Current Heart Failure Reports最新文献

Purpose of the review: This review provides an updated summary of the evaluation and management principles of chronic right heart failure (RHF) and tricuspid regurgitation (TR), with a focus on evolving diagnostic approaches and the role of transcatheter tricuspid valve interventions (TTVI).

Recent findings: Chronic RHF and TR frequently coexist and are associated with significant morbidity and mortality. Their interplay is both complex and bidirectional. TR leads to right ventricular (RV) volume overload, while RV remodeling in RHF promotes TR progression, primarily through annular dilatation and leaflet tethering. Advances in imaging modalities, including 3D echocardiography and cardiac magnetic resonance, have improved the evaluation of RV function and TR severity. Additionally, a refined TR grading system, now encompassing "massive" and "torrential" categories, enables more precise severity classification, which is particularly important for evaluating treatment response in device trials. Early identification of TR and RHF is crucial, and optimal management relies on understanding the underlying mechanisms, disease progression, and available treatment options. Although medical therapy for RHF and TR remains limited, TTVI offers an emerging alternative for selected patients. However, identifying appropriate candidates and the optimal timing for intervention remain key challenges. Timely diagnosis of RHF and TR, identification of the underlying causes, and comprehensive risk stratification, along with early referral to a multidisciplinary heart team, are critical for optimizing patient outcomes. Further research is needed to better define selection criteria and timing for TTVI.

Purpose of the review: While the benefits and need for integrating palliative care (PC) services into heart failure (HF) care have been well recognized, integration has been slow. Currently, only a small proportion of patients with HF utilize PC services, meaning there is a discrepancy between the knowledge about optimal care and the implementation of care. In recent years researchers have attempted to understand the barriers and facilitators of implementing PC models to patients with HF which has been captured in both primary, empirical research and secondary literature review papers. We aimed to synthesize these barriers and facilitators to the implementation of PC approaches for patients with HF within a well-known framework for assessing determinants of implementation, the consolidated framework for implementation research (CFIR).

Recent findings: We conducted a rapid synthesis of reviews using systematic review methods which sought to collate existing review articles pertaining to the research question. We used four search term categories: (1) Heart failure, (2) Palliative care, (3) Implementation, and (4) Review. We conducted searches in four databases (Scopus, EMBASE, CINAHL, COCHRANE) on the 1st of September 2025. We used the CFIR framework to synthesize the data. Firstly, we extracted key barriers and facilitators from the articles. We then categorized this information into sub-constructions of two of the CFIR's constructs (II. the Outer setting and III. The Inner setting). The search generated 2,080 results, of which 512 were duplicates. After screening, twenty-nine reviews were included in the data extraction and synthesis process. A range of barriers and facilitators were highlighted across the reviews. For the inner setting, this included a need for improving communication with patients and between healthcare professionals (HCPs) by engaging more openly and honestly about dying, an increase in joint working as part of multidisciplinary teams, funding and resource issues, and workforce recruitment and training issues. For the outer setting barriers and facilitators were associated with prognostic challenges and the complexity of caring for patients with HF, the needs of HF and geriatric patients, and the evidence and policy landscape associated with the principles of care and implementation of care for HF patients. Despite knowledge about the importance of PC, HCPs will struggle to integrate it into heart failure care unless they address practical, social, cultural, clinical, and economic determinants associated with care. By doing so, health care providers can develop implementation strategies for improving care.

Purpose of review: The purpose of this review is to examine past and current literature regarding maternal and fetal outcomes in pregnancy in patients with pulmonary hypertension (PH). In this review we will outline the management of PH during and after pregnancy.

Recent findings: Recent retrospective data has shown improvements in maternal and fetal outcomes in PH as well as successful management of PH and RV failure during pregnancy. With more data and experience, outcomes have improved, offering better guidance on the management of pregnancy in the PH patient. While it is important to recognize high-risk patients, low-risk patients may be able to safely carry and deliver a baby, representing a significant shift in the PH world. We hope to focus attention on the following aspects: comprehensive risk stratification, disease optimization, and careful planning through a multidisciplinary team approach.

