European Journal of Heart Failure最新文献

{"title":"Kidney status and events preceding death in heart failure: A real-world nationwide study.","authors":"Deewa Zahir Anjum, Caroline Hartwell Garred, Nicholas Carlson, Emil Fosbol, Mariam Elmegaard, Pardeep S Jhund, John J V McMurray, Mark C Petrie, Lars Kober, Morten Schou","doi":"10.1002/ejhf.3631","DOIUrl":"https://doi.org/10.1002/ejhf.3631","url":null,"abstract":"<p><strong>Aims: </strong>Chronic kidney disease is a frequent comorbidity in heart failure (HF) patients, affecting prognosis and mortality. This study investigates the relationship between kidney function and adverse kidney events preceding death in HF patients.</p><p><strong>Methods and results: </strong>We analysed registry data of HF patients who died between 2014 and 2021, with at least 1 year of HF diagnosis. Adverse kidney events, including acute kidney injury (AKI) and end-stage kidney disease (ESKD), were assessed. Patients were grouped by estimated glomerular filtration rate (eGFR) 1 year before death: eGFR ≥60, eGFR 30-59, and eGFR<30 ml/min/1.73 m². Among 36 435 HF patients who died, 37% had eGFR ≥60 ml/min/1.73 m², 46% had eGFR 30-59 ml/min/1.73 m², and 17% had eGFR <30 ml/min/1.73 m² 1 year before death. Median age was 81 years, and 61.2% were men. Adverse kidney events occurred in 13.1% of patients. AKI was inversely related to kidney function, affecting 6.5% (95% confidence interval 6.1-6.9) of those with eGFR ≥60 ml/min/1.73 m², 7.0% (6.6-7.4) with eGFR 30-59 ml/min/1.73 m², and 21.9% (20.9-22.9) with eGFR <30 ml/min/1.73 m². ESKD occurred in 0.7% (0.6-0.9), 2.6% (2.4-2.8), and 35.5% (34.3-36.7) of patients in the respective eGFR categories. In the last 3 months before death, kidney function notably declined, with increased chronic kidney replacement therapy. Factors associated with higher adverse kidney events included younger age, male sex, in-hospital death, and greater frailty.</p><p><strong>Conclusions: </strong>In HF patients, AKI and ESKD are common in the last year of life, particularly in those with lower baseline eGFR, with kidney decline accelerating in the final months.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536284","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":"Is earlier mechanical circulatory support in cardiogenic shock better?","authors":"Binyamin Ben Avraham,&nbsp;Oliviana Geavlete,&nbsp;Tuvia Ben-Gal","doi":"10.1002/ejhf.3630","DOIUrl":"10.1002/ejhf.3630","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 4","pages":"669-670"},"PeriodicalIF":16.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517926","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":"Urinary sodium analysis: The key to effective diuretic titration? European Journal of Heart Failure expert consensus document","authors":"Evelyne Meekers, Jeroen Dauw, Jozine M. ter Maaten, Pieter Martens, Petra Nijst, Frederik H. Verbrugge, Marnicq Van Es, Jonas Erzeel, Kevin Damman, Joan Carles Trullàs, Matthias Dupont, Wilfried Mullens","doi":"10.1002/ejhf.3632","DOIUrl":"https://doi.org/10.1002/ejhf.3632","url":null,"abstract":"In patients with heart failure, neurohumoral activation leads to increased renal sodium avidity across the entire renal tubules, resulting in a positive sodium and water balance, leading to decompensated heart failure requiring intravenous diuretics. As the dose of diuretic therapy required to achieve euvolaemia is difficult to estimate due to considerable intra- and interindividual differences, the European Society of Cardiology recommends assessment of the diuretic response within hours either via evaluation of the urinary sodium concentration or via urinary volume after initial diuretic administration. All diuretic agents enhance sodium excretion to a different extent depending on their side of action across the renal tubules, and renal adaptation mechanisms due to neurohumoral stimulation. Impaired sodium excretion, even in the presence of fluid loss, is associated with worse clinical outcomes. Therefore, assessing urinary sodium excretion is considered a good and direct marker of the diuretic efficacy. Such natriuresis-guided protocols have been tested prospectively by the Pragmatic