Cardiac Failure ReviewPub Date : 2025-08-26eCollection Date: 2025-01-01DOI: 10.15420/cfr.2025.18
Hao Cui, Jinwei Zhang, Jianbo Yu, Meng He, Peng Sun, Shengwei Wang, Jie Du, Yongqiang Lai, Changwei Ren
{"title":"High Troponin I in Patients Following Off-pump Coronary Artery Bypass Grafting.","authors":"Hao Cui, Jinwei Zhang, Jianbo Yu, Meng He, Peng Sun, Shengwei Wang, Jie Du, Yongqiang Lai, Changwei Ren","doi":"10.15420/cfr.2025.18","DOIUrl":"10.15420/cfr.2025.18","url":null,"abstract":"<p><strong>Background: </strong>Blood troponin I (TnI) concentrations, the reasons for increases in TnI after coronary artery bypass grafting (CABG) and the effects of TnI on short- and long-term outcomes are not well understood.</p><p><strong>Methods: </strong>Patients undergoing off-pump CABG at Anzhen Hospital between 2011 and 2022 were reviewed. Data on peak postoperative TnI and high-sensitivity (hs) TnI were collected, and patients were divided into a high TnI group (TnI ≥10 ≥g/l or hsTnI ≥10,000 pg/ml) and low TnI group. Baseline characteristics, graft flow, perioperative outcomes and long-term mortality were compared between the two groups.</p><p><strong>Results: </strong>In all, 19,196 patients were included in the study (median age 63 years; interquartile range [IQR] 57-68 years; 14,423 (75.1%) male). Compared with the low TnI group, patients in the high TnI group were more likely to have an intra-aortic balloon pump inserted (17.8% vs. 2.9%; p<0.001), receive extracorporeal membrane oxygenation support (3.6% vs. 0.1%; p<0.001), and undergo early revascularisation (2.81% vs. 0.12%; p<0.001); the high TnI group also had more in-hospital deaths (2.7% vs. 0.2%; p<0.001). After propensity score matching, patients in the high TnI group had fewer grafts to the left circumflex artery (LCX; 0.71 ± 0.58 versus 0.81 ± 0.57; p<0.001) and right coronary artery (RCA; 0.89±0.53 versus 0.95±0.53; p=0.011), as well as less graft flow to the LCX (median 33 [IQR 21-55] versus 41 [IQR 25-67] ml/min; p<0.001) and RCA (30 [IQR 18-50] versus 35 [IQR 22-55] ml/min; p<0.001) than patients in the low TnI group. Patients with high postoperative TnI also had reduced long-term survival (HR 2.59; 95% CI [1.76-3.82]; p<0.001).</p><p><strong>Conclusion: </strong>Elevated TnI following off-pump CABG may be associated with incomplete revascularisation in the LCX and RCA. It is also associated with increased early and late mortality.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e23"},"PeriodicalIF":5.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiac Failure ReviewPub Date : 2025-08-20eCollection Date: 2025-01-01DOI: 10.15420/cfr.2025.07
Tarek Bekfani, Joseph D Abraham, William T Abraham
{"title":"Revisiting Transvenous Phrenic Nerve Stimulation in Central Sleep Apnoea and Heart Failure: Emerging Innovations in Clinical Trials Analysis.","authors":"Tarek Bekfani, Joseph D Abraham, William T Abraham","doi":"10.15420/cfr.2025.07","DOIUrl":"10.15420/cfr.2025.07","url":null,"abstract":"<p><p>Central sleep apnoea (CSA) is a common comorbidity in patients with heart failure. Due to its insidious and chronic nature, CSA often remains unrecognised. Patients with CSA typically present with symptoms, such as daytime fatigue, recurrent heart failure decompensations and cardiac arrhythmias. Although the pathophysiology of CSA is not yet fully understood, the most widely accepted theory suggests that fluctuations in PaCO<sub>2</sub> levels, particularly crossing the apnoeic threshold, play a central role in its development. CSA is associated with various changes, including activation of the sympathetic nervous system, neurohormonal disturbances and haemodynamic perturbations, all of which contribute to increased morbidity and mortality. Transvenous phrenic nerve stimulation (TPNS) has been demonstrated to be a safe and effective therapy for reducing the apnoea-hypopnoea index and improving both left ventricular ejection fraction and quality of life in patients with CSA. These benefits have been validated in randomised clinical trials (RCTs). New methods of analysing RCTs were recently introduced. Applying the win ratio method in a post hoc analysis of the primary RCTs evaluating TPNS suggested that TPNS may also contribute to reduced mortality and fewer heart failure hospitalisations. In this article we explore the pathophysiology of CSA and evaluate the existing evidence on therapeutic options, with a particular focus on TPNS.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e22"},"PeriodicalIF":5.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiac Failure ReviewPub Date : 2025-08-18eCollection Date: 2025-01-01DOI: 10.15420/cfr.2025.09