Purpose of review: Heart failure is a complex cardiovascular syndrome with diverse etiologies. It is prevalent and has a substantial adverse global health impact. This review focuses on the peculiarities of HF in sub-Saharan Africa.

Findings: Heart failure poses a significant challenge in sub-Saharan Africa, primarily affecting young adults aged 36.5 to 61.5 years. Patients often present with advanced symptoms, exacerbated by socioeconomic factors and other complications. Key risk factors include hypertension, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease, with new challenges arising from obesity, air pollution, and infectious diseases, further complicating treatment approaches. Diagnostic capabilities in sub-Saharan Africa remain limited. Non-adherence to prescribed medications ranges between 23.7% and 74.7%, worsening disease progression and leading to increased rehospitalizations and mortality rates. Moreover, the high costs of guideline-recommended medications, including sodium-glucose cotransporter-2 inhibitors and angiotensin receptor-neprilysin inhibitors, restrict their availability. Additionally, advanced device therapies like implantable cardioverter-defibrillators and cardiac resynchronization therapy are often inaccessible due to their high costs, the scarcity of invasive cardiac laboratories, and a limited number of trained healthcare professionals. Heart failure poses a significant challenge in sub-Saharan Africa, especially among younger adults. Late clinical presentations, compounded by socioeconomic barriers, underscore the urgent need for improved healthcare access and education. Addressing key risk factors, enhancing diagnostics, and ensuring treatment adherence are vital for better management. Additionally, the high costs of advanced medications highlight the necessity for more affordable healthcare solutions to alleviate the burden of heart failure in the region.

Purpose of review: Immune checkpoint inhibitor (ICI)-associated myocarditis (ICI-M) is rare but often severe. Cardiac magnetic resonance imaging (CMR) can detect myocardial edema and injury as well as fibrosis, yet its role in the setting of ICI-M remains uncertain. This review evaluates recent evidence on CMR findings, prognostic markers, and practical limitations in ICI-M.

Recent findings: T1/T2 mapping and strain analysis may detect myocardial involvement not evident with conventional measures, but sensitivity is variable and affected by scan timing, prior therapies, and protocol heterogeneity. Prognostic associations have been reported for elevated native myocardial T1, septal late gadolinium enhancement (LGE), and impaired strain, though not consistently. In oncology patients, interpretation is further complicated by potential baseline myocardial abnormalities. While CMR can contribute to the diagnostic work-up and risk assessment of ICI-M, current evidence is inconsistent and hampered by methodological limitations. CMR should be timely and findings should be interpreted alongside clinical, biological, ECG, echocardiographic and pathology data. Standardized multicenter prospective studies are needed.

Purpose of review: Chagas cardiomyopathy (CCC) is a major cause of heart failure (HF) in Latin America, yet sex-specific differences in HF presentation and outcomes remain underexplored. This review summarizes current knowledge on clinical manifestations, HF phenotypes, and molecular mechanisms in women and men with CCC.

Recent findings: Men with CCC more frequently present with severe HF, arrhythmias, and sudden cardiac death, whereas women often exhibit nonspecific symptoms such as fatigue and palpitations. HF prevalence in women is variable, with some cohorts showing lower left ventricular systolic dysfunction in women. Among women with CCC-HF, 41% have HFrEF, 20% HFmrEF, and 39% HFpEF. Dyspnea affects 29% of women, approximately half the male rate. Comorbidities are generally similar, though chronic kidney disease is less common in women. Molecular and transcriptomic studies indicate that males exhibit stronger Th1 inflammatory signatures, while females show enrichment of Th2 and Treg cells, correlating with disease severity. Women with CCC tend to experience milder HF phenotypes and slower progression, potentially due to hormonal and immune-mediated mechanisms, highlighting the need for sex-specific evaluation and management strategies in CCC.

