European Journal of Heart Failure最新文献

{"title":"Type 2 diabetes and chronic kidney disease combinations in heart failure across the ejection fraction spectrum: clinical associations, medication use, and cause-specific outcomes: a contemporary, real-world analysis of the Swedish Heart Failure Registry.","authors":"Giulia Ferrannini, Tymon Pol, Charlotta Ljungman, Ulf Dahlström, Aurora Merolla, Lars H Lund","doi":"10.1093/ejhf/xuag249","DOIUrl":"https://doi.org/10.1093/ejhf/xuag249","url":null,"abstract":"<p><strong>Aims: </strong>The interactions between heart failure (HF), chronic kidney disease (CKD), type 2 diabetes mellitus (T2DM), and relative drug use remain poorly studied.</p><p><strong>Methods: </strong>Patients enrolled in the Swedish HF registry 2017-2023 were divided according to CKD and T2DM. HF medication use and all-cause death, cardiovascular death, first HF hospitalization (HHF), their composite, and end-stage renal disease (ESRD) were assessed.</p><p><strong>Results: </strong>Among 54 341 patients (34% females, mean age 73 years), 51% had no CKD/no T2DM, 24% CKD only, 14% T2DM only, and 11% both CKD/T2DM. CKD only and CKD/T2DM prevalences were higher in HF with preserved ejection fraction (HFpEF; 29% and 15%, respectively) than with mildly reduced EF (HFmrEF; 23% and 11%) and reduced EF (HFrEF 22% and 10%). HF medication use, especially of mineralocorticoid receptor antagonists, was generally lower in groups with CKD. Event rates for all outcomes were progressively higher going from no CKD/no T2DM, T2DM only, CKD only, and both CKD/T2DM in all EF categories. Independent risks of mortality and HF outcomes were significantly increased in the presence of CKD/T2DM, whereas for ESRD, T2DM alone did not significantly increase risk, CKD alone increased it threefold, and both CKD and T2DM increased it six-fold. CKD added more to the risk of events in HFrEF than in HFpEF.</p><p><strong>Conclusion: </strong>CKD was more common in HFpEF and a strong independent risk factor for all outcomes. T2DM was a moderate independent risk factor for all outcomes. These findings inform drug implementation and future aldosterone-targeting drug trials.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878715","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":"Contemporary decongestion strategies in acute heart failure: an individual patient data analysis of three randomized controlled trials.","authors":"Lara E E C Zonneveld, Pieter Martens, Juan C Trullàs, Kevin Damman, Frederik H Verbrugge, Jeroen Dauw, Iris E Beldhuis, Jesús Casado, Jose Luís Morales-Rull, Wilfried Mullens, Jozine M Ter Maaten","doi":"10.1093/ejhf/xuag253","DOIUrl":"https://doi.org/10.1093/ejhf/xuag253","url":null,"abstract":"<p><strong>Aims: </strong>Recent randomized controlled trials (RCTs) showed improved decongestive response with intensified treatment during hospitalization for acute decompensated heart failure (ADHF). Nevertheless, none demonstrated long-term benefit, possibly due to lack of statistical power. We therefore pooled individual data from three recent RCTs to assess the clinical impact of intensified decongestive therapy.</p><p><strong>Methods: </strong>Individual patient data from three RCTs evaluating decongestive strategies in ADHF-acetazolamide (ADVOR), hydrochlorothiazide (CLOROTIC), and natriuresis-guided therapy (PUSH-AHF)-were pooled. The primary endpoint was 90-day heart failure (HF) re-hospitalization and/or all-cause mortality (adjusted for sex and trial). Secondary endpoints included 24- and 48-h diuresis, natriuresis, in-hospital mortality, and length of stay (LOS).</p><p><strong>Results: </strong>A total of 1059 patients (mean age 79, 42% female) hospitalized for ADHF were included. Baseline characteristics were similar, except for a higher proportion of men in the intensified treatment arm (63% vs 54%, P = .004). Intensified treatment did not reduce 90-day all-cause mortality and/or HF readmissions (adjusted hazard ratio [HR] 1.03; 95% confidence interval [CI] 0.81-1.30); however, it was associated with lower in-hospital mortality (adjusted odds ratio [OR] 0.55; 95% CI 0.31-0.96; P = .038). Cumulative diuresis and natriuresis was significantly higher in patients with intensified treatment at 24 and 48 h (adjusted P < .001). There was no difference in doubling of serum creatinine at 3 days between the groups (adjusted P = .123). LOS was significantly shorter in patients in the intensified treatment arm (geometric mean of 9 [95% CI 8-9] days vs 10 [95% CI 9-10] days in the placebo group, adjusted P = .002).</p><p><strong>Conclusion: </strong>While intensified decongestive strategies in patients hospitalized for ADHF improve diuresis, natriuresis, and reduce LOS, no benefit was observed for post-discharge clinical outcomes. Although a potential reduction in in-hospital mortality was observed, this finding should be considered exploratory and hypothesis-generating.