European Journal of Heart Failure最新文献

{"title":"Long‐term results of tricuspid valve transcatheter edge‐to‐edge repair in patients with cardiac implantable electronic devices","authors":"Lukas Stolz, Felix Rudolph, Thomas J. Stocker, Maria Ivannikova, Philipp M. Doldi, Johannes Kirchner, Ludwig T. Weckbach, Muhammed Gerçek, Volker Rudolph, Jörg Hausleiter","doi":"10.1002/ejhf.3559","DOIUrl":"https://doi.org/10.1002/ejhf.3559","url":null,"abstract":"<p>Tricuspid valve transcatheter edge-to-edge repair (T-TEER) is an increasingly used treatment tool for patients with severe tricuspid regurgitation (TR) which has been shown to effectively and safely reduce TR and improve quality of life.<span><sup>1</sup></span> TR is a heterogeneous disease entity comprising primary, secondary and cardiac implantable electronic device (CIED)-related phenotypes.<span><sup>2</sup></span> Patients with CIED-related TR represent a continuous spectrum reaching from patients with transtricuspid leads as the main cause of TR to leads without relevant contribution.<span><sup>3</sup></span> Previous studies suggest a CIED prevalence of approximately 20–25% in patients undergoing T-TEER.<span><sup>4, 5</sup></span> Those data also hint at a comparable TR reduction at discharge and 30-day follow-up as well as comparable 1-year survival rates in patients with versus without transtricuspid leads.<span><sup>5</sup></span> However, more recent data from the PASTE registry with echocardiographic core laboratory supervision identified transvalvular CIED leads to be independently associated with relevant post-procedural TR.<span><sup>6</sup></span> Depending on the attempted T-TEER strategy and lead location, interventional TR treatment potentially interferes with CIED leads and might have an impact on device performance. Until today, information regarding CIED function before and after T-TEER is scarce. One single-centre study including 33 CIED patients found no significant change in lead function from baseline to immediate device follow-up 1 day after the procedure.<span><sup>7</sup></span> To expand the respective body of evidence, the present study aimed at not only confirming the safety and effectiveness of T-TEER in patients with CIEDs in a larger multicentre setting, but also at evaluating potential changes in CIED function from baseline to post-procedural and over the course of follow-up.</p>\u0000<p>The study included CIED patients with at least one transtricuspid lead from two European centres (LMU University hospital Munich, Clinic for General and Interventional Cardiology/Angiology Bad Oeynhausen) who underwent T-TEER for symptomatic TR between 2016 and 2022. Prior to T-TEER a multidisciplinary heart team involving interventional cardiologists, cardiac surgeons, heart failure specialists and electrophysiologists opted for T-TEER as primary treatment approach. With respect to the study objectives, echocardiographic evaluation included assessment of lead position before and after the procedure (anteroseptal, posteroseptal, posteroanterior, central, anterior leaflet body, posterior leaflet body, septal leaflet body), origin of the main TR jet (anteroseptal, posteroseptal, anteroposterior, central) and contribution of the lead to TR (none, partially, main aetiology). Device interrogation was performed prior and after the procedure, as well as at latest available follow-up. Evaluation of long-term CIED function included thre","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"15 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142887574","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 in acute myocardial infarction in patients with and without type 2 diabetes: A pre‐specified analysis of the EMPACT‐MI trial","authors":"Mark C. Petrie, Jacob A. Udell, Stefan D. Anker, Josephine Harrington, W. Schuyler Jones, Michaela Mattheus, Tomasz Gasior, Peter van der Meer, Offer Amir, M. Cecilia Bahit, Johann Bauersachs, Antoni Bayes‐Genis, Vijay K. Chopra, James L. Januzzi, Renato D. Lopes, Piotr Ponikowski, Xavier Rossello, Morten Schou, Shelley Zieroth, Martina Brueckmann, Mikhail Sumin, Deepak L. Bhatt, Adrian F. Hernandez, Javed Butler","doi":"10.1002/ejhf.3548","DOIUrl":"https://doi.org/10.1002/ejhf.3548","url":null,"abstract":"AimsIn the EMPACT‐MI trial, empagliflozin reduced heart failure (HF) hospitalizations but not mortality in acute myocardial infarction (MI). Contemporary reports of clinical event rates with and without type 2 diabetes mellitus (T2DM) in acute MI trials are sparse. The treatment effect of empagliflozin in those with and without T2DM in acute MI is unknown.Methods and resultsA total of 6522 patients with acute MI with newly reduced left ventricular ejection fraction (LVEF) to <45%, congestion, or both, were randomized to empagliflozin 10 mg or placebo. The primary endpoint was time to first HF hospitalization or all‐cause death. Rates of endpoints with and without T2DM and the efficacy and safety of empagliflozin according to T2DM status