Urinary Sodium-based algoritHm in Acute Heart Failure and the Efficacy of a Standardized Diuretic Protocol in Acute Heart Failure study, both demonstrating increased natriuresis and diuresis. Moreover, the Readily Available Urinary Sodium Analysis in Patients with Acute Decompensated Heart Failure study has demonstrated that a nurse-led natriuresis-guided protocol is feasible through the use of a point-of-care urinary sodium sensor, allowing an immediately readable urinary sodium result, enabling fast changes in diuretic therapy. This review summaries the rationale, current evidence and gaps supporting the role of urinary sodium concentration in patients with acute decompensated heart failure.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"7 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517927","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":"Left ventricular dysfunction in potential heart donors after brain death: When is it reversible?","authors":"Brian Wayda, Helen Luikart, Yingjie Weng, Shiqi Zhang, Bruce Nicely, Javier Nieto, John Belcher, Thomas Pearson, Nikole Neidlinger, John Nguyen, Tahnee Groat, Darren Malinoski, Jonathan Zaroff, Kiran K Khush","doi":"10.1002/ejhf.3596","DOIUrl":"https://doi.org/10.1002/ejhf.3596","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514292","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":"Clinical management and therapeutic optimization of patients with heart failure with reduced ejection fraction and low blood pressure. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC","authors":"Hadi Skouri,&nbsp;Nicolas Girerd,&nbsp;Luca Monzo,&nbsp;Mark C. Petrie,&nbsp;Michael Böhm,&nbsp;Marianna Adamo,&nbsp;Wilfried Mullens,&nbsp;Gianluigi Savarese,&nbsp;Mehmet Birhan Yilmaz,&nbsp;Offer Amir,&nbsp;Antoni Bayes-Genis,&nbsp;Biykem Bozkurt,&nbsp;Javed Butler,&nbsp;Ovidiu Chioncel,&nbsp;Alexandre Mebazaa,&nbsp;Jose L. Merino,&nbsp;Brenda Moura,&nbsp;Piotr Ponikowski,&nbsp;Petar Seferovic,&nbsp;Giuseppe M.C. Rosano,&nbsp;Marco Metra","doi":"10.1002/ejhf.3618","DOIUrl":"10.1002/ejhf.3618","url":null,"abstract":"<p>Despite major advancements in heart failure (HF) management and guideline recommendations over the past two decades, real-world evidence highlights suboptimal implementation of guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF). Low blood pressure (BP) is common in HFrEF patients and represents a major perceived barrier to implementing life-saving treatments in clinical practice, as physicians are often concerned about symptomatic hypotension and its consequences. Although low BP can be seen in those hospitalized with signs of shock, the most common scenario involves non-severe, asymptomatic hypotension in patients receiving foundational therapy for HFrEF, where premature down-titration or discontinuation of GDMT should be avoided. This clinical consensus statement provides a comprehensive overview of low BP in HFrEF, including its definition, risk factors, and effects of HF therapies on BP. We propose management pathways to optimize HFrEF treatment in the context of low BP, ultimately aiming to improve patient outcomes.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 4","pages":"707-722"},"PeriodicalIF":16.9,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3618","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514291","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":"What's new in heart failure? February 2025","authors":"Daniela Tomasoni,&nbsp;Pau Codina,&nbsp;Matthew M.Y. Lee,&nbsp;Alberto Aimo","doi":"10.1002/ejhf.3617","DOIUrl":"https://doi.org/10.1002/ejhf.3617","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 2","pages":"185-189"},"PeriodicalIF":16.