Shubh K Patel, Hwee Teoh, Ahreni Saunthar, Terrence M Yau, Subodh Verma
{"title":"The Emerging Role of Aldosterone Synthase Inhibitors in Overcoming Renin-Angiotensin-Aldosterone System Therapy Limitations: A Narrative Review.","authors":"Shubh K Patel, Hwee Teoh, Ahreni Saunthar, Terrence M Yau, Subodh Verma","doi":"10.15420/cfr.2025.09","DOIUrl":"10.15420/cfr.2025.09","url":null,"abstract":"<p><p>The renin-angiotensin-aldosterone system is integral to cardiorenal health, with aldosterone controlling fluid balance, blood pressure and cardiac remodelling. Despite the widespread use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and mineralocorticoid receptor antagonists, 'aldosterone escape' persists, contributing to treatment failure and adverse outcomes. Steroidal mineralocorticoid receptor antagonists also cause hyperkalaemia and anti-androgenic effects, limiting their use. Aldosterone synthase inhibitors (ASIs) selectively block cytochrome P450 11B2, reducing pathological aldosterone levels while preserving basal mineralocorticoid receptor activity, thus potentially lowering hyperkalaemia risk. This narrative review identified 41 relevant publications from a PubMed/MEDLINE search of \"aldosterone synthase inhibitor\" through 11 January 2025. Early clinical trials of ASIs (baxdrostat, lorundrostat, vicadrostat, dexfadrostat phosphate, JX09) report significant reductions in aldosterone, blood pressure and albuminuria, with promising safety. Challenges include ensuring high selectivity, mitigating hyperkalaemia and establishing long-term benefits. Ongoing Phase III trials will clarify their efficacy, safety and synergy with additional therapies - including sodium-glucose cotransporter 2 inhibitors - and clinical outcomes, positioning ASIs as an important advance in renin-angiotensin-aldosterone system modulation.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e20"},"PeriodicalIF":5.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiac Failure ReviewPub Date : 2025-08-18eCollection Date: 2025-01-01DOI: 10.15420/cfr.2025.02
Eugenio Carulli, Marialuisa Sveva Marozzi, Maria Cristina Carella, Andrea Igoren Guaricci, Giandomenico Tarsia, Angelo Vacca, Vanessa Desantis, Sebastiano Cicco
{"title":"Addressing Endothelial Dysfunction in Heart Failure: The Role of Endothelial Progenitor Cells and New Treatment Horizons.","authors":"Eugenio Carulli, Marialuisa Sveva Marozzi, Maria Cristina Carella, Andrea Igoren Guaricci, Giandomenico Tarsia, Angelo Vacca, Vanessa Desantis, Sebastiano Cicco","doi":"10.15420/cfr.2025.02","DOIUrl":"10.15420/cfr.2025.02","url":null,"abstract":"<p><p>Heart failure (HF) is closely linked to endothelial dysfunction, which contributes significantly to its progression. Endothelial dysfunction in HF is marked by reduced nitric oxide bioavailability, increased oxidative stress and inflammation, all of which impair vascular function. Endothelial progenitor cells (EPCs) - vital for vascular repair - are particularly affected, with their dysfunction further exacerbating HF outcomes. Emerging therapies targeting these mechanisms, including antioxidants, gene therapies enhancing endothelial nitric oxide synthase activity and EPCbased strategies, hold promise. Recent advances show encouraging results, especially with treatments improving EPC mobilisation and function. Additionally, pharmacological agents such as statins and sodium-glucose cotransporter 2 inhibitors demonstrate pleiotropic benefits, enhancing endothelial health and EPC activity. This review emphasises the therapeutic potential of these approaches, highlighting the critical need for further research to optimise endothelial-targeted treatments and improve outcomes for HF patients.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e21"},"PeriodicalIF":5.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiac Failure ReviewPub Date : 2025-08-14eCollection Date: 2025-01-01DOI: 10.15420/cfr.2025.10