were assessed. Overall, 32% had T2DM; 14% had pre‐diabetes; 16% were normoglycaemic; 38% had unknown glycaemic status. Patients with T2DM, compared to those without T2DM, were at higher risk of time to first HF hospitalization or all‐cause death (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.06–1.95) and all‐cause death (HR 1.70; 95% CI 1.13–2.56). T2DM did not confer a higher risk of first HF hospitalization (HR 1.22, 95% CI 0.82–1.83). Empagliflozin reduced first and total HF hospitalizations, but not all‐cause mortality, regardless of presence or absence of T2DM. The safety profile of empagliflozin was the same with and without T2DM.ConclusionPatients with acute MI, LVEF <45% and/or congestion who had T2DM were at a higher risk of mortality than those without T2DM. Empagliflozin reduced first and total HF hospitalizations regardless of the presence or absence of T2DM.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"83 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142887491","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 transcriptional profile of iron deficiency in patients with heart failure: Heme‐sparing and reduced immune processes","authors":"Niels Grote Beverborg, Ridha I.S. Alnuwaysir, George Markousis‐Mavrogenis, Martijn F. Hoes, Haye H. van der Wal, Simon P.R. Romaine, Mintu Nath, Andrea Koekoemoer, John G.F. Cleland, Chim C. Lang, Stefan D. Anker, Kenneth Dickstein, Marco Metra, Leong L. Ng, Dirk J. van Veldhuisen, Adriaan A. Voors, Nilesh J. Samani, Peter van der Meer","doi":"10.1002/ejhf.3562","DOIUrl":"https://doi.org/10.1002/ejhf.3562","url":null,"abstract":"AimsIron deficiency (ID) is highly prevalent in patients with heart failure (HF) and associated with morbidity and poor prognosis, but pathophysiological mechanisms are unknown. We aimed to identify novel biological pathways affected by ID.Methods and resultsWe studied 881 patients with HF from the BIOSTAT‐CHF cohort. ID was defined as a transferrin saturation &lt;20%. Transcriptome profiling was performed in whole blood. Identified targets were validated in a human <jats:italic>in vitro</jats:italic> stem cell‐derived cardiomyocyte ID model utilizing deferoxamine as iron chelator. ID was identified in 554 (62.9%) patients, and 89 differentially expressed genes between ID and non‐ID were identified, of which 60 were up‐ and 29 were downregulated. Upregulated genes were overrepresented in pathways of erythrocyte development and homeostasis. Heme biosynthetic processes were confirmed as relatively upregulated in ID, while iron–sulfur cluster assembly was downregulated. Downregulated processes further included natural killer cell and lymphocyte mediated immunity. In agreement with patient data, cardiomyocyte iron depletion significantly induced the expression of two genes (<jats:italic>SIAH2</jats:italic> and <jats:italic>CLIC4</jats:italic>), which could be normalized upon iron supplementation. Both <jats:italic>SIAH2</jats:italic> and <jats:italic>CLIC4</jats:italic> are associated with increased mortality in patients with HF (hazard ratio 2.40, 95% confidence interval 1.86–3.11, <jats:italic>p</jats:italic> &lt; 0.001 hazard ratio 1.78, 95% confidence interval 1.53–2.07, <jats:italic>p</jats:italic> &lt; 0.001, respectively).ConclusionIron deficiency is associated with the preservation of heme‐related processes at the cost of iron–sulfur clusters. Immune processes are downregulated, uncovering another high energy demand system affected. <jats:italic>SIAH2</jats:italic> and <jats:italic>CLIC4</jats:italic> might be modifiable factors in the relation between ID and impaired prognosis.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"15 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142887570","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":"Guideline‐directed medical therapy for heart failure in arrhythmia‐induced cardiomyopathy with improved left ventricular ejection fraction","authors":"Luis Manuel Domínguez‐Rodríguez, David Dobarro, Carla Iglesias‐Otero, María G. Crespo‐Leiro, Sergio Raposeiras‐Roubín, Jesús Álvarez‐García, Manuel Barreiro‐Pérez, Isabel Muñoz‐Pousa, Angel Sánchez‐Recalde, Ándrés Íñiguez‐Romo, José Luis Zamorano","doi":"10.1002/ejhf.3556","DOIUrl":"https://doi.org/10.1002/ejhf.3556","url":null,"abstract":"AimsNo 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.Methods and resultsWe 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]; <jats:italic>p</jats:italic> = 0.005) and beta‐blockers (adjusted HR 0.48 [0.28–0.81]; <jats:italic>p</jats:italic> = 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]; <jats:italic>p</jats:italic> = 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.ConclusionMaintaining RAS inhibitors and beta‐blockers was associated with a significantly lower incidence of relapse in the setting of AiCM with improved LVEF.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"28 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"https://doi.org/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>\u0000<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>\u0000<p>We apologize for this error.