEF) but are underused. Point prevalent use has been described, but the kinetics of discontinuation and the extent of reinitiation have not been studied.</p><p><strong>Methods and results: </strong>Patients with HFrEF enrolled in the Swedish Heart Failure Registry between 2006 and 2021 were linked to the Prescribed Drug Register. The rate of discontinuation during the first year of treatment and reinitiation the year after discontinuation were estimated using the Kaplan-Meier method. Multivariable Cox proportional hazards models were used to assess the predictors of discontinuation. Of 11 474 MRA new users, 71% remained on therapy at 1 year. Baseline characteristics independently associated with discontinuation were: estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m² (hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.34-2.27), hyperkalaemia (HR 1.73, 95% CI 1.25-2.40), eGFR 30-60 ml/min/1.73 m² (HR 1.51, 95% CI 1.37-1.66), age ≥80 years (HR 1.26, 95% CI 1.10-1.43), enrolment as inpatient (HR 1.25, 95% CI 1.14-1.38), a diagnosis of atrial fibrillation (HR 1.24, 95% CI 1.10-1.39), living alone (HR 1.23, 95% CI 1.13-1.34), ischaemic heart disease (HR 1.20, 95% CI 1.09-1.31), anaemia (HR 1.17, 95% CI 1.07-1.29), diabetes mellitus (HR 1.15, 95% CI 1.04-1.27) and New York Heart Association class III-IV (HR 1.13, 95% CI 1.02-1.24). Reinitiation within a year occurred in 46% of cases, mostly within 3 months after discontinuation.</p><p><strong>Conclusion: </strong>Among patients with HFrEF initiated on MRA, 71% remained on therapy at 1 year. Discontinuation occurred early and was more common in patients with advanced kidney disease, hyperkalaemia, lack of follow-up in specialty care, more severe heart failure, comorbidities, and markers of sociodemographic frailty. Among those who discontinued, almost half reinitiated treatment the year following discontinuation.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724354","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":"Mesenchymal precursor cells reduce mortality and major morbidity in ischaemic heart failure with inflammation: DREAM-HF.","authors":"Emerson C Perin, Kenneth M Borow, Timothy D Henry, Margaret Jenkins, Olga Rutman, Jack Hayes, Christopher W James, Eric Rose, Hicham Skali, Silviu Itescu, Barry Greenberg","doi":"10.1002/ejhf.3522","DOIUrl":"https://doi.org/10.1002/ejhf.3522","url":null,"abstract":"<p><strong>Aims: </strong>Progressive heart failure with reduced ejection fraction (HFrEF) is adversely affected by alterations in the myocardial balance between bone marrow-derived pro-inflammatory cardiac macrophages and embryo-derived reparative cardiac resident macrophages. Mesenchymal precursor cells (MPCs) may restore this balance and improve clinical outcomes when inflammation is present. The purpose was to (i) identify risk factors for cardiovascular death (CVD) in control patients with HFrEF in the DREAM-HF trial, and (ii) determine if MPCs improve major clinical outcomes (CVD, myocardial infarction [MI], stroke) in high-risk patients with ischaemic HFrEF and inflammation.</p><p><strong>Methods and results: </strong>Cause-specific regression analyses were used to identify CVD risk factors in DREAM-HF control patients. Aalen-Johansen cumulative incidence curves were used to examine CVD, 2-point major adverse cardiovascular events (MACE) (MI or stroke), and 3-point MACE (CVD or MI or stroke) by treatment group in ischaemic vs non-ischaemic HFrEF and in patients with or without baseline inflammation. In control DREAM-HF patients, factors portending the greatest risk for CVD were inflammation (baseline plasma high-sensitivity C-reactive protein ≥2 mg/L; p = 0.003) and ischaemic HFrEF aetiology (p = 0.097), with increased CVD risk of 61% and 38%, respectively. Over 30-month mean follow-up, MPCs reduced 2-point and 3-point MACE by 88% (p = 0.005) and 52% (p = 0.018), respectively, in patients with ischaemic HFrEF and inflammation compared to controls.</p><p><strong>Conclusion: </strong>Ischaemic aetiology and inflammation were identified as major risk factors for MACE in control DREAM-HF patients. A single intramyocardial MPC administration produced the most significant, sustained reduction in 2-point and 3-point MACE in patients with ischaemic HFrEF and inflammation.