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143489921","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 outcomes in patients with tricuspid regurgitation undergoing transcatheter tricuspid valve repair","authors":"Matteo Pagnesi, Marianna Adamo, Lukas Stolz, Edoardo Pancaldi, Karl-Patrik Kresoja, Jennifer von Stein, Vera Fortmeier, Benedikt Koell, Wolfgang Rottbauer, Mohammad Kassar, Bjoern Goebel, Paolo Denti, Paul Achouh, Tienush Rassaf, Manuel Barreiro-Perez, Peter Boekstegers, Andreas Rück, Monika Zdanyte, Flavien Vincent, Philipp Schlegel, Ralph-Stephan von Bardeleben, Mirjam G. Wild, Christian Besler, Stephanie Brunner, Stefan Toggweiler, Julia Grapsa, Tiffany Patterson, Holger Thiele, Tobias Kister, Giuseppe Tarantini, Giulia Masiero, Marco De Carlo, Alessandro Sticchi, Mathias H. Konstandin, Eric Van Belle, Tobias Geisler, Rodrigo Estévez-Loureiro, Peter Luedike, Nicole Karam, Francesco Maisano, Philipp Lauten, Fabien Praz, Mirjam Kessler, Daniel Kalbacher, Volker Rudolph, Christos Iliadis, Philipp Lurz, Jörg Hausleiter, Marco Metra","doi":"10.1002/ejhf.3623","DOIUrl":"https://doi.org/10.1002/ejhf.3623","url":null,"abstract":"The impact of malnutrition in patients with tricuspid regurgitation (TR) undergoing tricuspid transcatheter edge-to-edge repair (T-TEER) is not well established. We evaluated the impact of malnutrition among patients with symptomatic TR undergoing T-TEER.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"12 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463043","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":"Low blood pressure and the effect of empagliflozin in acute heart failure: An EMPULSE analysis","authors":"João Pedro Ferreira,&nbsp;Francisco Vasques-Nóvoa,&nbsp;Christiane E. Angermann,&nbsp;Jan Biegus,&nbsp;Sean P. Collins,&nbsp;Mikhail Kosiborod,&nbsp;Michael E. Nassif,&nbsp;Mitchell A. Psotka,&nbsp;Jasper Tromp,&nbsp;Robert J. Mentz,&nbsp;Piotr Ponikowski,&nbsp;John R. Teerlink,&nbsp;Adriaan A. Voors","doi":"10.1002/ejhf.3626","DOIUrl":"10.1002/ejhf.3626","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Empagliflozin improves outcomes in acute heart failure (AHF). Patients with AHF and low blood pressure (BP) have poor prognosis. Whether empagliflozin is effective and safe in patients with AHF and low BP is currently unknown. The aim of this study was to assess the efficacy and safety of empagliflozin (vs. placebo) in patients with low BP – either systolic BP (SBP) &lt;110 mmHg or diastolic BP (DBP) &lt;70 mmHg – at randomization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>EMPULSE included 530 patients with AHF followed for 90 days. The primary outcome was a hierarchical composite of all-cause mortality, HF events, and Kansas City Cardiomyopathy Questionnaire total symptom score changes at 90 days tested using the win ratio (WR). Patients were required to have SBP ≥100 mmHg for randomization. A total of 131 (25%) patients had SBP &lt;110 mmHg and 190 (36%) DBP &lt;70 mmHg. In placebo, low BP was associated with more clinical and adverse events. Compared to placebo, BP changes with empagliflozin were of small magnitude (−2 to 2 mmHg), not reaching statistical significance. Patients presenting with low BP increased their BP, on average, throughout the 90-day follow-up, regardless of treatment group. Empagliflozin (vs. placebo) improved clinical outcomes regardless of BP at randomization, potentially with a larger magnitude of effect in patients presenting with low DBP at randomization: primary outcome WR = 1.48, 95% confidence interval (CI) 1.15–1.90, <i>p</i> = 0.0025; WR = 1.23, 95% CI 0.94–1.60 in DBP ≥70 mmHg and WR = 2.11, 95% CI 1.46–3.04 in DBP &lt; 70 mmHg (interaction <i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients admitted for AHF with low BP had a higher risk of clinical events. Empagliflozin did not lower BP more than placebo and was effective and safe irrespective of BP. Empagliflozin should be considered for the treatment of AHF patients even when presenting with low BP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 4","pages":"671-680"},"PeriodicalIF":16.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463041","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":"Characteristics, determinants, and prognostic impact of severe tricuspid regurgitation in patients with atrial functional mitral regurgitation: Insights from the REVEAL-AFMR registry.","authors":"Tomohiro Kaneko, Azusa Murata, Masashi Amano, Yukio Sato, Yohei Ohno, Masaru Obokata, Kimi Sato, Taiji Okada, Wataru Fujita, Kojiro Morita, Tomoko Machino-Ohtsuka, Yukio Abe, Tohru Minamino, Nobuyuki Kagiyama","doi":"10.1002/ejhf.3624","DOIUrl":"https://doi.org/10.1002/ejhf.3624","url":null,"abstract":"<p><strong>Aims: </strong>Tricuspid regurgitation (TR) is often seen in patients with atrial functional mitral regurgitation (AFMR). The aim of this study was to investigate the characteristics, determinants, and prognostic impact of severe TR coexisting with AFMR.