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878681","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":"Gut microbiome-derived metabolites as prognostic biomarkers in heart failure: a systematic review and meta-analysis.","authors":"David Koeckerling, Rohin K Reddy, Salmina J Guivala, Timothy Woodhead, James P Howard, Yousif Ahmad, Ashraf Y Rangrez, Norbert Frey","doi":"10.1093/ejhf/xuag283","DOIUrl":"https://doi.org/10.1093/ejhf/xuag283","url":null,"abstract":"<p><strong>Background: </strong>Growing evidence implicates gut dysbiosis in heart failure (HF) pathogenesis. This systematic review and meta-analysis synthesises prognostic associations of microbial metabolites in HF.</p><p><strong>Methods: </strong>Electronic databases were searched through February 2026 for studies investigating associations between gut microbial metabolites and HF outcomes. Study characteristics, baseline covariates and outcomes were extracted in duplicate. The prespecified primary outcome was all-cause mortality; the secondary outcome was major adverse cardiac events (MACE). Random-effects models were applied to pool hazard ratios. Subgroup analyses stratified cohorts by HF phenotype and aetiology; meta-regression explored potential effect modifiers. This study was preregistered on PROSPERO (CRD42025631114).</p><p><strong>Results: </strong>Twenty studies comprising 17,715 patients were included in meta-analysis; six studies were synthesised narratively. Median follow-up was 31.7 months. Elevated trimethylamine-N-oxide (TMAO) was associated with all-cause mortality in the overall population (HR 1.72, 95%CI 1.42-2.08, p=0.0002, I2 37.3%) and across HF phenotypes (HRHFrEF 2.17, 95%CI 1.68-2.81, I2 0%; HRHFpEF 1.55, 95%CI 0.92-2.61, I2 0%). Higher TMAO was also associated with MACE (HR 1.60, 95%CI 1.44-1.78, p<0.0001, I2 0%), consistent across HF phenotypes (HRHFrEF 1.43, 95%CI 1.15-1.78, I2 0%; HRHFpEF 1.76, 95%CI 1.21-2.55, I2 31.6%). Elevated phenylacetylglutamine (PAGln) was associated with mortality (HR 1.60, 95%CI 1.33-1.94, p<0.0001, I2 0%) and MACE (HR 1.65, 95%CI 1.37-1.99, p<0.0001, I2 2.1%) in the overall population. Meta-regression demonstrated no significant effect modification by baseline age, NT-proBNP, renal function or BMI.</p><p><strong>Conclusion: </strong>Elevated TMAO and PAGln are consistently associated with adverse outcomes across diverse HF cohorts, highlighting their potential relevance as indicators of residual risk in HF.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148862926","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":"Diurnal variation in left atrial pressure in ambulatory patients with chronic heart failure.","authors":"Yuval Amir, Aviv Shaul, Oran Koren, Lior Merav, Binyamin Ben Avraham, Tuvia Ben Gal, David Meerkin, Antonio Laconelli, Maria Del Trigo, Ignacio J Amat-Santos, Omar Abdul-Jawad Altisent, Mikheil Metreveli, Nir Ayalon, Sitaramesh Emani, Sandip Zalawadiya, JoAnn Lindenfeld, Stefan D Anker, Ran Kornowski, William T Abraham, Leor Perl","doi":"10.1093/ejhf/xuag280","DOIUrl":"https://doi.org/10.1093/ejhf/xuag280","url":null,"abstract":"<p><strong>Aims: </strong>Circadian patterns influence cardiovascular physiology, yet have not been characterized in intracardiac pressures of ambulatory chronic heart failure patients. We aimed to assess diurnal variation via a novel remote intracardiac left atrial pressure sensor.</p><p><strong>Methods and results: </strong>Daily ambulatory left atrial pressure (LAP) measurements were obtained with an implantable intracardiac sensor. Patients performed morning and evening measurements during longitudinal follow-up. We compared diurnal variability in morning and evening LAP, examined its potential association with diuretic regimen, presence of atrial fibrillation and acute decompensated heart failure (ADHF) events.Across >15,500 measurement days with an average follow up time of 25.5±18.6 months in 73 heart failure patients, median left atrial pressure was higher in the evening than in the morning (12.4 [6.8, 18.3] vs.10.7 [5.5, 17.3] mmHg; p < 0.01). Neither higher diuretic dose, twice-daily dosing, nor atrial fibrillation modified this diurnal variation (p =0.98, p=0.50).Patients who suffered ADHF events demonstrated higher left atrial pressures (14.3 [9.5, 19.9] vs 10.4 [5.4, 17.3] mmHg, p < 0.01). Higher LAP was also independently associated with increased risk of ADHF events (OR 1.40, 95% CI 1.10-1.78; p < 0.01). Diurnal variation was present irrespective of acute decompensated heart failure status (p = 0.79).</p><p><strong>Conclusions: </strong>Using direct ambulatory intracardiac LAP monitoring, we observed consistent diurnal variation with higher evening pressures, largely unchanged by diuretic dose or dosing schedule, atrial fibrillation, or association with ADHF events.