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724359","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":"New cardiovascular biomarkers in patients with advanced cancer - A prospective study comparing MR-proADM, MR-proANP, copeptin, high-sensitivity troponin T and NT-proBNP.","authors":"Markus S Anker, Laura C Lück, Muhammad Shahzeb Khan, Jan Porthun, Sara Hadzibegovic, Alessia Lena, Ursula Wilkenshoff, Pia Weinländer, Ruben Evertz, Matthias Totzeck, Amir A Mahabadi, Tienush Rassaf, Stefan D Anker, Lars Bullinger, Ulrich Keller, Mahir Karakas, Ulf Landmesser, Javed Butler, Stephan von Haehling","doi":"10.1002/ejhf.3497","DOIUrl":"https://doi.org/10.1002/ejhf.3497","url":null,"abstract":"<p><strong>Aims: </strong>Traditional cardiovascular (CV) biomarkers (high-sensitivity troponinT [hsTnT] and N-terminal pro-B-type natriuretic peptide [NT-proBNP]) are important to monitor cancer patients' cardiac function and to assess prognosis. Newer CV biomarkers (mid-regional pro-adrenomedullin [MR-proADM], C-terminal pro-arginine vasopressin [copeptin], and mid-regional pro-atrial natriuretic peptide [MR-proANP]) might outperform traditional biomarkers.</p><p><strong>Methods and results: </strong>Overall, 442 hospitalized cancer patients without significant CV disease or current infection were enrolled (61 ± 15 years, 52% male, advanced cancer stage: 85%) and concentrations of CV biomarkers were analysed. Differences in echocardiographic, clinical, laboratory parameters were assessed. Patients were followed for up to 69 months for all-cause mortality. In univariable analyses, MR-proADM, hsTnT, copeptin, MR-proANP, and NT-proBNP predicted all-cause mortality. In multivariable analyses (adjusted for sex, age, Eastern Cooperative Oncology Group performance status, estimated glomerular filtration rate [eGFR], C-reactive protein, anti-cancer therapy, reason for hospitalization, cancer stage and type), only MR-proADM remained an independent predictor of mortality (MR-proADM per 1 ln: hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.47-3.50], p < 0.001). MR-proADM had the highest area under the curve (AUC) using receiver operating characteristic analysis (AUC [95% CI] 0.74 [0.69-0.79]; hsTnT: AUC 0.69; copeptin: AUC 0.66; MR-proANP: AUC 0.63; NT-proBNP: AUC 0.62). Optimal cut-point for mortality prediction with MR-proADM was 0.94 nmol/L (HR 2.43 [95% CI 1.92-3.06], p < 0.001). Patients with MR-proADM >0.94 nmol/L were older, more often had cancer stage IV, showed reduced performance status, eGFR, haemoglobin, diastolic left ventricular function, and elevated systolic pulmonary artery pressure.</p><p><strong>Conclusion: </strong>MR-proADM is an independent predictor of mortality in advanced stage, hospitalized cancer patients without significant CV disease or current infection. The optimal MR-proADM cut-point for mortality prediction was 0.94 nmol/L with hazards for mortality being approximately 2.5 times higher. There was a continuous increase in mortality risk with stepwise increase of MR-proADM concentrations. Elevated concentrations of MR-proADM were also associated with reduced performance status and mildly reduced left ventricular diastolic function as well as higher age and more often cancer stage IV.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724360","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 after left atrial appendage occlusion: Insights from the LAAOS III randomized trial.","authors":"Philipp Krisai, Emilie P Belley-Cote, William F McIntyre, Jorge Wong, Kate Tsiplova, Katheryn Brady, Philip Joseph, Isabelle Johansson, Linda Johnson, Lucas Yixi Xing, Andrea Colli, Shay McGuinness, Prakash Punjabi, Wilko Reents, Filip Rega, Petr Budera, Alistair G Royse, Domenico Paparella, Stuart Connolly, Richard P Whitlock, Jeff S Healey","doi":"10.1002/ejhf.3536","DOIUrl":"https://doi.org/10.1002/ejhf.3536","url":null,"abstract":"<p><strong>Aims: </strong>The left atrial appendage (LAA) produces natriuretic peptides and its removal or occlusion might increase the risk of heart failure (HF). We aimed to investigate the incidence of HF after LAA occlusion or removal (LAAO) in the Left Atrial Appendage Occlusion Study (LAAOS III).