</p><p><strong>Methods and results: </strong>In 26 facilities in Japan, patients with significant AFMR defined with moderate or severe functional mitral regurgitation with dilated left atrium and preserved left ventricular function were enrolled. The primary endpoint was a composite of heart failure hospitalization and all-cause mortality. The secondary endpoint was all-cause mortality. In 792 patients with AFMR (mean age 77 ± 9 years, 55% female), the prevalence of severe TR was 14.9% (n = 118) overall, and 34.6% in severe AFMR. Patients with severe TR were older, mostly with atrial fibrillation, and had more severe heart failure symptoms and more advanced left atrial and right heart remodelling than those with non-severe TR. Age >75 years, permanent atrial fibrillation, chronic obstructive pulmonary disease, and higher right atrial pressure appeared as independent determinants of severe TR. Severe TR was associated with both the primary and secondary endpoints after adjusted for covariates including the severity of AFMR (adjusted hazard ratio 1.65 [95% confidence interval 1.09-2.47], p = 0.017 and 1.80 [1.06-3.06], p = 0.029 for the primary and secondary endpoints, respectively). Atrial and ventricular functional TR accounted for 41% and 59% of significant TR. Despite more advanced right heart remodelling in ventricular TR, these groups showed similar prognosis.</p><p><strong>Conclusions: </strong>Severe TR coexisting with AFMR was common and was associated with increased event rates. Further study is warranted to establish therapeutic strategies.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456393","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":"Skeletal muscle and subcutaneous fat quantity as prognostic indicators in cardiac amyloidosis.","authors":"Joshua Longinow, Saeid Mirzai, Po-Hao Chen, Mazen Hanna, W H Wilson Tang","doi":"10.1002/ejhf.3622","DOIUrl":"10.1002/ejhf.3622","url":null,"abstract":"<p><strong>Aims: </strong>Disease-related changes in body composition are associated with worse outcomes in chronic heart failure. In cardiac amyloidosis (CA), the prognostic value of direct body composition measures is understudied.</p><p><strong>Methods and results: </strong>We identified 160 consecutive patients with CA (transthyretin [ATTR] or light chain [AL]) diagnosed between 2001 and 2021 who had chest computed tomography within 1 year before diagnosis. Skeletal muscle index (SMI), intermuscular adipose tissue percentage (IMAT%), and subcutaneous adipose tissue index (SATI) were quantified at the twelfth vertebral level and analysed continuously, in sex-stratified tertiles, and with derived outcome-based cutoffs. In a comprehensive model including IMAT% and SATI, only SMI independently predicted 10-year mortality (hazard ratio 0.69 per standard deviation increase, 95% confidence interval 0.52-0.91, p = 0.010). In tertile analyses, low SMI was associated with 2 to 2.5 times higher 1-year, 5-year, and 10-year mortality versus high SMI. Medium IMAT% and SATI showed approximately 1.9 times higher 5-year and 10-year mortality versus high tertiles. These associations were more pronounced in ATTR-CA, with low SATI also predicting higher mortality. AL-CA showed fewer significant associations. Interaction testing by CA type was not significant. Outcome-based SMI cutoffs of 23.5 cm²/m² (males) and 27.8 cm²/m² (females) for 10-year mortality were derived but need validation.</p><p><strong>Conclusion: </strong>Lower SMI was associated with increased mortality risk in patients with CA, particularly ATTR-CA. The relationship between SATI and mortality was more nuanced: in the overall cohort, medium SATI was associated with higher mortality risk, while in patients with ATTR-CA, lower SATI predicted higher mortality risk.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456403","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}