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148862907","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: Ziltivekimab in heart failure with preserved and mildly reduced ejection fraction: rationale and design of the ATHENA and HERMES trials.","authors":"","doi":"10.1093/ejhf/xuag248","DOIUrl":"10.1093/ejhf/xuag248","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148862909","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":"Dense but slow: bone remodelling in iron deficiency and heart failure.","authors":"Sam Majoor, Peter van der Meer, Niels Grote Beverborg","doi":"10.1093/ejhf/xuag235","DOIUrl":"https://doi.org/10.1093/ejhf/xuag235","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148862890","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":"Time in blood pressure range and cardiovascular outcomes in HFmrEF/HFpEF: a pooled participant-level analysis of four large-scale trials.","authors":"Henri Lu, Brian L Claggett, John W Ostrominski, Marc A Pfeffer, Bertram Pitt, Pardeep S Jhund, John J V McMurray, Scott D Solomon, Akshay S Desai, Muthiah Vaduganathan","doi":"10.1093/ejhf/xuag245","DOIUrl":"https://doi.org/10.1093/ejhf/xuag245","url":null,"abstract":"<p><strong>Aims: </strong>Blood pressure (BP) control is a Class I recommendation for the management of heart failure with preserved ejection fraction (HFpEF); however, evidence supporting systolic BP (SBP) targets remains limited. We investigated associations between BP control and subsequent outcomes in patients with HF with mildly reduced EF (HFmrEF)/HFpEF.</p><p><strong>Methods: </strong>We pooled TOPCAT (Americas), PARAGON-HF, DELIVER, and FINEARTS-HF, which tested spironolactone, sacubitril/valsartan, dapagliflozin, and finerenone, respectively, versus placebo or active control in patients with HF and an LVEF >40% (DELIVER), ≥40% (FINEARTS-HF), or ≥45% (TOPCAT-Americas, PARAGON-HF). Daily BPs were estimated by interpolation from standardized office measurements obtained at randomization and prespecified visits. Time in target range (TIR) was the percentage of the first year after randomization during which SBP was 110-<130 mmHg. Continuous associations between TIR and subsequent risk of HF hospitalization or cardiovascular death, its individual components, and all-cause death was assessed using landmark Cox proportional hazards models with linear splines, adjusted for baseline cardiovascular risk factors.</p><p><strong>Results: </strong>Among 17,788 patients (mean age 72±9 years; 47% women; mean baseline SBP 129±15 mmHg), the median TIR was 38% (≈139 days). Randomization to active therapies increased TIR by 2% (95% CI: -2 to 6) with spironolactone, 7% (5 to 9) with sacubitril/valsartan, 2% (0 to 4) with dapagliflozin, and 3% (1 to 5) with finerenone. Higher TIR was associated with lower subsequent risk of the composite outcome (P=0.021), primarily driven by lower HF hospitalization risk (P=0.007); associations with cardiovascular death and all-cause death were not significant. Sensitivity analyses using stricter (120-<130 mmHg) or more liberal ranges (100-<130 and 120-<140 mmHg) yielded qualitatively similar findings.</p><p><strong>Conclusions: </strong>In patients with HFmrEF/HFpEF, BP control during the first year was associated with a lower subsequent risk of HF hospitalization.</p><p><strong>Clinical trials registration: </strong>ClinicalTrials.gov ID NCT00094302 (TOPCAT), NCT01920711 (PARAGON-HF), NCT03619213 (DELIVER), NCT04435626 (FINEARTS-HF).</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860501","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":"Blood pressure control and outcomes in heart failure patients with preserved ejection fraction: an individual participant data meta-analysis of four major trials.","authors":"Sverre E Kjeldsen, Kristian Wachtell, Richard B Devereux","doi":"10.1093/ejhf/xuag269","DOIUrl":"https://doi.org/10.1093/ejhf/xuag269","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860451","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":"Long-term effects of acoramidis on mortality in variant transthyretin amyloid cardiomyopathy, including p.Val142Ile: findings from the open-label extension of ATTRibute-CM.","authors":"Frederick L Ruberg, Margot K Davis, Sarah A M Cuddy, Lily K Stern, Olakunle Akinboboye, Keyur Shah, Nitasha Sarswat, Michel G Khouri, Daniel P Judge, Jan M Griffin, Justin L Grodin, Souhiela Fawaz, Bret Zeldow, Jean-François Tamby, Adam Castaño, Uma Sinha, Marianna Fontana, Julian Gillmore, Kevin M Alexander","doi":"10.1093/ejhf/xuag258","DOIUrl":"https://doi.org/10.1093/ejhf/xuag258","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856849","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":"Efficacy of digitoxin over time in patients with heart failure and reduced ejection fraction: further analysis of DIGIT-HF.","authors":"Udo Bavendiek, Xiaofei Liu, Dominik Berliner, Nele Henrike Thomas, Johannes Schwab, Andreas J Rieth, Lars S Maier, Marija Zdravkovic, Martin Hülsmann, Heiko von der Leyen, Christian Veltmann, Stefan Störk, Michael Böhm, Armin Koch, Anika Großhennig, Johann Bauersachs","doi":"10.1093/ejhf/xuag275","DOIUrl":"https://doi.org/10.1093/ejhf/xuag275","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856838","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}