</p><p><strong>Methods and results: </strong>Patients (n = 4811) with atrial fibrillation (AF) and a CHA₂DS₂-VASc score ≥2, who were having cardiac surgery for another indication, were randomized to undergo surgical LAAO or not. We compared the composite outcome of HF-related hospitalizations and HF death between the two groups. HF assessment required clinical and radiographic evidence of HF. Analyses included a landmark analysis before and after 30 days and subgroups. Mean age was 71.2 years, 67.5% were male and 57.0% had prior HF. Over a mean follow-up of 3.8 years, 396 (8.3%) patients met the composite HF outcome: 209 (8.8%) with LAAO (n = 2379) and 187 (7.8%) without LAAO (n = 2391) (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.92-1.37, p = 0.25). There was no difference between the two groups in the first 30 days (1.6% vs. 1.1%; p = 0.12) and thereafter (7.6% vs. 7.1%; p = 0.57). Subgroups based on age, sex, body mass index, AF type, prior HF, cardiac rhythm or left ventricular ejection fraction showed consistent results. There was no difference in HF outcomes with LAAO between the cut-and-sew (HR 0.93, 95% CI 0.70-1.23, p = 0.62) versus other closure methods (HR 1.05, 95% CI 0.77-1.41, p = 0.77).</p><p><strong>Conclusions: </strong>Left atrial appendage occlusion or removal at the time of cardiac surgery does not appear to alter the risk of HF-related hospitalization or death.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov NCT01561651.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142714987","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":"State of the art and perspectives of gene therapy in heart failure. A scientific statement of the Heart Failure Association of the ESC, the ESC Council on Cardiovascular Genomics and the ESC Working Group on Myocardial & Pericardial Diseases","authors":"Sophie Van Linthout,&nbsp;Konstantinos Stellos,&nbsp;Mauro Giacca,&nbsp;Edoardo Bertero,&nbsp;Antonio Cannata,&nbsp;Lucie Carrier,&nbsp;Pablo Garcia-Pavia,&nbsp;Alessandra Ghigo,&nbsp;Arantxa González,&nbsp;Kristina H. Haugaa,&nbsp;Massimo Imazio,&nbsp;Luis R. Lopes,&nbsp;Patrick Most,&nbsp;Piero Pollesello,&nbsp;Heribert Schunkert,&nbsp;Katrin Streckfuss-Bömeke,&nbsp;Thomas Thum,&nbsp;Carlo Gabriele Tocchetti,&nbsp;Carsten Tschöpe,&nbsp;Peter van der Meer,&nbsp;Eva van Rooij,&nbsp;Marco Metra,&nbsp;Giuseppe M.C. Rosano,&nbsp;Stephane Heymans","doi":"10.1002/ejhf.3516","DOIUrl":"10.1002/ejhf.3516","url":null,"abstract":"<p>Gene therapy has recently become a reality in the treatment of cardiovascular diseases. Strategies to modulate gene expression using antisense oligonucleotides or small interfering RNA are proving to be safe and effective in the clinic. Adeno-associated viral vector-based gene delivery and CRISPR-Cas9-based genome editing have emerged as efficient strategies for gene delivery and repair in humans. Overall, gene therapy holds the promise not only of expanding current treatment options, but also of intervening in previously untackled causal disease mechanisms with little side effects. This scientific statement provides a comprehensive overview of the various modalities of gene therapy used to treat heart failure and some of its risk factors, and their application in the clinical setting. It discusses specifically the possibilities of gene therapy for hereditary heart diseases and (non)-genetic heart failure. Furthermore, it addresses safety and clinical trial design issues and challenges for future regulatory strategies.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 1","pages":"5-25"},"PeriodicalIF":16.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3516","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684539","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":"A functional role for spontaneously occurring natural anti-transthyretin antibodies from patients with transthyretin cardiac amyloidosis","authors":"Ortal Tuvali, Michael Fassler, Sorel Goland, Clara Benaim, Sara Shimoni, Jacob George","doi":"10.1002/ejhf.3527","DOIUrl":"https://doi.org/10.1002/ejhf.3527","url":null,"abstract":"<h2> Introduction</h2>\u0000<p>Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive disease that results from the accumulation of transthyretin (TTR) fibrils in the extracellular space of the myocardium, leading to heart failure.