Giovanni Battista Bonfioli, Matteo Pagnesi, Daniela Tomasoni, Amina Rakisheva, Marco Metra
{"title":"Understanding the Role of Glucagon-like Peptide-1 Receptor Agonists in the Treatment of Heart Failure.","authors":"Giovanni Battista Bonfioli, Matteo Pagnesi, Daniela Tomasoni, Amina Rakisheva, Marco Metra","doi":"10.15420/cfr.2025.10","DOIUrl":"10.15420/cfr.2025.10","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially developed for glycaemic control in patients with type 2 diabetes, have demonstrated significant cardiometabolic benefits beyond glucose regulation. These agents have multiple effects, including reducing body weight, improving insulin sensitivity, anti-inflammatory properties and enhancing endothelial function. All these mechanisms are potentially beneficial in patients with heart failure (HF), specifically those with HF with preserved left ventricular ejection fraction. Recent trials, including STEP-HFpEF and SUMMIT, underscore the efficacy of GLP-1 RAs in improving quality of life and exercise capacity, as well as possibly reducing major adverse cardiovascular events. Furthermore, these trials demonstrated improvements in other endpoints, such plasma N-terminal pro B-type natriuretic peptide, troponin and C-reactive protein concentrations, consistent with the beneficial effects of GLP-1 RAs on myocardial function and inflammation. Further data are needed regarding the effects of GLP-1 RAs on cardiovascular outcomes, and possibly in a broader range of patients with HF, such as those with HF reduced ejection fraction and/or patients without obesity.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e19"},"PeriodicalIF":5.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pharmacological Therapy of HFrEF in 2025: Navigating New Advances and Old Unmet Needs in An Eternal Balance Between Progress and Perplexities.","authors":"Massimo Mapelli, Filippo Maria Rubbo, Simona Costantino, Nicola Amelotti, Piergiuseppe Agostoni","doi":"10.15420/cfr.2024.37","DOIUrl":"10.15420/cfr.2024.37","url":null,"abstract":"<p><p>Recent advances in medical therapy have significantly improved the prognosis of patients with heart failure and reduced ejection fraction (HFrEF). The established four pillars of HFrEF treatment - β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor- neprilysin inhibitors, mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors - serve as the foundation for ongoing innovations in this domain. However, these represent only the starting point for the therapy and management of heart failure. New medications, new devices and improvements in the use of diuretic therapy are fundamental and recent advancements. This article aims to highlight the latest findings in HFrEF treatment. While emphasising the optimism these developments bring, the article also addresses the significant unresolved challenges that persist in the management of this syndrome, which remains a leading global cause of mortality, morbidity and poor quality of life with high use of resources and healthcare costs.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e18"},"PeriodicalIF":5.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12326316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiac Failure ReviewPub Date : 2025-07-17eCollection Date: 2025-01-01DOI: 10.15420/cfr.2024.39
Massimo Iacoviello, Filippo Maria Sarullo, Claudio Bilato, Michele Correale, Gabriele Di Gesaro, Mauro Driussi, Andrea Passantino, Alessandra Villani, Andrea Di Lenarda
{"title":"Improving the Management of Patients with Heart Failure with Reduced Ejection Fraction in Clinical Practice: The Case for Angiotensin Receptor-Neprilysin Inhibitor.","authors":"Massimo Iacoviello, Filippo Maria Sarullo, Claudio Bilato, Michele Correale, Gabriele Di Gesaro, Mauro Driussi, Andrea Passantino, Alessandra Villani, Andrea Di Lenarda","doi":"10.15420/cfr.2024.39","DOIUrl":"10.15420/cfr.2024.39","url":null,"abstract":"<p><p>The high risk of adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF) demands urgent efforts in the initiation of guideline-directed medical therapy to reduce morbidity and mortality. Angiotensin receptor-neprilysin inhibitor showed substantial benefits in reducing the risks of heart