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"31 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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, Maria A. Pabon, Eugene Braunwald, Karola Jering, Muthiah Vaduganathan, Brian L. Claggett, Lars Køber, Eldrin F. Lewis, Christopher B. Granger, Peter van der Meer, Jean L. Rouleau, Aldo P. Maggioni, John J.V. McMurray, Scott D. Solomon, Marc A. Pfeffer","doi":"10.1002/ejhf.3557","DOIUrl":"https://doi.org/10.1002/ejhf.3557","url":null,"abstract":"AimsThe 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.Methods and resultsExclusively 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 (<jats:italic>n</jats:italic> = 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.ConclusionsCardiovascular 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.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"83 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-19","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":"Prediction of new‐onset atrial fibrillation in patients with hypertrophic cardiomyopathy using machine learning","authors":"Ree Lu, Heidi S. Lumish, Kohei Hasegawa, Mathew S. Maurer, Muredach P. Reilly, Shepard D. Weiner, Albree Tower‐Rader, Michael A. Fifer, Yuichi J. Shimada","doi":"10.1002/ejhf.3546","DOIUrl":"https://doi.org/10.1002/ejhf.3546","url":null,"abstract":"AimsAtrial 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).Methods and resultsIn 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 <jats:italic>p</jats:italic> &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.ConclusionOur ML model showed superior performance compared to the conventional HCM‐AF score for the prediction of new‐onset AF in patients with HCM.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"41 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-19","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":"Observational study for multiparametric assessment of cardiac congestion in outpatient worsening heart failure (EVOLUTION)","authors":"Gad Cotter, Beth Davison, Philip Janiak, Christopher Edwards, Maria Novosadova, Koji Takagi, Marie‐Laure Ozoux, Francesca Lawson, Hamlet Hayrapetyan, Hamayak Sisakian, Victor R. Ter‐Grigoryan, Katell Peoc'h, Alexandre Raynor, Paul Bruzeau, Alexis Nguyen, Alexandre Mebazaa","doi":"10.1002/ejhf.3555","DOIUrl":"https://doi.org/10.1002/ejhf.3555","url":null,"abstract":"AimsWe 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.Methods and resultsBetween 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.ConclusionPatients 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.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"35 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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, Gabby Elbaz-Greener, Shemy Carasso, Brian Claggett, Olga Barbarash, Azfar Zaman, Christina Christersson, Songsak Kiatchoosakun, John Anonuevo, Grzegorz Opolski, Mody F. Vaghaiwalla, Peter van der Meer, Yinong Zhou, Douglas L. Mann, Lars Kober, Gabriel Steg, Karola Jering, Ian Kulac, Carmine G. De Pasquale, John J.V. McMurray, Marc A. Pfeffer","doi":"10.1002/ejhf.3542","DOIUrl":"https://doi.org/10.1002/ejhf.3542","url":null,"abstract":"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.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"62 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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, Orly Vardeny, Brian Claggett, Muthiah Vaduganathan, Sheila M. Hegde, Hicham Skali, Maria A. Pabon, Alberto Foà, Safia Chatur, Annamaria Kosztin, Eileen O'Meara, Jean Rouleau, Margaret Redfield, Carolyn S.P. Lam, Michael Zile, Milton Packer, Amil M. Shah, Maja Cikes, Mauro Gori, Bela Merkely, Marc A. Pfeffer, John J.V. McMurray, Scott D. Solomon","doi":"10.1002/ejhf.3535","DOIUrl":"https://doi.org/10.1002/ejhf.3535","url":null,"abstract":"AimsTo evaluate clinical outcomes, echocardiographic features, and the efficacy and safety of sacubitril/valsartan compared to valsartan across age groups in the PARAGON‐HF trial.Methods and resultsA 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 (<jats:italic>n</jats:italic> = 825), 65–74 years (<jats:italic>n</jats:italic> = 1772), and ≥75 years (<jats:italic>n</jats:italic> = 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 (<jats:italic>p</jats:italic><jats:sub>interaction</jats:sub> = 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 (<jats:italic>p</jats:italic><jats:sub>interaction</jats:sub> = 0.026). Older patients had smaller left ventricular chamber sizes, higher LVEF, and were more likely to have abnormal measures of diastolic function.ConclusionOlder 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.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"29 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-16","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}