<span>¹</span> The pathogenesis of ATTR-CA results from a reduction in cardiac compliance due to amyloid fibril deposition, but recent observations suggest that soluble TTR intermediate oligomers are toxic to cardiomyocytes and contribute to myocardial functional compromise.<span>²</span></p>\u0000<p>Recently, proof-of-mechanism and proof-of-concept have been established for the ability of monoclonal antibodies to induce Fc gamma-mediated clearance of extracellular beta-amyloid in patients with Alzheimer's disease.<span>³</span> This led to the Food and Drug Administration approval of a drug that clears amyloid plaques and attenuates cognitive decline.<span>³</span> In pre-clinical studies, several monoclonal antibodies have been shown to mediate Fc gamma-dependent clearance of aggregated TTR by macrophages in experimental models.<span>^4-6</span> Very recently, an initial phase I study demonstrated the safety of this approach and provided initial hints of efficacy in reducing imaging-related pathology via magnetic resonance imaging and scintigraphy.<span>⁷</span></p>\u0000<p>In a recent preliminary observation, antibodies binding to TTR were described for the first time in two patients with ATTR-CA, and were associated with spontaneous clinical recovery and regression of imaging-related findings.<span>⁸</span> However, this intriguing finding has not yet established a mechanistic role for these naturally occurring antibodies in facilitating amyloid removal.</p>\u0000<p>We aimed to characterize in detail the spontaneously occurring purified antibodies to TTR oligomers and fibrils and test their related functional activities <i>in vitro</i> and in cellular and experimental models, supporting their potential involvement in the spontaneous regression of ATTR amyloidosis.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"69 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142672861","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":"Malnutrition and severe heart failure in real-world study settings. Letter regarding the article ‘Impact of malnutrition in patients with severe heart failure’","authors":"Meng-Che Wu,&nbsp;Shih-Chi Yang,&nbsp;Shuo-Yan Gau","doi":"10.1002/ejhf.3524","DOIUrl":"10.1002/ejhf.3524","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 1","pages":"181"},"PeriodicalIF":16.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142672859","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":"Treat or not treat COVID-19 with combined renin–angiotensin system and neprilysin inhibition: Have we found a solution?","authors":"Insa E. Emrich,&nbsp;Michael Böhm","doi":"10.1002/ejhf.3510","DOIUrl":"10.1002/ejhf.3510","url":null,"abstract":"&lt;p&gt;Since 2019, coronavirus disease 2019 (COVID-19) has affected millions of individuals worldwide, leading to multiple deaths and numerous long-term multiorgan sequelae. In patients with COVID-19, cardiovascular diseases, including heart failure (HF), are common and associated with an increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; and high mortality rates.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Epidemiological data revealed that prevalent HF was an independent predictor of increased in-hospital mortality&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;: in an Italian cohort, nearly 42% of patients with known HF who had been hospitalized with COVID-19 died during hospitalization.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Although SARS-CoV-2 infection affects primarily the respiratory system, infected individuals can develop multiple de-novo cardiovascular complications, including HF,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; arrhythmia, acute coronary syndrome or (peri-) myocarditis.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Persistent cardiac injury, defined as long-term high-sensitivity cardiac troponin T (hs-cTnT) elevation or persistent abnormalities in cardiac magnetic resonance&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;—even after the primary SARS-CoV-2 infection was cured—has been described.