Purpose of review: Frailty is a common multidimensional syndrome in patients with heart failure (HF); it is associated with worse outcomes, including poor quality of life, disability, hospitalizations, and increased mortality. This narrative review critically summarizes the most widely used instruments in clinical practice for frailty assessment in HF, compares their strengths and limitations, and discusses their role in predicting adverse outcomes.

Recent findings: Various tools have been developed to assess frailty in the HF patient population, aiming to guide clinical decisions and improve patient management. These scoring systems vary in their complexity and applicability and follow two main different approaches (the Fried phenotype and the frailty index). Recently, a new Heart Failure Frailty Score (HFFS) specifically designed to assess frailty in HF patients has been proposed. Frailty is a critical prognostic modifier in HF, making its systematic assessment in clinical practice essential for guiding therapeutic decision-making and optimizing clinical outcomes in this vulnerable population.

Purpose of review: Worsening renal function (WRF) frequently occurs in acute heart failure (AHF) and represents a clinical challenge, as it may lead to inappropriate alterations in therapy. Understanding its mechanisms and prognostic implications is essential for optimization of treatment.

Recent findings: The prognostic impact of WRF depends on clinical context. WRF is associated with poor outcomes when residual congestion persists; however, it is not harmful if effective decongestion is achieved. Systemic processes such as inflammation and oxidative stress may contribute to WRF with adverse outcomes, as demonstrated by novel biomarkers. Conversely, the initial decline in glomerular filtration rate observed following the initiation of heart failure therapies is typically a benign physiological response. This review outlines the concept, pathophysiology, prognosis, and management of WRF in AHF. Clinicians should carefully interpret the clinical context of WRF and avoid the premature discontinuation of heart failure therapies to ensure optimal therapeutic decision-making.

Purpose of review: Cardiorenal syndrome type 4 (CRS-4) is characterised by the development of cardiac dysfunction secondary to chronic kidney disease (CKD). This review outlines the pathophysiology of CRS-4, with a focus on the emerging role of mitochondrial dysfunction, and evaluates novel mitochondria-targeting therapeutics for CRS-4.

Recent findings: Current research has positioned mitochondrial dysfunction in cardiomyocytes as a key driver of CRS-4 pathophysiology, characterised by impaired adenosine triphosphate production, increased reactive oxygen species (ROS) generation, dysregulated mitophagy, altered mitochondrial biogenesis and dynamics, and bioenergetic malfunction. Currently licensed drugs, such as dapagliflozin and sacubitril/valsartan, have demonstrated mitoprotective effects in CRS-4, and numerous other therapies targeting mitochondria have proven efficacious in preclinical studies. However, real-world clinical trials are required to determine whether mitochondria represent a viable therapeutic target that offers meaningful clinical benefits to patients with CKD. There is increasing evidence that mitochondrial dysfunction is a key pathomechanism in the development of CRS-4. Mitochondrial-targeting therapies offer a novel mechanism-driven approach, with numerous showing preclinical promise. However, real-world clinical trials are required to determine their therapeutic potential.

Purpose of review: Cardiorenal syndrome refers to disorders of the heart and kidneys in which dysfunction in one organ has resulted in dysfunction of the other. Wasting continuum disorders such as cachexia are highly prevalent in cardiorenal syndrome, yet the clinical impact, pathophysiological mechanisms, and management options have not been well elucidated in previous literature. In this review, we aim to summarize current knowledge regarding the epidemiology, clinical impact, and pathophysiology of CRS-induced wasting continuum disorders, as well as highlight effective and potentially emerging treatment options.

Recent findings: Neurohormonal activation, inflammation, metabolic dysfunction, gastrointestinal abnormalities, protein degradation, and mitochondrial pathway dysfunction are pathophysiologic mechanisms underlying CRS-induced cachexia. Recent studies have investigated various treatment options targeting such mechanisms with mixed results. Early screening of wasting continuum disorders in CRS, in combination with nutritional supplementation and exercise rehabilitation strategies, is the mainstay of management. Pharmacologic optimization may also benefit patients. Future studies are necessary to improve generalizability and consensus definitions of cardio- and renal-specific wasting continuum disorders.