failure hospitalisation and cardiovascular mortality in HFrEF patients. Therefore, the European Society of Cardiology 2021 guidelines recommend angiotensin receptor-neprilysin inhibitor as a first-line therapy for HFrEF patients. The guidelines emphasise the importance of the early use and rapid titration of the 'four pillars' in HFrEF: angiotensin receptor-neprilysin inhibitor, β-blockers, sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists. However, real-world application of the guidelines remains suboptimal, limiting patient outcomes. This statement paper investigates the barriers to the use of the 'four pillars', and aims to give guidance to improve their implementation in different HFrEF patient types.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e16"},"PeriodicalIF":5.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiac Failure ReviewPub Date : 2025-07-17eCollection Date: 2025-01-01DOI: 10.15420/cfr.2024.33
Giorgia Panichella, Alberto Aimo, Vincenzo Castiglione, Giuseppe Vergaro, Michele Emdin
{"title":"Heart Failure Management in Cardiac Amyloidosis: Towards a Paradigm Shift.","authors":"Giorgia Panichella, Alberto Aimo, Vincenzo Castiglione, Giuseppe Vergaro, Michele Emdin","doi":"10.15420/cfr.2024.33","DOIUrl":"10.15420/cfr.2024.33","url":null,"abstract":"<p><p>Heart failure (HF) and cardiac amyloidosis (CA) are significant clinical challenges, with evolving epidemiological patterns reshaping the understanding of these conditions. Traditionally linked with HF with preserved ejection fraction, CA is increasingly recognised for its specific characteristics, including a considerable subset of patients presenting with reduced left ventricular ejection fraction. This review explores how the neurohormonal activation observed in CA impacts on disease progression and management strategies. Historically, neurohormonal antagonists were considered contraindicated in CA owing to concerns about autonomic dysfunction and chronotropic incompetence. However, recent evidence suggests a paradigm shift, indicating that such agents may offer therapeutic benefits even in these patients. By examining these developments, this review provides a comprehensive overview of current therapeutic approaches, the role of neurohormonal modulation and the need for personalised care strategies to address the complexities of HF in the context of CA.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e15"},"PeriodicalIF":5.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12308146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiac Failure ReviewPub Date : 2025-06-25eCollection Date: 2025-01-01DOI: 10.15420/cfr.2025.05
Anastasia Shchendrygina, Amin Yehya, Hadi Skouri
{"title":"The Timing for Primary Prevention for ICD in the Current Era of Pharmacotherapy.","authors":"Anastasia Shchendrygina, Amin Yehya, Hadi Skouri","doi":"10.15420/cfr.2025.05","DOIUrl":"10.15420/cfr.2025.05","url":null,"abstract":"<p><p>Recent advances in the pharmacological therapy of heart failure with reduced ejection fraction (HFrEF) have significantly impacted the overall survival, heart failure hospitalisations and rates of sudden cardiac death (SCD). In this context, the relevant timing of placing ICDs as primary prevention is a matter of on-going debate. This manuscript provides evidence for an updated view regarding the timing of implanting ICD in eligible patients with HFrEF receiving optimal guideline-directed medical therapy, accounting for the timing to reverse cardiac remodelling (RCR) occurrence and residual SCD risks over time. Clinically significant RCR occurs beyond 3 months of optimal guideline-directed medical therapy, while the residual risks of SCDs remain low for certain HFrEF populations. However, when deciding on ICD implantation, one should always consider individual modulators of RCR and SCD risks, as well as the non-competing risks of death that can affect patients' overall outcomes. Risk stratification algorithms need to be developed and validated in future pragmatic clinical trials to further define better timing for the use of ICDs in primary prevention.</p>","PeriodicalId":33741,"journal":{"name":"Cardiac Failure Review","volume":"11 ","pages":"e14"},"PeriodicalIF":4.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}