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Proposed underlying mechanisms include activation of inflammatory and thrombotic cascades,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; direct viral infiltration or emerging/worsening of underlying baseline myocardial structural or atherosclerotic abnormalities.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In a detailed review of the European Society of Cardiology task force for the management of COVID-19,&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt; the dysregulation of angiotensin-converting enzyme (ACE)/ACE2 system due to direct SARS-CoV-2 interaction is highlighted as one of the central pathways.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; In brief, SARS-CoV-2 binds to the ACE2 receptor—located among others on myocytes—to mediate cellular internalization (&lt;i&gt;Figure&lt;/i&gt; 1).&lt;span&gt;&lt;sup&gt;7, 8&lt;/sup&gt;&lt;/span&gt; Thus, viral infiltration can lead to inflammation, cardiac fibrosis and direct cardiac damage by microvascular and macrovascular dysfunction (e.g. myocarditis with consequent arrhythmias or HF).&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; In combination with immune over-reactivity or ‘cytokine storm’, these processes can destabilize atherosclerotic plaques resulting in acute coronary syndrome.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;All these described changes can result in HF with preserved ejection fraction (HFpEF)—particularly in those patients with underlying risk factors as hypertension, obesity or diabetes—or unmask subclinical preexisting HFpEF.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; Consecutively, its adequate diagnostics and treatment are essential.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; As quantitative markers of cardiomyocyte injury and haemodynamic myocardial stress measurement of hs-cTnT and N-terminal pro-B-type natriuretic peptide (NT-proBNP) should not be delayed. These bio","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 1","pages":"148-151"},"PeriodicalIF":16.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3510","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142672860","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":"Hypertensive pregnancy disorder, an under-recognized women specific risk factor for heart failure?","authors":"Chahinda Ghossein-Doha, Basky Thilaganathan, Arthur Jason Vaught, Joan E. Briller, Jolien W. Roos-Hesselink","doi":"10.1002/ejhf.3520","DOIUrl":"https://doi.org/10.1002/ejhf.3520","url":null,"abstract":"During pregnancy, the maternal cardiovascular (CV) system undergoes major haemodynamic alterations ensuring adequate placental perfusion and a healthy pregnancy course. Hypertensive disorders of pregnancy (HDP) occur in almost 10% of gestations and preeclampsia, a more severe form, in 3–4%. Women with HDP demonstrated impaired myocardial function, biventricular chamber dysfunction and adverse biventricular remodelling. Shortly after delivery, women who experienced HDP express increased risk of classic CV risk factors such as hypertension, renal disease, abnormal lipid profile, and diabetes. Within the first two decades following a HDP, women experience increased rates of heart failure, chronic hypertension, ischaemic heart and cerebral disease. The mechanism underlying the relationship between HDP in younger women and CV disease later in life could be explained by sharing pre-pregnancy CV risk factors or due to a direct impact of HDP on the maternal CV system conferring a state of increased susceptibility to future metabolic or haemodynamic insults. Racial disparities in CV risk and social determinants of health also play an important role in their remote CV risk. Although there is general agreement that women who suffered from HDP should undertake early CV screening to allow appropriate prevention and timely treatment, a screening and intervention protocol has not been standardized due to limited available evidence. In this review, we discuss why women with hypertensive pregnancy may be disproportionately affected by heart failure with preserved ejection fraction and how cardiac remodelling during or after pregnancy may influence its development.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"39 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142672955","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}